Quality Of Erections Research Articles

1062 Sexual satisfaction within 6 months after radical prostatectomy: Does the quality of erections represent the quality of the relationship?

1062 Sexual satisfaction within 6 months after radical prostatectomy: Does the quality of erections represent the quality of the relationship?

Treatment of Incidental Prostate Cancer Diagnosed during BPH Surgery with Radical Prostatectomy: Appropriate or over Treatment?

Objective: Prostate cancer is detected in pathology specimens in 3% - 16% of patients undergoing Benign Prostatic Hyperplasia (BPH) surgery. There is no consensus about the optimal treatment plan for these patients. In this study, T1a,b and T1c patients were compared oncologically and in terms of operative morbidity. Materials and Methods: This study included 54 patients (Group 1) undergoing RP based on the detection of incidental prostate cancer and 54 patients (Group 2) undergoing RP based on the diagnosis of carcinoma by biopsy in three different centers. The parameters that may affect the recurrence were investigated and compared between the two groups. Additionally, patient complaints after RP such as stress urinary incontinence, lower urinary tract symptoms and erectile dysfunction were evaluated according to questionnaires and were compared between the groups and within the group in which incidental carcinoma was identified. Data analysis was performed using SPSS version 15. Results: The mean age of the patients was 63.8 years (range 51 - 78 years) with a mean follow up of 60.4 months (range 12 - 82 months). There were statistical differences in age (p = 0.036), pre-RP PSA (p < 0.001) and pre-RP prostate volume (p < 0.001) between Group 1 and Group 2. Despite the absence of a statistically significant difference in PSM between the two groups (p = 0.09), ECE was more common in Group 2 patients (p = 0.014). None of the patients with T1a disease had biochemical recurrence which was observed in 9 patients (27.3%) with stage T1b disease (p = 0.007). There were significant differences in Gleason scores in BPH specimens and RP specimens, PSM, ECE and T stages between the two subgroups. The assessment of the morbidities that are likely to affect the quality of life by questionnaires revealed that there were no significant differences between Group 1 and Group 2 however significant differences were noted in the erection quality between the subgroups (p = 0.006). Conclusion: The course of the disease is determined by the stage of the disease (pT1a, pT1b) that indicates tumor burden in these patients. With regard to postoperative complications, the problems affecting the quality of life were not poorer in patients with T1a and T1b disease than that in patients with T1c disease, which is encouraging for radical surgery.

PA01.55. Efficacy of ′Ashwa′ capsule in male sexual dysfunction

Purpose: 1. Now a day's erectile dysfunction is very common Problem among The people and available measures or managament are not up to the mark & hence this disease still having ray of hope & Ayurveda could be the solution. 2. To put forth effect of Cap. Ashwa in such way to accept the medicine in the modern era. Method: Open Uncontrolled study with 30 Sample size of age group 24 70 years treated with Cap. Ashwa 1 gm BD with milk (Shatavari, Aswagandha, gokshur, Kronchbeej 250 mg each) Parameters assessed were subjective and haematological and tolerability and International Index of erectile function (IIEF) Result: Cap. Ashwa helps to significantly increase sexual desire, increase quality and sustainability of erection, increase intravaginal ejaculatory latency time & correct the premature ejaculation. No severe adverse effect was observed and the treatment was very well tolerated and safe. Conclusion: Cap. Ashwa is Very good for erectile dysfunction (66.70%) and very safe drug. It significantly increases intravaginal ejaculatory latency time. This clinical trial must be tested on more sample size, with Controlled and multicenteric level trial.

Erectile dysfunction improvement: pistachio or placebo effect

I read with interest the paper by Aldemir et al.1 They conducted a before and after study evaluating the pistachio diet on erectile function parameters and serum lipid profiles in patients with erectile dysfunction (ED). They concluded that pistachio diet improved erectile function parameters without any side effects in patients with ED. I think this study design is not appropriate for the evaluation of this relationship, because its main limitation is the lack of a control group, which makes it difficult to establish a causal relationship. The effect of pistachio on ED may be a placebo effect because de Araujo et al.2 showed that treatment of ED with oral placebo agents demonstrates clinical effects, improving erectile function and quality of erection. In addition, in recent years patients have more positive attitudes to complementary medicine.3 We see in our daily practice a large number of patients who think herbal medicine has more effect and lower adverse effect than conventional treatments. This positive attitude can increase the placebo effect of herbal medicine.

