Molecular Mechanisms of Vacuum Therapy in Penile Rehabilitation: A Novel Animal Study
|
|
- Judith Bruce
- 6 years ago
- Views:
Transcription
1 EUROPEAN UROLOGY 58 (2010) available at journal homepage: Sexual Medicine Molecular Mechanisms of Vacuum Therapy in Penile Rehabilitation: A Novel Animal Study Jiuhong Yuan a,b, Haochen Lin c,b, Ping Li d, Rongzheng Zhang e, Annie Luo e, Francesco Berardinelli f, Yutian Dai c, Run Wang b,g, * a Department of Urology, West China Hospital, Sichuan University, Chengdu, China b Division of Urology, University of Texas Health Science Center, Houston, TX, USA c Department of Urology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China d Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA e Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, TX, USA f Urology, Department of Medicine and Aging Science, G. D Annunzio University, Chieti, Italy g Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA Article info Article history: Accepted July 7, 2010 Published online ahead of print on July 16, 2010 Keywords: Cavernous nerve injury Erectile dysfunction Penile rehabilitation Radical prostatectomy Vacuum erectile device Vacuum therapy Abstract Background: Penile rehabilitation (PR) is widely applied after radical prostatectomy. Vacuum erectile device (VED) therapy is the one of three PR methods used in the clinical setting that improve erectile function (EF) and is the only PR method which may preserve penile length. However, its unknown mechanism hampered doctors recommendations and patients compliance. Objectives: To assess the effects of VED therapy on erectile dysfunction (ED) in a rat model of bilateral cavernous nerve crush (BCNC) and to investigate the molecular mechanism of VED in postprostatectomy ED. Design, setting, and participants: This was an experimental study using Sprague-Dawley rats in three groups: sham, BCNC, and BCNC plus VED. Intervention: Intervention included BCNC, electrical stimulation of the cavernous nerve (CNS), and VED therapy. Measurements: At the end of a 4-wk period, CNS was used to assess EF by maximum intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio and duration (area under the curve [AUC]). For the structural analyses, whole rat penis was harvested. Terminal deoxynucleotidyl transferase biotin-dutp nick end labeling assay was used for the assessment of apoptotic indices (AI). Immunohistochemistry was performed for endothelial nitric oxide synthase (enos), a-smooth muscle actin (ASMA), transforming growth factor beta 1 (TGF-b1), and hypoxia inducible factor-1a (HIF-1a). Staining for Masson s trichrome was utilized to calculate the smooth muscle/collagen ratios. Results and limitations: EF was improved with VED therapy measured by ICP/MAP ratios and AUC. VED therapy reduced HIF-1a expression and AI significantly compared with control. Animals exposed to VED therapy had decreased TGF-b1 expression, increased smooth muscle/ collagen ratios, and preserved ASMA and enos expression. Conclusions: To our knowledge, this is the first scientific study to suggest that VED therapy in the BCNC rat model preserves EF through antihypoxic, antiapoptotic, and antifibrotic mechanisms. Published by Elsevier B.V. on behalf of European Association of Urology. * Corresponding author. Department of Urology, University of Texas Medical School, M.D. Anderson Cancer Center, 6431 Fannin Street, Ste , Houston, TX 77030, USA. Tel ; Fax: address: run.wang@uth.tmc.edu (R. Wang) /$ see back matter Published by Elsevier B.V. on behalf of European Association of Urology. doi: /j.eururo
2 774 EUROPEAN UROLOGY 58 (2010) Introduction Prostate cancer is the most common solid-organ cancer in men and one of the leading causes of death [1]. With early detection and radical prostatectomy (RP), the 15-yr overall, actuarial, cancer-specific survival rate has reached 90% [2,3]. Unfortunately, RP is associated with at least transient erectile dysfunction (ED), with ED rates ranging from 20% to 90% depending upon the study reviewed [1 4]. It is postulated that the development of post-rp ED is due predominantly to a combination of temporary cavernous nerve (CN) injury and damage to the erectile tissue secondary to neuropraxia and potentially the absence of cavernosal oxygenation [5]. To improve the patients quality of life and the acceptance of the RP, penile rehabilitation (PR) after RP is now widely applied in clinical practice [3]. Currently, PR methods include the use of phosphodiesterase type 5 inhibitors, intracavernosal injection/intraurethral suppository, the vacuum erectile device (VED), or combination therapy [3]. Vacuum therapy utilizes negative pressure to distend the corporal sinusoids and to increase blood inflow to the penis. Clinical data indicated that vacuum therapy is the only PR method that may preserve penile length, improves patient and partner sexual satisfaction, and allows earlier return of spontaneous erection [3,6]. However, its unknown mechanism hampered doctors recommendation and patients compliance [3]. To explore the underlying mechanism of VED therapy after RP, we applied our newly designed rat-specific VED [7] to the bilateral cavernous nerve crush (BCNC) rat model. The BCNC rat model is believed to simulate the neural injury that occurs during RP and is designed to study the mechanisms of ED after RP as well as to explore EDminimizing strategies [8]. Fig. 1 Erectile function assessment by intracavernous pressure tracing under cavernous nerve stimulation. Representative intracavernous pressure (ICP) tracing in response to cavernous nerve stimulation (CNS) (7.5 V for 60 s) at week 4 after (A) sham operation, (B) bilateral cavernous nerve crush (BCNC), and (C) BCNC plus VED therapy; (D) the voltage dependent erectile response to CNS represented by the ratio of maximum ICP/mean arterial pressure (MAP); (E) area under the erectile curve (AUC, mmhgs). Significant differences were found in ICP/MAP and AUC only at 5.0 V and 7.5 V, between BCNC group and BCNC plus VED group (both p < 0.05).
