Loss Of Erectile Function Research Articles

MP73-10 PATIENT-REPORTED TREATMENT RELATED REGRET (TRR) FOLLOWING PRIMARY PARTIAL GLAND CRYOABLATION (PPGCA):A PROSPECTIVE COHORT STUDY OF MEN WITH LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP73-10 PATIENT-REPORTED TREATMENT RELATED REGRET (TRR) FOLLOWING PRIMARY PARTIAL GLAND CRYOABLATION (PPGCA):A PROSPECTIVE COHORT STUDY OF MEN WITH LOCALIZED PROSTATE CANCER Herbert Lepor, Eli Rapoport, Rozalba Gogaj, Sameer Thakker, and James Wysock Herbert LeporHerbert Lepor More articles by this author , Eli RapoportEli Rapoport More articles by this author , Rozalba GogajRozalba Gogaj More articles by this author , Sameer ThakkerSameer Thakker More articles by this author , and James WysockJames Wysock More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: TRR captures the effect of treatment-related functional impairments, oncologic anxiety and outcomes, and behavioral, emotional, and interpersonal changes associated with diagnosis and treatment within the context of patient values and expectations. The objective is to determine the rate of TRR following PPGCA and characterize factors predisposing to TRR. METHODS: Men with prostate cancer undergoing PPGCA since 3/2017 were enrolled in a prospective outcome registry. Preoperative baseline characteristics (i.e., patient age, race, IPSS and SHIM, and Gleason Grade Group); post-operative outcomes (i.e., recurrence on surveillance biopsy, receipt of salvage treatment); and functional status (measured using the IPSS and SHIM) were recorded. Between June and August 2022, the Clark et al. validated prostate cancer-related treatment regret decision scale was distributed. A score≥40 on the regret scale was considered significant TRR. Men were considered potent at baseline or post-treatment if their response to Question #2 of the SHIM was>2. Associations between significant treatment regret and baseline characteristics (i.e., patient age, race, IPSS, SHIM and preoperative GGG) and longitudinal outcomes (i.e., recurrence on surveillance biopsy, receipt of salvage treatment, a clinically significant change in IPSS, decline in potency or erectile function, and loss of potency among those who were potent at baseline) were assessed using logistic regressions. RESULTS: 245 men met criteria for inclusion in the study, of whom 163 completed the survey (response rate: 66.5%). Significant TRR was expressed by 15.8% of men. Age, race, baseline erectile function, and Gleason Grade Group were not statistically significant predictors of TRR. Among those who were potent at baseline, loss of potency was associated with higher probability of significant TRR. Similarly, among those who had erectile function and severe LUTS at baseline, and loss of erectile function were associated with higher probabilities of significant TRR. No associations were identified between TRR and recurrence of csPCa or salvage treatment. CONCLUSIONS: The overwhelming majority of men do not express TRR following PPGCA. Baseline severe LUTS at baseline and the development of erectile dysfunction are factors predisposing to TRR. It is imperative to elucidate short, intermediate and long term functional and oncological outcomes predisposing to TRR in order to optimize outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1038 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Herbert Lepor More articles by this author Eli Rapoport More articles by this author Rozalba Gogaj More articles by this author Sameer Thakker More articles by this author James Wysock More articles by this author Expand All Advertisement PDF downloadLoading ...

Rupture of the Superficial Dorsal Vein of the Penis: About Two Cases

Superficial dorsal vein rupture is a rare penile emergency, it presentation could suggest penile fracture instead. While penile fractures are a true emergency, superficial dorsal vein rupture is not as the consequences for the patient are different and loss of erectile function is rare. We report the observation of 2 men who presented with a clinical picture suggestive of a fracture of the corpora cavernosa, and whose exploration objectified a rupture of the superficial dorsal vein of the penis. The evolution is most often favorable after surgical management.

