J P Mulhall

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..quot; At the suggestion of several SMSNA members, it was requested that this debate might be of interest to JSM readers in the form of a published controversy...

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..To survey patient satisfaction, using validated questionnaires, in a group of men with erectile dysfunction who had used and responded to both sildenafil citrate and intracavernosal injection (ICI) therapy...

..There exists little data on the vascular assessment of men who present with ED following radiation therapy for prostate cancer. This study was conducted to evaluate the erectile hemodynamics in such a patient population...

..This analysis was designed to assess the ability of a post-RP vasoactive drug program to improve long-term spontaneous erectile function...

..Additionally, limited information is available regarding real-world utilization patterns of PDE5 inhibitors...

..This is an up-to-date review of the current state of science supporting penile rehabilitation after radical prostatectomy...

..We provide a recommendation for the design of such trials that can minimize bias and provide better data for physicians and their patients...

..This review explores the links between sexual dysfunction and prostatitis...

..This study was undertaken to define the outcomes of a penile reconstructive surgery algorithm in men with Peyronie's disease and concomitant erectile dysfunction (ED)...

..This analysis was undertaken to define how often and in which patients, intra-operative adjuvant maneuvers are required...

..Clinical practice guidelines for management of erectile dysfunction (ED) provide limited direction in defining appropriate treatment goals with phosphodiesterase type 5 (PDE5) inhibitor therapy...

..It is now increasingly recognized that sexual health is important to overall good health and well-being...

..The immunophilin-ligand FK506 has been shown to ameliorate erectile function and preserve cavernous nerve (CN) architecture in short-term-studies using rat models of CN injury...

..Recent data suggest an association between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Anecdotally some patients cite improvement in LUTS while using sildenafil...

..Aim. This study was undertaken to define the effects of such a regimen in an animal model...

..Little information exists on the natural history of PD. We defined the course of PD in a group of men with this condition who received no treatment...

..Duplex Doppler penile ultrasonography can reliably document penile hemodynamics. This study aimed at defining response rates based on degree of penile vascular sufficiency...

..These data further undermine the value of cavernosography, particularly in men with low-grade venous leak...

..Furthermore, such an animal model may, in the future, allow a more ready evaluation of the therapeutic interventions for Peyronie's disease...

..Erection hardness is a fundamental component of erectile function, and is a very specific and easily monitored outcome. The Erection Hardness Score (EHS) is a single-item, patient-reported outcome (PRO) for scoring erection hardness...

..This has led to a shift in focus from scientifically rigorous endpoints such as efficacy and adverse event profiles to patient preference...

..In conclusion, it is likely that in the near future we will see dramatic developments in our understanding of this condition...

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..While the etiology of these findings is not clear, it is likely that these pathobiological characteristics contribute to the pathophysiology of this disease process...

..The absence of a single brief measure that assesses function and health-related quality of life (HRQoL) hinders evaluation of the sexual experience in men with erectile dysfunction (ED)...

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..There is controversy regarding the impact of androgen deprivation on erectile function. We defined the impact of androgen deprivation on the sildenafil response in patients with erectile dysfunction following radiation therapy...

..It has been suggested that the institution of a pharmacologically based penile rehabilitation program in the early stages after radical prostatectomy (RP) may benefit some patients...

..The animal evidence is highly supportive of such agents' having a positive impact on erectile function recovery after RP. Human trial data are awaited...

..These findings may explain the high cell proliferation rates in these cells and suggests a role for perturbation of the p53 pathway in the pathogenesis of Peyronie's disease...

..Furthermore, it may permit the elaboration of therapeutic strategies to prevent or reduce tunical scarring and plaque formation...

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..It is our clinical experience that some men who have functional erections in the days to weeks after RP go on to lose erectile function (EF) after the first 3 months postsurgery...

..To define the likelihood of nitrate users wishing to use sildenafil citrate being permitted by their nitrate-prescribing physicians to cease nitrate use, and to attempt to derive predictors of a "no" response to this request...

..Phosphodiesterase type 5 inhibitor (PDE5) use is a treatment strategy for prostate cancer patients with post-radiation therapy (RT) erectile dysfunction (ED)...

..This report outlines the criteria for patient selection and the technique we use to accomplish crural ligation...

..Further refinement of this model and future analyses may permit an increased understanding of the pathogenesis of this condition and allow the development of therapeutic strategies...

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..We describe the results of surgical treatment in 10 such patients in whom sexual relations were restored by reconstructive glanulopexy. All procedures were performed on an outpatient basis using local anesthesia...

..To prospectively evaluate whether a modified surgical technique for neurovascular bundle (NVB) preservation during radical prostatectomy (RP) is associated with an improvement in erectile function (EF) recovery after RP...

..While some data indicate high bother from erectile dysfunction (ED) following prostate cancer treatments, other results suggest the life-saving nature of the treatment may mitigate ED concern...

..Furthermore, it appears that the prognosis for the return of functional erection is worst when venous leakage is present...

..Most of the data linking the two suggest that CP/CPPS impairs the overall quality of life and it is this that contributes to or causes erectile dysfunction...