3 EUROPEAN UROLOGY 58 (2010) Methods 2.1. Animal grouping, bilateral cavernous nerve crush, and vacuum erectile device therapy Fifteen Sprague-Dawley rats (Harlan Laboratories, Houston, TX, USA), initially weighing g, were randomly and equally divided into three groups: (1) sham (CN expose surgery only, no nerve crushing, no VED therapy); (2) control (BCNC procedure, no VED therapy); and (3) treatment group (BCNC procedure; VED therapy beginning at 2 wk after BCNC surgery, 5 min twice daily with a 1 min interval, Monday Friday, total VED treatment time: 4 wk). The BCNC procedure was reported previously [8]. The animals were cared for and housed under strict guidelines established by the University Texas Health Science Center at Houston Institutional Animal Care and Use Committee Statistical analysis The mean averages were built for maximum ICP/mean arterial pressure (MAP) ratios, area under the ICP curves (AUCs), smooth muscle/collagen ratios, and AIs for each group, and reported as the mean plus or minus standard error of the mean. Individual pairwise comparison between groups was analyzed with independent two-tailed t tests. Results were considered statistically significant if p < Results 3.1. Erectile function assessment EF was assessed by tracing the ICP under the CNS, and in the meantime [(Fig._2)TD$FIG] measuring the AP. The typical ICP tracings of 2.2. Functional analysis and tissue harvesting At the end of 4 wk of treatment, the animals were recorded for intracavernosal pressure (ICP) and the corresponding arterial pressure (AP) with CN stimulation (CNS) under pentobarbital anesthesia [9]. At the completion of functional analysis, the penis was excised for histopathology Histopathology Following routine dehydration and paraffin embedding, tissue samples were cut into 5-mm sections from the midshaft of the penis mounted on slides and dried. Then the tissue slides, showing the cross-section of the corpora cavernosa (CC), were deparaffinized and rehydrated for following studies Masson s trichrome To evaluate the smooth muscle/collagen ratio, slides were stained for Masson s trichrome (MT) according to standard protocol, which was reported previously [9]. Smooth muscle/collagen ratios were analyzed using ImageJ v.1.43n (US National Institutes of Health, Bethesda, MD, USA). One slide per animal (slides are from the midshaft of penis about the same level) was used to calculate the ratio of the red-staining smooth muscle to the blue-staining collagen content in the cross-section of the CC building the group average. The ratios were compared among the three groups Immunohistochemistry The corporal tissue of the rat penis was immunohistochemically stained for endothelial nitric oxide synthase (enos), alpha smooth muscle actin (ASMA), hypoxia-inducible factor 1a (HIF-1a), and transforming growth factor beta 1 (TGF-b1) following the manufacturer s instructions. The antibodies of enos and ASMA were from Abcam Inc. (Cambridge, MA, USA); the antibodies of HIF-1a and TGF-b1 are from R&D Systems (Minneapolis, MN, USA). The results of the tissue sample staining were compared among the three groups: sham, control, and treatment Apoptosis assessment Terminal deoxynucleotidyl transferase biotin-dutp nick end labeling (TUNEL) assay was performed following the manufacturer s instructions (Roche Applied Science, Mannheim, Germany) to assess apoptosis. Two slides from two different animals per group were randomly selected. Each slide was analyzed by counting cells in five nonoverlapping zones of the entire mounted CC section at 400 magnification. The ratio of the percentage of cells stained with the TUNEL method to the total number of cells stained with 4 0,6 diamidino-2-phenylindole was recorded and reported as the apoptotic index (AI). Fig. 2 Vacuum erectile device (VED) therapy partially reversed bilateral cavernous nerve crush (BCNC)-induced HIF-1a expression. Compared with the sham operation group (A), immunohistochemistry demonstrated that BCNC (B) dramatically increased HIF-1a expression in penile sinusoid. VED treatment (C) partially reversed HIF-1a expression in penile sinusoid compared to nerve crush only (B).
4 776 EUROPEAN UROLOGY 58 (2010) sham, BCNC, and BCNC with daily VED therapy are shown in Fig. 1A C. The analysis is presented in ICP/MAP ratios and AUCs (Fig. 1D and E). The ICP/MAP ratios in the sham group were at 5.0 V and at 7.5 V, which were significantly higher compared with all other groups ( p < 0.01). BCNC dramatically decreased the ICP/MAP ratios: at 5 V and at 7.5 V. The daily VED therapy in BCNC rats preserved the ICP/MAP ratios: at 5 V and at 7.5 V, which is significant compared with the BCNC control ( p < 0.01). The AUCs demonstrated the same trend as the ICP/MAP ratios in the three groups Apoptosis analysis At 6 wk after BCNC, the BCNC plus VED group demonstrated a significant reduction in apoptosis within the corporal tissue (Fig. 3C) with a mean AI of 21 4%, compared with an AI of 61 5% in the BCNC group ( p < 0.001) (Fig. 3B and D). For comparison, the AI value in the sham group was 10 6% (Fig. 3A and D), which was significantly lower compared with BCNC ( p < 0.001) or BCNC plus VED ( p < 0.05) (Fig. 3B, C and D) Penile structure molecular analysis 3.2. Hypoxia assessment On IHC, the staining intensity of HIF-1a in the BCNC group (Fig. 2B) was dramatically higher than the sham group (Fig. 2A). In the BCNC plus VED group, the HIF-1a staining (Fig. 2C) was significantly reduced compared with the BCNC group, although still higher than the sham group. [(Fig._3)TD$FIG] Endothelial nitric oxide synthase and alpha smooth muscle actin immunohistochemistry Immunohistochemical staining of enos in the BCNC group (Fig. 4B) was dramatically reduced compared with the sham group (Fig. 4A). The enos staining in the BCNC plus VED group (Fig. 4C) was significantly improved compared with BCNC group; however, it was still lower than sham group. ASMA expression showed the same trend (Fig. 4D F). Fig. 3 Vacuum erectile device (VED) therapy decreased apoptosis. Compared with the sham operation group (A), bilateral cavernous nerve crush (BCNC) (B) dramatically increased apoptosis in penile sinusoid (brown-stained nuclei; magnified T400), VED treatment (C) significantly reduced BCNC-induced apoptosis in penile sinusoid compared with nerve crush only (B). Apoptotic indices (AI) is presented as ratio of apoptotic nuclei (brown-stained nuclei) to total number of nuclei counted. A significantly reduced AI percentage for VED therapy was found (D) compared to BCNC only ( p < 0.01), although still higher than the sham group ( p < 0.05).