TURP and sex: patient and partner prospective 12 years follow‐up study

• To evaluate the effect of transurethral resection of the prostate (TURP) on sexual function in the short (6 months), medium (6 years) and long (12 years) term and assess the conformity between patient and partner regarding sexual function. • A prospective cohort study set at the Aberdeen Royal Infirmary University Hospital. • A total of 280 men referred with lower urinary tract symptoms (LUTS) to a university hospital underwent TURP between January 1993 and September 1994; 145 of their partners (partner or spouse) participated. • Assessment included American Urological Association symptom score, flow rates and validated self-reported sexual questionnaires (SQ). • Data were collected at baseline, 3 months, 6 months, 6 years and 12 years of follow-up. • In all, 120 (43%) men were sexually active preoperatively. At 6 months, 73 (61%) of these 120 men completed the SQ and all were sexually active. • No sexually active patient became impotent after the procedure. Moreover, 27 (15%) with pre-existing erectile dysfunction reported improved sexual activity and erection quality. • At 6 years 101 men completed the SQ and 31 (30.7%) were sexually active. At 12 years, 36 (31.9%) of 113 who completed the SQ were sexually active. • Partners agreed with the men's self assessment at all visits. • Limitations include possible attrition bias and lack of information from non-responders. • Erectile dysfunction associated with LUTS frequently precedes TURP. • The TURP did not adversely affect sexual function. • Pre-operative erectile dysfunction can be improved by TURP and long-term sexual function is maintained after TURP. These findings, corroborated by the partners, were statistically significant.

2106 INFLUENCE OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) ON SEXUAL FUNCTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology1 Apr 20112106 INFLUENCE OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) ON SEXUAL FUNCTION José Placer, Enrique Trilla, Carlos Salvador, Jorge Ropero, David Lorente, Jacques Planas, Carles Raventós, Miguel Ángel López, and Juan Morote José PlacerJosé Placer Barcelona, Spain More articles by this author , Enrique TrillaEnrique Trilla Barcelona, Spain More articles by this author , Carlos SalvadorCarlos Salvador Barcelona, Spain More articles by this author , Jorge RoperoJorge Ropero Barcelona, Spain More articles by this author , David LorenteDavid Lorente Barcelona, Spain More articles by this author , Jacques PlanasJacques Planas Barcelona, Spain More articles by this author , Carles RaventósCarles Raventós Barcelona, Spain More articles by this author , Miguel Ángel LópezMiguel Ángel López Barcelona, Spain More articles by this author , and Juan MoroteJuan Morote Barcelona, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2302AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) may affect the quality of sexual function. The influence on erection and ejaculation of the new surgical procedures available to treat BPH has been poorly studied. Although testosterone levels correlate with sexual function, the effect of BPH surgery on these levels in unknown. OBJECTIVES To assess the effect of HoLEP on sexual function in a group of patients with LUTS secondary to BPH. To assess whether HoLEP has any effect on serum testosterone levels. METHODS Prospective study that analyzes changes in sexual function and urinary symptoms in a group of 100 consecutive patients that underwent HoLEP. To assess the changes on erection and ejaculation, urinary symptoms and their interference on quality of life, four validated questionnaires were used: IIEF-5, ICIQ-MLUTSsex, AUA questionnaire and QoL index of the ICC. Serum determinations of total, free and bioavailable testosterone were performed in half of patients. Patients were evaluated before surgery and 3 and 12 months after HoLEP. Patients under PDE5 or testosterone treatment were excluded. RESULTS Mean age was 69 years. Half of patients were on 5ARI treatment before surgery. The table shows the changes in scores on the questionnaires employed. There was a significant and sustained improvement in the scores of questionnaires evaluating urinary symptoms and the interference of the symptoms in QoL. No significant differences were observed between the number of patients with erectile disfunction (mild/moderate/severe) before and after surgery. The percentage of patients with absence or severely decreased ejaculation increased with HoLEP from 33% to 80%. The degree of importance that patients gave to their ejaculatory problems decreased with surgery. No significant differences were found between testosterone levels with surgery. Before surgery Follow-up 3 months Follow-up 12 months p value AUA-SS 19,6 6,7 5,7 p <0,05 QoL 4,3 1,4 1,1 p <0,05 IIEF-5 12,3 12,2 10,8 NS ICIQ-MLUTSsex (total) 3,7 4,2 4,4 NS ICIQ-MLUTSsex (erections possible) 1,1 1 1,2 NS ICIQ-MLUTSsex (eyaculation possible) 1,2 2,3 2,4 NS ICIQ-MLUTSsex (pain/discomfort during ejaculation) 0,05 0,05 0,04 NS ICIQ-MLUTSsex (impact of urinary symptoms on sex life) 1,2 0,9 0,9 NS AUA-SS (American Urological Association Symptom Score); QoL (Quality of Life Index of the ICC); IIEF-5 (5-item version of the International Index of Erectile Function); ICIQ-MLUTSsex (ICIQ-Male Sexual Matters associated with Lower Urinary Tract Symptoms). CONCLUSIONS HoLEP causes an improvement in the scores of questionnaires that assess urinary symptoms and the interference of the symptoms in the quality of life of patients. Although surgery causes most of patients have retrograde ejaculation, its presence is not interpreted as a problem by patients. In contrast, the quality of erection does not change at all with surgery. HoLEP has not effect on serum testosterone levels. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e842 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information José Placer Barcelona, Spain More articles by this author Enrique Trilla Barcelona, Spain More articles by this author Carlos Salvador Barcelona, Spain More articles by this author Jorge Ropero Barcelona, Spain More articles by this author David Lorente Barcelona, Spain More articles by this author Jacques Planas Barcelona, Spain More articles by this author Carles Raventós Barcelona, Spain More articles by this author Miguel Ángel López Barcelona, Spain More articles by this author Juan Morote Barcelona, Spain More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sexual quality of life for localized prostate cancer: a cross-cultural study between Japanese and American men.

