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Re: Corporoplasty Using Buccal Mucosa Graft in Peyronie Disease: Is it a First Choice?
Urological Survey Male and Female Sexual Function and Dysfunction; Andrology Re: Corporoplasty Using Buccal Mucosa Graft in Peyronie Disease: Is it a First Choice? A. Zucchi, M. Silvani, A. L. Pastore, F. Fioretti, A. Fabiani, T. Villirillo and E. Costantini Department of Urology and Andrology, S.M. Misericordia Hospital, University of Perugia, Perugia, Department of Urology, “Degli Infermi” Hospital, Biella, Department of Urology, Surgical Sciences and Biotechnologies, “La Sapienza” University, Rome and Department of Urology, Hospital ASUR Marche Area Vasta 3, Macerata, Italy Urology 2015; 85: 679e683.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.058 available at http://jurology.com/ Editorial Comment: The authors retrospectively studied 32 patients with stable disease and normal erections. All patients underwent corporoplasty with plaque incision and buccal mucosa graft between 2006 and 2013. At 6 and 12 months postoperatively patients answered the International Index of Erectile Function (IIEF) and the Patient Global Impression of Improvement questionnaires. No major complications developed in any patient. At 1 year curvature relapse was present in 1 patient (3.5%) and 1 patient had slight erectile dysfunction. IIEF values had significantly improved at 1 year postoperatively (p ¼ 0.031). Patient satisfaction was 85% on the Patient Global Impression of Improvement questionnaire. Of 28 partners 25 (90%) were satisfied. Data analysis confirmed the stability of the IIEF score in 16 patients at 2 years (mean score 21.3). These data are interesting, since most of the cohort had dorsal plaque and curvature of 90 degrees or less. All patients had previously undergone intraplaque injection therapy (verapamil plus betamethasone) to achieve a stable plaque. This technique seems feasible and may be a reasonable option in select patients. Allen D. Seftel, MD
Suggested Reading Hellstrom WJ, Feldman R, Rosen RC et al: Bother and distress associated with Peyronie’s disease: validation of the Peyronie’s disease questionnaire. J Urol 2013; 190: 627.
Re: Sexual Activity and Counseling in the First Month after Acute Myocardial Infarction among Younger Adults in the United States and Spain: A Prospective, Observational Study S. T. Lindau, E. M. Abramsohn, H. Bueno, G. D’Onofrio, J. H. Lichtman, N. P. Lorenze, R. Mehta Sanghani, E. S. Spatz, J. A. Spertus, K. Strait, K. Wroblewski, S. Zhou and H. M. Krumholz Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine, Department of Medicine-Geriatrics, MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at NORC Chicago Center on Demography and Economics of Aging, Department of Medicine, Section of Cardiology and Department of Health Studies, University of Chicago, Chicago, Illinois, Department ~o n and Instituto de Investigacio n Gregorio Maran ~o n, and Universidad Complutense of Cardiology, Hospital General Universitario Gregorio Maran de Madrid, Madrid, Spain, Center for Outcomes Research and Evaluation, Yale University, Department of Emergency Medicine, and Section of Cardiovascular Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine/Yale-New Haven Hospital, and Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, and Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, Missouri Circulation 2014; 130: 2302e2309.
0022-5347/15/1941-0166/0 THE JOURNAL OF UROLOGY® Ó 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
166
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.04.058 Vol. 194, 166-171, July 2015 Printed in U.S.A.
