Testosterone therapy in erectile dysfunction
|
|
- Willis Hancock
- 5 years ago
- Views:
Transcription
1 The Aging Male 2004;7: Testosterone therapy in erectile dysfunction R. Department of Urology, Columbia University, New York, USA Key words: TESTOSTERONE, TESTOGEL 1, ERECTILE DYSFUNCTION, HYPOGONADISM, SYMPTOMATIC LATE-ONSET HYPOGONADISM, NITRIC OXIDE, SILDENAFIL ABSTRACT Studies in animals have indicated that the nitric oxide erectile pathway is testosterone-dependent. Castration induces erectile dysfunction and a reduction in nitric oxide synthase-stained nerves in erectile tissue. Furthermore, castration adversely affects penile hemodynamics and smooth muscle content, leading to venoocclusive dysfunction. Testosterone replenishment reverses these physiological, biochemical and structural changes. Several clinical studies have demonstrated the benefits of a combination of testosterone and sildenafil. A recently published, multicenter study evaluated the safety and efficacy of testosterone gel 1% (Testogel 1 ; Schering AG, Germany/AndroGel 1 ; Solvay Pharmaceuticals) vs. placebo gel in conjunction with sildenafil, in producing an erectile response in hypogonadal men who did not respond to treatment with sildenafil alone for erectile dysfunction. The selection criteria required subjects to have had erectile dysfunction for at least 3 months, to be nonresponsive to 100 mg sildenafil and to have low testosterone levels (5 400 ng/dl). The primary efficacy measurement was the mean change from baseline in the Erectile Function domain of the International Index of Erectile Function (IIEF). Secondary outcome measures included the mean change from baseline in the other domains and the total sum of the IIEF. Subjects were randomized to receive either testosterone gel + sildenafil, or placebo gel + sildenafil for 12 weeks. Testosterone therapy with testosterone gel improved the erectile response to sildenafil. Therefore, testosterone therapy may be considered for the treatment of erectile dysfunction in men with low to low-normal testosterone levels, who have failed prior treatment with sildenafil alone. Consequently, it is important to screen for hypogonadism in men who fail PDE5 inhibitors. INTRODUCTION Testosterone is the main sexual hormone in human males, and has a pharmacological effect on the physiology of sexual function. It is known that suppression of testosterone in eugonadal adult males leads to reduced sexual desire and activity 1, and may result in erectile dysfunction. The prevalence of erectile dysfunction is high, affecting approximately 30% of men in the US 2. Erectile dysfunction is defined as the consistent inability to achieve and/or maintain an erection sufficient for satisfactory sexual activity 3. Erectile dysfunction is clearly associated with a decrease in quality of life, and may lead to depression and, eventually, the avoidance of sexual activity 4,5. Although erectile dysfunction is multifactorial in etiology, it is strongly associated with age. The incidence of complete erectile dysfunction increases from 5% in men 40 years of age to 15% in Correspondence: Professor R., Department of Urology, Columbia University, 161 Fort Washington Avenue, New York, NY 10032, USA ª 2004 Parthenon Publishing. A member of the Taylor & Francis Group DOI: / Received Accepted
2 men 70 years of age 6. With aging, there is a decline in serum testosterone that may lead to symptomatic late-onset hypogonadism (SLOH), of which erectile dysfunction is often a symptom. While some data suggest that erectile dysfunction and hypogonadism are independent, it is thought that a certain threshold of testosterone may be required for full sexual function 7. Testosterone replacement is indicated in men with SLOH, and has been demonstrated to significantly increase sexual desire and activity, and the frequency of erections. Thus, although testosterone deficiency may not always be the causative factor in cases of age-related erectile dysfunction, it is certainly a potential cause 8, and should be investigated in patients presenting with erectile dysfunction. ANDROGEN REGULATION OF CELLULAR PROLIFERATION Castrated rats provide a good, albeit not perfect, animal model of hypogonadism, and studies have shown that, in rats, penile erection is androgendependent 9,10. Studies in castrated rats have provided morphological evidence of the effects of testosterone on the penis Castration induced apoptosis in specific cells in the corpora cavernosa (erectile tissue) of the rat penis, suggesting that certain cell types are dependent on testosterone for survival (Figure 1). Replenishment of testosterone after castration induced new DNA synthesis in the smooth muscle cells, stroma and blood vessels, and there was a pancellular proliferative effect in the penis (Figure 2). ANDROGEN REGULATION OF NITRIC OXIDE The physiology of the erectile response is mostly understood, although gaps in our knowledge remain. In rats, it has been demonstrated that penile erections are mediated by nitric oxide (NO) and are androgen-dependent Direct or indirect stimuli can trigger an erectile response that starts with the release of relaxing substances, primarily the neurotransmitter NO, from the nerve endings in the corpora cavernosa. The effects of NO are mediated via two distinct second messenger systems: the cyclic guanosine monophosphate (cgmp) pathway and the cyclic adenosine monophosphate (camp) pathway. NO stimulates the synthesis of cgmp, leading to the phosphorylation of cellular membrane proteins and the efflux of calcium. Calcium efflux leads to vasodilation of the penile arteries and sinusoidal spaces, resulting in an erection 7,17. In addition, NO activates other second messengers such as prostaglandin E1, leading to the synthesis of camp and an increase in calcium efflux 7. It is generally accepted that, in animals, testosterone stimulates the production of NO. More specifically, androgens are thought to stimulate the synthesis of the neuronal isoform of nitric oxide synthase (nnos) 16. Studies in castrated rats have demonstrated a smaller increase in intracavernosal pressure in response to electrical Figure 1 Castration causes apoptosis in the rat penis. Adapted from R. The effects of testosterone on the cavernous tissue and erectile function. World J Urol 1997;15:21 6. Copyright Springer-Verlag 1997 Figure 2 Replacement of testosterone after castration induces new DNA synthesis in the rat penis. Reprinted from R, Raymond JF, Olsson CA, O Toole K, Buttyan R. Androgen induction of DNA synthesis in the rat penis. Urology 1998;52: Copyright Elsevier 1998 The Aging Male 313
3 stimulation, compared with uncastrated rats, suggesting an androgen-dependent portion of the erectile response 16. In addition, molecular studies have demonstrated that the castrated animals had a reduction in the level of nnos mrna expression, compared with uncastrated animals. These results suggest that androgens mediate the erectile response in the rat penis by stimulating the expression of nnos, thus maintaining an adequate supply of NO 16. Although NO is considered to be the predominant vasodilator in the penis, there are other vasodilatory pathways in the erectile response that are independent of NO but are androgenregulated 18. When castrated rats were treated with a combination of testosterone and a competitive inhibitor of NOS (L-nitro-L-arginine methyl ester), there was an increase in intracavernosal pressure in response to electrical stimulation, similar to that observed in uncastrated rats 18. In order to elucidate further the effect of testosterone on NO and penile innervation, Baba and colleagues 19 assessed three groups of rats: castrated; castrated with testosterone replacement; and sham-operated. The rats were subjected to three types of induced erections: apomorphine (to study centrally mediated erections), electrical stimulation and papaverine injections (to