Race and ethnicity are important factors in health-related quality of life (QOL) because of racial differences in preferences for, and trust in, health systems. Such factors are likely to affect QOL and patient satisfaction with care. Using a self-reported questionnaire, Japanese men with prostate cancer reported lower sexual function scores at baseline. In detail, Japanese men were more likely than American men to report poor sexual desire, poor erection ability, poor overall ability to function sexually, poor ability to attain orgasm, poor quality of erections, infrequency of erections, infrequency of morning erections, and intercourse in the previous 4 weeks. However, Japanese men were less likely than American men to be concerned about their sexual function. Two years after surgery, American patients were more likely than Japanese patients to regain their baseline sexual function. The use of phosphodiesterase-5 (PDE-5) inhibitors has been widely publicized as the solution to erectile dysfunction after prostate cancer treatment. Although PDE-5 inhibitors have been available in Japan since 1999, it is striking that Japanese men with localized prostate cancer are much less likely (only 10%) to use PDE-5 inhibitors than American men. Japanese patients with localized prostate cancer report worse sexual function but are less concerned about their reduced function. In the absence of a biological explanation for such differences, however, we suspect that cultural differences may explain the differences between QOL survey results from Japanese or American men with prostate cancer.

When Condom Use is Not Condom Use: An Event‐Level Analysis of Condom Use Behaviors during Vaginal Intercourse

Little is known about event-level condom use errors during vaginal sex. The aim of this article is to examine factors associated with complete condom use compared to forms of incomplete condom use, including delayed condom application and early condom removal, over a 30-day period. Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation multinomial logistic regression. Condom use during vaginal sex: complete use, delayed application, early removal, and both delayed application/early removal. Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted (in 2009) on 83.2% of these intercourse events (6,325), during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198), and both types of incomplete use during 2% (129) of events. Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participant's history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use. Men's incomplete condom use is associated with recent condom use patterns, as well as with their physiological characteristics and perceptions of condoms during sexual intercourse. Event-level analyses such as these help describe how incomplete condom use occurs among individuals incorporating condoms into their sexual activities.