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.059 available at http://jurology.com/ Editorial Comment: The prospective longitudinal VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI [Acute Myocardial Infarction] Patients) study, conducted at 127 hospitals in the United States and Spain, was designed partly to evaluate gender differences in baseline sexual activity, function and patient experience with physician counseling about sexual activity after acute myocardial infarction. This study used baseline and 1-month data collected from the 2:1 sample of women (2,349) and men (1,152) 18 to 55 years old with a history of AMI. Median age was 48 years. In the less than 15% of patients who received counseling about sexual activity recommendations were inconsistent and only weakly related to patient characteristics. Two thirds of those who talked with a physician about sex were given permission to resume sexual activity but were told to limit activity and/or exertion during sex. The findings indicated that United States and Spanish physicians rarely counsel younger patients, especially women, with a history of AMI about resuming sexual activity, although the majority of these patients were sexually active in the year before their event, valued sexuality as an important part of life before and after AMI, and felt it was appropriate for physicians to initiate discussion of sexual matters in the context of AMI care. These are important data that will need to be acted on to change physician practice patterns. Allen D. Seftel, MD
Re: Association of Pain and Depression in Those with Chronic Low Back Pain: The Mediation Effect of Patient Sexual Functioning A. H. Pakpour, M. Nikoobakht and P. Campbell Social Determinants of Health Research Centre, Department of Public Health and Department of Neurosurgery, Qazvin University of Medical Sciences, Qazvin, Iran, and Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom Clin J Pain 2015; 31: 44e51.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.060 available at http://jurology.com/ Editorial Comment: One theoretical model suggests that the pathway from pain to depression is through the disruption of social and relationship function. This study sought to test this hypothesis by considering the mediating effect of sexual functioning on the association between pain intensity and depressive symptoms in sexually active patients with chronic low back pain. A total of 742 patients (351 men and 391 women) participated in this study. Sexual functioning had a negative association with pain intensity and depressive symptoms, indicating a decrease in the level of sexual functioning as pain and depressive symptoms increase. Results show a positive association between pain intensity and depressive symptoms, and sexual functioning has a negative association with pain intensity and depressive symptoms. The findings of the mediation models give some support to the hypothesis that the interruption of normal social relationships (in this case reduced sexual function in sexually active patients) brought about by pain intensity is associated with greater levels of depressive symptoms. This is an interesting set of data and offers a perspective on how sexual function may have a modulatory effect. Allen D. Seftel, MD
Re: A Randomised Controlled Trial of a Couples-Based Sexuality Intervention for Men with Localised Prostate Cancer and their Female Partners S. K. Chambers, S. Occhipinti, L. Schover, L. Nielsen, L. Zajdlewicz, S. Clutton, K. Halford, R. A. Gardiner and J. Dunn School of Applied Psychology, Griffith University, and Cancer Council Queensland and University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Prostate Cancer Foundation of Australia, Sydney, and Health and Wellness Institute, Edith Cowan University, Perth, Australia Psychooncology 2014; Epub ahead of print.
167
BENIGN PROSTATIC HYPERPLASIA
168
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.061 available at http://jurology.com/ Editorial Comment: Diagnosis and treatment of prostate cancer are followed by substantive sexual morbidity. The optimal approach for intervention remains unclear. A 3-arm randomized controlled trial was undertaken with 189 heterosexual couples in whom the man had been diagnosed with prostate cancer and treated surgically. The authors investigated the efficacy of peer delivered telephone support vs nurse delivered telephone counseling vs usual care in improving sexual adjustment in men and women. Assessments were undertaken at baseline (pre-test), with followup at 3, 6 and 12 months. At 12 months men in the peer (p ¼ 0.016) and nurse intervention (p ¼ 0.008) arms were more likely to use medical treatments for erectile dysfunction vs men in the usual care arm. Men in the nurse intervention group more frequently used oral medication for erectile dysfunction vs men in the usual care group (p ¼ 0.002). No significant effects were found for sexual function, sexuality needs, sexual self-confidence, masculine self-esteem, marital satisfaction or intimacy. Thus, the true impact of the peer delivered and nurse delivered counseling and support remains unclear despite the fact that the men in these arms were more likely to use medical treatments. Allen D. Seftel, MD
