4
ESSM
Today
Highlights from the
“ESSM Meeting Istanbul”
by Alejandra Egui / JIMS
alejandra Egui rojo, Md
Attending Urologist
Hospital Universitario Fuenlabrada
Madrid, Spain
Dear ESSM members / friends:
The past 29 January to 1 February, in the
city of Istanbul, Turkey, we celebrated the
16
th
ESSM Congress, with the participation of
73 countries, becoming in the most important
event of the Andrological community in Europe.
In this event, we reviewed the updates in the field
of Andrology by a large panel of international
experts. Similarly, the innovations that were in-
troduced this year were presented. The top 5 of
the represented countries have been Turkey, Italy,
Spain, the United Kingdom and Germany. Briefly,
we will summarize the top important topics:
Podium Session
Prostate
Chairs:
Mustafa Faruk Usta (Turkey),
Andreas Bannowsky (Germany)
In this session commented the relative to treat-
ment with PDE5 inhibitors, in patients with LUTS
(Lower Urinary Tract Symptoms) and Erectile
dysfunction. The association between both con-
ditions has a multifactorial origin (decreased
NO /cGMP, Rhoquinase / Endotelin-1 decreased
activity, increased noradrenergic system, pelvic
atherosclerosis) and age-related. Tadalafil 5 mg
daily seems to be a reasonable treatment option.
Another interesting issue commented several
times throughout the congress was the role
of PDE5 inhibitors in penile rehabilitation ap-
peared, according to the results of
REACTT
study: A multicenter, randomized, double-
blind, placebo-controlled trial conducted in
50 centers in Europe and Canada , that included
423 men younger than 68 years, undergoing
NSRP for prostate cancer (Gleason < 7) and
good preoperative erectile function, to deter-
mine the rehabilitative potential and the protec-
tive effect of PDE5 inhibitors on penile function
after NSRP.
They compare the efficacy of tadalafil 5 mg once
daily (N = 139), tadalafil 20 mg on demand
(N = 1423) and placebo (N = 141) for 9 months,
followed by a drug-free washout (DFW) of
6 weeks, and by an open label of 3 months with
5 mg tadalafil once daily for all patients.
The primary endpoint was to determine the
effect on erectile function, measured by the
proportion of patients achieving an International
Index of Erectile Function (IIEF)> 22, after wash-
out period of 6 weeks. Secondary endpoints
were the erectile function domain of the IIEF, the
Question 3 of the Sex Encounter Profile (SEP3)
and the penile length.
The 20.9%, 16.9%, and 19.1% of patients in
the tadalafil once daily, tadalafil on demand, and
placebo groups, respectively, achieved IIEF EF
scores
≥
22 after DFW. At the end of double-
blind treatment (EDT), the mean IIEF-EF score im-
provement significantly exceeded the minimally
clinically important difference in both tadalafil
groups; and in the case of SEP 3 just for tadalafil
daily ( p = 0.019). All groups experienced a wors-
ening of erectile function was during the DFW
period, which improved again during the open
label of the study. After 9 months of treatment,
decreased penile length was lower in patients
treated with tadalafil daily (p = 0.032).
In conclusion, tadalafil daily proved to be the
most effective drug in the recovery of erectile
function in patients undergoing NSRP. Daily
administration of tadalafil early after surgery
contributes to the restoration of erectile func-
tion, possibly exerting a protective role against
the structural changes of the penis. In those
patients who did not received early treatment
with PDE5 inhibitors, erectile function did not
improve after discontinuing treatment with
PDE5 inhibitors.
Featured Round Tables
Pharmacology of Premature Ejaculation (PE):
A critical reappraisal
Chairs:
Ege Can Serefoglu (Turkey),
Patrick Jern (Finland)
Speakers:
Pierre Clement (France), François
Giulinao (France), Mario Maggi (Italy), Ignacio
Moncada (Spain) and Enmanuele A Jannini (Italy).
The fundamental concepts and the current
role of Dapoxetine (Priligy) was reviewed
An overview of the physiology of ejacula-
tion and pathophysiology of PE was made,
as well as the different treatments that have
been used historically in the treatment of this
disorder, with special emphasis on dapox-
etine, as the only approved treatment with
this indication. Again, the controversy of what
should be the optimal dose to start treatment,
even though the manufacturer recommends
starting with 30 mg dose and increase if the
clinical response is not ideal arises. There
were several comments from those present
in the room, where it seems that an increasing
proportion of andrologists, opts for starting
treatment with full doses. The details of the
new scientific evidence available on the use
of dapoxetine, discussed below in the section
on trade symposiums.
dr. Juan i. Martínez-Salamanca
Hospital Universitario Puerta de
Hierro-Majadahonda Universidad
Autónoma de Madrid
Department of Urology