Recreational Use of Phosphodiesterase Type 5 Inhibitors by Healthy Young Men

In recent years, PDE5 inhibitors (PDE5i) use has become more popular among men without ED to enhance sexual performance. However, reports in the literature are scarce. The aim of this study was to evaluate the recreational use of PDE5i in healthy young men. We evaluated the recreational use of PDE5i among young and healthy men, their main reasons for use, how they were obtained these drugs, and the combination with alcohol or other drugs. Descriptive, transversal study consisting in 400 brief surveys with structured multiple choice and open questions. Nonprobability samples (quota samples) included young men between 18 and 30 years of age in a public area (high schools, universities, and gyms) between August and November 2009. Collecting the questionnaires in a sealed box enforced confidentiality. The survey included demographic and sexual health data and PDE5i use characteristics. For statistical analysis we used Fisher's exact and Mann-Whitney tests. A total of 321 questionnaires were appropriate for the purposes of evaluation. Mean age and standard deviation were 25.1±3.3 years old. Regarding PDE5i use, 69 men (21.5%) mentioned trying the pill (being sildenafil the most commonly used one) at least one time in their lives and 37 (53.4%) men combined it with alcohol or drugs. Referred sources of acquisition PDE5i were 75.4% (N=52) from a friend, 17.4% (N=15) from a pharmacy/drugstore without a medical prescription, 4.3% (N=3) prescribed by a physician and 2.9% (N=2) through Internet. There were several reasons for taking PDE5i related to sexual confidence, erection quality, and better sexual performance. According to our results, 21.5% of healthy men between 18 and 30 years old used PDE5i as a recreational drug, mostly associated with alcohol or other drugs without medical control. This could have led to misuse and a public health problem. Further studies are needed to evaluate not only PDE5i recreational use prevalence, but also psychosocial determinants, long term safety, misuse, and abuse related to it.

The effects of three phosphodiesterase type 5 inhibitors on ejaculation latency time in lifelong premature ejaculators: a double‐blind laboratory setting study

Study Type--Therapy (RCT) Level of Evidence 1b. What's known on the subject? and What does the study add? Several authors have reported their experience with PDE5 inhibitors alone or in combination with selective serotonin re-uptake inhibitors for treating premature ejaculation. However, to our knowledge, this is the first laboratory design study to evaluate the effects of three PDE5 inhibitors throughout the ejaculation process in men with lifelong premature ejaculation. In this laboratory setting study PDE5 inhibitors seem to prolong ELT but the difference from placebo is significant only in vardenafil. The quality of penile rigidity is better with PDE5 inhibitors in the post-ejaculatory period but the difference is significant only in sildenafil and vardenafil. • To evaluate the effects of three phosphodiesterase type 5 (PDE5) inhibitors on the ejaculation process in men with lifelong premature ejaculation using a double-blind laboratory setting. • Eighty men with lifelong premature ejaculation, 20 in each group, received placebo, vardenafil (10 mg), sildenafil (50 mg) or tadalafil (20 mg) in a double-blind study design. Placebo or PDE5 inhibitor was ingested after at least 2 h fasting and non-smoking. The subjects were placed in a silent room immediately and real-time penile rigidity and tumescence was monitored. • Subjects read some magazines or newspapers without any sexually stimulating material for 1.5 h. At the end of this period audiovisual sexual stimulation began with a video film and after the 8th minute the subject began vibratory stimulation to the frenular area. • At the beginning of ejaculation the patient stopped stimulation. When the patient began and stopped stimulation, the light near the observer turned on and off and the observer calculated the ejaculation period with a chronometer. The elapsed time was the ejaculation latency time (ELT) in seconds. • There was no interaction between subjects and observer during the test. The ELT, and the qualities of base and tip rigidities during ELT and after ejaculation were calculated. • Median age of patients was 29 (range 22-39) years and median duration of premature ejaculation was 60 (range 7-180) months and there was no significant difference between groups. Median duration of vibratory stimulation (ELT) of subjects who received placebo was 48.5 s: 53.5 s for sildenafil, 70.0 s for tadalafil and 82.5 s for vardenafil. Compared with the placebo group, ELT was significantly longer only in subjects receiving vardenafil (P = 0.019). • In the post-ejaculatory refractory period, times to last recorded base rigidities were significantly longer than placebo in vardenafil and sildenafil groups with better erection quality (P < 0.01 for each). • The PDE5 inhibitors seem to prolong ELT and the quality of penile rigidity is better with PDE5 inhibitors in post-ejaculatory period. • These findings suggest that PDE5 inhibitors might have some beneficial effects in men with lifelong premature ejaculation.

