CLINICAL ANDROLOGY 2003 Male Infertility & Sexual Dysfunctions

 

CLINICAL ANDROLOGY 2003

Hussein Ghanem M.D.

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Shamloul, R., and H. Ghanem, "Erectile dysfunction", The Lancet, vol. Volume 381, issue 9861, pp. 153 - 165, 2013. AbstractWebsite

Erectile dysfunction is a common clinical entity that affects mainly men older than 40 years. In addition to the classical causes of erectile dysfunction, such as diabetes mellitus and hypertension, several common lifestyle factors, such as obesity, limited or an absence of physical exercise, and lower urinary tract symptoms, have been linked to the development of erectile dysfunction. Substantial steps have been taken in the study of the association between erectile dysfunction and cardiovascular disease. Erectile dysfunction is a strong predictor for coronary artery disease, and cardiovascular assessment of a non-cardiac patient presenting with erectile dysfunction is now recommended. Substantial advances have occurred in the understanding of the pathophysiology of erectile dysfunction that ultimately led to the development of successful oral therapies, namely the phosphodiesterase type 5 inhibitors. However, oral phosphodiesterase type 5 inhibitors have limitations, and present research is thus investigating cutting-edge therapeutic strategies including gene and cell-based technologies with the aim of discovering a cure for erectile dysfunction.

ftp://mtr26-1-82-239-144-183.fbx.proxad.net/bibli/-%20Revue%20Articles%20FB/Biblio%20130109+23%20rout%E9e/963.1301-Erectile%20dysfunction_Shamloul,%20Lancet%20(Seminar).pdf

Ghanem, H., A. Salonia, and A. Martin-Morales, "SOP: Physical Examination and Laboratory Testing for Men with Erectile Dysfunction", The Journal of Sexual Medicine, vol. 10, issue 1, pp. 108–110, 2013. Abstractsop_physical_examination_and_laboratory_testing_for_men_with_erectile_dysfunction.pdfWebsite

Introduction.  Physical examination and laboratory evaluation of men with erectile dysfunction (ED) are opportunities to identify potentially life-threatening etiologies and comorbid conditions.

Aim.  To review genital anatomy, identify any physical abnormalities, assess for comorbid conditions, and reveal significant risk factors for ED.

Methods.  Expert opinion was based on evidence-based medical literature and consensus discussions between members of this International Society for Sexual Medicine (ISSM) standards committee.

Results.  For men with ED, a general examination including blood pressure and pulse measurements and a focused genital exam are advised. Fasting blood sugar, serum total testosterone, prolactin levels, and a lipid profile may reveal significant comorbid conditions.

Conclusions.  Though physical examination and laboratory evaluation of most men with ED may not reveal the exact diagnosis, these opportunities to identify critical comorbid conditions should not be missed.

Glina, S., and H. Ghanem, "SOP: Corpus Cavernosum Assessment (Cavernosography/Cavernosometry)", The Journal of Sexual Medicine, vol. 10, issue 1, pp. 111-114, 2013. Abstractsop_corpus_cavernosum_assessment_cavernosography_-_cavernosometry.pdfWebsite

Introduction.  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.

Aim.  To develop evidence-based guidelines for the performance and interpretation of cavernosography/cavernosometry.

Methods.  Review the methodology behind cavernosography/cavernosometry and evaluate the evidence that supports its use and interpretation of results.

Main Outcome Measure.  Expert opinion based on review of the literature, extensive internal committee discussion, public presentation, and debate.

Results.  The detailed technique of cavernosography/cavernosometry is described. An evidence-based perspective to the use and interpretation of cavernosometry is presented.

Conclusion.  The positive predictive value of cavernosometry still needs further assessment. It is unknown how many potent men would test positive for VOD (false positive)

Porst, H., A. Burnett, G. Brock, H. Ghanem, F. Giuliano, S. Glina, W. Hellstrom, A. Martin-Morales, A. Salonia, and I. Sharlip, "SOP Conservative (Medical and Mechanical) Treatment of Erectile Dysfunction", The Journal of Sexual Medicine, vol. 10, issue 1, pp. 130–171, 2013. Abstractsop_conservative_medical_and_mechanical_treatment_of_erectile_dysfunction..pdfWebsite

Introduction.  Erectile dysfunction (ED) is the most frequently treated male sexual dysfunction worldwide. ED is a chronic condition that exerts a negative impact on male self-esteem and nearly all life domains including interpersonal, family, and business relationships.

Aim.  The aim of this study is to provide an updated overview on currently used and available conservative treatment options for ED with a special focus on their efficacy, tolerability, safety, merits, and limitations including the role of combination therapies for monotherapy failures.

Methods.  The methods used were PubMed and MEDLINE searches using the following keywords: ED, phosphodiesterase type 5 (PDE5) inhibitors, oral drug therapy, intracavernosal injection therapy, transurethral therapy, topical therapy, and vacuum-erection therapy/constriction devices. Additionally, expert opinions by the authors of this article are included.

Results.  Level 1 evidence exists that changes in sedentary lifestyle with weight loss and optimal treatment of concomitant diseases/risk factors (e.g., diabetes, hypertension, and dyslipidemia) can either improve ED or add to the efficacy of ED-specific therapies, e.g., PDE5 inhibitors. Level 1 evidence also exists that treatment of hypogonadism with total testosterone < 300 ng/dL (10.4 nmol/L) can either improve ED or add to the efficacy of PDE5 inhibitors. There is level 1 evidence regarding the efficacy and safety of the following monotherapies in a spectrum-wide range of ED populations: PDE5 inhibitors, intracavernosal injection therapy with prostaglandin E1 (PGE1, synonymous alprostadil) or vasoactive intestinal peptide (VIP)/phentolamine, and transurethral PGE1 therapy. There is level 2 evidence regarding the efficacy and safety of the following ED treatments: vacuum-erection therapy in a wide range of ED populations, oral L-arginine (3–5 g), topical PGE1 in special ED populations, intracavernosal injection therapy with papaverine/phentolamine (bimix), or papaverine/phentolamine/PGE1 (trimix) combination mixtures. There is level 3 evidence regarding the efficacy and safety of oral yohimbine in nonorganic ED. There is level 3 evidence that combination therapies of PDE5 inhibitors + either transurethral or intracavernosal injection therapy generate better efficacy rates than either monotherapy alone. There is level 4 evidence showing enhanced efficacy with the combination of vacuum-erection therapy + either PDE5 inhibitor or transurethral PGE1 or intracavernosal injection therapy. There is level 5 evidence (expert opinion) that combination therapy of PDE5 inhibitors + L-arginine or daily dosing of tadalafil + short-acting PDE5 inhibitors pro re nata may rescue PDE5 inhibitor monotherapy failures. There is level 5 evidence (expert opinion) that adding either PDE5 inhibitors or transurethral PGE1 may improve outcome of penile prosthetic surgery regarding soft (cold) glans syndrome. There is level 5 evidence (expert opinion) that the combination of PDE5 inhibitors and dapoxetine is effective and safe in patients suffering from both ED and premature ejaculation. Porst H, Burnett A, Brock G, Ghanem H, Giuliano F, Glina S, Hellstrom W, Martin-Morales A, Salonia A, Sharlip I, and the ISSM Standards Committee for Sexual Medicine. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med 2013;10:130–171.

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