Potent Men Research Articles

Comparison Between Tadalafil Plus Paroxetine and Paroxetine Alone in the Treatment of Premature Ejaculation.

Background:Several recent studies have investigated the therapeutic role of phosphodiesterase type 5 (PDE5) inhibitors in premature ejaculation (PE) used in the treatment of erectile dysfunction.Objectives:In the present research, the efficacy of paroxetine alone and paroxetine plus tadalafil was compared in patients referred because of premature ejaculation.Patients and Methods:This quasi-experimental study was performed on 100 consecutive 17 to 49-year-old potent men with premature ejaculation and without any clear organic disease. All patients had lifelong PE with an intravaginal ejaculation latency time (IELT) shorter than 1.5 minutes. Informed consent was obtained from all patients who were randomly divided into two groups using a computer-generated random tabulation list. In group A, patients received 10 mg paroxetine daily, in addition to four hours before planned sexual activity. In group B, 10 mg paroxetine was taken daily, plus 10 mg tadalafil one hour before planned sexual activity. The duration of the intervention was six months and patients were evaluated for IELT three and six months after the beginning of therapy.Results:The mean age of patients in groups A and B were 33 ± 9.6 and 31.2 ± 9.3 years, respectively (P = 0.368). The mean number of intercourses were 1.08 ± 0.6 and 1.12 ± 0.6 per week in groups A and B, respectively (P = 0.791). Mean IELT at the 3-month follow up in groups A and B was 4.5 ± 1.5 and 5 ± 2.4 minutes, respectively (P = 0.285) and at the 6-month follow up was 4.8 ± 1 and 5.3 ± 2 minutes, respectively (P = 0.278).Conclusions:The results of the study show that tadalafil can increase the mean IELT and can be used for treatment of premature ejaculation in combination with paroxetine.

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens.

This is a report on urinary function results from a randomized trial of nightly versus on-demand sildenafil after nerve-sparing radical prostatectomy (RP), a secondary objective. We analyzed the effects of these sildenafil administration schemes on urinary health-related quality of life after RP. In total, 100 potent men were equally randomized to nightly and on-demand sildenafil 50 mg after minimally-invasive RP for 1 year. Health-related quality of life questionnaires were administered at various postoperative intervals. Urinary function was assessed using appropriate expanded prostate cancer index composite (EPIC) subscales. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment over time on urinary recovery, controlling for age, nerve-sparing score, and time from surgery. The nightly (n = 50) and on-demand (n = 50) sildenafil groups were well-matched at baseline. Nightly sildenafil patients had worse EPIC urinary bother and urinary irritative/obstructive subscale scores at 3 and 6 months after RP, even after controlling for multiple variables. On mixed-model analyses, the differences between groups for these EPIC subscales (4.9 and 2.5, respectively) were greater than documented thresholds for clinical significance. Increasing nerve-sparing score was associated with improvements in EPIC urinary summary, bother, incontinence, and function scores; time from surgery was associated with improvements in all EPIC urinary health-related quality of life subscales. In this specific population and drug dose, we found that on-demand short-acting phosphodiesterase-5 inhibitor (PDE5i) dosing may be more effective after RP to maximize early urinary health-related quality of life. In preoperatively potent men, nightly sildenafil 50 mg impaired urinary health-related quality of life more than on-demand use in the early months after nerve-sparing RP, independent of effects on urinary continence.

Silodosin Causes Impaired Ejaculation and Enlargement of Seminal Vesicles in Sexually Active Men Treated for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

To evaluate the sexual side effects including ejaculation after silodosin treatment in potent men with regular sexual activity, as well as possible alterations in seminal vesicle volume. Sexually active patients aged ≥ 40 years with moderate to severe lower urinary tract symptoms were enrolled prospectively. International Prostate Symptom Score (IPSS) and Quality of Life (QoL), International Index of Erectile Function (IIEF) questionnaire, ejaculation frequency, and seminal vesicle volumes measured by transrectal ultrasonography were determined at study entry, and silodosin 8 mg/d was prescribed for 4 weeks. Alterations in IPSS-QoL, all domains of IIEF, ejaculation frequency, seminal vesicle volumes, and patient-reported side effects were evaluated after silodosin treatment. Thirty patients were included, and mean age was 56.7 ± 6.9 years (44-70 years). IPSS-total, IPSS-storage, and IPSS-voiding subscores and QoL were significantly improved after treatment. Despite a slight decrease in erectile function domain of IIEF (26.7 ± 1.9 vs 22.9 ± 7.5; P <.05), no significant change was determined for orgasmic functions, sexual desire, intercourse satisfaction, and overall satisfaction. Ninety percent of patients (27 of 30) had impaired ejaculation, and seminal vesicles were significantly enlarged at the end of treatment (8.1 ± 6.4 vs 16.4 ± 8.2 cc; P <.001). Impaired ejaculation is a common problem for sexually active men treated with silodosin, and this may result in the slight decrease in erectile functions. Enlargement of seminal vesicles may represent for the loss of seminal emission and accumulation of seminal vesicle secretion. Further studies are required for better clarifying the effects of silodosin on sexual functions including ejaculatory functions.