Le blessé médullaire : quel sperme et quelle prise en charge en Assistance médicale à la procréation ?

Men with spinal cord injury present a unique infertile population. Only 10 % of them can father children without medical assistance, owing to potential impairments in erection, ejaculation and semen quality. The algorithm typically followed is to retrieve semen by Penile Vibratory Stimulation, in case of failure by Electro Ejaculation. Most of these patients have normal sperm concentrations but abnormally low sperm motility and vitality in the ejaculate. The reasons for poor semen quality in spinal cord injured men are reviewed. If semen cannot be obtained by Electro Ejaculation, or if the ejaculate from Penile Vibratory Stimulation or Electro Ejaculation contains an insufficient quantity or quality of sperm for in vitro fertilization with intracytoplasmic sperm injection, then retrieval of sperm from reproductive tissues is attempted. Despite abnormal semen quality, successful pregnancies with sperm from spinal cord injured male partners have occurred by intravaginal insemination, intrauterine insemination, and in vitro fertilization with intracytoplasmic sperm injection. The prevailing pregnancy and fecundity rates in couples with a spinal cord injured male partner are reviewed.

Sexual function changes after transurethral plasmakinetic resection of the prostate

Objective To investigate the influence of transurethral plasmakinetic resection of the prostate(PKRP)on sexual function. Methods From January 2007 to December 2007.165 patients received PKRP,who had sexual active and completed the follow-up data forms before and after surgery.The average age of this cohort was 71 years(from 55 to 79 years).The average history of disease was 5.5(3-15)years while the average prostate volume 57(33-82)g,IPSS(26.4±2.6),quality of lire score(5.54±0.50),the maximum flow rate(7.04±4.10)ml/s,the average residual 120(55～250)ml.45 cases were complicated with urinary retention,and bladder stones 45 cases.15 cases with prostate stones.Their sexual function was assessed by the international index of erectile function,ejaculation function and sexual satisfaction before and 6 months after surgery by questionnaires,and compared the respective scores using SPSS14.0 and χ2 test. Results All of 165 patients,the IIEF-5 improved from(23.4±4.7)point to(24.1±4.9)point 6 months after operation(P>0.05),there was not significant.The abnormal ejaculation rate increased from 18.8%(31/165 patients)to 75.2%(124/165 patients)(P<0.001)after PKRP,respectively.The retrograde ejaculation rate increased from 11.6% (19/165 patients) to 64.2%(106/165 patients) after PKRP, respectively.There was a significant difference.128 patients (77.6 % ) and 132 patients (80.0 % ) were satisfied with their sexual active before and after 6 months PKRP, respectively. Conclusions The results of this study confirmed that PKRP has no negative influence on the quality of erections measured by IIEF-5.The loss of ejaculatory function has no influence on patients sexual active. Key words: Benign prostate hyperplasia; Transurethral plasmakinetic resection of the prostate; Sexual function

Long-term outcome of penile appearance and sexual function after hypospadias repairs: situation and relation

The aim of this study was to assess the long-term cosmetic and sexual outcomes of hypospadias surgery performed in childhood and to analyze the relation between them. A long-term follow-up was made to 174 patients who were operated for hypospadias in this institute between 1984 and 1992. Their records were analyzed retrospectively, and a detailed questionnaire was mailed to them. Responses from returned questionnaires were pooled and analyzed. Forty-three (24.7%) of 174 patients finished the questionnaire. The mean patient age of the 43 patients was 21.6years. Twenty-three (53.5%) of 43 patients were dissatisfied with penile appearance. The main reason for dissatisfaction was smaller penile size and curvature. Thirty-six (83.7%) of 43 patients were satisfied with overall sexual function. Of these 43 patients, 76.7% reported good quality of erection, but 23.3% reported the existence of problems during erection. The main complaint was smaller penile size and curvature. There were 17 patients (39.5%) with ejaculation problems, mainly including impotent ejaculation. Sixteen (88.9%) of the 18 patients who had experienced sexual intercourse reported no problems during intercourse. Depending on the severity of hypospadias, these patients with proximal hypospadias were more dissatisfied with penile appearance than those with distal hypospadias (76.5 vs. 38.5%, P<0.025). And they complained more problems during erection (41.2 vs. 11.5%, P<0.05), ejaculation (100 vs. 0%), and sexual intercourse (50 vs. 0%, P<0.05), and were less likely to experience sexual intercourse (23.5 vs. 53.8%, P<0.05), compared to those with distal hypospadias. Depending on their self-evaluation on penile appearance, these patients who were satisfied with penile appearance had less problems in achieving erection (5.0 vs. 39.1%, P<0.025) and ejaculation (20 vs. 56.5%, P<0.025) and were more likely to experience sexual intercourse (60 vs. 26.1%, P<0.05), compared to those who were dissatisfied. The self-rated satisfaction scale correlates positively with the penile appearance and sexual function (r=0.469, P<0.01). Patients who had been operated for hypospadias have a significantly careful concern on penile appearance. Penile size can obviously impact satisfaction with penile appearance and sexual function. Some patients have erection, ejaculation, and intercourse problems in adulthood, but majority have a rather normal sexual function. The more severe the hypospadias, the more dissatisfactory the long-term outcome. Better cosmetic outcome is related to better sexual outcome. Although remaining challenging, it is necessary to follow up hypospadias patients after surgeries into adulthood.

