Management Of Male Sexual Dysfunction Research Articles

LONG-TERM FOLLOWUP OF TREATMENT FOR PEYRONIE’S DISEASE: MODELING THE PENIS OVER AN INFLATABLE PENILE PROSTHESIS

We originally reported inflatable penile implants used to treat impotence in patients with Peyronie's disease in 1993. We now present a historical prospective study of 104 patients in whom the modeling procedure was used to correct Peyronie's curvature after implantation with the Mentor Alpha 1dagger and AMS 700CXdouble dagger penile prostheses. We compared revision-free survival experience of these implants with 905 similar implants in men with nonPeyronie's disease. The reasons for revision were classified as mechanical failure, patient dissatisfaction, infection and medical causes, including reoperation for straightening. Overall and cause specific revision-free survival in the 2 study cohorts was compared. Maximum followup was more than 12 years and average followup was more than 5. No significant difference in device survival was observed in the 2 study cohorts in 5 years. Similarly each prosthesis provided the same permanent straightening without the need for revision. In Peyronie's disease cases mechanical survival of the Mentor Alpha 1 was superior to that of the AMS 700CX (p = 0.0270). There was no significant difference in mechanical reliability of the devices in nonPeyronie's disease cases. Implantation and modeling appear to provide permanent straightening without an increase in revisions. In the nonmodeled group there was no significant difference in mechanical reliability of the AMS 700CX or Mentor Alpha 1. In modeled cases the Mentor Alpha 1 appeared less likely to fail mechanically than the AMS 700CX when followed more than 5 years. Based on this single series modeling may predispose the AMS 700CX to earlier mechanical failure.

Commitment to change statements: a way of understanding how participants use information and skills taught in an educational session.

Commitment to change has gained increasing use in assessing short course effectiveness. This study examined the changes that learners intended to make in practice following an intensive day-long course offered at multiple sites, counted changes relative to the curriculum's focus, and analyzed which changes were implemented in practice. Participants at a course on the management of male sexual dysfunction were asked to identify the changes to which they would commit. Six months after the course, they were asked to indicate which changes they implemented fully, partially, or not at all. A total of 352 physicians attended the courses held in 21 centers. A majority of attendees (344 or 97.7%) completed forms at the end of the course, providing 1,635 commitment statements. Six months later, 197 (57.3%) physicians provided follow-up data about 935 (55.4%) of the commitment statements originally submitted. Of these, 602 (66.52%) were completely implemented. Many of the changes related to two specific aspects of the course, namely, sexual history taking and medical intervention, accounting for 45.93% of the intended commitments and 47.67% of the changes completely implemented. Slightly over half (58%) of the course time was devoted to these two areas. There was a significant correlation between the number of changes and the amount of time allocated to that content within the course. Commitment to change statements offered by course participants can be used to examine the impact of a course relative to its learning focus. Continuing medical education providers must take a critical look at commitment to change statements as an "intervention" in their own right and determine how the tool can best be used as a continuing medical education intervention.

Recent developments in male sexual dysfunction.

The past few years have witnessed major developments in the management of male sexual dysfunction. The introduction of the first efficacious and safe oral medication (sildenafil) resulted in the expansion of the patient base and, the change in health care delivery, with erectile dysfunction (ED) entering the primary care physician's practice. New guidelines for the diagnosis and treatment of ED have been developed, including the Process of Care in the USA and the 1st International Consultation on ED sponsored by the World Health Organization. Well-defined algorithms for diagnosis and treatment have been adopted. These recent developments have brought up challenging issues, including the cardiovascular safety of sexual activity, societal changes, internet prescriptions, definition of the patient, expansion of clinical and laboratory research, rise of interest in female sexual dysfunction, and a significant economic impact. The recent developments in male sexual dysfunction continue with the study of new oral medications. Some of these new medications, such as sublingual apomorphine, have a central mode of action, whereas others, such as the phosphodiesterase inhibitor IC351, have a selective peripheral vasodilation-enhancing action.

Changing Practice Patterns in Erectile Dysfunction: A Diagnostic Algorithm for the New Millennium

In the era when there was only one cause-specific treatment for erectile dysfunction (vasoactive penile injection), most patients could be safely directed to therapy following a good sexual history, assessment of medical risks, and physical examination. Without diagnostic testing, efficacy and satisfaction was a matter of chance. The next millennium will see the development of multiple oral agents for the management of male sexual dysfunction. These agents with their differing mechanisms of pharmacological action (central initiators, central conditioners, and peripheral modulators) present for the first time the possibility of cause-specific therapy. Currently with only 1 pill available, clinicians are compelled to categorize patients as having oral-agent-responsive or oral-agent-resistant erectile dysfunction (ED). For the time being, we may categorize patients as: Viagra (Pfizer Pharmaceuticals, New York, NY) successes or Viagra failures. But when faced with a laundry list of options for ED, the role of erectile function testing will assume a two-fold importance: (1) establishing an etiology specific diagnosis and (2) formulating a treatment plan with a reasonable likelihood of success. Patients failing first-line therapy by primary caregivers will seek the expertise of specialists; they will want to know not only what is wrong with them but also why a specific agent has failed to reverse their ED. We must be prepared to meet these demands; our diagnostic algorithms must incorporate these new pharmacological agents. Our prescribing patterns, to be successful, must have some objective basis. ED testing will need to produce vascular profiles to predict which drug or combination of drugs (oral, cutaneous, urethral, intracavenosal) will effectively restore erection. Conversely, to spare patients the frustration and the potential side effects of empiric trials, ED testing will need to determine whether patients would be better served by a mechanical solution, a vacuum erection device or penile prosthesis.

Management of male sexual dysfunction in multiple sclerosis

Sexual dysfunction is a common complaint in men with Multiple Sclerosis: up to 80% of them report erectile dysfunction and 10% ejaculatory problems at some stage of the disease. The aim of this article is to provide sexologists and psychiatrists some practical advice about investigating and treating erectile disorders in these patients suffering from a chronic and distressing disease.

A Multidisciplinary Approach to the Evaluation and Management of Male Sexual Dysfunction

AbstractWe recently established a multidisciplinary center for the evaluation and treatment of male sexual dysfunction. The patients are seen in a single day by the endocrinologist, psychiatrist, psychologist, neurophysiologist and urologist. Laboratory studies include chemical and hormonal profiles, pudendal nerve latency testing and determination of the penile blood pressure. Nocturnal penile tumescence studies are done in selected cases. A diagnosis was made in 95 of 106 patients (90 per cent). The problem was psychogenic in 42 per cent of the patients, vascular and neurologic in 34 per cent, hormonal in 15 per cent, urologic in 7 per cent and medication-related in 2 per cent. The interdisciplinary approach to this problem allows for a more comprehensive and accurate evaluation, while providing a convenient service to the patient.

Practical office management of male sexual dysfunction

A discussion of the importance of the close relationship between patient and physician in the office. Emphasis on detailed history of the patient to include; physical examination, laboratory work and any additional tests if necessary.