study peripherally induced erections). All three types of stimulation resulted in significantly fewer erections in the castrated rats, compared with rats that received testosterone treatment or were shamoperated. After sacrifice, castrated rats were found to have fewer nerve fibers in the corpora cavernosa and dorsal root containing NOS (as demonstrated by NADPH diaphorase staining of penile histological sections), compared with the other two groups. Thus, testosterone acts on the nervous system to mediate erection, and, in its absence, the production and activity of NO may be down-regulated. Testosterone replacement can preserve erectile function and NOS-containing neurons in the rat. The role of testosterone in the human erectile response is less well understood. Some severely hypogonadal men continue to have an erectile response, and, although testosterone therapy in hypogonadal men with erectile dysfunction may increase the number and quality of erections, improvements are observed in only 40 60% of patients 20,21. TESTOSTERONE THERAPY Testosterone therapy can improve certain aspects of male sexual function, including erectile function. Intramuscular injections of testosterone enanthate and testosterone cypionate have been widely prescribed. However, this form of treatment is not always ideal, as it may lead to wide variations in serum testosterone levels 22. The first transdermal mode of testosterone application was a scrotal patch, which had to be applied once daily on shaved scrotal skin Although effective, the scrotal patch did not become readily accepted, due to the concomitant supraphysiological levels of dihydrotestosterone and the unpleasantness of scrotal skin shaving. Adding an absorption enhancer to the patch made application on non-scrotal skin possible 27. In a 16-month investigation in 34 hypogonadal men, a non-scrotal testosterone transdermal system was shown to increase the frequency, duration and rigidity of erections, and enhance patient assessment of sexual desire, compared with during the withdrawal period 22. Thus, transdermal testosterone treatment in hypogonadal men significantly enhanced both objective and subjective parameters of sexual function, relative to the hypogonadal state, while achieving physiologically normal levels of serum testosterone and major metabolites. Despite the efficacy of the transdermal testosterone system, a large number of patients experienced considerable skin reactions due to the enhancer 28,29. In addition, the reservoir patches were generally judged to be too large, uncomfortable, visually obtrusive and noisy 29 ; therefore, the non-scrotal patch has not become well established. These problems in delivery have led to the development of an open testosterone delivery system using a 1% hydroalcoholic testosterone gel (Testogel 1 ; Schering AG, Germany/AndroGel 1 ; Solvay Pharmaceuticals), which can be applied to the abdomen, shoulders or upper arms, and delivers between 5 mg and 10 mg testosterone/ day This formulation of testosterone has been demonstrated to increase rapidly serum and free testosterone levels in hypogonadal men to within the normal range, and to improve sexual function and mood. The open system provided flexibility in dosing, with little skin irritation, and was well tolerated 30, The Aging Male
4 TESTOSTERONE THERAPY IN COMBINATION WITH PDE5 INHIBITORS Phosphodiesterase 5 (PDE5) inhibitors, such as sildenafil (Viagra 1 ), prevent the degradation of cgmp by PDE5 in the corpora cavernosa, thereby enhancing erection. Thus, in order to obtain an erection, a level of testosterone is required that supports both NO synthesis and cgmp synthesis. PDE5 inhibitors help to maintain an erection by preventing cgmp degradation and, therefore, principally act to improve vasodilation, as opposed to libido, sexual interest and activity. Consequently, the efficacy of drugs such as sildenafil may depend on the presence of adequate levels of testosterone 17. Combination therapy with sildenafil and testosterone in hypogonadal subjects may lead to an improved ability to achieve and maintain an erection 17,33,34. In a study by Kalinchenko and colleagues 17, 120 men with organic erectile dysfunction associated with type II diabetes mellitus, and receiving oral anti-diabetic drugs, were evaluated for the cause of failure to respond to treatment with sildenafil citrate. At baseline, these patients were found to have significantly lower levels of testosterone and depressed libido than controls (age-matched patients with diabetes mellitus, receiving treatment, but who responded positively to treatment with sildenafil citrate). After 2 weeks of treatment with oral testosterone undecanoate, testosterone levels were restored to normal and libido was increased. The subsequent use of 100 mg sildenafil citrate prior to coitus induced satisfactory erections in 70% of previous non-responders (p ). More recently, the use of testosterone gel in combination with sildenafil citrate has been evaluated in men with erectile dysfunction and hypogonadism, who were previously refractory to monotherapy with sildenafil 33. A total of 75 men, who had experienced erectile dysfunction for a minimum of 3 months, had low to low-normal total testosterone (5 400 ng/dl) and had previously failed to respond to sildenafil, were randomized to 12 weeks of treatment with either testosterone (50 mg daily) + sildenafil citrate (100 mg), or placebo + sildenafil citrate (100 mg). The etiology of erectile dysfunction was either organic or mixed, and most patients (91%) had experienced erectile dysfunction for over 1 year the majority had either moderate or severe erectile dysfunction. Baseline characteristics were similar in both groups; the mean age was 58.5 years and obesity was common (mean body mass index, kg/m 2 ). The primary efficacy outcome was the International Index of Erectile Function (IIEF), while secondary measures were sexual desire, orgasmic function, satisfaction (evaluated via a questionnaire) and serum testosterone levels. Evaluations were performed every 4 weeks. After 12 weeks of treatment, serum testosterone had significantly increased in the group receiving testosterone, from a baseline level of 300 ng/dl to ng/dl (p , compared with placebo) (Figure 3). While there was a slight decrease at week 12, this was probably due to patient dropout. In contrast, the group who received placebo showed no change. An interim analysis at 4 weeks after the start of treatment demonstrated that erectile function had improved significantly from baseline in the group receiving the testosterone and sildenafil combination (mean change from baseline IIEF = 4.4), in contrast to those receiving placebo and sildenafil (mean change from baseline IIEF = 2.2) (p = 0.029) (Figure 4). In addition, the Figure 3 Testosterone levels in patients treated for erectile dysfunction. Subjects used sildenafil (100 mg) as needed and applied testosterone gel daily (50 mg testosterone) in the form of Testogel 1 or AndroGel 1. Reprinted from R, Kaufman J, Steidle J, Padma-Nathan H. Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol 2004;172: Copyright Lippincott Williams & Wilkins 2004 The Aging Male 315