Integra for penile coverage after traumatic degloving – case report

Penile soft tissue defects can be caused by tumor excision, trauma, burns, Fournier’s gangrene and self-mutilation. Reconstruction of such defects has been achieved through various methods (local or regional flaps, full-thickness or split-thickness skin grafts, skin substitutes). Although no consensus has been reached, it seems that split thickness skin grafts are the method of choice. Penis resurfacing is a delicate procedure, especially in potent men, as it aims normal coverage, sensibility, aesthetic aspect and restoring erectile function with sexual satisfaction. We present a case of traumatic avulsion of the anterior perineum successfully treated using split thickness skin grafts for the testicles and Integra for the penis. The follow-up period was 5 years. Functional result was excellent, the penile skin regaining its elasticity, flexibility and pliability. No urinary problems or erectile dysfunctions were noted. Due to its advantages (skin elasticity, limited hypertrophic scar formation and inhibited myofibroblasts contraction) Integra might be the optimal penile coverage solution.

The Potent Eunuch: The Story of Wei Zhongxian

Abstract Literary and historical sources assumed ulterior, even diabolical, motives in the man who voluntarily became a eunuch. If he was lucky, he could become the ruler's confidant and even usurp imperial power. Focusing on Ming eunuch Wei Zhongxian (1568–1627), the article addresses key questions in the portrayal of eunuchs: How and why did a man become a eunuch? What were his motives, as far as can be learned from historical cases; and what did storytellers and other writers think his motives were? In the case of powerful and influential eunuchs, the question also became, how, after his act of self-destruction, did the eunuch reconstruct himself? How did he re-create himself as a newly potent man?

Predictive factors for return of erectile function in robotic radical prostatectomy: case series from a single centre.

Postprostatectomy erectile dysfunction is a frequent complication of robotic-assisted radical prostatectomy (RARP). We attempted to retrospectively identify objective predictors of erectile recovery in a population of potent men undergoing RARP. Data for 375 consecutive patients were collected prospectively from a single surgeon in an academic institution from 2005 to 2011. Inclusion criteria were 2 years of complete follow-up, preoperative International Index of Erectile Function (IIEF) scores of ≥ 22 without erectogenic aids and no adjuvant therapy (n = 86). Patients were grouped by erectile function at 2 years as 'Recovery' (IIEF ≥ 17, n = 41) and 'non-recovery' (IIEF < 16, n = 45). Baseline and perioperative characteristics were evaluated between groups. Body mass index, operative time and gland volumes were not different between groups. Univariate analysis demonstrated that higher preoperative prostate-specific antigen, longer apical dissection time and non-nerve-sparing surgery decreased erectile recovery. Multivariable analysis demonstrated that longer apical dissection time remained an independent predictor of decreased erectile function (P < 0.001). In contrast, postoperative intracavernosal injection (ICI) was found to predict erectile recovery (P = 0.017). At 2-year follow-up, prolonged apical dissection time predicts nonrecovery and ICI rehabilitation predicts recovery of erectile function after RARP. This can inform patients' postoperative expectations. However, further studies are needed to support the findings of this exploratory analysis.

Medical Hypothesis: Loss of the Endocrine Function of the Prostate Is Important to the Pathophysiology of Postprostatectomy Erectile Dysfunction

Three decades after the first nerve-sparing radical prostatectomy, postoperative erectile dysfunction (ED) remains a challenging and common problem. Despite considerable advances and improvements in surgical techniques, full recovery of erectile function remains elusive even for young, potent men. This suggests, ipso facto, that factors other than surgical technique must be important to recovery of erectile function. This study aims to review evidence that the prostate is an endocrine gland with contributions to local and systemic concentrations of 5α-dihydrotestosterone (5α-DHT), a potent androgen shown to be critical to penile physiology. Literature review of human and animal studies related to endocrine role of prostate and postoperative recovery of erectile function. Effect of 5α-DHT on erectile function and recovery after surgical injury. We advance the following hypothesis: "Loss of endocrine function of the prostate, specifically reduced local 5α-DHT concentration plays a major role in the failure of full recovery of erectile function following anatomic nerve-sparing radical prostatectomy." We propose two separate, yet interrelated, mechanisms whereby the loss of 5α-DHT interferes with postoperative recovery of erectile function: (i) 5α-DHT contributes to cavernous nerve integrity and its ability to recover from surgical insult. (ii) 5α-DHT is important to the structural/functional integrity of penile tissues and erectile physiology. Kacker R, Morgentaler A, and Traish A. Medical hypothesis: Loss of the endocrine function of the prostate is important to the pathophysiology of postprostatectomy erectile dysfunction.