5 EUROPEAN UROLOGY 58 (2010) TGF-b1 immunohistochemistry Immunohistochemical staining of TGF-b1 in the BCNC group (Fig. 4H) was dramatically increased compared with the sham group (Fig. 4G). The BCNC plus VED treatment was partially reversed (Fig. 4I), although it was still higher than sham group Smooth muscle/collagen ratios The staining with MT in the sham group revealed smooth muscle/collagen ratios of %, the highest smooth muscle/collagen ratio of all animal groups (Fig. 5D). This result was significantly higher compared with % for the BCNC group (Fig. 5A, B and D) (p < 0.05) and remained superior to the BCNC plus VED group as well (Fig. 5C and D) (p < 0.05). The BCNC plus VED group reached %, which was significantly greater than the BCNC group (p < 0.05), and displayed a clear trend toward improvement compared with the BCNC group ( %; p < 0.05), but not the sham group. 4. Discussion The rat BCNC as an RP-induced ED model has been widely accepted in PR research. It was first reported by Quinlan et al in 1989 and documented in prior experiments using this animal model in the assessment of functional and structural changes of erectile tissue under various interventions [8]. Our study showed a dramatic reduction in ICP/ MAP ratios and AUC in animals after BCNC when compared with the sham group. The reduced ICP/MAP ratios and AUC were associated with significantly reduced smooth muscle/ collagen ratios and highly increased apoptosis rates and TGF-b1 expression in the control group compared with sham animals. Previous reports in rat CN transection models have demonstrated increased apoptosis within the corpora. Klein et al reported that apoptosis of penile erectile tissue occurs after denervation of the rat penis [10]. User et al similarly confirmed increased apoptosis, especially subjacent to the tunica albuginea involving smooth [(Fig._4)TD$FIG] Fig. 4 Vacuum erectile device (VED) therapy preserves penile endothelial nitric oxide synthase (enos) and alpha smooth muscle action (ASMA) expression, and ameliorated transforming growth factor beta 1 (TGF-b1) expression. Penile tissue was harvested and processed after functional measurement. Immunohistochemistry was used for the expression of enos, ASMA, and TGF-b1 in penile sinusoid. Bilateral cavernous nerve crush (BCNC) dramatically reduced the expression of enos (B) and ASMA (E) compared to the sham group (A and D), respectively. VED therapy significantly preserved the expression of (C) enos ((BCNC plus VED therapy) and (F) ASMA (BCNC plus VED therapy) compared to (B) and (E), respectively. Compared to sham operation (G), BCNC (H) dramatically increased TGF-b1 expression in penile sinusoid. VED treatment (I) partially reversed TGF-b1 expression in penile sinusoid compared to nerve crush only (H).
6 778 [(Fig._5)TD$FIG] EUROPEAN UROLOGY 58 (2010) Fig. 5 Vacuum erectile device (VED) therapy partially preserves penile smooth muscle/collagen ratios. Masson s trichrome staining was used for penile smooth muscle/collagen ratios. Compared with sham operation (A), bilateral cavernous nerve crush (BCNC) (B) dramatically decreased penile smooth muscle/collagen ratio. VED treatment (C) significantly increased penile smooth muscle/collagen ratio compared to nerve crush only (D). muscle cells [11]. They hypothesized that damage to the subtunical smooth muscle cells prevents compression of the perforating subtunical veins, resulting in veno-occlusive dysfunction and subsequent failure of recovery of EF. The daily use of VED therapy commencing 2 wk after BCNC improved ICP/MAP ratios and AUCs compared with the control group at 4 wk. The 4-wk time point was chosen as this is generally believed to represent the 2-yr time point in the human [9]. After RP, the period of neuropraxia may last as long as 24 mo [12] and we generally expect EF recovery by this time point if ideal nerve-sparing RP was performed. The regimen we use is exactly what is used in the VED protocol in a clinical setting [13]. VED regimen in men after RP has been documented in preserving EF and penile length and size. Raina reported 109 patients with nerve-sparing RP who were placed into early VED daily usage (group 1, n = 74) versus no erectogenic aid (group 2, n = 35) with 9-mo follow-up, and showed early use of VED facilitates early sexual intercourse and early patient/spousal sexual satisfaction [14]. Kohler et al randomized 28 patients into early VED therapy or control (control group accepted VED therapy 6 mo later) with 1-yr observation and concluded that early VED use after RP improves sexual function [15]. Our experimental findings confirmed the clinical outcome of VED application. EF becomes impaired immediately following RP secondary to damage to CN during surgery, resulting in neuropraxia [16]. A reduction in arterial inflow has also been reported due to ligation of the accessory internal pudendal arteries during RP [17,18]. The combination of nerve damage with decreased arterial inflow may cause penile tissue hypoxia, leading to apoptosis and collagen deposition, which ultimately results in venous leak. This, in turn, has been linked to the pathophysiology of ED after RP [10,19 27]. As our data demonstrated, BCNC induced HIF-1a expression. With VED therapy, the HIF-1a expression was partially reversed. Although we did not have data on oxygen level in the rat penis after VED application due to technique limitation, we do see rat penis engorgement with pink color [7], and we see similar pressure with our device compared with the human one [7]. The latter demonstrated that mean O 2 saturation of corporal blood