1500 EXERCISE CORRELATES TO HIGHER SEXUAL FUNCTION SCORES IN A COHORT OF HEALTHY MEN

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-Surgical Therapy II1 Apr 20101500 EXERCISE CORRELATES TO HIGHER SEXUAL FUNCTION SCORES IN A COHORT OF HEALTHY MEN Erin R. McNamara, Jean Alfred-Thomas, and Stephen J. Freedland Erin R. McNamaraErin R. McNamara More articles by this author , Jean Alfred-ThomasJean Alfred-Thomas More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1237AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Exercise has often been postulated to improve sexual function. Several studies have seen improvement in sexual function scores in the setting of weight loss secondary to diet and exercise. We hypothesized men with higher exercise level would have higher sexual function scores. METHODS We prospectively recruited 178 healthy men at the Durham VA who completed the RAND 12-Item Health Survey v2, which includes 6 sexual function questions: ability to have erection, ability to reach orgasm, quality of erection, frequency of erection, overall sexual function and bother. These answers were converted to a numeric score on a 0 to 100 scale, and averaged into an overall sexual function score with higher scores equating higher function. They were also asked to complete a survey regarding current exercise behavior. Participants were asked average frequency of mild, moderate, and strenuous intensity exercise in a typical week, as well as average duration. Total current exercise was calculated in terms of MET hours per week. RESULTS Median age and BMI were 62 years and 31 kg/m2, respectively. A total of 59 men (33%) were black and 111 (62%) were white. Median sexual function was 53 points. After adjusting for age, race, BMI, heart disease, diabetes, medications, and depression, men who reported more MET hrs/wk of exercise had significantly higher sexual function scores (p = 0.006). CONCLUSIONS Men who reported higher MET hrs/wk of exercise had higher sexual function scores. Further investigation is required to confirm these findings in a larger sample size and to better characterize the molecular mechanisms through which exercise affects sexual function. Durham, NC© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e578 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erin R. McNamara More articles by this author Jean Alfred-Thomas More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Importance of Axial Penile Rigidity in Objective Evaluation of Erection Quality in Patients with Erectile Dysfunction – Comparison with Radial Rigidity

Introduction: The aim of this prospective study was to evaluate the usefulness of measurement of axial penile rigidity, compared with radial penile rigidity. Patients and Methods: Twenty-two patients, aged 21–75 years old (a mean of 50), with erectile dysfunction underwent axial penile rigidity measurements by the digital inflection rigidometer (DIR) as well as radial penile rigidity measurements by the RigiScan Plus during intracavernous pharmacological erection testing. Results: A significant correlation was recognized between axial rigidity, and radial rigidity at the tip (p = 0.0024) and base (p = 0.0098) of the penis. In 10 patients, the DIR revealed axial rigidity of 550 g or more, and they also had radial rigidity of 60% or more at the tip and base. In 14 and 17 subjects, radial rigidity of 60% or more was observed at the tip and base, respectively. Four of the former 14 and 7 of the latter 17 had axial rigidity <550 g. Conclusions: A RigiScan results of radial rigidity of 60% or more should be interpreted cautiously and not necessarily regarded as normal.