Three-year outcomes of recovery of erectile function after open radical prostatectomy with sural nerve grafting.

Optimal oncologic control of higher stage prostate cancers often requires sacrificing the neurovascular bundles (NVB) with subsequent postoperative erectile dysfunction (ED), which can be treated with interposition graft using sural nerve. To examine the long term outcome of sural nerve grafting (SNG) during radical retropubic prostatectomy (RRP) performed by a single surgeon. Sixty-six patients with clinically localized prostate cancer and preoperative International Index of Erectile Function (IIEF) score >20 who underwent RRP were included. NVB excision was performed if the risk of side-specific extra-capsular extension (ECE) was >25% on Ohori' nomogram. SNG was harvested by a plastic surgeon, contemporaneously as the urologic surgeon was performing RRP. IIEF questionnaire was used pre- and postoperatively and at follow-up. Postoperative IIEF score at three years of men undergoing RRP with SNG. Recovery of potency was defined as postoperative IIEF-EF domain score >22. There were 43 (65%) unilateral SNG and 23 (35%) bilateral SNG. Mean surgical time was 164 minutes (71 to 221 minutes).The mean preoperative IIEF score was 23.4+1.6. With a mean follow-up of 35 months, 19 (28.8%) patients had IIEF score >22. The IIEF-EF scores for those who had unilateral SNG and bilateral SNG were 12.9+4.9 and 14.8+5.3 respectively. History of diabetes (P=0.001) and age (P=0.007) negatively correlated with recovery of EF. 60% patients used PDE5i and showed a significantly higher EF recovery (43% vs. 17%, P=0.009). SNG can potentially improve EF recovery for potent men with higher stage prostate cancer undergoing RP. The contemporaneous, multidisciplinary approach provides a good quality graft and expedited the procedure without interrupting the work-flow.

MP48-18 COMPARISON OF PAROXETINE AND DAPOXETINE, A NOVEL SELECTIVE SEROTONIN REUPTAKE INHIBITOR, IN THE TREATMENT OF PREMATURE EJACULATION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-surgical1 Apr 2014MP48-18 COMPARISON OF PAROXETINE AND DAPOXETINE, A NOVEL SELECTIVE SEROTONIN REUPTAKE INHIBITOR, IN THE TREATMENT OF PREMATURE EJACULATION Abdulmuttalip Simsek, Omer Sarilar, Sinan Kirecci, Onur Kucuktopcu, Faruk Ozgor, Fatih Akbulut, Erkan Sonmezay, Yalcýn Berberoglu, and Gokhan Gurbuz Abdulmuttalip SimsekAbdulmuttalip Simsek More articles by this author , Omer SarilarOmer Sarilar More articles by this author , Sinan KirecciSinan Kirecci More articles by this author , Onur KucuktopcuOnur Kucuktopcu More articles by this author , Faruk OzgorFaruk Ozgor More articles by this author , Fatih AkbulutFatih Akbulut More articles by this author , Erkan SonmezayErkan Sonmezay More articles by this author , Yalcýn BerberogluYalcýn Berberoglu More articles by this author , and Gokhan GurbuzGokhan Gurbuz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1492AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Dapoxetine is a novel SSRI, which acts by potent inhibition of 5-HT transport. As a short acting SSRI, dapoxetine is probably better suited to use as an on-demand treatment for PE. Few studies have compared the performance of paroxetine and dapoxetine in the treatment of PE. Here we have prospectively compared safety and efficacy of daily paroxetine and dapoxetine (30 and 60 mg doses) in patients with PE. Methods We evaluated 150 patients (between 30 and 36 years-old) suffering from PE and referred to our outpatient clinic between May 2009 and November 2012. All patients were married potent men in stable relationship for at least 6 months and had an uncontrolled ejaculation within 1 min of vaginal intromission, with no obvious organic cause for PE Patients were divided into three equal groups of 50 patients. Group 1 patients received 30 mg dapoxetine 1-3 hours before planned intercourse. Group 2 patients received 60 mg dapoxetine 1-3 hours before planned intercourse and group 3 patients received 20 mg paroxetine once a day for a month. All patients followed up for 1 month, beginning after initiation of treatment. Results The average age of all the patients was 33.1 ± 3.2 yr and the mean baseline IELT was 44.9 ± 25.1 sec. There was no difference between groups in terms of age (p=0.18), body mass index (p=0.13), duration of marriage (p=0.20) or baseline IELT scores (p=0.87). The IELT increase from baseline to post-treatment was 117% in the 30 mg dapoxetine group (p<0.01), 170% in the 60 mg dapoxetine group (p<0.01), and 117% in the paroxetine group (p<0.01). The improvement of baseline IELT scores were similar for the 30 mg dapoxetine and paroxetine groups (p>0.05), whereas the improvement of IELT of 60 mg dapoxetine group was better than both the 30 mg dapoxetine (p<0.05) and paroxetine group (p<0.01) (Table 1). Conclusions On demand dapoxetine is a novel effective treatment modality for PE. Although a lower dose of dapoxetine (30 mg) does not outperform the currently used paroxetine treatment, 60 mg dapoxetine 1-3 hours before planned intercourse produces a greater increase in IELT for men with PE, compared to paroxetine. We propose that in cases of severe PE (e.g., IELT less than 30 sec), 60 mg dapoxetine should be given directly. Table 1. IELT score before and after treatment with Dapoxetine and paroxetine in premature ejaculation patients Dapoxetine 30 mg Dapoxetine 60 mg Paroxetine 20 mg Before After p Before After p Before After p IELT ((Seconds) 46,1±23,2 100,2±24,5 a 0,001 43,5±20,6 118,2±40,8 b 0,001 45,2±31,6 98,4±26,3 c 0,001 Values are expressed as mean ± S.D. for each group. IELT: Intravaginal ejaculatory latency time, There was no statistical difference among groups concerning baseline IELT score (p=0.87), a (Dapoxetin 30 mg) vs b ( dapoxetine 60 mg), p<0.05, a vs c ( paroxetine 20 mg), p>0.05, b vs c , p<0.01 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e534 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Abdulmuttalip Simsek More articles by this author Omer Sarilar More articles by this author Sinan Kirecci More articles by this author Onur Kucuktopcu More articles by this author Faruk Ozgor More articles by this author Fatih Akbulut More articles by this author Erkan Sonmezay More articles by this author Yalcýn Berberoglu More articles by this author Gokhan Gurbuz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP58-11 NIGHTLY SILDENAFIL USE AFTER RADICAL PROSTATECTOMY HAS ADVERSE EFFECTS ON URINARY CONVALESCENCE: RESULTS FROM A RANDOMIZED TRIAL OF NIGHTLY VS ON-DEMAND DOSING REGIMENS