Sexual Functional Prognosis of Penile Emergencies at the University Hospital of Libreville

Introduction: Penile emergencies are multiple and varied, and they can jeopardize the sexual functional prognosis of the patient. The objective of our study was to evaluate the sexual functional prognosis of patients admitted for penile emergencies. Patients and Methods: We conducted a cross-sectional study from January 1 to 31, 2021, in the urology department of the University Hospital. Variables included sociodemographic, diagnostic, and evolutionary data of sexually active patients admitted for a penile emergency. Results: During this period, 68 patients were admitted for penile emergencies. We included 45 sexually active patients, with a mean age ranging from 34.5 ± 14.1 years with extremes of 16 and 90 years. The most frequent penile emergencies were priapism (62.2%) and penile fracture (22.2%), with a mean time for treatment of 21.4 ± 52.5 hours. The sexual functional prognosis was very satisfactory (normal erection) in 71.1% (n = 32) of patients. Loss of erectile function was observed in 4.4% (n = 2) of cases. Conclusion: Penile emergencies are relatively frequent, dominated by priapism and penile fracture in our context. The sexual functional prognosis is good.

Comparative results of nerve-sparing robotic-assisted prostatectomy

Background. Considering decreasing age of patients with prostate cancer, increasing cancer alertness of first-line doctors as well as increased frequency of radical prostatectomies (RP), the problem of preservation of erectile function (EF) is vitally important (erectile dysfunction develops in 25–75 % of all patients who underwent surgery).The study objective is to analyze preservation of EF after RP depending on the type of endoscopic access and nerve preservation.Materials and methods. Between February of 2015 and February of 2016, in the Urology Clinic of the Sechenov University, 507 RPs were performed; the retrospective single-center study included 231 patients with localized prostate cancer. Surgery was performed with the following accesses: laparoscopic, extraperitoneal laparoscopic, and robotic. Indications for nerve preservation were formulated based on the Briganti nomogram, Partin table as well as patient’s desire to preserve EF. Further evaluation of EF was performed using the International Index of Erectile Function (IIEF5), evaluation of quality of life – using the QoL (Quality of Life) scale.Results. RP with nerve preservation was performed in 150 patients. Surgical time and blood loss did not significantly differ for surgeries with and without nerve preservation (р = 0.064 and р = 0.073 respectively). Pathomorphological examination showed that in all cases (n = 231) integrity of the prostatic capsule and negative surgical margin were achieved. Frequent significant erectile dysfunction and full loss of EF were observed in patients after RP without nerve preservation compared to the group with preserved neurovascular bundles (5.0 (0.0–10.0) points compared to 6.5 (0.8–19.0) points per the IIEF5 scale, р = 0.271): 96.2 % versus 72.2 % (p <0.001). Nerve preservation significantly improved quality of life: 1.63 ± 1.16 points versus 1.88 ± 1.02 points per the QoL scale (р = 0.035).Conclusions. The best results were achieved in the robotic access group. Surgery with nerve preservation decreased frequency of EF loss. This benefit in conjunction with the radical nature of the operative intervention allows to consider RP techniques with nerve preservation as reasonable approach to erectile dysfunction prevention in patients with localized prostate cancer.

Design and Implementation of a Low-Cost Priapism Reduction Task Trainer.