Sacrifice of Accessory Pudendal Arteries in Normally Potent Men during Robot-Assisted Radical Prostatectomy Does Not Impact Potency

Whether or not sacrificing accessory pudendal arteries (APAs) during radical prostatectomy affects potency has been an ongoing source of concern. Herein, we present our potency results relative to sacrificing APAs in normally pre-potent men following robot-assisted radical prostatectomy (RARP). The distribution of APAs and clinical characteristics were prospectively recorded in 200 consecutive patients undergoing RARP with a cautery-free technique. Sexual function was assessed using the International Index of Erectile Function 5-item questionnaire (IIEF-5). All APAs were sacrificed due to stapling the dorsal vein complex. Postoperatively, potency was defined by an affirmative answer to the following two questions: "Were erections adequate for penetration?" and "were the erections satisfactory?" Postoperative IIEF-5 scores and quality of erections (% of preoperative firmness: 0%, 25%, 50%, 75%, 100%) were also obtained. Subgroup analysis of patients age < or =65 years with IIEF-5 score of 22-25 was performed. Eighty patients (40%) had APAs. Preoperatively, there was no association with having an APA and normal/abnormal sexual function. Preoperatively, 58/200 were < or =65 years with self-administered IIEF-5 scores of 22-25. Postoperatively, 53/58 (91%) were potent at 24 months follow-up. Nineteen of 58 patients had a sacrificed APA; 39 patients had no APA. Eighteen of 19 (95%) patients with sacrificed APAs were potent vs. 35/39 (90%) with no APA present (P = 0.53). Multivariate analysis showed no significant correlation between sacrificing an APA and time of potency recovery, quality of postoperative erections (94% vs. 90% P = 0.80) or mean IIEF-5 score (22.4 vs. 20.8, P = 0.13). We found no correlation between the presence or absence of APAs and preoperative sexual function. Furthermore, after sacrificing all APAs, we found no correlation with potency return, time to return of potency, quality of erections, or mean IIEF-5 scores at 24 months.

The Management of Erectile Dysfunction with Placebo Only: Does it Work?

Randomized clinical trials (RCT) remain the gold standard in providing scientific evidence in medical practice in spite of the significant placebo effect in the treatment of several disorders. Although the first-line therapy for erectile dysfunction (ED) is oral phosphodiesterase type-5 inhibitor (iPDE5), the placebo effect in RCT of iPDE5 for ED occurs at a rate as high as 50%. To evaluate the role of therapeutic illusion in the oral treatment for ED. A prospective, controlled, single-blind, parallel-group study was performed at single-center. One hundred and twenty-three patients with ED were randomly assigned into three groups and received different letters: Group 1 (G1) was informed to be receiving a substance for ED treatment; Group 2 (G2) was informed that they could be receiving an active drug or placebo; Group 3 (G3) was conscious to be using placebo. Starch capsules were dispensed to all patients. Median follow up was 12 weeks. ED improvement was assessed after 8 weeks of the intervention by the erectile function domain of the International Index of Erectile Function (IIEF) and the Quality of Erection Questionnaire. ED severity was classified by the IIEF erectile function (IIEF-EF) domain score into five categories: no ED (score of 26-30), mild (22-25), mild to moderate (17-21), moderate (11-16), and severe (6-10). Improvement in IIEF-EF domain was considered as a change in category of severity. ED severity improved in all three groups (G1 = 31.7%, P = 0.039; G2 = 36.8%, P = 0.028; G3 = 36.8%, P = 0.002) and no difference was found among groups (P = 0.857). Improvement of quality of erection score was only significant in G2 (P = 0.005) and G3 (P < 0.001). Written-suggested therapeutic illusion for patients with ED has no major influence in the outcomes. However, treatment of ED with oral placebo capsules demonstrates clinical effects, improving erectile function and quality of erection.

La dysfonction érectile après prostatectomie totale : quelle prise en charge ?

The objective of a radical prostectomy is to cure cancer of the prostate while preserving the best quality of life of patients. Changes in the quality of erections after the operation pose the greatest problems as far as sexuality is concerned. This is the consequence of lesions of the cavernous nerves during the lateral dissection of the prostate, which are sometimes definitive. The treatment of erectile dysfunction after radical prostectomy begins with an evaluation of the sexuality of the patient who is informed of the consequences of surgery before operating. Specialized physiotherapy should be proposed to patients in the 2 to 3 months following the intervention. Should this treatment prove to be unsuccessful, patients are treated using classical therapy for erectile dysfunction. In the case of patient transfer and delegation of competences, consultation between the doctor and clinical nurses is advised throughout treatment.