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 2014MP58-11 NIGHTLY SILDENAFIL USE AFTER RADICAL PROSTATECTOMY HAS ADVERSE EFFECTS ON URINARY CONVALESCENCE: RESULTS FROM A RANDOMIZED TRIAL OF NIGHTLY VS ON-DEMAND DOSING REGIMENS Matthew Eric Hyndman, Trinity J. Bivalacqua, Zhaoyong Feng, Lynda Mettee, Li-Ming Su, Bruce Trock, and Christian Pavlovich Matthew Eric HyndmanMatthew Eric Hyndman More articles by this author , Trinity J. BivalacquaTrinity J. Bivalacqua More articles by this author , Zhaoyong FengZhaoyong Feng More articles by this author , Lynda MetteeLynda Mettee More articles by this author , Li-Ming SuLi-Ming Su More articles by this author , Bruce TrockBruce Trock More articles by this author , and Christian PavlovichChristian Pavlovich More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1827AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We recently reported a randomized double-blind trial of penile rehabilitation using nightly vs. on-demand sildenafil after nerve-sparing (NS) minimally invasive radical prostatectomy (RP). While the primary objective was to analyze the recovery of potency with these differing pharmacotherapeutic regimens, a secondary objective was to quantify any effects these dosing schemes might have on urinary quality of life after RP. METHODS 100 men were randomized to nightly vs. on-demand postoperative 50mg sildenafil after minimally invasive RP for one year, and were evaluated with EPIC and IIEF questionnaires at various intervals after surgery. Urinary function was assessed using urinary-specific HRQOL subscales from the EPIC questionnaire, and stratified by treatment group. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment group over time on urinary convalescence, controlling for age, nerve-sparing score (NSS) and time from surgery. RESULTS The nightly sildenafil (n=50) and on-demand sildenafil (n=50) groups were well-matched at baseline. Nightly sildenafil patients had significantly worse EPIC urinary bother and urinary irritative subscale scores during the one –year convalescence period overall compared to on-demand sildenafil patients even after controlling for age and NSS as continuous variables as well as for baseline function. This effect was more pronounced during the early recovery phase. The nightly sildenafil group also had significantly worse EPIC item 34 outcomes (“Overall, how big a problem has your urinary function been for you over the past 4 weeks?”; 5 point scale)for the first 9 months after surgery. Time from surgery was associated with improvements in all EPIC urinary-specific HRQOL subscales, and increasing NSS was associated with improvements in EPIC urinary summary, bother, incontinence and function scores. CONCLUSIONS Our data suggest that in preoperatively potent men who receive NS minimally-invasive RP, treatment with nightly sildenafil may impair early post-operative urinary function, specifically urinary bother and irritation. These data and a lack of improvement of potency with nightly vs. on-demand sildenafil suggests that on demand rehab post RP is superior to daily use. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e662 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Matthew Eric Hyndman More articles by this author Trinity J. Bivalacqua More articles by this author Zhaoyong Feng More articles by this author Lynda Mettee More articles by this author Li-Ming Su More articles by this author Bruce Trock More articles by this author Christian Pavlovich More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A reassessment of penile sensory pathways and effects of prilocaine–lidocaine cream in primary premature ejaculation