5 transdermal administration of testosterone can improve response to sildenafil 34. Figure 4 At 4 weeks, treatment with testosterone and sildenafil had significantly improved erectile function from baseline, compared with placebo (p = 0.029). Reprinted from R, Kaufman J, Steidle J, Padma-Nathan H. Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol 2004;172: Copyright Lippincott Williams & Wilkins 2004 group receiving the testosterone and sildenafil combination demonstrated significant improvements from baseline in orgasmic function (p = 0.009), overall satisfaction (p = 0.02) and total score of the sexual function questionnaire (p = 0.011), compared with the placebo and sildenafil group. The discovery that a combination of testosterone treatment and sildenafil could improve orgasmic function was an important finding of this study, as monotherapy with PDE5 inhibitors or prostaglandin E1 can only improve vasodilation and erectile function. These findings are supported by a smaller study, in which 20 hypogonadal subjects were randomized either to testosterone treatment by patch administration or to placebo, indicating that CONCLUSIONS Erectile dysfunction is extremely common and can impact significantly on the quality of life and self-esteem of sufferers. Erectile dysfunction is often associated with aging and may be a symptom of late-onset hypogonadism. Many men do not respond adequately to treatment with PDE5 inhibitors or prostaglandin E1 unless testosterone levels are sufficient. It is important, therefore, to screen men who present with erectile dysfunction for low serum testosterone and hypogonadism, especially if they fail treatment with PDE5 inhibitors. Clinical trials have demonstrated that testosterone replacement therapy, with products such as Testogel 1 /AndroGel 1, can rapidly increase levels of testosterone and improve sexual function and mood in men with hypogonadism 30,31. Testogel 1 /AndroGel 1, in combination with the PDE5 inhibitor sildenafil, has been demonstrated to improve erectile response and orgasmic function in patients with erectile dysfunction and hypogonadism who had previously not responded to sildenafil monotherapy, compared with placebo 33,34. Therefore, testosterone treatment may be considered for the treatment of erectile dysfunction in men with low to low-normal total testosterone levels who have failed previous treatment with sildenafil. Conflict of interest The author presented this paper at a symposium sponsored by Schering AG at the XIXth Congress of the European Association of Urology, Vienna, March References 1. Vermeulen A. Andropause. Maturitas 2000;34: Laumann E, Paik A, Rosen R. Sexual dysfunction in the United States: prevalence and predictors. J Am Med Assoc 1999;281: NIH Consensus Development Panel on Impotence: impotence. J Am Med Assoc 1993;270: Rosen RC, Seidman SN, Menza MA, et al. Quality of life, mood, and sexual function: a path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms. Int J Impot Res 2004;16: The Aging Male
6 5. Turner LA, Althof SE, Levine SB, et al. Selfinjection of papaverine and phentolamine in the treatment of psychogenic impotence. J Sex Marital Ther 1989;15: Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and physiological correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: R. Hypogonadism and erectile dysfunction: the role of testosterone therapy. Int J Impot Res 2003;15(Suppl 4):S Morley J. Impotence. Am J Med 1986;80: Mills T, Wiedmeier V, Stopper V. Androgen maintenance of erectile function in the rat penis. Biol Reprod 1992;46: Mills T, Stopper V, Wiedmeier V. Effects of castration and androgen replacement on the hemodynamics of penile erection in the rat. Biol Reprod 1994;51: R. The effects of testosterone on the cavernous tissue and erectile function. World J Urol 1997;15: R, Raymond JF, Olsson CA, O Toole K, Buttyan R. Androgen induction of DNA synthesis in the rat penis. Urology 1998;52: Klein LT, Miller MI, Buttyan R, et al. Apoptosis in the rat penis after penile denervation. J Urol 1997;158: Andersson KE, Holmquist F. Regulation of tone in penile cavernous smooth muscle. Established concepts and new findings. World J Urol 1994;12: Burnett AL. Role of nitric oxide in the physiology of erection. Biol Reprod 1995;52: Reilly CM, Zamorano P, Stopper VS, Mills TM. Androgenic regulation of NO availability in rat penile erection. J Androl 1997;18: Kalinchenko SY, Kozlov GI, Gontcharov NP, Katsiya GV. Oral testosterone undecanoate reverses erectile dysfunction associated with diabetes mellitus in patients failing on sildenafil citrate therapy alone. Aging Male 2003;6: Reilly CM, Lewis RW, Stopper VS, Mills TM. Androgenic maintenance of the rat erectile response via a non-nitric-oxide-dependent pathway. J Androl 1997;18: Baba K, Yajima M, Carrier S, et al. Delayed testosterone replacement restores nitric oxide synthase-containing nerve fibres and the erectile response in rat penis. BJU Int 2000;85: Buvat J, Lemaire A. Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy. J Urol 1997;158: Jain P, Rademaker A, McVary K. Testosterone supplementation for erectile dysfunction: results of a meta-analysis. J Urol 2000;164: Arver S, Dobs AS, Meikle AW, Allen RP, Sanders SW, Mazer NA. Improvement of sexual function in testosterone deficient men treated for 1 year with a permeation enhanced testosterone transdermal system. J Urol 1996;155: Findlay J, Place V, Snyder P. Treatment of primary hypogonadism in men by the transdermal administration of testosterone. J Clin Endocrinol Metab 1989;68: Bals-Pratsch M, Knuth UA, Yoon YD, Nieschlag E. Transdermal testosterone substitution therapy for male hypogonadism. Lancet 1986;2: Korenman SG, Viosca S, Garza D, et al. Androgen therapy of hypogonadal men with transscrotal testosterone systems. Am J Med 1987;83: Ahmed SR, Boucher AE, Manni A, Santen RJ, Bartholomew M, Demers LM. Transdermal testosterone therapy in the treatment of male hypogonadism. J Clin Endocrinol Metab 1988;66: Dobs AS, Meikle AW, Arver S, Sanders SW, Caramelli KE, Mazer NA. Pharmacokinetics, efficacy, and safety of a permeation-enhanced testosterone transdermal system in comparison with bi-weekly injections of testosterone enanthate for the treatment of hypogonadal men. J Clin Endocrinol Metab 1999;84: Meikle AW, Arver S, Dobs AS, Sanders SW, Rajaram L, Mazer NA. Pharmacokinetics and metabolism of a permeation-enhanced testosterone transdermal system in hypogonadal men: influence of application site a clinical research center study. J Clin Endocrinol Metab 1996;81: Parker S, Armitage M. Experience with transdermal testosterone replacement therapy for hypogonadal men. Clin Endocrinol (Oxf) 1999;50: Swerdloff RS, Wang C, Cunningham G, et al. Long-term pharmacokinetics of transdermal testosterone gel in hypogonadal men. J Clin Endocrinol Metab 2000;85: Wang C, Swedloff RS, Iranmanesh A, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. Testosterone Gel Study Group. J Clin Endocrinol Metab 2000;85: The Aging Male 317
7 32. Wang C, Berman N, Longstreth JA, et al. Pharmacokinetics of transdermal testosterone gel in hypogonadal men: application of gel at one site vs four sites: a General Clinical Research Center Study. J Clin Endocrinol Metab 2000;85: R, Kaufman J, Steidle J, Padma-Nathan H. Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol 2004;172: Aversa A, Isidori AM, Spera G, Lenzi A, Fabbri A. Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction. Clin Endocrinol (Oxf) 2003;58: The Aging Male
Sponsored by. Schering. Sidney Glina
Sponsored by Schering Sidney Glina Testosterone and erectile dysfunction Sidney Glina Keywords Androgen Hormone replacement therapy Hypogonadism Impotence Testosterone Abstract The role of testosterone
More information/04/ /0 Reprinted from Vol. 172, , August 2004 THE JOURNAL OF UROLOGY
0022-5347/04/1722-0658/0 Reprinted from Vol. 172, 658 663, August 2004 THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright 2004 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000132389.97804.d7
More informationTestim 1 Gel: Review of Clinical Data
European Urology Supplements European Urology Supplements 4 (2005) 24 30 Testim 1 Gel: Review of Clinical Data Tom A. McNicholas* Department of Urology, Lister Hospital, Corey s Mill Lane, Stevenage, Hertfordshire
More informationIC351 (tadalafil, Cialis): update on clinical experience
(2002) 14, Suppl 1, S57 S64 ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00 www.nature.com/ijir IC351 (tadalafil, Cialis): update on clinical experience 1 * 1 Urological practice,
More informationManaging the Patient with Erectile Dysfunction: What Would You Do?