..Both prostate cancer and Peyronie's disease (PD) are prevalent in men after their fifth decade of life. The evidence to support or refute a link between radical prostatectomy (RP) and PD is limited...

..Although surgical outcomes have been reported, the impact of this treatment on sexual relationship, confidence, self-esteem, and sexual function has never been established...

..This article provides a basis for evaluating new therapies, reviews the therapeutic alternatives that are currently available, and outlines a number of therapies that are on the horizon...

..Furthermore, the lack of consistency may significantly lower the patient's interest in continuing this treatment long term...

..Based on this study, we suggest that it may be necessary only to perform DIC at intracorporal pressures between 60 and 90 mmHg...

..The limitations of this literature are discussed and recommendations are made for the reporting of erectile function outcomes after radical prostatectomy...

..Venous leak portends a poor prognosis for erections recovery as well as phosphodiesterase type 5 inhibitor (PDE5i) response...

..This paper gives an overview of these factors and attempts to give a common-sense, practical guide to a rehabilitation program...

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..In addition, we assessed the impact on biochemical recurrence and the functional outcomes of potency and continence at 1 year after radical prostatectomy as well as postoperative bladder neck contracture...

..4). CONCLUSIONS: On multivariate analysis low preoperative total testosterone was associated with advanced pathological stage but not with BCR. Future studies are warranted with data on more patients who have progressed...

..Peyronie's disease (PD) is usually seen in men in their fifth decade of life...

..51; P < .001). Regression analysis estimated that corrected ED-attributable and overall costs were 41% (P < .001) and 43% (P < .001) higher for patients who switched versus those who refilled sildenafil, respectively...

..This article reviews the numerous factors potentially involved in male sexual dysfunction associated with a variety of cancers...

..There is a clear time dependence for the response to this therapy with a stepwise decrease in all end points examined serially in a 3-year period...

..It is likely that the transdermal and topical drug armamentarium for sexual dysfunction, male and female, will grow over the next decade...

..The use of testosterone supplementation in this population for the treatment of erectile dysfunction is questionable...

..This study was undertaken to define SWT impact at varied energy/dose levels at different time points on functional and structural changes in erectile tissue...

..This study is the first to our knowledge to explore this question in men with prostate cancer...

..Therefore, a low plasma concentration, achieved rapidly, would be selective for the desired erectile response but would be below the dopamine threshold for nausea...

..CONCLUSION: No significant difference in the magnitude and consistency of hemodynamic alterations has been demonstrated in all CN injury models assessed in this study...

..It is accepted that the corpora cavernosa are oxygenated fully during a rigid erection. However, it remains unknown what degree of penile rigidity is required to achieve cavernosal oxygenation at the arterial level...

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..Most patients (55%) had orgasm-associated pain for <1 min. CONCLUSIONS: These results indicate that orgasmic functional changes are relatively common after RP and are worth considering by clinicians and researchers...

..The leading vascular etiology of ED in PD is arteriogenic in older patients and those with greater associated comorbidities...

..Infertility has been associated with anxiety, stress, and sexual problems in both men and women...

..To define the impact of intralesional verapamil injection therapy on penile deformity in men with Peyronie's disease...

..Cavernosal oxygenation appears to be important for preservation of erectile tissue health. Hyperbaric oxygen therapy (HBOT) has been shown to improve tissue oxygenation and has neuromodulatory effects...

..Its exact position in the market remains to be seen, however, its ability to permit spontaneous sexual relations will prove to be of significant benefit to many men...

..Currently, no evidence-based treatments have been proven to ameliorate this condition...

..80, P = 0.012). CONCLUSIONS: Men presenting with symptoms consistent with SAS have a significant risk of erectile dysfunction, and the correlation between the severity of sleep apnea and the severity of erectile dysfunction is strong...

..For the practicing clinician, appreciating Peyronie's disease (PD) significant negative psychological impact is apparent. Despite this, there exists not a single study using validated instruments assessing this issue...

..CONCLUSIONS: Several key factors in trial design, patient enrollment and outcome analysis need to be assessed to interpret accurately the data generated from erectile dysfunction drug trials...

..Erectile function recovery (EFR) rates after radical prostatectomy (RP) vary greatly based on a number of factors, such as erectile dysfunction (ED) definition, data acquisition means, time-point postsurgery, and population studied...

..These data should encourage the development of radiation delivery strategies that minimize corporeal tissue exposure...

..Further study is aimed at defining the effect of irradiation on plaque tissue...

..4 points) for all treatment groups. CONCLUSION: Tamsulosin decreases orgasmic pain intensity in patients with orgasmic pain. These data support the hypothesis that orgasmic pain is related to bladder neck and/or pelvic floor muscle spasm...

..Limited information is available regarding sexual functioning among adults aged 70 years and older...

..We prospectively collected data on mental and physical health related quality of life as well as sexual and relationship function in couples presenting for the treatment of infertility...

..The incidence of premature ejaculation (PE) and other sexual problems in infertile couples is unknown...

..If sparing of the penile bulb is achieved by reducing the margin for the apex, an oncological risk is taken, while it is uncertain whether this will improve potency-preservation...

..Is cavernosometry a useful tool in treating men with erectile dysfunction?..