To assess the penile sensory pathway abnormalities of the patients with primary premature ejaculation (PPE) and effects of prilocaine-lidocaine (PLA) cream, we enrolled 82 PPE patients and 34 normal potent male volunteers. Somatosensory evoked potentials of dorsal nerve (DNSEP) and glans penis (GPSEP) were performed in each subject. In addition, among the 82 patients, 60 were selected and randomly divided into PLA and placebo subgroups, each with 30 patients. Cream was applied evenly on the glans penis for 10 min and washed off just before DNSEP and GPSEP were repeatedly measured. Mean latencies of DNSEP and GPSPE were both remarkably shorter in the patients than those in the normal potent men (P<0.001, both). Compared with the control group, the mean amplitudes of GPSEP were significantly greater in the patient group (P<0.001), but not considerably on the amplitudes of DNSEP (P=0.229). After cream application, the latencies and amplitudes of both DNSEP and GPSEP were significantly prolonged and reduced, respectively, in the PLA cream subgroup (P<0.001, all). These results showed that hyperexcitable ejaculatory reflex neurological factor was linked to PPE, because of hypersensitivity of the penile, accelerated conduction and cortical amplification of the genital stimuli. The PLA cream could delay sensory latency and decrease glans penile hyperexcitability, which may be the mechanism for PPE treatment.

Urinary Outcomes Are Significantly Affected by Nerve Sparing Quality During Radical Prostatectomy

To assess the effect of nerve sparing (NS) quality on self-reported patient urinary outcomes after radical prostatectomy. A total of 102 preoperatively potent men underwent laparoscopic or robotic radical prostatectomy; NS was prospectively graded at surgery using a 0-4 scale/neurovascular bundle. Urinary functional outcomes were measured by validated Expanded Prostate Cancer Index Composite questionnaire at baseline and follow-up time points (1, 3, 6, 9, and 12 months) in 99 men who underwent various degrees of NS. Mixed linear regression was used to analyze the effect of NS quality and other clinical factors on urinary outcomes. Patients with at least 1 neurovascular bundle spared completely, along with its supportive tissues (NS grade 4/4), noted significantly improved Expanded Prostate Cancer Index Composite urinary functional and continence outcomes as early as 1 month postoperatively and up to 12 months. Significantly less urinary bother was also noted in these men by 9-12 months postoperatively. Multivariate analysis revealed that bilateral or unilateral excellent NS (at least 1 bundle graded 4/4), increasing time from surgery, young patient age, and lower body mass index positively and significantly affected urinary functional outcomes, including pad use. Men who received excellent unilateral NS recovered urinary function about as well as men who had both neurovascular bundles spared in similar fashion. The quality of NS significantly influences patient-defined urinary functional convalescence. Completely sparing at least 1 neurovascular bundle along with its supportive tissues has a dramatic effect on the recovery of urinary continence and quality of life in preoperatively potent men.

Clinical characteristics and penile afferent neuronal function in patients with primary delayed ejaculation

Primary delayed ejaculation (DE) is a relatively uncommon condition and has not been studied broadly. In this study, we aimed to investigate the clinical characteristics and penile afferent neuronal function using somatosensory evoked potentials in patients with primary DE. Twenty-four patients with primary DE and 24 age-matched normally potent men were enrolled in this study. Results indicated that patients with primary DE had remarkably higher frequency of masturbatory activity (especially, some with idiosyncratic styles), lower night emissions, longer intravaginal ejaculation latency time (IELT), higher anxiety and depression states (p=0.010, p=0.017, p<0.001, p<0.001, p<0.001 respectively). In addition, the mean penile shaft sensory threshold values in the patients were considerably higher than those in the healthy men (p<0.001). Mean latencies of dorsal nerve somatosensory evoked potential DNSEP were 4.32ms longer in the DE group than those in the control group (p<0.001). However, the latencies of glans penis somatosensory evoked potential (GPSEP) between the two group showed no significant difference (p=0.985). At the same time, in comparison with the control group, the amplitudes of DNSEP were considerably lower in the DE group (p=0.016), but not in the amplitudes of GPSEP (p=0.934). This study indicates that the patients with primary DE appear to have penile shaft rather than glans hyposensitivity and hypoexcitability, and adaptation to a certain masturbatory technique (higher and idiosyncratic) may be related to the causes of primary DE, which is also associated with lower night emissions, longer IELT, higher anxiety and depression states.