Managing the Patient with Erectile Dysfunction: What Would You Do? Florida A & M University College of Pharmacy and Pharmaceutical Sciences 42 nd Annual Clinical Symposium Wayne A. Sampson, M.D. Cross
More informationThe effect of sildenafil on electrostimulation-induced erection in the rat model
(2002) 14, 251 255 ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00 www.nature.com/ijir The effect of sildenafil on electrostimulation-induced erection in the rat model N Ueno 1,
More informationTHE RELEVANCE OF TESTOSTERONE THERAPY IN MANAGING PATIENTS WITH ERECTILE DYSFUNCTION
THE RELEVANCE OF TESTOSTERONE THERAPY IN MANAGING PATIENTS WITH ERECTILE DYSFUNCTION Aksam A. Yassin MD PhD EdD FEBU Professor of Urology & Human Sexuality Institute of Urology & Andrology, Segeberger
More informationThe Role of Testosterone in the Sexual Function. Luiz Otavio Torres President Elect of ISSM Belo Horizonte - Brazil
The Role of Testosterone in the Sexual Function Luiz Otavio Torres President Elect of ISSM Belo Horizonte - Brazil Hormones and Sexual Function Paraventricular Nucleus Stimuli visual Sexual Desire Melatonine
More informationManaging Erectile Dysfunction
Managing Erectile Dysfunction Lewis E. Harpster MD, FACS Urology of Central PA 4/23/16 1 Objectives 1. Review physiologic mechanism of erection 2. Discuss medical management of ED 3. Discuss surgical management
More informationAdministration of Testosterone and its Rationale in the Treatment of Erectile Dysfunction
ORIGINAL ARTICLE Administration of Testosterone and its Rationale in the Treatment of Erectile Dysfunction *CATM Mowladad 1, HM Rafiqul 2, A Bakhtiar 3, KM Rahman 4, R Shofiqur 5 *1 Prof. Chowdhury ATM
More informationNitric Oxide in the Penis: Scientific Discoveries and Clinical Applications
Nitric Oxide in the Penis: Scientific Discoveries and Clinical Applications Arthur L. (Bud) Burnett, M.D., M.B.A., F.A.C.S. Patrick C. Walsh Professor of Urology The James Buchanan Brady Urological Institute
More informationTopical application of a Rho-kinase inhibitor in rats causes penile erection
(2004) 16, 294 298 & 2004 Nature Publishing Group All rights reserved 0955-9930/04 $30.00 www.nature.com/ijir Topical application of a Rho-kinase inhibitor in rats causes penile erection Y Dai 1,2,3, K
More informationfor ED and LUTS/BPH Pierre Sarkis, M.D. Assistant Professor Fellow of the European Board of Urology
Tadalafil 5 mg once daily for ED and LUTS/BPH Pierre Sarkis, M.D. Assistant Professor Fellow of the European Board of Urology Why this conference? Not promotional but educational The pharmacist regularly
More informationREVIEW The relationship between hypogonadism and erectile dysfunction
(2008) 20, 231 235 & 2008 Nature Publishing Group All rights reserved 0955-9930/08 $30.00 www.nature.com/ijir REVIEW The relationship between hypogonadism and erectile dysfunction TIS Hwang 1,2,3 and Y-C
More informationTestosterone and PDE5 inhibitors in the aging male
Testosterone and PDE5 inhibitors in the aging male Francesco Romanelli Department of Experimental Medicine Medical Pathophysiology, Food Science and Endocrinology Section Sapienza University of Rome 3005
More informationErectile Dysfunction: A Primer for Primary Care Providers
Erectile Dysfunction: A Primer for Primary Care Providers Jeanne Martin, DNP, ANP-BC Objectives 1. Understand the definition, incidence and prevalence of Erectile Dysfunction in the U.S. 2. Understand
More informationCurrent Data and Considerations Novel Testosterone Formulations
Current Data and Considerations Novel Testosterone Formulations 1 Hypogonadism: Treatment Safety and Prostate Health 2 Monitoring for Testosterone Therapy DRE 1,2 PSA Parameter Voiding/IPSS 1,2 Hemoglobin
More informationEvidence Review for Surrey Prescribing Clinical Network. Treatment: Oral and non-oral combination therapy for erectile dysfunction
Evidence Review for Surrey Prescribing Clinical Network Treatment: Oral and non-oral combination therapy for erectile dysfunction Prepared by: Linda Honey Topic Submitted by: Prescribing Clinical Network
More informationSexual dysfunction in men with diabetes
Article Sexual dysfunction in men with diabetes Lesley Mills Citation: Mills L (2015) Sexual dysfunction in men with diabetes. Journal of Diabetes Nursing 19: 332 8 Article points 1. Sexual dysfunction
More informationThe use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction
(2002) 14, 245 250 ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00 www.nature.com/ijir The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic
More informationORIGINAL ARTICLE Hypogonadism is associated with overt depression symptoms in men with erectile dysfunction
(2008) 20, 157 161 & 2008 Nature Publishing Group All rights reserved 0955-9930/08 $30.00 www.nature.com/ijir ORIGINAL ARTICLE Hypogonadism is associated with overt depression symptoms in men with erectile
More informationDifferent hemodynamic responses by color Doppler ultrasonography studies between sildenafil non-responders and responders
DOI: 10.1111/j.1745-7262.2007.00227.x www.asiaandro.com. Clinical Experience. Different hemodynamic responses by color Doppler ultrasonography studies between sildenafil non-responders and responders Shih-Tsung