7 EUROPEAN UROLOGY 58 (2010) immediately after VED-induced erection was 79.2%, which translates to 58% arterial and 42% venous flows, respectively [28]. Therefore, we believe there is increased oxygenation of the penis when VED is applied. Daily VED-induced tissue oxygenation overcomes RP-induced hypoxia in a consistently flaccid penis, which is lack of spontaneous erection and nocturnal tumescence. Nocturnal erections have been implicated in preserving normal erectile function by providing regular tissue oxygenation [29]. The partial oxygenation of VED imitates the nocturnal erection and provides the penis with regular partial oxygenation. Our data showed that with regular partial oxygenation, the apoptosis of penile tissue was partially reversed. With intermittent interruption of penile hypoxia with VED application, progressive cavernosal fibrosis produced by persistent penile hypoxia was halted. It has been shown that the progressive cavernosal fibrosis induces venoocclusive dysfunction [30]. Our data also showed that VED therapy decreased TGF-b1 expression, and increased enos and ASMA, and smooth muscle/collagen ratios. Therefore, the VED regimen preserved penile EF via antihypoxic, antiapoptotic, and antifibrotic mechanisms to preserve the veno-occlusive mechanism. The oxygen level of the VED-applied penis is a key issue; however, it could not be measured in our experiments because of the technique challenge. In addition to the tissue oxygenation mechanism, the beneficial effects of VED therapy after RP may be mediated by stretch forces, other nutrient factors, and neuroregeneration, although we did not address it in our experiments. We also did not optimize the VED regimen, such as applying optimal vacuum pressure (highest oxygen level in the penis without intolerable side effects), application duration and frequency, and follow-up time. Ongoing experiments are needed to explore these issues. 5. Conclusions We have demonstrated that VED therapy in the BCNC model preserves EF and acts by preserving smooth muscle content and endothelial integrity via antihypoxia, antiapoptosis, and antifibrosis mechanisms. The daily VED therapy effect on EF recovery is consistent with patients results and without significant side effects. This scientific evidence, although from an animal model, may motivate physicians recommendations and improve patients compliance in the clinical setting. Author contributions: Run Wang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Yuan, Lin, Wang. Acquisition of data: Yuan, Lin, Li, Zhang, Luo, Berardinelli. Analysis and interpretation of data: Yuan, Lin, Wang. Drafting of the manuscript: Yuan. Critical revision of the manuscript for important intellectual content: Dai, Wang. Statistical analysis: Yuan, Lin, Wang. Obtaining funding: Yuan, Wang. Administrative, technical, or material support: Yuan, Lin, Li, Zhang, Luo, Dai, Wang. Supervision: Wang. Other (specify): None. Financial disclosures: I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/ affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: This study was funded in part by unlimited education/research grants from Augusta Medical System and Timm Medical Technologies, Inc. (Yuan, Wang). Acknowledgements: The authors would like to thank Ms. Dorothy Stradinger for her editorial assistance. References [1] Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer Statistics, CA Cancer J Clin 2009; 59: [2] Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am 2001;28: [3] Wang R. Penile rehabilitation after radical prostatectomy: where do we stand and where are we going? J Sex Med 2007;4: [4] Litwin MS, Hays RD, Fink A, et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA 1995;273: [5] Levine LA. Erectile dysfunction following treatment of prostate cancer: new insights and therapeutic options. J Mens Health Gen 2004; 1: [6] Hinh P, Wang R. Overview of contemporary penile rehabilitation therapies. Adv Urol 2008; [7] Yuan JH, Westney OL, Wang R. Design and application of a new ratspecific vacuum erectile device for penile rehabilitation research. J Sex Med 2009;6: [8] Mullerad M, Donohue JF, Li PS, Scardino PT, Mulhall JP. Functional sequelae of cavernous nerve injury in the rat: is there model dependency. J Sex Med 2006;3: [9] Mulhall JP, Müller A, Donohue JF, et al. The functional and structural consequences of cavernous nerve injury are ameliorated by sildenafil citrate. J Sex Med 2008;5: [10] Klein LT, Miller MI, Buttyan R, et al. Apoptosis in the rat penis after penile denervation. J Urol 1997;158: [11] User HM, Hairston JH, Zelner DJ, McKenna KE, McVary KT. Penile weight and cell subtype specific changes in post-radical prostatectomy model of erectile dysfunction. J Urol 2003;169: [12] McCullough AR. Prevention and management of erectile dysfunction following radical prostatectomy. Urol Clin North Am 2001; 28: [13] Dalkin BL, Christopher BA. Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device. Int J Impot Res 2007;19: [14] Raina R, Agarwal A, Ausmundson S, et al. Early use of vacuum constriction device following radical prostatectomy facilitates early sexual activity and potentially earlier return of erectile function. Int J Impot Res 2006;18: [15] Köhler TS, Pedro R, Hendlin K, et al. A pilot study on the early use of the vacuum erection device after radical retropubic prostatectomy. BJU Int 2007;100:
8 780 EUROPEAN UROLOGY 58 (2010) [16] Burnett AL. Rationale for cavernous nerve restorative therapy to preserve erectile function after radical prostatectomy: results from CaPSURE. J Urol 2004;171: [17] Mulhall JP, Graydon RJ. The hemodynamics of erectile dysfunction following nerve-sparing radical retropubic prostatectomy. Int J Impot Res 1996;8:91 4. [18] Mulhall JP, Slovick R, Hotaling J, et al. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J Urol 2002;167: [19] Saenz de Tejada I, Morouluan P, Tessier J, Kim JJ, Goldstein I, Frohrib D. Trabecular smooth muscle modulates the capacitor function of the penis. Studies on a rabbit model. Am J Physiol 1991;260: H [20] Moreland RB, Traish A, McMillin MA, Smith B, Goldstein I, Saenz de Tejada I. PGE1 suppresses the induction of collagen synthesis by transforming growth factor-beta 1 in human corpus cavernosum smooth muscle. J Urol 1995;153: [21] Moreland RB, Watkins MT, Nehra A, et al. Oxygen tension modulates transforming growth factor-b1 expression and PGE production in human corpus cavernosum smooth muscle cells. Mol Urol 1998;2:41 7. [22] Moreland RB, Gupta S, Goldstein I, Traish A. Cyclic AMP modulates TGF-beta-1 induced fibrillar collagen synthesis in cultured human corpus cavernosum smooth muscle cells. Int J Impot Res 1998;10: [23] Moreland RB. Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the Society for the Study of Impotence. Int J Impot Res 1998;10: [24] Moreland RB, Albadawi H, Bratton C, et al. O 2 -dependent prostanoid synthesis activates functional PGE receptors on corpus cavernosum smooth muscle. Am J Physiol Heart Circ Physiol 2001;281:H [25] Leungwattanakij S, Bivalacqua TJ, Usta MF, et al. Cavernous neurotomy causes hypoxia and fibrosis in rat corpus cavernosum. J Androl 2003;24: [26] Gontero P, Kirby R. Proerectile pharmacological prophylaxis following nerve-sparing radical prostatectomy. Prostate Cancer Prostatic Dis 2004;7: [27] McVary KT, Podlasek CA, Wood D, McKenna KE. Apoptotic pathways are employed in neuropathic and diabetic models of erectile dysfunction. J Urol 2006; 175(Suppl):387. Abstract [28] Bosshardt RJ, Farwerk R, Sikora R, Sohn M, Jakse G. Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device. Br J Urol 1995;75: [29] Kim N, Vardi Y, Padma-Nathan H, Daley J, Goldstein I, Saenz de Tejada I. Oxygentensionregulates the nitric oxidepathway. Physiological role in penile erection. J Clin Invest 1993;91: [30] Ferrini MG, Kovanecz I, Sanchez S, et al. Fibrosis and loss of smooth muscle in the corpora cavernosa precede corporal veno-occlusive dysfunction (CVOD) induced by experimental cavernosal nerve damage in the rat. J Sex Med 2009;6:
MANAGEMENT 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 informationReview Article Overview of Contemporary Penile Rehabilitation Therapies
Hindawi Publishing Corporation Advances in Urology Volume 2008, Article ID 481218, 6 pages doi:10.1155/2008/481218 Review Article Overview of Contemporary Penile Rehabilitation Therapies Peter Hinh and
More informationPenile Rehabilitation After Radical Prostatectomy: Important Therapy or Wishful Thinking?
MANAGEMENT UPDATE Penile Rehabilitation After Radical Prostatectomy: Important Therapy or Wishful Thinking? Joseph E. Dall Era, MD, Jesse N. Mills, MD, Hari K. Koul, MD, Randall B. Meacham, MD Division
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 informationGerald Brock Professor of Surgery University of Western Ontario
Treatment Induced Erectile Dysfunction Gerald Brock Professor of Surgery University of Western Ontario 1 1 2 Should you believe in Rehab? 3 3 Should you believe in Rehab? Avoidance Education related to
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 informationPenile Rehabilitation after Radical Prostatectomy
Penile Rehabilitation after Radical Prostatectomy The PRO Position John P. Mulhall MD MSc FECSM FACS Director, Sexual & Reproductive Medicine Program Urology Service Memorial Sloan Kettering Cancer Center
More informationSexual Dysfunction Caused by Cancer Treatments Issues in Men. Dr Christopher Love
Sexual Dysfunction Caused by Cancer Treatments Issues in Men Dr Christopher Love Urological and Prosthetic Surgeon Bayside Urology 66 Balcombe Rd., Mentone Men s Health Melbourne Level M 233 Collins St.,
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 informationRecovery of erectile function after nerve-sparing radical prostatectomy: improvement with nightly low-dose sildenafil
Sexual Medicine RECOVERY OF ERECTILE FUNCTION AFTER NERVE-SPARING RP WITH NIGHTLY LOW-DOSE SILDENAFIL BANNOWSKY et al. Associate Editor Michael G. Wyllie Editorial Board Ian Eardley, UK Jean Fourcroy,
More informationVacuum Erectile Device for Penile Rehabilitation
Review Article Vacuum Erectile Device for Penile Rehabilitation Haocheng Lin 1, Grace Wang 1, Run Wang 1,2 1 Division of Urology, University of Texas, Medical School at Houston, 2 Department of Urology,
More informationPreserved Postoperative Penile Size Correlates Well with Maintained Erectile Function after Bilateral Nerve-Sparing Radical Retropubic Prostatectomy
european urology 52 (2007) 702 707 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer Preserved Postoperative Penile Size Correlates Well with Maintained Erectile
More informationPenile rehabilitation after radical prostatectomy: patients attitude and feasibility in China
Original Article Penile rehabilitation after radical prostatectomy: patients attitude and feasibility in China Yi-Jun Shen 1,2, Jian Li 1,2, Ding-Wei Ye 1,2 1 Department of Urology, Fudan University Shanghai
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 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 informationIs There a Rationale for Penile Rehabilitation Following Radical Prostatectomy?