Nightly vs on‐demand sildenafil for penile rehabilitation after minimally invasive nerve‐sparing radical prostatectomy: results of a randomized double‐blind trial with placebo

To clarify the role of phosphodiesterase type 5 (PDE5) inhibitors in post-prostatectomy penile rehabilitation (PPPR). To compare nightly and on-demand use of PDE5 inhibitors after nerve-sparing minimally invasive radical prostatectomy (RP). We conducted a single-institution, double-blind, randomized controlled trial of nightly vs on-demand 50-mg sildenafil citrate after nerve-sparing minimally invasive RP. A total of 100 preoperatively potent men, aged <65 years, with scores on the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) ≥26, underwent nerve-sparing surgery. The patients were randomized to either nightly sildenafil and on-demand placebo (nightly sildenafil group), or on-demand sildenafil and nightly placebo (on-demand sildenafil group; maximum on-demand dose six tablets/month) for 12 months. Patients then underwent a 1-month washout period. Validated measures of erectile function (IIEF-EF score and the Expanded Prostate Cancer Index Composite [EPIC]) were compared between treatment groups over the entire 13-month time course, using multivariable mixed linear regression models. The treatment groups were well matched preoperatively (mean age 54.3 vs 54.6 years, baseline IIEF-EF score 29.4 vs 29.3, for the nightly vs the on-demand sildenafil groups, respectively). No significant differences were found in erectile function between treatments (nightly vs on-demand sildenafil) at any single timepoint after RP, after adjusting for potential confounding factors. When evaluated over all timepoints simultaneously, no significant effects of treatment group (nightly vs on-demand sildenafil) were found on recovery of potency, as assessed by absolute IIEF-EF scores (P = 0.765), on percentage of men returning to an IIEF-EF score >21 (P = 0.830), or on IIEF-EF score recovery to a percentage of baseline value (P = 0.778). When evaluated over all timepoints simultaneously, no significant effects of treatment group were found on secondary endpoints such as assessment of potency (including EPIC item 59 response 'erections firm enough for intercourse'), attempted intercourse frequency or confidence. Erectile recovery up to 1 year after RP does not differ between previously potent men who use sildenafil nightly compared to on-demand. This trial does not support chronic nightly sildenafil as being any better than on-demand sildenafil for use in penile rehabilitation after nerve-sparing minimally invasive RP.

Short-term Functional Outcomes and Complications Associated With Transperineal Template Prostate Mapping Biopsy

To assess the complications and erectile and urinary functional outcomes of transperineal template mapping biopsy (TTMB) of the prostate. We retrospectively reviewed the records of 84 patients undergoing TTMB at our institution and recorded complications and functional outcomes. Erectile and urinary functions were measured at baseline, 2 weeks, and 6 ± 2 weeks after TTMB using the International Index of Erectile Function short version (IIEF-5) and International Prostate Symptom Score questionnaires. Erectile and urinary function parameters were compared between baseline and 2 and 6 weeks after TTMB in a paired fashion. A subanalysis of erectile function was performed in preoperatively potent men (IIEF-5 >17). Sixteen patients (19%) experienced complications. The most common events were transient urinary retention (6%), prostatitis (4%) and local events, including perineal hematoma, bruising, or perineal pain (5%). One patient with hematuria required intervention. IIEF-5 scores at baseline, 2 weeks, and 6 weeks were 20 (interquartile range [IQR], 16-23), 18 (IQR, 12-22), and 18 (IQR, 12-22), respectively (P= .096 and P= .034). Among preoperatively potent men, IIEF-5 scores at baseline, 2 weeks, and 6 weeks were 22 (IQR, 20-24), 21 (IQR, 18-24), and 22 (IQR, 18-24), respectively(P= .011 and P= .018). International Prostate Symptom Scores were 6 (IQR, 3.5-11) at baseline, rose to 10 (IQR, 4.8-15) at 2 weeks (P= .012), and returned to 7 (IQR, 3.5-13) at 6 weeks (P= .628). TTMB has a favorable morbidity profile, with mostly mild and transient complications. Urinary retention occurred in 6%, and only 1 patient required intervention with bladder irrigation. Despite a statistically significant decline in erectile function from baseline, the median change in IIEF-5 score was 1 point. Urinary symptoms worsened initially but returned to baseline within 6weeks.