More informationSmooth muscle pathology and erectile dysfunction
(2002) 14, Suppl 1, S17 S21 ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00 www.nature.com/ijir and erectile dysfunction 1 * 1 Department of Urology, C.H.U. de Charleroi, Charleroi,
More informationMMM. Topic The use of Tadalafil 5mg daily for the treatment of BPH-LUTS
Dr Tan & Partners MMM Vol. 1 No. 1 Morbidity & Mortality Meeting 14 th November 2014 Introduction Topic The use of Tadalafil 5mg daily for the treatment of BPH-LUTS Tadalafil 5mg daily is a well established
More informationCanadian Undergraduate Urology Curriculum (CanUUC): Erectile Dysfunction
Canadian Undergraduate Urology Curriculum (CanUUC): Erectile Dysfunction Last reviewed July 2014 Objectives 1. Define erectile dysfunction 2. List and classify the risk factors for erectile dysfunction
More information/02/ /0 Vol. 168, , October 2002 THE JOURNAL OF UROLOGY
0022-5347/02/1684-1332/0 Vol. 168, 1332 1336, October 2002 THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright 2002 by AMERICAN UROLOGICAL ASSOCIATION, INC. DOI: 10.1097/01.ju.0000028041.27703.da Original
More informationLONG-TERM EFFECT OF SILDENAFIL CITRATE ON ERECTILE DYSFUNCTION AFTER RADICAL PROSTATECTOMY: 3-YEAR FOLLOW-UP
ADULT UROLOGY LONG-TERM EFFECT OF SILDENAFIL CITRATE ON ERECTILE DYSFUNCTION AFTER RADICAL PROSTATECTOMY: 3-YEAR FOLLOW-UP RUPESH RAINA, MILTON M. LAKIN, ASHOK AGARWAL, RAKESH SHARMA, KUSH K. GOYAL, DROGO
More information/03/ /0 Vol. 170, , July 2003 THE JOURNAL OF UROLOGY. Printed in U.S.A. Copyright 2003 by AMERICAN UROLOGICAL ASSOCIATION
0022-5347/03/1701-0159/0 Vol. 170, 159 163, July 2003 THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright 2003 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000072524.82345.6d COMPARISON OF SATISFACTION
More informationClinical evaluation of Tentex forte and Himcolin cream in the treatment of functional erectile dysfunction
Medicine Update (2004): 11(9), 47-51 Clinical evaluation of Tentex forte and Himcolin cream in the treatment of functional erectile dysfunction Dr. Roumen Bostandjiev, Ph.D. Founder and Director of Sexology
More informationErectile dysfunction (ED) is a mutifactorial condition
Journal of Andrology, Vol. 22, No. 5, September/October 2001 Copyright American Society of Andrology Efficacy and Safety of Sildenafil Citrate for Treatment of Erectile Dysfunction in a Population With
More informationTreatment Strategy for Non-Responders to PDE5 Inhibitors
pissn: 2287-4208 / eissn: 2287-4690 World J Mens Health 2013 April 31(1): 31-35 http://dx.doi.org/10.5534/wjmh.2013.31.1.31 Review Article Treatment Strategy for Non-Responders to PDE5 Inhibitors Nam Cheol
More informationErectile dysfunction (ED) is the inability to obtain or maintain an erection satisfactory
Determining the Feasibility of Managing Erectile Dysfunction in Humans With Placental-Derived Stem Cells Jason A. Levy, OMS IV, MS; Melissa Marchand, PA-C; Leanne Iorio, OMS II; Walquiria Cassini; and
More information6/14/2010. GnRH=Gonadotropin-Releasing Hormone.
Male Androgen Replacement Mitchell Sorsby, MD June 19, 2010. QUESTION # 1 Which of the following is not a symptom associated with low T levels? a) decreased libido b) erectile dysfunction c) depression
More informationErectile dysfunction
Erectile dysfunction Good Erectile Function Having good Erections => crucial for all men Because erections & the coitus they allow major pleasure brings self-confidence confirms his state of being a full
More informationDiagnosis and management of sexual dysfunction. Dr Chris Simpson Consultant Psychiatrist
Diagnosis and management of sexual dysfunction Dr Chris Simpson Consultant Psychiatrist What are we talking about? Male Erectile dysfunction Premature ejaculation Delayed ejaculation Sexual aversion Paraphilia
More informationTestosterone levels in men with erectile dysfunction
Original Article TESTOSTERONE LEVELS IN MEN WITH ED MARTÍNEZ-JABALOYAS et al. Testosterone levels in men with erectile dysfunction JOSÉ M. MARTÍNEZ-JABALOYAS, ALFONSO QUEIPO-ZARAGOZÁ*, FRANCISCO PASTOR-HERNÁNDEZ,
More informationReview Article Penile Rehabilitation Therapy with PDE-V Inhibitors Following Radical Prostatectomy: Proceed with Caution
Advances in Urology Volume 2009, Article ID 852437, 4 pages doi:10.1155/2009/852437 Review Article Penile Rehabilitation Therapy with PDE-V Inhibitors Following Radical Prostatectomy: Proceed with Caution
More informationSexual Dysfunction. Jae Il Kang, Byeong Kuk Ham, Mi Mi Oh, Je Jong Kim, Du Geon Moon. DOI: /kju
www.kjurology.org DOI:10.4111/kju.2011.52.6.416 Sexual Dysfunction Correlation between Serum Total Testosterone and the AMS and IIEF Questionnaires in Patients with Erectile Dysfunction with Testosterone
More informationThe New England Journal of Medicine
The New England Journal of Medicine Copyright, 199, by the Massachusetts Medical Society VOLUME 33 M AY 14, 199 NUMBER ORAL IN THE TREATMENT OF ERECTILE DYSFUNCTION IRWIN GOLDSTEIN, M.D., TOM F. LUE, M.D.,
More informationMALE SEXUAL DYSFUNCTION. Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara
MALE SEXUAL DYSFUNCTION Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara DEFINITION The inability to achieve a satisfactory sexual relationship May involve : - inadequacy
More informationERECTION HARDNESS: A UNIFYING FACTOR FOR DEFINING RESPONSE IN THE TREATMENT OF ERECTILE DYSFUNCTION
ERECTION HARDNESS: A UNIFYING FACTOR FOR DEFINING RESPONSE IN THE TREATMENT OF ERECTILE DYSFUNCTION JOHN P. MULHALL, LAURENCE A. LEVINE, and KLAUS-PETER JÜNEMANN ABSTRACT The extensive sildenafil citrate
More information, David Stultz, MD. Erectile Dysfunction. David Stultz, MD September 10, 2001
Erectile Dysfunction David Stultz, MD September 10, 2001 Case Presentation A 66 year old male presents to your office requesting Viagra. He states that for the past year he has had difficulty forming
More informationCombining Testosterone and PDE5 Inhibitors in Erectile Dysfunction: Basic Rationale and Clinical Evidences
european urology 50 (2006) 940 947 available at www.sciencedirect.com journal homepage: www.europeanurology.com Review Sexual Medicine Combining Testosterone and PDE5 Inhibitors in Erectile Dysfunction:
More informationERECTILE DYSFUNCTION DIAGNOSIS
ERECTILE DYSFUNCTION DIAGNOSIS Head of Andrology and Sexual Medicine Dep.of Urology and Nefrology Hospital Virgen del Rocío ANDROMEDI. Sexual Medicine SEVILLA. SPAIN General Secretary ESSM Natalio Cruz
More informationManaging Testosterone Deficiency: A Practical Guide. John Grantmyre MD Professor of Urology Dalhousie University
Managing Testosterone Deficiency: A Practical Guide John Grantmyre MD Professor of Urology Dalhousie University 1 2 Case Study #1 A 59-Year-Old Man with Erectile Dysfunction 3 Case History Robert is a
More informationEfficacy of Sildenafil Citrate intreatment of Erectile Dysfunction:EffectofType2Diabetes
European Urology European Urology 46 (2004) 503 509 Efficacy of Sildenafil Citrate intreatment of Erectile Dysfunction:EffectofType2Diabetes Ahmed I. El-Sakka a,b,* a Department of Urology, Suez Canal
More informationSerum Total Testosterone Level and Identification of Late-Onset Hypogonadism: A Community-Based Study
www.kjurology.org http://dx.doi.org/10.4111/kju.2013.54.9.619 Sexual Dysfunction/Male Infertility Serum Total Testosterone Level and Identification of Late-Onset Hypogonadism: A Community-Based Study Sungmin
More informationPoint-Counterpoint: Late Onset Hypogonadism (LOH)
Point-Counterpoint: Late Onset Hypogonadism (LOH) We are Under-diagnosing and Treating Men with LOH LOH is a Non-existent Disease ~ Robert E. Donohue, MD Late Onset Hypogonadism LOH: underdx. & undertx
More informationProduct Introduction
Product Introduction 康達生命科學有限公司 Contek Life Science Co., Ltd. Red Algae Peptide Hydrolysate-EDpeptide The Next Generations of Erectile Dysfunction Cure Introduction of small peptides Erectile dysfunction
More informationTransdermal testosterone gel: pharmacokinetics, efficacy of dosing and application site in hypogonadal men
Original Article TRANSDERMAL TESTOSTERONE GEL A.W. MEIKLE et al. Testosterone gels are being increasingly used throughout the world. There is still some controversy associated with their use, but many
More informationTreatment Options for Erectile Dysfunction in Patients Failing Oral DrugTherapy
EAU Update Series 2 (2004) 75 83 Treatment Options for Erectile Dysfunction in Patients Failing Oral DrugTherapy Konstantinos Hatzimouratidis, Dimitrios G. Hatzichristou * 2nd Department of Urology, Papageorgiou
More informationTreatment of male sexual dysfunction
Simon Holmes Department of Urology, St Mary's Hospital, Portsmouth, UK Male sexual dysfunction is a prevalent condition in the population, is a major health problem and has previously been both under diagnosed
More informationSildenafil citrate improves erectile function after castration in a rat model
Sildenafil citrate improves erectile function after castration in a rat model John P. Mulhall*, Nipun Verma, Serkan Deveci, Raanan Tal*, Keith Kobylarz and Alexander Müller* *Department of Urology, Memorial
More informationOnset and duration of action of sildena l citrate for the treatment of erectile dysfunction
Onset and duration of action of sildena l citrate for the treatment of erectile dysfunction Ian Eardley, 1 Peter Ellis, 2 Mitradev Boolell 2 & Maria Wulff 2 1 Department of Urology, St James University
More informationGUIDELINES ON ERECTILE DYSFUNCTION
16 GUIDELINES ON ERECTILE DYSFUNCTION E. Wespes (chairman), E. Amar, D. Hatzichristou, Dr. F. Montorsi, J. Pryor, Y. Vardi Eur Urol 2002;41:1-5 1. Background, definition and classification Male erectile
More informationI N T I M A C Y A N D S E X U A L I T Y I N L A T E R L I F E
I N T I M A C Y A N D S E X U A L I T Y I N L A T E R L I F E 2 0 1 6 DESPITE THE COMMON COMPLAINT, EACH PATIENT COMES AS AN INDIVIDUAL, WITH UNIQUE EXPECTATIONS My special interest Counseling patients
More informationORIGINAL INVESTIGATION. Sildenafil for Male Erectile Dysfunction
Sildenafil for Male Erectile Dysfunction A Systematic Review and Meta-analysis ORIGINAL INVESTIGATION Howard A. Fink, MD, MPH; Roderick Mac Donald, MS; Indulis R. Rutks, BS; David B. Nelson, PhD; Timothy
More informationHypogonadism 4/27/2018. Male Hypogonadism -- Definition. Epidemiology. Objectives HYPOGONADISM. Men with Hypogonadism. 95% untreated.