Benign Prostatic Hyperplasia Re: Treatment of LUTS Secondary to BPH while Preserving Sexual Function: Randomized Controlled Study of Prostatic Urethral Lift K. T. McVary, S. N. Gange, N. D. Shore, D. M. Bolton, B. E. Cowan, B. T. Brown, A. E. Te, P. T. Chin, D. B. Rukstalis and C. G. Roehrborn; L.I.F.T. Study Investigators Southern Illinois University, Springfield, Illinois J Sex Med 2014; 11: 279e287.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.044 available at http://jurology.com/ Editorial Comment: Often new technologies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia are not well studied regarding preprocedural and postprocedural sexual function. Generally data seem to focus primarily on erectile function. Of concern, particularly when said new technologies are compared to transurethral prostatectomy (TURP), is the paucity of data on postprocedural ejaculatory dysfunction. These authors analyze erectile and ejaculatory function after implantation of the prostatic urethral lift (PUL). Of significance, there appears to be no evidence of de novo sustained anejaculation or erectile dysfunction. In fact, in many men ejaculatory function improved. The authors do not report the incidence of reduced ejaculation or painful ejaculation, as the data are clustered around mean changes in total sexual function proxies. Moreover, men were allowed to continue taking phosphodiesterase type 5 inhibitors throughout the study. The overall take home message is reasonable, that is PUL does not adversely affect either erectile or ejaculatory function. The reporting of improvement in ejaculation is somewhat unexpected, and the potential reasons are perplexing and require further study and followup. The manufacturers of the PUL device tout the preservation of sexual function as a potential advantage compared to other technologies. However, device placement requires rigid cystoscopy, and issues of tolerance in an office setting, particularly in a younger, sexually active group of men, remain to be determined. Moreover, long-term durability and sustainability, the bane of previous office based procedures, remain to be determined. Steven A. Kaplan, MD
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.058 available at http://jurology.com/ Editorial Comment: The authors retrospectively studied 32 patients with stable disease and normal erections. All patients underwent corporoplasty with plaque incision and buccal mucosa graft between 2006 and 2013. At 6 and 12 months postoperatively patients answered the International Index of Erectile Function (IIEF) and the Patient Global Impression of Improvement questionnaires. No major complications developed in any patient. At 1 year curvature relapse was present in 1 patient (3.5%) and 1 patient had slight erectile dysfunction. IIEF values had significantly improved at 1 year postoperatively (p ¼ 0.031). Patient satisfaction was 85% on the Patient Global Impression of Improvement questionnaire. Of 28 partners 25 (90%) were satisfied. Data analysis confirmed the stability of the IIEF score in 16 patients at 2 years (mean score 21.3). These data are interesting, since most of the cohort had dorsal plaque and curvature of 90 degrees or less. All patients had previously undergone intraplaque injection therapy (verapamil plus betamethasone) to achieve a stable plaque. This technique seems feasible and may be a reasonable option in select patients. Allen D. Seftel, MD
Suggested Reading Hellstrom WJ, Feldman R, Rosen RC et al: Bother and distress associated with Peyronie’s disease: validation of the Peyronie’s disease questionnaire. J Urol 2013; 190: 627.
Re: Sexual Activity and Counseling in the First Month after Acute Myocardial Infarction among Younger Adults in the United States and Spain: A Prospective, Observational Study S. T. Lindau, E. M. Abramsohn, H. Bueno, G. D’Onofrio, J. H. Lichtman, N. P. Lorenze, R. Mehta Sanghani, E. S. Spatz, J. A. Spertus, K. Strait, K. Wroblewski, S. Zhou and H. M. Krumholz Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine, Department of Medicine-Geriatrics, MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at NORC Chicago Center on Demography and Economics of Aging, Department of Medicine, Section of Cardiology and Department of Health Studies, University of Chicago, Chicago, Illinois, Department ~o n and Instituto de Investigacio n Gregorio Maran ~o n, and Universidad Complutense of Cardiology, Hospital General Universitario Gregorio Maran de Madrid, Madrid, Spain, Center for Outcomes Research and Evaluation, Yale University, Department of Emergency Medicine, and Section of Cardiovascular Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine/Yale-New Haven Hospital, and Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, and Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, Kansas City, Missouri Circulation 2014; 130: 2302e2309.
0022-5347/15/1941-0166/0 THE JOURNAL OF UROLOGY® Ó 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
166
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.04.058 Vol. 194, 166-171, July 2015 Printed in U.S.A.
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.059 available at http://jurology.com/ Editorial Comment: The prospective longitudinal VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI [Acute Myocardial Infarction] Patients) study, conducted at 127 hospitals in the United States and Spain, was designed partly to evaluate gender differences in baseline sexual activity, function and patient experience with physician counseling about sexual activity after acute myocardial infarction. This study used baseline and 1-month data collected from the 2:1 sample of women (2,349) and men (1,152) 18 to 55 years old with a history of AMI. Median age was 48 years. In the less than 15% of patients who received counseling about sexual activity recommendations were inconsistent and only weakly related to patient characteristics. Two thirds of those who talked with a physician about sex were given permission to resume sexual activity but were told to limit activity and/or exertion during sex. The findings indicated that United States and Spanish physicians rarely counsel younger patients, especially women, with a history of AMI about resuming sexual activity, although the majority of these patients were sexually active in the year before their event, valued sexuality as an important part of life before and after AMI, and felt it was appropriate for physicians to initiate discussion of sexual matters in the context of AMI care. These are important data that will need to be acted on to change physician practice patterns. Allen D. Seftel, MD