Sympathetic skin response in patients with primary premature ejaculation

To evaluate the possible role of the autonomic (sympathetic) nervous system function among the patients with primary premature ejaculation (PPE) and determine whether there is an etiological basis for this condition. We performed sympathetic skin response located in the penis (PSSR) in 52 patients with PPE and 46 normally potent men. The latencies and amplitudes of PSSR were measured. The PSSR waveforms were classified into P type and N type according to the waveform characteristics. The waveform distribution in the PPE patients was not statistically different from that in the control group (P=0.609). Mean latency of the PSSR was significantly shorter in the patients than that in the normally potent men (P<0.001). Mean amplitude of the PSSR was significantly greater in patients than that in the normal men (P<0.001). Patients with PPE have hyperactivity of the sympathetic nervous system, which may be another factor involved in the pathological mechanisms of PPE, and the PSSR is an objective test to evaluate patients with PPE.

1390 INCREASED RISK OF DEVELOPING ERECTILE DYSFUNCTION SUCCESSIVELY WITH INCREASING AGE UP TO THE AGE OF 65 YEARS: DATA FROM A LONGITUDINAL STUDY IN MEN AGED 45 YEARS AND ABOVE

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation (II)1 Apr 20131390 INCREASED RISK OF DEVELOPING ERECTILE DYSFUNCTION SUCCESSIVELY WITH INCREASING AGE UP TO THE AGE OF 65 YEARS: DATA FROM A LONGITUDINAL STUDY IN MEN AGED 45 YEARS AND ABOVE Johan Stranne, Ulf Malmsten, Björn Areskoug, Ian Milsom, Ulla Molander, and Ralph Peeker Johan StranneJohan Stranne Gothenburg, Sweden More articles by this author , Ulf MalmstenUlf Malmsten Gothenburg, Sweden More articles by this author , Björn AreskougBjörn Areskoug Gothenburg, Sweden More articles by this author , Ian MilsomIan Milsom Gothenburg, Sweden More articles by this author , Ulla MolanderUlla Molander Gothenburg, Sweden More articles by this author , and Ralph PeekerRalph Peeker Gothenburg, Sweden More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2744AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim was to explore the risk of developing erectile dysfunction (ED) over time in men aged 45 years and above followed longitudinally during a period of 11 years, adjusted for a number of known risk factors. METHODS A questionnaire containing questions relating to urogenital health issues such as urinary incontinence and erectile dysfunction was sent to a random sample (10 458) of men living in Gothenburg, Sweden in 1992. The men were from the age cohorts 45, 50, 55 years etc., up to the age of 85 or older. An analogous survey was sent to a random sample (10,845) of men from the age cohorts 46, 51, 56 years etc. resident in the city of Gothenburg in 2003. The response rate was 74.2% in 1992 (n = 7 763) and 67.8% in 2003 (n = 7 349). A total of 3256 men answered both questionnaires. We calculated the risk of developing ED for age cohort 45, 50, 55, 60, 65 and 70 years between the two questionnaires, 11 years apart, using variance analysis with repeated measures. The risk was adjusted for changes in known risk factors such as concomitant morbidity, intake of medication, smoking, alcohol consumption and physical exercise. RESULTS The prevalence of ED ranged from 1.1% in men aged 45 years of age to 10.4% in men aged 70 years at the baseline assessment in 1992 (Fig. 1). Between the two surveys the proportion of smokers in the population had decreased and the frequency of physical exercise had increased. This was paralleled by an increase in concomitant morbidity, intake of medications and in alcohol consumption, which was adjusted for in the analyses. There was a successive linear increase (+1.82% to +11.42%) in the prevalence of ED in the men grouped according to age at baseline from the age of 45 to a maximum at 65 years of age. CONCLUSIONS The risk of developing ED within 11 years increased successively from 45 to 65 years of age. The increase in risk was high already from the age of 50 years. For the older age cohorts in the study there is likely to have been a selection bias towards healthier, and potentially more potent men, answering both surveys. This information is important when planning and analyzing longitudinal interventional studies on ED in various age groups. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e569 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johan Stranne Gothenburg, Sweden More articles by this author Ulf Malmsten Gothenburg, Sweden More articles by this author Björn Areskoug Gothenburg, Sweden More articles by this author Ian Milsom Gothenburg, Sweden More articles by this author Ulla Molander Gothenburg, Sweden More articles by this author Ralph Peeker Gothenburg, Sweden More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

SOP: Corpus Cavernosum Assessment (Cavernosography/Cavernosometry)

There is no universal gold standard diagnostic test to differentiate psychogenic from organic erectile dysfunction (ED). Cavernosography/cavernosometry has been used to evaluate veno-occlusive dysfunction (VOD) in men with a proposed organic ED. To develop evidence-based guidelines for the performance and interpretation of cavernosography/cavernosometry. Review the methodology behind cavernosography/cavernosometry and evaluate the evidence that supports its use and interpretation of results. Expert opinion based on review of the literature, extensive internal committee discussion, public presentation, and debate. The detailed technique of cavernosography/cavernosometry is described. An evidence-based perspective to the use and interpretation of cavernosometry is presented. The positive predictive value of cavernosometry still needs further assessment. It is unknown how many potent men would test positive for VOD (false positive).