This low-cost priapism reduction task trainer is designed to instruct emergency medicine (EM) resident physicians. Priapism is a true urologic emergency that EM physicians must be able to diagnose and treat in order to prevent significant tissue damage and loss of erectile function. Given the nature of the condition, priapism treatment is often both physically invasive and psychologically upsetting. Simulation allows learners to practice invasive or rare procedures in a safe and educational environment. At present, there are few inexpensive and easily created task trainers for priapism reduction. Our goal was to create an inexpensive, reusable task trainer that allows learners to practice the skills needed for priapism reduction. By the end of this educational session, learners should be able to 1) Verbalize the difference between low-flow and high-flow priapism 2) Describe the landmarks for a penile ring block and cavernosal aspiration/injection 3) Demonstrate the appropriate technique for performing a penile ring block, cavernosal aspiration, and cavernosal injection. Using inexpensive and commonly found materials, we were able to successfully create a partial task trainer for teaching priapism reduction techniques including administering local anesthesia, medication injection, and realistic cavernosal aspiration with simulated blood return. As part of a standard EM residency didactics curriculum, this task trainer has been used to teach post graduate year (PGY) 1-4 resident learners. After an introductory didactic session, participants were given the opportunity for hands-on skills-based practice using the simulated task trainer. Learners were asked to complete a post-session survey to assess the educational value of the station and the task trainer. We were able to successfully create a low cost, easy to build partial task trainer for priapism reduction that allowed learners to perform local anesthesia, medication injections, and corporal aspiration. Twenty-five residents (ten PGY-1, five PGY-2, five PGY-3, five PGY-4) participated in a single didactic session and completed a post-session survey. The majority (68%, N=17) of participants had never previously treated a patient with priapism. On average, participants rated their comfort managing a patient with priapism before the session to be 1.76 on a 5-point Likert-scale (where 1=not at all comfortable and 5=extremely comfortable). Following the session, participants' comfort increased to 3.76 on the same scale. Participants rated the usefulness of the priapism model for teaching priapism reduction techniques to be 4.64 on a 5- point scale (where 1=not at all useful and 5=extremely useful). Using inexpensive and commonly found materials, we were able to successfully create a partial task trainer for teaching priapism reduction techniques including local anesthesia, medication injection, and cavernosal aspiration. Learners reported that the educational session greatly increased their confidence in caring for patients presenting with priapism. Additionally, they found the priapism model to be extremely helpful for teaching reduction techniques. Our model was successful in teaching a procedure that providers may encounter in clinical practice yet most resident learners had not yet had the opportunity to perform in training. Penile anesthesia, priapism reduction, urologic emergencies.

The role of body image in treatment decision-making and post-treatment regret following prostatectomy

Three main treatments are offered to men with localised prostate cancer: active monitoring, radiotherapy and prostatectomy. The aim of this research was to explore the role of body image in treatment decision-making and post-treatment regret following prostatectomy for localised prostate cancer. Data were collected via nine semi-structured interviews. Interviews underwent thematic analysis and four themes emerged: need to prolong life, loss of function and self, post-surgery effects on body image and confidence, and coping strategies. Participants revealed that loss of erectile function following surgery resulted in reduced self-confidence, and changes in their perception of their body.

264 Male Sexual Dysfunction after Prostate Radiotherapy: A Review and Guide to Management

Prostate cancer is the second leading cause of cancer related death in men. Radiation is a common treatment option and modalities include external beam radiation and brachytherapy. As a result of this treatment, male sexual dysfunction commonly occurs afterwards. The pathophysiology is multifactorial and is related to arterial and nerve damage. Loss of erectile function had been attributed to physiologic stress and a worsened quality of life. In addition, ischemia and scarring to the ejaculatory ducts commonly leads to anejaculation which has been shown to further exacerbate symptoms and impact libido and satisfaction. Management of patient’s erectile function after radiation requires a complicated, multi-modal approach including perspectives from radiation oncology, urology, and psychiatry. Provide a framework for practitioners regarding sexual dysfunction in men post radiotherapy for prostate cancer from a clinical, epidemiologic, and psychosocial aspect. Multi-institutional collaborative literature review from urology, radiation oncology, and psychiatry. We specifically targeted erectile dysfunction, libido, altered ejaculation, and orgasm. Particular focus was placed on psychological impact of these issues and optimal management in this patient population.

Nerve Bundle Hydrodissection and Sexual Function after Robot Prostatectomy.

