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Re: Erectile Dysfunction, Vascular Risk, and Cognitive Performance in Late Middle Age
Urological Survey Male and Female Sexual Function and Dysfunction; Andrology Re: Erectile Dysfunction, Vascular Risk, and Cognitive Performance in Late Middle Age C. S. Moore, M. D. Grant, T. A. Zink, M. S. Panizzon, C. E. Franz, M. W. Logue, R. L. Hauger, W. S. Kremen and M. J. Lyons Department of Psychology, University of Iowa Carver College of Medicine, Iowa City, Iowa, Department of Psychology, Ohio University, Athens, Ohio, Department of Psychiatry, University of California, San Diego, California, and Biomedical Genetics, Boston University School of Medicine, Boston, Massachusetts Psychol Aging 2014; 29: 163e172.
Permission to Publish Abstract Not Granted Editorial Comment: These are fascinating data. Men with vasculogenic erectile dysfunction seem to be at risk for cognitive impairment. This finding certainly deserves our attention. Allen D. Seftel, MD
Suggested Reading Ryu JK, Jin HR, Yin GN et al: Erectile dysfunction precedes other systemic vascular diseases due to incompetent cavernous endothelial cell-cell junctions. J Urol 2013; 190: 779. Nehra A, Jackson G, Miner M et al: Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk. J Urol 2013; 189: 2031.
Re: Duration of Erection: Does it Really Matter? A Randomized, Double-Blind Clinical Trial to Assess the Impact of Vardenafil ODT on Duration of Erection and its Correlation with Patients’ and Partners’ Sexual Quality of Life and Duration of Intercourse: The VADEOPEN Study rrez-Herna ndez, J. Romero-Otero and J. A. Romero-Martı´n; A. Martin-Morales, P. Gutie Vadeopen Study Group Hospital Universitario Carlos Haya, Malaga, Spain J Sex Med 2014; 11: 1527e1538.
Abstract available at http://jurology.com/ Editorial Comment: Use of the stopwatch to measure erectile function is nontraditional. Nonetheless, this novel end point seems to prove effective in measuring erectile function in this study and falls in line with the standard end points. Importantly vardenafil orodispersible tablets improved erections and met the study end points, verifying their efficacy. Allen D. Seftel, MD
0022-5347/14/1923-0880/0 THE JOURNAL OF UROLOGY® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
880
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.06.047 Vol. 192, 880-884, September 2014 Printed in U.S.A.
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Re: Effect of Once-Daily Tadalafil on Confidence and Perceived Difficulty in Performing Sexual Intercourse in Men who were Incomplete Responders to As-Needed PDE5 Inhibitor Treatment A. D. Seftel, R. C. Rosen, R. P. Hayes, S. Althof, E. Goldfisher, W. Shen and A. Sontag Division of Urology, Cooper University HospitaleCooper Medical School of Rowan University, Camden, New Jersey Int J Clin Pract 2014; 68: 841e849.
Abstract available at http://jurology.com/ Editorial Comment: This 12-week, double-blind, placebo controlled study investigated once daily tadalafil (2.5 mg titrated to 5 mg, or 5 mg) in 176 patients and 79 controls regarding confidence and perceived difficulty in performing sexual intercourse. Subjects were men with erectile dysfunction who were incomplete responders to as needed phosphodiesterase type 5 inhibitor therapy. The CPSIQ (Confidence in Performing Sexual Intercourse Questionnaire) and DPSIQ (Difficulty in Performing Sexual Intercourse Questionnaire) were administered at baseline and at 12 weeks. Mean change in CPSIQ for the tadalafil group was 1.8, which represents a shift from “very low” to “moderate” sexual confidence vs a mean change of 0.5 in the placebo group (p <0.0001). Mean change in DPSIQ for tadalafil was 1.6, which represents a shift from “very difficult” to “moderately” or “slightly difficult” sexual performance vs a mean change of 0.4 in the placebo group (p <0.0001). Once daily tadalafil vs placebo improves confidence and decreases difficulty in performing sexual intercourse for men with erectile dysfunction who were incomplete responders to as needed phosphodiesterase type 5 inhibitor therapy. The CPSIQ and DPSIQ are novel measures of confidence and difficulty in performing sexual intercourse. Both questionnaires would seem to have a role in understanding male erectile dysfunction. 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: Asexuality Development among Middle Aged and Older Men Y. P. Huang, B. Chen, P. Ping, H. X. Wang, K. Hu, H. Yang, T. Zhang, T. Feng, Y. Jin, Y. F. Han, Y. X. Wang and Y. R. Huang Shanghai Institute of Andrology, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China PLoS One 2014; 9: e92794.