The Martini-Clinic technique of open radical retropubic prostatectomy

Despite the emergence of robotic approaches, the technique of open radical retropubic prostatectomy (RP) is still the predominant approach for surgical treatment of clinically localized prostate cancer in most clinics worldwide. The principles of this technique and its oncological efficacy were published decades ago; however, the surgery carried out today has undergone continuous refinements, reducing the morbidity rate and significantly improving postoperative functional outcomes such as urinary continence and erectile function. We report on the current technique of open nerve-sparing radical RP with data analysis to address the issues of urinary continence, potency, cancer control rates and perioperative morbidity. The analyses are based on 1875 patients who were treated with nerve-sparing RP in the Martini-Clinic. The key elements of open radical RP are a selective ligation of the dorsal vein complex and early release of the neurovascular bundles using a high anterior tension-free and energy-free intrafascial technique, intraoperative frozen section (NeuroSAFE technique) and full functional length urethral sphincter preparation (FFLU technique). During dissection of the urethra, the posterior insertion at Denonvilliers' fascia is preserved and remains in situ, and is selectively opened above the seminal vesicles. The later seminal vesicles are completely removed inside Denonvilliers' fascia and six muscle-sparing interrupted sutures are used for anastomosis. Functional and oncological outcome data were determined, which were prospectively collected using validated questionnaires and intraoperative and perioperative morbidity data were also evaluated. Patient age and the extent to which the nerve-sparing approach was influenced by urinary continence and potency. Overall, 97.4% of men less than 60 years of age, and 84.1% of men over 70 years, had complete urinary continence 1 year after nerve-sparing RP. In preoperative potent men, erections sufficient for intercourse were seen in 84–92% of patients who underwent bilateral nerve sparing and in 58.3–70% of men who underwent unilateral nerve sparing. Median blood loss was 590 ml (range 130–1800 ml) and the transfusion rate was 4.5%. Median operative time was 175 minutes (range 95–215 minutes). In organ-confined cancers, recurrence-free survival and cancer-specific survival at 10 years after RP were 87% and 98.3%, respectively. Open intrafascial nerve-sparing RP combines excellent long-term cancer control rates with superior functional outcome and a low morbidity.

Retrograde Versus Antegrade Nerve Sparing During Robot-assisted Radical Prostatectomy: Which Is Better for Achieving Early Functional Recovery?

BackgroundAlthough the retrograde approach to nerve sparing (NS) aimed at maximizing NS during robot-assisted radical prostatectomy (RARP) has been described, its significant benefits compared to the antegrade approach have not yet been investigated. ObjectiveTo evaluate the impact of NS approaches on perioperative, pathologic, and functional outcomes. Design, setting, and participantsFive hundred one potent (Sexual Health Inventory for Men [SHIM] score >21) men underwent bilateral full NS and were followed up for a minimum of 1 yr. After propensity score matching, 344 patients were selected and were then categorized into two groups. Surgical procedureRARP with antegrade NS (n=172) or RARP with retrograde NS (n=172). Outcome measurements and statistical analysisFunctional outcomes were assessed using validated questionnaires. Multivariable logistic regression models were applied. Results and limitationsPositive margin rates were similar (11.1% vs 6.9%; p=0.192), and no correlation with the NS approach was found on regression analysis. At 3, 6, and 9 mo, the potency rate was significantly higher in the retrograde approach (65% vs 80.8% and 72.1% vs 90.1% and 85.3% vs 92.9%, respectively). The multivariable model indicated that the NS approach was an independent predictor for potency recovery at 3, 6, and 9 mo, along with age, gland size, and hyperlipidemia. After adjusting for these predictors, the hazard ratio (HR) for the retrograde relative to the antegrade approach was 2.462 (95% confidence interval [CI], 1.482–4.089; p=0.001) at 3, 4.024 (95% CI, 2.171–7.457; p<0.001) at 6, and 2.145 (95% CI, 1.019–4.514; p=0.044) at 9 mo. Regarding continence, the recovery rates at each time point and the mean time to regaining it were similar, and the method of NS had no effect on multivariable analysis. The absence of randomization is a major limitation of this study. ConclusionsIn patients with normal erectile function who underwent bilateral full NS, a retrograde NS approach facilitated early recovery of potency compared to that with an antegrade NS approach without compromising cancer control.