Background and Objectives:Loss of erectile function is common after prostatectomy, and surgeons have long sought techniques that reduce this adverse outcome. This study was conducted to assess erectile function after robot-assisted laparoscopic prostatectomy, with and without hydrodissection (HD) of the neurovascular bundles (NVBs).Methods:Using a database of 335 consecutive RALP procedures conducted by 2 surgeons, we identified all nerve-sparing surgeries performed by HD or standard dissection (SD). The primary and secondary endpoints were Sexual Health Inventory for Men (SHIM) scores and surgical margin positivity, respectively. Subset analyses were performed on men with preoperative SHIM scores ≥17. Determinants of the postoperative SHIM score were evaluated by multivariate linear regression.Results:Among men with preoperative SHIM scores ≥17 who underwent bilateral complete nerve sparing (n = 73), mean preoperative SHIM scores were similar in the HD and SD groups, but were significantly higher in the HD group at 6 months (16.1 ± 8.6 vs 8.3 ± 8.1; P = .024) and >1 year after surgery (16.9 ± 7.1 vs 9.1 ± 6.4; P = .004). According to multivariate linear regression analysis including all patients, HD at RALP (odds ratio [OR] 6.9; 95% confidence interval (CI) 2.8–11.0; P = .001) and preoperative SHIM score were independent predictors of erectile function at >1 year after surgery. There was no significant difference in surgical margin positivity between groups (P = .36).Conclusion:HD of the NVB appears to improve erectile function after RALP.

Subacute Hemolysis in Sickle Cell Mice Causes Priapism Secondary to NO Imbalance and PDE5 Dysregulation.

Recent research suggests that priapism in sickle cell disease (SCD) is due to dysregulation of penile erection homeostasis including alteration of nitric oxide synthase (NOS) and phosphodiesterase type 5 (PDE5) activities by excessive levels of reactive oxygen species (ROS) released during hemolysis. It is unknown if subacute exposure to hemolysis is sufficient or if chronic reconditioning of erectile tissues is required for perturbation of homeostatic pathways and whether PDE5 inhibitor (PDE5I) treatment can restore erectile homeostasis in the subacute setting. The aim of this study was to investigate the effects of subacute hemolysis (3-month exposure) on priapism and NO pathway regulation. Mice underwent bone marrow transplantation with either SCD (BM-SS) or wild-type (WT) bone marrow. BM-SS mice were treated with sildenafil 100 mg/kg/day. We measured intracavernous pressure (ICP) measurements with or without cavernous nerve stimulation following bone marrow transplantation to assess for priapism. ICP and frequency of erections were assessed. Penile tissues were analyzed for NOS, protein kinase G (PKG), PDE5, and ROS activities. BM-SS mice demonstrated a priapism phenotype. PDE5I treatment reduced the frequency of erections in BM-SS mice (1.7 ± 1.1 vs. 5.5 ± 2.8 erections per hour, P < 0.05). Penile tissues from BM-SS mice demonstrated decreased NOS, PKG, PDE5 and elevated ROS activities compared with that of control mice. PDE5I treatment increased NOS (11.6 ± 1.3% vs. 7.8 ± 2.3%, P < 0.05) and PDE5 (76.3 ± 9.8% vs. 52.3 ± 11.1%, P < 0.05) activities and decreased ROS activity (137.8 ± 12.1% vs. 199.1 ± 11.3%, P < 0.05) compared with non-PDE5I treated BM-SS mice. PKG activity was increased beyond control levels with PDE5I treatment (158.4 ± 10.3%, P < 0.05). Short-term hemolysis is sufficient to establish a priapism phenotype and results in loss of erectile function. PDE5I treatment ameliorates priapism, in part, because of restored NO balance with decreased ROS generation and increased PDE5 activity.

Microarray screening of angiogenic gene alterations in diabetic cavernosal tissue

Summary Diabetes is an important vascular risk factor associated with the development and progression of erectile dysfunction (ED). Loss of erectile function in the diabetic individual is thought to involve alterations in the functionality of vascular endothelial cells lining the penile vasculature. However, the exact mechanisms impairing endothelial function in diabetic corpus cavernosum (CC) leading to ED have not been fully elucidated. We aim to investigate alterations in the expression of angiogenic genes in cavernosal tissue of an experimental model of type 1 diabetes mellitus (T1DM), which can be potentially involved in diabetic vasculopathy and erectile insufficiency. To achieve this, we have used a microarray analysis, which allowed us to evaluate the expression of a full range of angiogenic-related genes in diabetic rats CC, which were compared to age-matched healthy controls. Preliminary results suggested a downregulation in the expression of several genes in diabetic cavernosal tissue. The identified genes are involved in the regulation of intracellular cascades, G-protein signaling, response to oxidative stress, and directly related to the angiogenic process. This microarray analysis provided evidence of the deregulation of specific angiogenic molecules and pathways in diabetic CC, which might impair endothelial integrity and proper erectile function.