Re: Association of Pain and Depression in Those with Chronic Low Back Pain: The Mediation Effect of Patient Sexual Functioning A. H. Pakpour, M. Nikoobakht and P. Campbell Social Determinants of Health Research Centre, Department of Public Health and Department of Neurosurgery, Qazvin University of Medical Sciences, Qazvin, Iran, and Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom Clin J Pain 2015; 31: 44e51.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.060 available at http://jurology.com/ Editorial Comment: One theoretical model suggests that the pathway from pain to depression is through the disruption of social and relationship function. This study sought to test this hypothesis by considering the mediating effect of sexual functioning on the association between pain intensity and depressive symptoms in sexually active patients with chronic low back pain. A total of 742 patients (351 men and 391 women) participated in this study. Sexual functioning had a negative association with pain intensity and depressive symptoms, indicating a decrease in the level of sexual functioning as pain and depressive symptoms increase. Results show a positive association between pain intensity and depressive symptoms, and sexual functioning has a negative association with pain intensity and depressive symptoms. The findings of the mediation models give some support to the hypothesis that the interruption of normal social relationships (in this case reduced sexual function in sexually active patients) brought about by pain intensity is associated with greater levels of depressive symptoms. This is an interesting set of data and offers a perspective on how sexual function may have a modulatory effect. Allen D. Seftel, MD
Re: A Randomised Controlled Trial of a Couples-Based Sexuality Intervention for Men with Localised Prostate Cancer and their Female Partners S. K. Chambers, S. Occhipinti, L. Schover, L. Nielsen, L. Zajdlewicz, S. Clutton, K. Halford, R. A. Gardiner and J. Dunn School of Applied Psychology, Griffith University, and Cancer Council Queensland and University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Prostate Cancer Foundation of Australia, Sydney, and Health and Wellness Institute, Edith Cowan University, Perth, Australia Psychooncology 2014; Epub ahead of print.
167
BENIGN PROSTATIC HYPERPLASIA
168
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.061 available at http://jurology.com/ Editorial Comment: Diagnosis and treatment of prostate cancer are followed by substantive sexual morbidity. The optimal approach for intervention remains unclear. A 3-arm randomized controlled trial was undertaken with 189 heterosexual couples in whom the man had been diagnosed with prostate cancer and treated surgically. The authors investigated the efficacy of peer delivered telephone support vs nurse delivered telephone counseling vs usual care in improving sexual adjustment in men and women. Assessments were undertaken at baseline (pre-test), with followup at 3, 6 and 12 months. At 12 months men in the peer (p ¼ 0.016) and nurse intervention (p ¼ 0.008) arms were more likely to use medical treatments for erectile dysfunction vs men in the usual care arm. Men in the nurse intervention group more frequently used oral medication for erectile dysfunction vs men in the usual care group (p ¼ 0.002). No significant effects were found for sexual function, sexuality needs, sexual self-confidence, masculine self-esteem, marital satisfaction or intimacy. Thus, the true impact of the peer delivered and nurse delivered counseling and support remains unclear despite the fact that the men in these arms were more likely to use medical treatments. Allen D. Seftel, MD
Benign Prostatic Hyperplasia Re: Treatment of LUTS Secondary to BPH while Preserving Sexual Function: Randomized Controlled Study of Prostatic Urethral Lift K. T. McVary, S. N. Gange, N. D. Shore, D. M. Bolton, B. E. Cowan, B. T. Brown, A. E. Te, P. T. Chin, D. B. Rukstalis and C. G. Roehrborn; L.I.F.T. Study Investigators Southern Illinois University, Springfield, Illinois J Sex Med 2014; 11: 279e287.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.04.044 available at http://jurology.com/ Editorial Comment: Often new technologies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia are not well studied regarding preprocedural and postprocedural sexual function. Generally data seem to focus primarily on erectile function. Of concern, particularly when said new technologies are compared to transurethral prostatectomy (TURP), is the paucity of data on postprocedural ejaculatory dysfunction. These authors analyze erectile and ejaculatory function after implantation of the prostatic urethral lift (PUL). Of significance, there appears to be no evidence of de novo sustained anejaculation or erectile dysfunction. In fact, in many men ejaculatory function improved. The authors do not report the incidence of reduced ejaculation or painful ejaculation, as the data are clustered around mean changes in total sexual function proxies. Moreover, men were allowed to continue taking phosphodiesterase type 5 inhibitors throughout the study. The overall take home message is reasonable, that is PUL does not adversely affect either erectile or ejaculatory function. The reporting of improvement in ejaculation is somewhat unexpected, and the potential reasons are perplexing and require further study and followup. The manufacturers of the PUL device tout the preservation of sexual function as a potential advantage compared to other technologies. However, device placement requires rigid cystoscopy, and issues of tolerance in an office setting, particularly in a younger, sexually active group of men, remain to be determined. Moreover, long-term durability and sustainability, the bane of previous office based procedures, remain to be determined. Steven A. Kaplan, MD