528237JMHXXX10.1177/1557988314528237American Journal of Men s HealthBarazani et al. research-article2014 Article Is There a Rationale for Penile Rehabilitation Following Radical Prostatectomy? American
More informationProspective analysis of penile length changes after radical prostatectomy
Prospective analysis of penile length changes after radical prostatectomy Boback M. Berookhim, Christian J. Nelson*, Brian Kunzel, John P. Mulhall and Joseph B. Narus Male Sexual and Reproductive Medicine
More informationMedicines Q&As. Date prepared: November 2016
Q&A 128.3 What is the rationale and evidence for the use of phosphodiesterase-5 inhibitors as supportive therapy to rehabilitate Erectile Function after nerve sparing radical prostatectomy? Summary Prepared
More informationA Proposed Study of Hyperbaric Oxygen Therapy Following Radical Prostatectomy: Effects on Erectile Dysfunction
A Proposed Study of Hyperbaric Oxygen Therapy Following Radical Prostatectomy: Effects on Erectile Dysfunction Anthony J. Bella MD, FRCSC Division of Urology, Department of Surgery and Department of Neuroscience
More informationStrategies for preventing erectile dysfunction induced by radical prostatectomy
Contemporary Urology Archive November 2002 Strategies for preventing erectile dysfunction induced by radical prostatectomy By Edward D. Kim, MD Despite refinements in technique, erectile dysfunction remains
More informationPenile rehabilitation following treatment for prostate cancer: an analysis of the current state of the art
REVIEW Penile rehabilitation following treatment for prostate cancer: an analysis of the current state of the art Tariq Al Shaiji, MD ChB; Trustin Domes, MD; Gerald Brock, MD See related article on page
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 informationEffect of chronic hypoxia on penile erectile function in rats
Effect of chronic hypoxia on penile erectile function in rats D.P. Yu 1, X.H. Liu 2 and A.Y. Wei 3 1 Department of Urology, The First People s Hospital of Jining City in Shandong Province, Jining, Shandong,
More informationSponsored 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 informationresponse to MUSE was 70% in the office setting, compared to a 57% success rate when used at home.
Original Article EARLY USE OF MUSE AFTER RP RAINA et al. The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful
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 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 informationSchemi terapeutici complessi per la gestione della disfunzione erettile post trattamento del carcinoma prostatico: non solo PDE5i
Schemi terapeutici complessi per la gestione della disfunzione erettile post trattamento del carcinoma prostatico: non solo PDE5i M. Lazzeri MD-PhD Department of Urology Ist. Clinico Humanitas IRCCS Schema
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 informationIs This Really a Fair Debate? 2013 MFMER slide-2
Sex Rehab after Radical Prostatectomy: Is it Really Justified? Con Position Landon Trost, MD Assistant Professor of Urology Mayo Clinic, Rochester, MN ISSM 16 th World Meeting on Sexual Medicine October
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 informationReview Article Preclinical Evidence for the Benefits of Penile Rehabilitation Therapy following Nerve-Sparing Radical Prostatectomy
Advances in Urology Volume 2008, Article ID 594868, 10 pages doi:10.1155/2008/594868 Review Article Preclinical Evidence for the Benefits of Penile Rehabilitation Therapy following Nerve-Sparing Radical
More informationRehabilitation of Erectile Function. Dr Chris G McMahon Australian Centre for Sexual Health St. Leonards, Sydney
Rehabilitation of Erectile Function Dr Chris G McMahon Australian Centre for Sexual Health St. Leonards, Sydney Sexual Dysfunction Post RP Erectile Dysfunction Anejaculation Anorgasmia Dysorgasmia (painful
More informationPenile rehabilitation following prostate cancer treatment: review of current literature
(2015) 17, 916 922 2015 AJA, SIMM & SJTU. All rights reserved 1008-682X www.asiaandro.com; www.ajandrology.com Prostate Cancer Open Access INVITED REVIEW Penile rehabilitation following prostate cancer
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 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 informationIntroduction. Original Article: Clinical Investigation. Lu Sun, 1,3 Fang-Li Peng, 2 Zhi-Ling Yu, 1 Cai-Ling Liu 1 and Jun Chen 3.
bs_bs_banner International Journal of Urology (2014) 21, 1263 1267 doi: 10.1111/iju.12564 Original Article: Clinical Investigation Combined sildenafil with vacuum erection device therapy in the management
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 informationGUIDELINES ON PRIAPISM
GUIDELINES ON PRIAPISM (Text update March 2015) A. Salonia, I. Eardley, F. Giuliano, I. Moncada, K. Hatzimouratidis Eur Urol 2014 Feb;65(2):480-9 Introduction Priapism is a pathological condition representing
More informationERECTILE DYSFUNCTION TREATMENTS
ERECTILE DYSFUNCTION TREATMENTS Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage
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 informationIntroduction. RRaina 1,2, A Agarwal 1, S Ausmundson 1,MLakin 1,KCNandipati 1, DK Montague 1, D Mansour 2 and CD Zippe 1
(2006) 18, 77 81 & 2006 Nature Publishing Group All rights reserved 0955-9930/06 $30.00 www.nature.com/ijir ORIGINAL ARTICLE Early use of vacuum constriction device following radical prostatectomy facilitates
More informationRadical prostatectomy (RP) is a common treatment
1 A Pilot Study to Determine Penile Oxygen Saturation Before and After Vacuum Therapy in Patients with Erectile Dysfunction After Radical Prostatectomy R. Charles Welliver Jr, MD, Clay Mechlin, MD, Brianne
More informationTopical alprostadil (Vitaros ) in the treatment of erectile dysfunction after non-nerve-sparing robotassisted radical prostatectomy
UJ ISSN 0391-5603 Urologia 2017 ; 00 ( 00): 000=000 DOI: 10.5301/uj.5000267 ORIGINAL RESEARCH ARTICLE Topical alprostadil (Vitaros ) in the treatment of erectile dysfunction after non-nerve-sparing robotassisted
More informationErectile Dysfunction and the Prostate Cancer Patient
BAUN & Prostate cancer UK Erectile Dysfunction Study Day Erectile Dysfunction and the Prostate Cancer Patient Lorraine Montgomery Specialist Nurse Practitioner Urology Queen Elizabeth Hospital Gateshead
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 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 informationTadalafil Rehabilitation Therapy Preserves Penile Size After Bilateral Nerve Sparing Radical Retropubic Prostatectomy
Clinical Urology International Braz J Urol Vol 37 (3): 336-346, May - June, 2011 doi: 10.1590/S1677-55382011000300007 Tadalafil Rehabilitation Therapy Preserves Penile Size After Bilateral Nerve Sparing
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 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 informationBJUI. Irbesartan promotes erection recovery after nerve-sparing radical retropubic prostatectomy: a retrospective long-term analysis
BJUI Irbesartan promotes erection recovery after nerve-sparing radical retropubic prostatectomy: a retrospective long-term analysis Robert L. Segal, Trinity J. Bivalacqua and Arthur L. Burnett Department
More informationPriapism. Medical Student case-based learning
Priapism Medical Student case-based learning A 45 year old man presents with an erection lasting over 5 hours. What are the two major subtypes of priapism? Types of Priapism Ischemic veno-occlusive or
More informationPhosphodiesterase Type 5 Inhibitors Quantity Limit Program Summary
Phosphodiesterase Type 5 Inhibitors Quantity Limit Program Summary FDA APPROVED INDICATIONS AND DOSAGE 1-4,23 Agent FDA Approved Dosage and Administration Indication Cialis (tadalafil) (ED) ED; As needed:
More informationIs there a role of radial rigidity in the evaluation of erectile dysfunction?