Male Hypogonadism -- Definition - Low T, Low Testosterone Hypogonadism -...a clinical syndrome that results from failure of the testes to produce physiological concentrations of testosterone due to pathology
More informationSYED TABREZ ALI Department of Physiology, Faculty of Medicine P.O. Box 7607, Umm-Al-Qura University, Makkah, Saudi Arabia
EFFECTIVENESS OF SILDENAFIL CITRATE (VIAGRA TM ) AND TADALAFIL (CIALIS TM ) ON SEXUAL RESPONSES IN SAUDI MEN WITH ERECTILE DYSFUNCTION IN ROUTINE CLINICAL PRACTICE SYED TABREZ ALI Department of Physiology,
More informationAssessment of Erectile and Ejaculatory Function after Penile Prosthesis Implantation
www.kjurology.org DOI:.4/kju.2.5.3.22 Sexual Dysfunction/Infertility Assessment of Erectile and Ejaculatory Function after Penile Prosthesis Implantation Jang Ho Bae, Phil Hyun Song, Hyun Tae Kim, Ki Hak
More informationLong-term efficacy and compliance of intracorporeal (IC) injection for erectile dysfunction following radical prostatectomy: SHIM (IIEF-5) analysis
(2003) 15, 318 322 & 2003 Nature Publishing Group All rights reserved 0955-9930/03 $25.00 www.nature.com/ijir Long-term efficacy and compliance of intracorporeal (IC) injection for erectile dysfunction
More informationWITH ERECTILE DYSFUNCTION
Clinical Urology International Braz J Urol Vol. 29 (4): 320-326, July - August, 2003 Official Journal of the Brazilian Society of Urology OF PATIENTS WITH ERECTILE DYSFUNCTION JOAQUIM A. CLARO, SÉRGIO
More informationERECTILE DYSFUNCTION. & Current Therapies. GP Conference, Rotorua 7-10 June 2012
ERECTILE DYSFUNCTION & Current Therapies GP Conference, Rotorua 7-10 June 2012 Jan Burns & Annie Woodsford Jan: EN, RCpN, BHSc, RPN (USA),MHSc, Member of the Sexual Medicine Society Urology Nurse Specialist
More informationOpinion: Yes. PDE-5 inhibitors should be used post radical prostatectomy as erection function rehabilitation?
Difference of opinion Vol. 43 (3): 385-389, May - June, 2017 doi: 10.1590/S1677-5538.IBJU.2017.03.03 PDE-5 inhibitors should be used post radical prostatectomy as erection function rehabilitation? Opinion:
More informationX/00/$03.00/0 Vol. 85, No. 8 The Journal of Clinical Endocrinology & Metabolism. Printed in U.S.A. Copyright 2000 by The Endocrine Society
0021-972X/00/$03.00/0 Vol. 85, No. 8 The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A. Copyright 2000 by The Endocrine Society Transdermal Testosterone Gel Improves Sexual Function,
More informationMANAGEMENT UPDATE , LLC MedReviews
MANAGEMENT UPDATE 2013 MedReviews, LLC rostate cancer is the most common cancer in men over the age of 50 years. 1 When patients undergo a radical prostatectomy (RP), there is a risk of postoperative erectile
More informationSidney Glina Faculdade de Medicina do ABC Instituto H. Ellis Editor-in-Chief of the International Brazilian Journal of Urology
Sidney Glina Faculdade de Medicina do ABC Instituto H. Ellis Editor-in-Chief of the International Brazilian Journal of Urology (www.intbrazjurol.com.br) glinas@terra.com.br Conflict of Interest: In the
More informationClinical Case Reports: Open Access
Clinical Case Reports: Open Access Review Vol 1 Iss 1 Erectile Dysfunction: Causes and Diagnosis Afa Bayramova * Department of Reproductive System and Disorders, USA * Corresponding author: Bayramova A,
More informationGUIDELINES ON ERECTILE DYSFUNCTION
GUIDELINES ON ERECTILE DYSFUNCTION (Text updated March 2005) E. Wespes (chairman), E. Amar, D. Hatzichristou, K. Hatzimouratidis, F. Montorsi, J. Pryor, Y. Vardi 88 Erectile Dysfunction Eur Urol 2001;40:97-101
More informationOral phentolamine: an alpha-1, alpha-2 adrenergic antagonist for the treatment of erectile dysfunction
(2000) 12, Suppl 1, S75±S80 ß 2000 Macmillan Publishers Ltd All rights reserved 0955-9930/00 $15.00 www.nature.com/ijir Oral phentolamine: an alpha-1, alpha-2 adrenergic antagonist for the treatment of
More informationThe efficacy and safety of tadalafil: an update
Original Article C.C. CARSON et al. The efficacy and safety of tadalafil: an update C.C. CARSON, J. RAJFER, I. EARDLEY, S. CARRIER, J.S. DENNE, D.J. WALKER, W. SHEN and W.H. CORDELL Department of Surgery,
More informationDiagnosis and Clinical Evaluation of Hypogonadism in Adult Patients with Obesity and Diabetes
Diagnosis and Clinical Evaluation of Hypogonadism in Adult Patients with Obesity and Diabetes Adrian Dobs, M.D., M.H.S. Professor of Medicine and Oncology The Johns Hopkins University School of Medicine
More informationSildenafil Citrate (VIAGRA ) Improves Erectile Function in Elderly Patients With Erectile Dysfunction: A Subgroup Analysis
Journal of Gerontology: MEDICAL SCIENCES 2001, Vol. 56A, No. 2, M113 M119 Copyright 2001 by The Gerontological Society of America Sildenafil Citrate (VIAGRA ) Improves Erectile Function in Elderly Patients
More informationThe Role of Erection Hardness in Determining Erectile Dysfunction (ED) Treatment Outcome
european urology supplements 5 (2006) 767 772 available at www.sciencedirect.com journal homepage: www.europeanurology.com The Role of Erection Hardness in Determining Erectile Dysfunction (ED) Treatment
More informationClinic for urology, pediatric urology and andrology. Penile diseases. Dr. Arne Hauptmann
Clinic for urology, pediatric urology and andrology JUSTUS- LIEBIG UNVERISTY GIESSEN Penile diseases Dr. Arne Hauptmann Clinic for urology, pediatric urology and andrology University Giessen und Marburg
More informationErectile Dysfunction (ED) Shawn McGee M.D. CentraCare Adult and Pediatric Urology January 30 th, 2016
Erectile Dysfunction (ED) Shawn McGee M.D. CentraCare Adult and Pediatric Urology January 30 th, 2016 Erectile dysfunction: The inability to attain or maintain penile erection sufficient for satisfactory
More informationCorporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency
Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testosterone_pellet_implantation_for_androgen_deficiency
More informationCardiovascular Parameter Changes in Patients With Erectile Dysfunction Using Pde-5 Inhibitors: A Study With Sildenafil and Vardenafil
Journal of Andrology, Vol. 25, No. 4, July/August 2004 Copyright American Society of Andrology Cardiovascular arameter Changes in atients With Erectile Dysfunction Using de-5 Inhibitors: A Study With Sildenafil
More informationSildenafil citrate for the treatment of erectile dysfunction in men with Type II diabetes mellitus
Diabetologia 2001) 44: 1296±1301 Ó Springer-Verlag 2001 Sildenafil citrate for the treatment of erectile dysfunction in men with Type II diabetes mellitus A. J.M. Boulton 1, J-L.Selam 2, M. Sweeney 3,
More informationPhysiology and disturbances of sexual functions Prof. Jolanta Słowikowska-Hilczer, M.D., Ph.D.