Abstract available at http://jurology.com/ Editorial Comment: These are interesting data and highlight an under studied area, that of “asexuality.” Approximately 37% of the 1,581 Chinese men surveyed acknowledged that they did not have sexual intercourse for at least 6 months. The specific reasons given included “erectile difficulty” (52.9%), “do not care about sexuality” (53.5%), “no longer necessary to have sexuality at this age” (47.7%), “severe stress” (44.4%), “severe fatigue” (26.3%) and “masturbation” (26.9%). There was no mention of partner status, which may have had an important role. Further study of this phenomenon is warranted. Allen D. Seftel, MD
Suggested Reading Nehra A, Jackson G, Miner M et al: Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk. J Urol 2013; 189: 2031.
881
882
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Re: Penile Straightening Maneuvers Employed during Penile Prosthesis Surgery: Technical Options and Outcomes R. L. Segal, M. R. Cabrini, T. J. Bivalacqua and A. L. Burnett James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland Int J Impot Res 2014; Epub ahead of print.
Abstract available at http://jurology.com/ Editorial Comment: These authors provide insightful suggestions for ancillary maneuvers, called “straightening maneuvers,” during selected cases of penile prosthesis insertion. Within the straightening maneuvers group modeling was performed in 40 cases (43%), tunical relaxing incisions in 37 (39.8%) and tunical reconstruction in 16 (17.2%), most commonly using allograft dermis or pericardium, or synthetic polytetrafluoroethylene grafts. There were no significant differences in terms of device infection (p ¼ 0.15), mechanical failure (p ¼ 0.23) or erosion (p ¼ 0.96). This study suggests that in men with penile deformity requiring complex reconstruction to achieve straightening inflatable penile prosthesis implantation may be done proficiently and without increased adverse outcome risk. Allen D. Seftel, MD
Suggested Reading Katz BF, Gaunay GS, Barazani Y et al: Use of a preoperative checklist reduces risk of penile prosthesis infection. J Urol 2014; 192: 130. Enemchukwu EA, Kaufman MR, Whittam BM et al: Comparative revision rates of inflatable penile prostheses using woven DacronÒ fabric cylinders. J Urol 2013; 190: 2189. Segal RL, Cabrini MR, Harris ED et al: Combined inflatable penile prosthesis-artificial urinary sphincter implantation: no increased risk of adverse events compared to single or staged device implantation. J Urol 2013; 190: 2183.
Re: Penile Plication for Peyronie’s Disease: Our Results with Mean Follow-up of 103 Months on 89 Patients U. Cantoro, M. Polito, F. Catanzariti, L. Montesi, V. Lacetera and G. Muzzonigro Department of Odontostomatologic and Specialized Clinical Sciences, Department of Uro-Andrology and Department of Urology, Faculty of Medicine, Polytechnic University of Marche, and Department of General and Specialized Surgery, University Hospital, Ancona, Italy Int J Impot Res 2014; Epub ahead of print.
Abstract available at http://jurology.com/ Editorial Comment: These authors provide useful data. They report on 89 patients who underwent corporoplasty/straightening surgery using penile plication for Peyronie disease between 1990 and 2012. Followup data included 1) correction of the curvature, 2) any penile shortening, 3) sexual function and 4) complications. Mean followup was 103 months. Complete correction of the curvature was achieved in 81 patients (91%). Shortening of the penis (1.5 to less than 3 cm) was observed in 20 patients (22.5%), and 79 (88.7%) had good erectile function (International Index of Erectile Function score greater than 5 to 21). The most frequent complications were decreased sensitivity of the glans (8 patients, 8.9%), which resolved within about a year postoperatively (mean 11 months), and penile shortening (20 patients, 22.5%), which did not result in problems during sexual intercourse. These data provide reassurance that the corporeal plication procedure for Peyronie disease remains a viable surgical option. Allen D. Seftel, MD
Suggested Reading Hudak SJ, Morey AF, Adibi M et al: Favorable patient reported outcomes after penile plication for wide array of Peyronie disease abnormalities. J Urol 2013; 189: 1019.