(2001) 13, 200±204 ß 2001 Nature Publishing Group All rights reserved 0955-9930/01 $15.00 www.nature.com/ijir Is there a role of radial rigidity in the evaluation of erectile dysfunction? JH Ku 1 *, YS
More informationBEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE. Bulletin 169: Daily Tadalafil (Cialis ) for penile rehabilitation following radical prostactectomy
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE September 2012 Review date: September 2014 Bulletin 169: Daily Tadalafil (Cialis ) for penile rehabilitation following radical prostactectomy JPC Recommendation:
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 informationTITLE: PHARMACOLOGICAL PREVENTION AND REVERSION OF ERECTILE DYSFUNCTION AFTER RADICAL PROSTATECTOMY, BY MODULATION OF NITRIC OXIDE/cGMP PATHWAYS
AD Award Number: W81XWH-07-1-0129 TITLE: PHARMACOLOGICAL PREVENTION AND REVERSION OF ERECTILE DYSFUNCTION AFTER RADICAL PROSTATECTOMY, BY MODULATION OF NITRIC OXIDE/cGMP PATHWAYS PRINCIPAL INVESTIGATOR:
More informationA Numerical Study of the Relationship Between Erectile Pressure and. Shear Wave Speed of Corpus Cavernosa in Ultrasound Vibro-elastography
A Numerical Study of the Relationship Between Erectile Pressure and Shear Wave Speed of Corpus Cavernosa in Ultrasound Vibro-elastography Boran Zhou 1, Landon W. Trost 2, Xiaoming Zhang 1 1 Department
More informationCurrent rehabilitation strategy: clinical evidence for erection recovery after radical prostatectomy
Review Article Current rehabilitation strategy: clinical evidence for erection recovery after radical prostatectomy Arthur L. Burnett Department of Urology, Johns Hopkins Medical Institutions, Baltimore,
More informationSexual Issues following Prostate Cancer Treatments. Seacourses December 30, 2017 January 6, 2018 Dr. Stacy Elliott
Sexual Issues following Prostate Cancer Treatments Seacourses December 30, 2017 January 6, 2018 Dr. Stacy Elliott Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be
More informationEUROPEAN UROLOGY 62 (2012)
EUROPEAN UROLOGY 62 (2012) 720 727 available at www.sciencedirect.com journal homepage: www.europeanurology.com Sexual Medicine Both Immediate and Delayed Intracavernous Injection of Autologous Adipose-derived
More informationIs there a role for extracorporeal shock wave therapy for erectile dysfunction unresponsive to phosphodiesterase type 5 inhibitors?
DOI 10.1007/s00345-016-1899-y LETTER TO THE EDITOR Is there a role for extracorporeal shock wave therapy for erectile dysfunction unresponsive to phosphodiesterase type 5 inhibitors? Zi jun Zou 1 Zhi hong
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 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 informationImmediate penile prosthesis insertion after failed T shunt and snake maneuver in patient with prolonged priapism
Immediate penile prosthesis insertion after failed T shunt and snake maneuver in patient with prolonged priapism Evangelos Zacharakis PhD, FRCS, FECSM, FEAA Consultant Urological Surgeon St Peter s Anrology
More informationPotency after unilateral nerve sparing surgery: a report on functional and oncological results of unilateral nerve sparing surgery
Potency after unilateral nerve sparing surgery: a report on functional and oncological results of unilateral nerve sparing surgery F Van der Aa 1, S Joniau 1, D De Ridder 1 & H Van Poppel 1 * 1 Department
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 informationAcceptance of and Discontinuation Rate from Erectile Dysfunction Oral Treatment in Patients following Bilateral Nerve-Sparing Radical Prostatectomy
european urology 53 (2008) 564 570 available at www.sciencedirect.com journal homepage: www.europeanurology.com Prostate Cancer Acceptance of and Discontinuation Rate from Erectile Dysfunction Oral Treatment
More information13-Oct-15 ERECTILE DYSFUNCTION. Urology Subdepartement dr. Mintohardjo Naval Hospital dr. Isdiyanto Septiadi, Sp.U
ERECTILE DYSFUNCTION Urology Subdepartement dr. Mintohardjo Naval Hospital dr. Isdiyanto Septiadi, Sp.U 1 2 3 So what is impotence or erectile dysfunction..? The persistent inability to achieve or maintain
More informationErectile Dysfunction; It s Not Just About Sex
Erectile Dysfunction; It s Not Just About Sex Disclosures Conflict of interest: I am not paid by Boston Scientific but once in a while they buy me a tasty meal. I do routinely use their products without
More informationD Udelson, A Nehra, DG Hatzichristou, K Azadzoi, RB Moreland, RJ Krane, I Saenz de Tejada and I Goldstein
International Journal of Impotence Research (1998) 10, 89±99 ß 1998 Stockton Press All rights reserved 0955-9930/98 $12.00 http://www.stockton-press.co.uk/ijir Engineering analysis of penile hemodynamic
More informationProstate Cancer and Sexual Function
pissn: 2287-428 / eissn: 2287-469 World J Mens Health 2 August 3(2): 99-17 http://dx.doi.org/1.5534/wjmh.2.3.2.99 Review Article Prostate Cancer and Sexual Function Jae Saog Hyun Department of Urology,
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 informationBiomechanics. and Functional Anatomy. of Human Male Genitalia. For designers and creators of biomimetic androids, dolls and robots
Biomechanics and Functional Anatomy of Human Male Genitalia For designers and creators of biomimetic androids, dolls and robots The Penis The shaft or body of the penis is formed principally by a fused