Physiology and disturbances of sexual functions Prof. Jolanta Słowikowska-Hilczer, M.D., Ph.D. Department of Andrology and Reproductive Endocrinology Medical University of Łódź, Poland SEXUALITY Sexuality
More informationErectile dysfunction. By Anas Hindawi Supervised by Dr Khalid AL Sayyid
Erectile dysfunction By Anas Hindawi Supervised by Dr Khalid AL Sayyid ED is the persistent/recurrent inability to attain and/or maintain a penile erection rigid enough for satisfactory sexual intercourse
More informationErectile Dysfunction Medical Treatment
1 Erectile Dysfunction Medical Treatment Alireza Ghoreifi Assistant of Urology Mashhad University of Medical Sciences March 2012 2 Treatment of ED Unknown cases of ED First-line therapy Second-line therapy
More informationAbstract and Introduction. Topical/transdermal Therapies
www.medscape.com Testosterone Replacement Therapy for Male Hypogonadism: Part III. Pharmacologic and Clinical Profiles, Monitoring, Safety Issues, and Potential Future Agents A Seftel Int J Impot Res.
More informationEffects of testosterone on erectile function: implications for the therapy of erectile dysfunction
Mini Reviews SAAD et al. Effects of testosterone on erectile function: implications for the therapy of erectile dysfunction Farid Saad, Anca S. Grahl 1, Antonio Aversa 2, Aksam A. Yassin 3,4, Atez Kadioglu
More informationCell Communication CHAPTER 11
Cell Communication CHAPTER 11 What you should know: The 3 stages of cell communication: reception, transduction, and response. How a receptor protein recognizes signal molecules and starts transduction.
More informationHigh dose sildenafil citrate as a salvage therapy for severe erectile dysfunction
(2002) 14, 533 538 ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00 www.nature.com/ijir High dose sildenafil citrate as a salvage therapy for severe erectile dysfunction 1 * 1 Australian
More informationSexual dysfunction of chronic kidney disease. Razieh salehian.md psychiatrist
Sexual dysfunction of chronic kidney disease Razieh salehian.md psychiatrist Disturbances in sexual function are a common feature of chronic renal failure. Sexual dysfunction is inversely associated with
More informationErectile Dysfunction
a report by Asif Muneer, Nigel Borley and David J Ralph The St Peter s Andrology Centre, London Erectile dysfunction is a common male sexual function disorder and is defined as the inability to achieve
More informationDipartimento Ostetricia, Ginecologia, Urologia - Clinica Urologica Università di Napoli Federico II, Italy; 2
ORIGINAL PAPER DOI: 10.4081/aiua.2016.2.128 A survey on the experience of 136 Italian urologists in the treatment of erectile dysfunction with PDE5 inhibitors and recommendations for the use of Avanafil
More informationChoosing the 5 th type phosphodiesterase inhibitors for treatment the patients with erectile dysfunction and chronic prostatitis
18 a r c h i v e u r o m e d i c a 2 0 14 v o l. 4 n u m. 1 Choosing the 5 th type phosphodiesterase inhibitors for treatment the patients with erectile dysfunction and chronic prostatitis Esilevskiy Yu.M.,
More informationA dro r gen e R e R p e lac a e c m e e m n e t t T her e a r p a y Androgen Replacement Therapy in the Aging O j b ecti t ve v s Male
Androgen Replacement Therapy in the Aging Male Thomas J. Walsh, MD, MS Department of Urology University of California, San Francisco Objectives 1. List 3 effects of androgens on normal male physiology.
More informationGUIDELINES ON. Introduction. G.R. Dohle, S. Arver, C. Bettocchi, S. Kliesch, M. Punab, W. de Ronde
GUIDELINES ON Male Hypogonadism G.R. Dohle, S. Arver,. Bettocchi, S. Kliesch, M. Punab, W. de Ronde Introduction Male hypogonadism is a clinical syndrome caused by androgen deficiency. It may adversely
More informationErectile dysfunction: unmet needs
Erectile dysfunction: unmet needs Dimitris Hatzichristou Professor of Urology / Andrology Director, Center for Sexual and Reproductive Health Aristotle University of Thessaloniki, Greece The numbers MMAS
More informationEvaluation of the Pharmacokinetic Profiles of the New Testosterone Topical Gel Formulation, Testim TM, Compared to AndroGel 1
BIOPHARMACEUTICS & DRUG DISPOSITION Biopharm. Drug Dispos. 24: 115 120 (2003) Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/bdd.345 Evaluation of the Pharmacokinetic
More informationDisclosure Slide. Dr Michael Gillman IMPOTENCE ERECTILE DIFFICULTIES. Do Men Really Care??? 15/10/2014 ASSESSMENT OF ERECTILE DYSFUNCTION
ASSESSMENT OF ERECTILE DYSFUNCTION Dr Michael Gillman St Andrews Hospital North St Specialist Suites Mater Hospital 3 rd Floor Mater Private Clinic Wesley Hospital Suite 5 Level 9 Evan Thomson Bld Cleveland-
More informationLONG-TERM INTRACAVERNOUS THERAPY RESPONDERS CAN POTENTIALLY SWITCH TO SILDENAFIL CITRATE AFTER RADICAL PROSTATECTOMY
ADULT UROLOGY LONG-TERM INTRACAVERNOUS THERAPY RESPONDERS CAN POTENTIALLY SWITCH TO SILDENAFIL CITRATE AFTER RADICAL PROSTATECTOMY RUPESH RAINA, MILTON M. LAKIN, ASHOK AGARWAL, SANDRA AUSMUNDSON, DROGO
More informationERECTION MISDIRECTION: PENILE REHABILITATION & TREATMENTS FOR ERECTILE DYSFUNCTION. Gregory Harochaw Pharmacy Manager Tache Pharmacy (204)
ERECTION MISDIRECTION: PENILE REHABILITATION & TREATMENTS FOR ERECTILE DYSFUNCTION Gregory Harochaw Pharmacy Manager Tache Pharmacy (204) 233-3469 Nerve Function After careful prostatectomy where the erectile
More informationDefined as the consistent inability to attain and maintain an erection adequate for sexual intercourse Usually qualified by being present for several
Defined as the consistent inability to attain and maintain an erection adequate for sexual intercourse Usually qualified by being present for several months and occurring at least half the time. Vinik
More informationThe Centre for Men s Health
96 Harley Street (London) and Manchester All Enquiries - +44 (0)20 7486 2277 www.centreformenshealth.co.uk/ This leaflet provides information about: The Centre for Men s Health The conditions we treat:
More informationTestosterone Substitution and the Prostate
European Urology Supplements European Urology Supplements 4 (2005) 16 23 Testosterone Substitution and the Prostate E. David Crawford* University of Colorado Health Sciences Center, 1665 N. Ursula Street,
More information