A Compact Laparoscopic Probe for Optical Stimulation of the Prostate Nerves

The cavernous nerves (CN) course along the prostate surface and are responsible for sexual function. Optical nerve stimulation (ONS) has recently been tested as a potential alternative to electrical nerve stimulation for identifying and preserving these delicate nerves during prostate cancer surgery. However, the optimal range of laser parameters for safe and consistent laser nerve stimulation is relatively narrow; low-level irradiation may not stimulate the nerve, while high-level irradiation may result in thermal damage to the nerve and loss of erectile function. The objective of this study is to design, build, and provide preliminary data on testing of a laparoscopic probe capable of delivering a collimated, flat-top spatial beam profile to the nerve surface for uniform, safe, and reproducible irradiation of the nerve. Chemical etching of the distal fiber optic tip in combination with an aspheric lens resulted in a 3.4-mm-OD laparoscopic probe capable of delivering a collimated 1-mm-diameter, flat-top laser beam over a working distance of about 20 mm. Successful ONS using this probe was observed in a rat prostate model, in vivo. Upon further testing, this probe may be useful for identifying and preserving the CN during laparoscopic nerve-sparing prostate cancer surgery.

Risk Factors for Incident Erectile Dysfunction among Community-Dwelling Men

Compared to the prevalence of erectile dysfunction (ED), fewer studies have focused on the incidence of ED and even fewer have focused on nonmedical risk factors. We examined psychosocial, demographic/socioeconomic, medical/behavioral, and sexual function risk factors at T1 (1987-1989) and development of incident ED at T2 (1995-1997). Longitudinal population-based epidemiologic study of 814 community-dwelling men participating in the Massachusetts Male Aging Study. ED was defined according to a validated, discriminant-analytic formula based on questionnaire responses and categorized as moderate/complete ED vs. none/minimal. Multivariate logistic regression models (odds ratios [ORs] and 95% confidence intervals [CI]) were used to estimate the association of risk factors with ED. Among 814 men free of ED at T1, 22% developed moderate/complete ED at T2 (on average, approximately 8.8 years later). In a multivariate model, sexual function variables captured at baseline were inversely associated with ED (e.g., more or similar level of sexual arousal compared to adolescence vs. less, OR = 0.56, 95% CI: 0.34, 0.92; frequency of sexual thoughts at least two to three times weekly vs. less, OR = 0.55, 95% CI: 0.33, 0.92) after adjustment for age, education, and other risk factors. Our results indicate that in the context of other risk factors, sexual desire variables at baseline were associated with incident ED. This in turn suggests that indications of reduced function appear earlier than ED itself, and that there may be a time window for intervention before a loss of erectile function.

Significant loss of erectile function in the third year after low dose-rate prostate brachytherapy

Significant loss of erectile function in the third year after low dose-rate prostate brachytherapy

Couple, conjugalité et dysfonction érectile

Erectile Dysfunction (ED) is extremely common in men. Erection problems will usually produce a significant psychological and emotional reaction in most men, and their partners. Both are likely to face a drop in sexual quality of life and challenges to their intimate relationship as couples' sexual activities are curtailed by the loss of erectile function. If successful and effective management is to occur, any discussion of treatment should include the couple. ED is a couple's problem and therefore it requires a couple's solution. The quality of relationship is to be improved by couple-centred understanding and solutions.