Permission to Publish Abstract Not Granted Editorial Comment: These are fascinating data. Men with vasculogenic erectile dysfunction seem to be at risk for cognitive impairment. This finding certainly deserves our attention. Allen D. Seftel, MD
Suggested Reading Ryu JK, Jin HR, Yin GN et al: Erectile dysfunction precedes other systemic vascular diseases due to incompetent cavernous endothelial cell-cell junctions. J Urol 2013; 190: 779. Nehra A, Jackson G, Miner M et al: Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk. J Urol 2013; 189: 2031.
Re: Duration of Erection: Does it Really Matter? A Randomized, Double-Blind Clinical Trial to Assess the Impact of Vardenafil ODT on Duration of Erection and its Correlation with Patients’ and Partners’ Sexual Quality of Life and Duration of Intercourse: The VADEOPEN Study rrez-Herna ndez, J. Romero-Otero and J. A. Romero-Martı´n; A. Martin-Morales, P. Gutie Vadeopen Study Group Hospital Universitario Carlos Haya, Malaga, Spain J Sex Med 2014; 11: 1527e1538.
Abstract available at http://jurology.com/ Editorial Comment: Use of the stopwatch to measure erectile function is nontraditional. Nonetheless, this novel end point seems to prove effective in measuring erectile function in this study and falls in line with the standard end points. Importantly vardenafil orodispersible tablets improved erections and met the study end points, verifying their efficacy. Allen D. Seftel, MD
0022-5347/14/1923-0880/0 THE JOURNAL OF UROLOGY® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
880
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.06.047 Vol. 192, 880-884, September 2014 Printed in U.S.A.
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Re: Effect of Once-Daily Tadalafil on Confidence and Perceived Difficulty in Performing Sexual Intercourse in Men who were Incomplete Responders to As-Needed PDE5 Inhibitor Treatment A. D. Seftel, R. C. Rosen, R. P. Hayes, S. Althof, E. Goldfisher, W. Shen and A. Sontag Division of Urology, Cooper University HospitaleCooper Medical School of Rowan University, Camden, New Jersey Int J Clin Pract 2014; 68: 841e849.
Abstract available at http://jurology.com/ Editorial Comment: This 12-week, double-blind, placebo controlled study investigated once daily tadalafil (2.5 mg titrated to 5 mg, or 5 mg) in 176 patients and 79 controls regarding confidence and perceived difficulty in performing sexual intercourse. Subjects were men with erectile dysfunction who were incomplete responders to as needed phosphodiesterase type 5 inhibitor therapy. The CPSIQ (Confidence in Performing Sexual Intercourse Questionnaire) and DPSIQ (Difficulty in Performing Sexual Intercourse Questionnaire) were administered at baseline and at 12 weeks. Mean change in CPSIQ for the tadalafil group was 1.8, which represents a shift from “very low” to “moderate” sexual confidence vs a mean change of 0.5 in the placebo group (p <0.0001). Mean change in DPSIQ for tadalafil was 1.6, which represents a shift from “very difficult” to “moderately” or “slightly difficult” sexual performance vs a mean change of 0.4 in the placebo group (p <0.0001). Once daily tadalafil vs placebo improves confidence and decreases difficulty in performing sexual intercourse for men with erectile dysfunction who were incomplete responders to as needed phosphodiesterase type 5 inhibitor therapy. The CPSIQ and DPSIQ are novel measures of confidence and difficulty in performing sexual intercourse. Both questionnaires would seem to have a role in understanding male erectile dysfunction. 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: Asexuality Development among Middle Aged and Older Men Y. P. Huang, B. Chen, P. Ping, H. X. Wang, K. Hu, H. Yang, T. Zhang, T. Feng, Y. Jin, Y. F. Han, Y. X. Wang and Y. R. Huang Shanghai Institute of Andrology, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China PLoS One 2014; 9: e92794.