Quantitative and qualitative analysis of the recovery of potency after radical prostatectomy: effect of unilateral vs bilateral nerve sparing

To analyse the impact of a approximately 50% reduction of cavernous nervous tissue on the qualitative and quantitative recovery of sexual function after unilateral (UNS) and bilateral (BNS) nerve-sparing robotic radical prostatectomy (RALP), by evaluating these differences in two groups treated with cautery and a cautery-free technique (CFT). UNS was defined as wide-excision of one neurovascular bundle (NVB). Only men aged < or =65 years with preoperative International Index of Erectile Function (IIEF-5) scores of > or =22 were included. The cautery group comprised 42 men (of case numbers 1-125) undergoing RALP with cautery, and the CFT group (62 men of cases 151-350) had a cautery-free technique along the NVB. Data were collected prospectively using validated self-administered questionnaires. Potency was defined as two affirmative answers to: do you have erections 'adequate for vaginal penetration?' and 'Are they satisfactory?'. Patient-reported IIEF-5 scores and quality of erections (i.e. an estimate of erection as 0%, 25%, 50%, 75% or 100% of preoperative fullness) were obtained after surgery. In the cautery group, doubling the nerve volume increased potency by 1.36 times (UNS 50% vs BNS 68%). The results were similar in the CFT group as doubling nerve tissue increased potency by 1.15 times (UNS 80% and BNS 93%). At 24 months, comparing IIEF-5 scores, there was no difference between UNS and BNS for the cautery group, at 19.6 (95% confidence interval 15.7-23.5) vs 18.9 (16.6-21.0), or the CFT group, at 22.0 (20.2-23.8) vs 21.0 (19.8-22.1). Doubling the nerve volume only increased potency by 1.15-1.36 times for both the CFT and cautery groups. Furthermore, the quality of erections and IIEF-5 scores did not vary appreciably with doubling of nerve tissue.

ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Sildenafil Citrate 100 mg Starting Dose in Men with Erectile Dysfunction in an International, Double-Blind, Placebo-Controlled Study: Effect on the Sexual Experience and Reducing Feelings of Anxiety About the Next Intercourse Attempt

ABSTRACT Introduction Sildenafil citrate 50 mg is the recommended starting dose for men with erectile dysfunction (ED); however, most men are later titrated to sildenafil 100 mg for improved efficacy. Aim Assess the tolerability and efficacy of sildenafil initiated at the 100-mg dose in men with ED. Methods Men with ED (score ≤25 on the Erectile Function domain of the International Index of Erectile Function) who had received ≤6 total doses of a phosphodiesterase type 5 inhibitor and none within 4 weeks were randomized to 8 weeks of double-blind, placebo-controlled (DBPC), fixed-dose treatment (50 or 100 mg sildenafil or placebo) followed by 4 weeks of open-label flexible-dose sildenafil (50 or 100 mg). Main Outcome Measures Efficacy, tolerability, treatment satisfaction, and other end points were measured at baseline and/or the end of the double-blind and open-label phases and compared between placebo and sildenafil initiated at doses of 50 and 100 mg. Results Improvements in DBPC patient-reported outcomes from baseline were statistically significant for both sildenafil 50 and 100 mg compared with placebo. At the end of DBPC treatment, 56% of men on the 100-mg dose felt no anxiety about the next intercourse attempt compared with 39% in the 50-mg group (odds ratio 2.03; P = 0.0197). Changes in functional scores from baseline were not statistically significant with the 100-mg dose compared with the 50-mg dose in the DBPC. Measures of treatment satisfaction and sexual experience significantly favored the 100-mg dose compared with the 50-mg dose in the DBPC. There was no increase in adverse events with the higher dose. Conclusions Sildenafil at 50 mg or 100 mg significantly improved erection quality, treatment satisfaction, anxiety levels, and the sexual experience compared with placebo during DBPC. Sildenafil 100 mg improved the sexual experience and treatment satisfaction, and reduced feelings of anxiety compared with the 50-mg dose.