REVIEWS: Are Androgens Critical for Penile Erections in Humans? Examining the Clinical and Preclinical Evidence

Androgens are deemed critical for penile-tissue development, growth, and maintenance of erectile function, however, their role in erection, especially in humans, remains controversial. In this review, we summarize information from clinical and animal model studies to provide a comprehensive and rational argument for the role of androgens, or lack thereof, on penile erection ability in humans. The goal of this review is to present the clinical and preclinical evidence available in the literature with regard to testosterone and erectile physiology and engage the reader in this discussion. Ultimately, each reader will have to form his or her own conclusions based on the existing evidence. In humans, androgen-deficiency manifestations are noted in clinical situations such as: (i) inadequate development of the penis; and (ii) loss of erectile function in prostate cancer and benign prostatic hyperplasia patients managed with medical or surgical castration or antiandrogen therapy. Androgen treatment causes: (i) improvement in sexual function in hypogonadal patients treated with androgen supplementation; (ii) improvement in nocturnal penile tumescence in hypogonadal patients treated with androgens; (iii) improvement in erectile function with androgen supplementation in patients who did not respond to phosphodiesterase type 5 inhibitor therapy initially; and (iv) improvement in the well-being, mood, energy, and sexual function in aging men who have testosterone deficiency treated with androgen therapy. In contrast to animals, especially rodents in which the adrenal cortex does not synthesize androgens, the human adrenal is a source of peripherally circulating androgen precursors, thus, complete androgen insufficiency may not be observed in men at a younger age. Furthermore, in light of the concept that a threshold of androgen levels exists in animals and humans below which sexual function is diminished, further contributes to the complexity of understanding androgens role in erections, especially in humans. Nevertheless, based on the preclinical and clinical data available in the literature, to date, we infer that androgens play a critical role in maintaining erectile physiology in humans.

Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men

The Men in Australia Telephone Survey (MATeS) describes the prevalence of self-reported reproductive health disorders as well as related concerns and health behaviours among middle-aged and older Australian men. A representative sample population (n=5990) of Australian men (>or=40 years) was obtained by contacting a random selection of households with unbiased sampling, stratified by age and state. A 20-min computer-assisted telephone interview was done to assess reproductive health and related knowledge and beliefs, sociodemographic factors, general health, and lifestyle factors. A response rate of 78% (5990/7636) was achieved. 34% (1627/4737) of men surveyed reported one or more reproductive health disorder, all of which were most common in the oldest age group. Age-standardised prevalence of significant lower urinary tract symptoms was 16%, erectile dysfunction was 21%, and prostate disease was 14%. About 50% of participants reported having had a prostate cancer test whereas only 30% (300/1012) of men with erectile dysfunction sought medical help. Willingness to seek medical help for erectile dysfunction was related to age and ethnic origin. Although men aged 40-69 years expressed a moderate or high level of concern about prostate cancer and loss of erectile function, concern about reproductive health was less in the oldest age group (>or=70 years). The high prevalence of reproductive health disorders and associated concerns in middle-aged and older Australian men draws attention to the need to develop appropriate services and education strategies specifically directed to improving reproductive health in these men.

Pathophysiologie und Rehabilitation der erektilen Dysfunktion nach nerverhaltender radikaler Prostatektomie

Radical prostatectomy is the current standard procedure for locally confined prostate cancer and accounts for the largest portion of invasive therapies. However, a major drawback of this approach remains the frequently ensuing postoperative erectile dysfunction. This aspect represents a frequent cause of fear and concern both for the patients and their partners and has a significant impact on the choice of therapy.After bilateral sparing of the neurovascular bundles, an average of 50% of the patients is likely to complain of erectile dysfunction. It is only in the course of the first 2 years after prostatectomy that rehabilitation of erectile dysfunction can be expected. It is all the more crucial to begin with rehabilitation therapy of the erectile tissue at an early postoperative stage to the prevent an irretrievable loss of erectile function. Application of PDE-5 inhibitors as well as prostaglandins, phentolamine, or papaverine can help to induce and to support penile blood perfusion and oxygenation, thus preserving structure and function of the corpora cavernosa. All efforts must be directed towards keeping the erectile function at the level ascertained prior to the intervention.