Abstract available at http://jurology.com/ Editorial Comment: These are interesting data and highlight an under studied area, that of “asexuality.” Approximately 37% of the 1,581 Chinese men surveyed acknowledged that they did not have sexual intercourse for at least 6 months. The specific reasons given included “erectile difficulty” (52.9%), “do not care about sexuality” (53.5%), “no longer necessary to have sexuality at this age” (47.7%), “severe stress” (44.4%), “severe fatigue” (26.3%) and “masturbation” (26.9%). There was no mention of partner status, which may have had an important role. Further study of this phenomenon is warranted. Allen D. Seftel, MD
Suggested Reading Nehra A, Jackson G, Miner M et al: Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk. J Urol 2013; 189: 2031.
881
882
MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY
Re: Penile Straightening Maneuvers Employed during Penile Prosthesis Surgery: Technical Options and Outcomes R. L. Segal, M. R. Cabrini, T. J. Bivalacqua and A. L. Burnett James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland Int J Impot Res 2014; Epub ahead of print.
Abstract available at http://jurology.com/ Editorial Comment: These authors provide insightful suggestions for ancillary maneuvers, called “straightening maneuvers,” during selected cases of penile prosthesis insertion. Within the straightening maneuvers group modeling was performed in 40 cases (43%), tunical relaxing incisions in 37 (39.8%) and tunical reconstruction in 16 (17.2%), most commonly using allograft dermis or pericardium, or synthetic polytetrafluoroethylene grafts. There were no significant differences in terms of device infection (p ¼ 0.15), mechanical failure (p ¼ 0.23) or erosion (p ¼ 0.96). This study suggests that in men with penile deformity requiring complex reconstruction to achieve straightening inflatable penile prosthesis implantation may be done proficiently and without increased adverse outcome risk. Allen D. Seftel, MD
Suggested Reading Katz BF, Gaunay GS, Barazani Y et al: Use of a preoperative checklist reduces risk of penile prosthesis infection. J Urol 2014; 192: 130. Enemchukwu EA, Kaufman MR, Whittam BM et al: Comparative revision rates of inflatable penile prostheses using woven DacronÒ fabric cylinders. J Urol 2013; 190: 2189. Segal RL, Cabrini MR, Harris ED et al: Combined inflatable penile prosthesis-artificial urinary sphincter implantation: no increased risk of adverse events compared to single or staged device implantation. J Urol 2013; 190: 2183.
Re: Penile Plication for Peyronie’s Disease: Our Results with Mean Follow-up of 103 Months on 89 Patients U. Cantoro, M. Polito, F. Catanzariti, L. Montesi, V. Lacetera and G. Muzzonigro Department of Odontostomatologic and Specialized Clinical Sciences, Department of Uro-Andrology and Department of Urology, Faculty of Medicine, Polytechnic University of Marche, and Department of General and Specialized Surgery, University Hospital, Ancona, Italy Int J Impot Res 2014; Epub ahead of print.
Abstract available at http://jurology.com/ Editorial Comment: These authors provide useful data. They report on 89 patients who underwent corporoplasty/straightening surgery using penile plication for Peyronie disease between 1990 and 2012. Followup data included 1) correction of the curvature, 2) any penile shortening, 3) sexual function and 4) complications. Mean followup was 103 months. Complete correction of the curvature was achieved in 81 patients (91%). Shortening of the penis (1.5 to less than 3 cm) was observed in 20 patients (22.5%), and 79 (88.7%) had good erectile function (International Index of Erectile Function score greater than 5 to 21). The most frequent complications were decreased sensitivity of the glans (8 patients, 8.9%), which resolved within about a year postoperatively (mean 11 months), and penile shortening (20 patients, 22.5%), which did not result in problems during sexual intercourse. These data provide reassurance that the corporeal plication procedure for Peyronie disease remains a viable surgical option. Allen D. Seftel, MD
Suggested Reading Hudak SJ, Morey AF, Adibi M et al: Favorable patient reported outcomes after penile plication for wide array of Peyronie disease abnormalities. J Urol 2013; 189: 1019.