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 informationA step by step tutorial on PD surgery: Incision and Grafting
A step by step tutorial on PD surgery: Incision and Grafting Wayne J.G. Hellstrom, MD, FACS President Elect, International Society of Sexual Medicine Professor of Urology Chief, Section of Andrology Tulane
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 informationManagement of Post-Prostatectomy Urinary Incontinence and Sexual Dysfunction
Management of Post-Prostatectomy Urinary Incontinence and Sexual Dysfunction Robert C. Eyre, MD, FACS Associate Clinical Professor of Surgery (Urology) Harvard Medical School Post-prostatectomy Incontinence
More informationCURRICULUM VITAE Robert Brannigan, M.D. Revised : 04/01
CURRICULUM VITAE Robert Brannigan, M.D. Revised : 04/01 CURRICULUM VITAE Robert Brannigan, M.D. Address The Center for Human Reproduction 60 East Delaware Place The Annex to the 900 North Michigan Building
More informationEffect of penile rehabilitation on erectile function after bilateral nerve-sparing robotic-assisted radical prostatectomy
original article Journal of Andrological Sciences 2010;17:17-22 Effect of penile rehabilitation on erectile function after bilateral nerve-sparing robotic-assisted radical prostatectomy G. Novara, V. Ficarra,
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 informationVardenafil in Erectile Dysfunction: The Evidence of Its Therapeutic Value
Clinical Medicine Insights: Therapeutics Review pen Access Full open access to this and thousands of other papers at http://www.la-press.com. Vardenafil in Erectile Dysfunction: The Evidence of Its Therapeutic
More informationPolicy #: 370 Latest Review Date: April 2017
Name of Policy: Nerve Graft with Radical Prostatectomy Policy #: 370 Latest Review Date: April 2017 Category: Surgery Policy Grade: B Background/Definitions: As a general rule, benefits are payable under
More informationNORMAL ANATOMY OF THE PENIS
NORMAL ANATOMY OF THE PENIS IOANNIS VARKARAKIS ASOSCIATE PROFESSOR OF UROLOGY 2 ND DEPT OF UROLOGY NATIONAL & KAPODISTRIAN UNIVERSITY OF ATHENS PENILE GROSS ANATOMY 3 ERECTILE COLUMNS TWO CORPORA CAVERNOSA
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 informationPenile Rehabilitation and Neuromodulation
Review Special Issue: Sexual Dysfunction TheScientificWorldJOURNAL (2009) 9, 652 664 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2009.86 Penile Rehabilitation and Neuromodulation Fernando Facio, Jr. 1,
More informationPolicy #: 370 Latest Review Date: December 2013
Name of Policy: Nerve Graft in Association with Radical Prostatectomy Policy #: 370 Latest Review Date: December 2013 Category: Surgery Policy Grade: B Background/Definitions: As a general rule, benefits
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 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 informationDipyridamole reduces penile apoptosis in a rat model of post-prostatectomy erectile dysfunction
ORIGINAL ARTICLE Vol. 43 (5): 966-973, September - October, 2017 doi: 10.1590/S1677-5538.IBJU.2017.0023 Dipyridamole reduces penile apoptosis in a rat model of post-prostatectomy erectile dysfunction Omer
More informationErectile Dysfunction Case Study 2. Medical Student Case-Based Learning
Erectile Dysfunction Case Study 2 Medical Student Case-Based Learning The Case of Mr. Power s Limp Mojo Mr. Powers develops erectile dysfunction after his radical prostatectomy for prostate cancer. You
More informationIntraoperative Identification and Monitoring of the Somatic Nerves Critical to Potency Preservation during da Vinci Prostatectomy
Intraoperative Identification and Monitoring of the Somatic Nerves Critical to Potency Preservation during da Vinci Prostatectomy J. Rasmussen, J. Schneider Background Since Walsh and Donker first introduced
More informationCHARACTERIZATION OF PENILE ERECTILE STATES USING EXTERNAL COMPUTER-BASED MONITORING
From Journal of Biomechanical Engineering May 1987, Vol. 109 CHARACTERIZATION OF PENILE ERECTILE STATES USING EXTERNAL COMPUTER-BASED MONITORING D.A. Frohrib, I. Goldstein, T.R. Payton, H. Padma-Nathan,
More informationInformation for Patients. Priapism. English
Information for Patients Priapism English Table of contents What is priapism?... 3 What causes priapism?... 3 Diagnosing priapism... 3 Treating priapism... 4 Conservative, first- and second-line treatments...
More informationShockwave Therapy Applications
Shockwave Pressure Level (bar) Shockwave Therapy Applications 500 Urology 250 0 ESWL ~ 450 Bar Stone Fragmentation ESWT ~ 200 bar Anti Inflammatory Orthopedics LSWT ~80 bar Angiogenesis ED 80 s 90 s 2000+
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 informationSurgery and hormonal treatment for prostate cancer and sexual function
Review Article Surgery and hormonal treatment for prostate cancer and sexual function Katie Canalichio 1, Yasmeen Jaber 2, Run Wang 1,2 1 Division of Urology, University of Texas Health Science Center,
More informationMoving Beyond Cancer To A New Normal in Intimacy For Men & Their Partners. Presented by Mary Ellen West, RN, MN, CNM AASECT Certified Sex Counselor
Moving Beyond Cancer To A New Normal in Intimacy For Men & Their Partners Presented by Mary Ellen West, RN, MN, CNM AASECT Certified Sex Counselor WHO Definition of Sexuality Central aspect of being human
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 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 information