Effects on Sexual Function by the Drugs used in the Treatment of Benign Prostatic Hyperplasia and Prostate Cancer. A Practical Guide for the Urologist

The effects on sexual function (SF) by the drugs commonly used in the treatment of benign prostatic hyperplasia (BPH) and prostate cancer (PC) have been analyzed. BPH therapy: alpha-blockers have no adverse effects on SF; the only one without significant hypotensive effect, Tamsulosin, can cause retrograde ejaculation in 4–8% of cases. 5-Alpha-reductase (Finasteride and Dutasteride) inhibitors could have detrimental effects on erectile function, libido and ejaculation in a small percentage of cases rarely exceeding 10%; these effects are reversible and their incidence reduces after 1 yr. Phytotherapy (extracts from pygeum africanum and serenoa repens) and mepartricin have no unfavorable action on SF. PC therapy: Loss of erectile function and libido are the norm with the use of LH-RH analogues, estrogens and steroidal antiandrogens (cyproterone acetate). Non-steroidal antiandrogens (Flutamide, Bicalutamide and Nilutamide) allow the preservation of SF in two-thirds of cases.

Adipocyte Accumulation in Penile Corpus Cavernosum of the Orchiectomized Rabbit: A Potential Mechanism for Veno‐occlusive Dysfunction in Androgen Deficiency

Androgens are deemed to be critical for the development, growth, and maintenance of penile tissue as well as for erectile function. Androgens are also reported to inhibit differentiation of stroma progenitor cells into adipocytes and promote differentiation into smooth muscle. The objective of this study was to investigate whether androgen deprivation results in accumulation of adipocytes in the corpus cavernosum. Mature, New Zealand white male rabbits were subjected to sham surgery (control) or orchiectomy. Two weeks after surgery, erectile function was assessed by monitoring changes in intracavernosal blood pressure (ICP) in response to pelvic nerve stimulation. All ICP measurements were normalized to the mean systemic arterial blood pressure. In parallel studies, penile cross sections from control and orchiectomized rabbits were fixed and stained with either Masson's trichrome or hematoxylin and eosin to assess smooth muscle and connective tissue content. Alternatively, tissue sections were stained with Toluidine blue to assess accumulation of fat-containing cells. Orchiectomy resulted in loss of erectile function and penile atrophy, associated with reduced trabecular smooth muscle and increased connective tissue content. Most strikingly, tissue from orchiectomized animals exhibited accumulation of fat-containing cells (adipocytes) in the subtunical region of the corpus cavernosum. We hypothesize that androgen deprivation promotes differentiation of progenitor stroma cells into an adipogenic lineage producing fat-containing cells, thus altering erectile function.

Lower Urinary Tract Symptoms and Erectile Dysfunction: Co-Morbidity or Typical “Aging Male” Symptoms? Results of the “Cologne Male Survey”

Due to demographic developments in industrial nations, age-correlated diseases are becoming more important. From many epidemiological studies we know that the prevalence of benign prostatic hyperplasia (BPH) and the loss of erectile function (= erectile dysfunction or ED) increase with advancing age. Are these two illnesses related or/and independent? We mailed our newly developed and validated questionnaire on male erectile dysfunction (KEED), as well as a set of questions pertaining to voiding problems (IPSS), to a representative population sample of 8000 men from 30 to 80 years of age residing in the city of Cologne. The responses included 4489 evaluable replies (56.1%). The response rates in the different age groups ranged from 41 to 61%. The mean age of the men who answered was 51.8 years. The overall prevalence of ED was 19.2% (n=862), with a steep age-related increase from 2 to 53%. Furthermore, 31.2% (n=1957) of all men complained of lower urinary tract symptoms (LUTS), the prevalence and the intensity of which increased with age. Interestingly, a high co-morbidity was found between ED and voiding problems. Prevalence of LUTS in men suffering from ED was about 72.2% (n=621) vs. 37.7% (1367) in men with normal erections. The odds ratio was evaluated with 2.11. The trivariate analysis showed that the occurrence of LUTS can be considered as an age-independent risk factor for the development of ED (p<0.001). Even though the pathogenetic relationship between LUTS and ED is not yet completely understood, one has to postulate a direct association between these two typical symptom complexes in the aging male.