7
ESSM
Today
AUA 2014 Men’s health highlights
anced regulation of neurogenic control.
The second paper study the increase in Rho ki-
nase 2 an increase of synthetic smooth muscle-
specific marker expression observed in the cor-
pus cavernosum of patients with severe ED (MP
47 20). Clinical research has shown upregulation
of the RhoA / Rho protein kinase (ROCK) path-
way, (specifically ROCK2 isoform) in the corpus
cavernosum (CC) of animal models of erectile
dysfunction. In other vascular diseases, activation
of ROCK results in contractile phenotypic change
of smooth muscle cells (SMCs) to synthetic SMCs
(for example, myofibroblasts). This analysis as-
sessed whether these phenotypic changes were
happening in the SMCs of the CC of patients with
severe ED. Fourteen samples of human corpus
cavernosum of patients with ED undergoing pe-
nile prosthesis implantation were analyzed and
compared with 5 samples of cavernous tissue
from healthy men, obtained by core biopsy. In
both tissues, the expression of mRNA coding for
ROCK 1, ROCK2, MYH11 (heavy chain kinase
SMCs) and aSMA (SMC alpha-actin) the latter
present in the contractile muscle cells (healthy)
were assessed. The findings provide evidence
of phenotypic changes in the CC of the SMCs of
ED patients, suggesting that chronic inhibition
of ROCK 2 interfere with these changes, and it
may be a future therapeutic target for preven-
tion of the DE. ROCK inhibitors for the treatment
of cardiovascular disease are currently under
development.
The third paper discusses the preliminary results
of the use of stem cells derived from human
adipose tissue in the treatment of Peyronie's
disease (PD). (PD 21-01). The aim of this study
was to evaluate the effects of a local injection of
stem cells derived from human adipose tissue
(hADSCs) in a rat model of PD in chronic phase.
The results showed that in a rat model of chronic
EP, ADSC injections in the tunica albuginea par-
tially reversed the fibrosis and restored the ratio
of collagen III / I to normal. The success of this
pioneering study may indicate a new approach
to the future of clinical research, however, in this
study no data were reported about the improve-
ment of penile curvature, which is the reason for
patient consultation
It also highlights the progress towards new
therapeutic regimens used in both the DE, and
premature ejaculation (PE). Here, we discuss the
most outstanding studies:
The first paper investigates the management of
erectile dysfunction induced by diabetes with a
combination of PDE5 inhibitors and strict gly-
cemic control (MP 47-11). Recent research has
indicated that the DE-induced diabetes (DM) can
be effectively controlled by strict control of gly-
cemia, as well as chronic treatment with PDE5
inhibitors. To this end, experimental work was
performed in rat model (control, DM, DM treated
with insulin, DM treated with PDE5 inhibitors and
DM treated with insulin and PDE5 inhibitors).
The analysis of the results concluded that the
diabetic rats showed decreased in erection pa-
rameters compared to normal rats. The combi-
nation of both treatments PDE5 inhibitors and
glycemic control with insulin show a restoring
erectile function, producing a greater effect
compared to insulin treatment alone or PDE5
inhibitors alone. Multiple mechanisms (including
apoptosis, endothelial rehabilitation, Rho kinase
pathway), may be responsible for the additional
effects. Evidence postulates that improved gly-
cemic control in diabetic patients with ED can
be beneficial. The results should be confirmed
by clinical data.
The second paper, questions the role of sildenafil
in rehabilitation after radical prostatectomy (RP)
(MP 48-12). Sildenafil was considered an effec-
tive treatment for ED post RP. This study evalu-
ated the patterns of recovery of erectile function
after RP, and responses in 94 patients undergoing
nerve sparing RP, treated with sildenafil 50 mg or
placebo, from the first day after surgery and with
a postoperative follow-up of 13 months. Interna-
tional Index of Erectile Function (IIEF), tumescence
and nocturnal penile rigidity and the subjective
assessment of the patient about erectile func-
tion were measured. The results show that the
nightly use of sildenafil citrate does not provide
a therapeutic benefit in the recovery of erectile
function after RP. Regardless of treatment, both
subjective and objective measures of erectile
function improve with time.
The third paper investigates the impact of treat-
ment with Silodosin 8 mg on sexual function in
patients with BPH-LUTS treated with this drug
(MP 40-15). This paper provides an analysis
of sexual function in 137 patients diagnosed
with LUTS / BPH treated with silodosin. Sexual
function was assessed by IIEF orgasmic func-
tion (questions 9 and 10). With regard to the
results, about 70% of patients with LUTS / BPH
treated with silodosin reported anejaculation or
hypospermia, and approximately 17% of men
experienced impaired orgasmic function. An-
ejaculation found to be the cause of the inter-
ruption silodosin in 6% of patients. These robust
findings reiterate previous evidence of deleteri-
ous effects of silodosin in the mechanisms that
lead to the failure of ejaculation and decreased
ejaculatory volume.
Finally, we discuss the study presented by Sim-
sek et al, where perform a comparative analysis
between Dapoxetine and paroxetine in the treat-
ment of premature ejaculation (PE) (MP 48-18).
This prospective analysis compared the safety
and efficacy of paroxetine 20 mg daily versus
dapoxetine (30 and 60 mg) in 150 patients diag-
nosed with PE. The results showed that although
the dose of 30 mg dapoxetine not exceeded
paroxetine results, treatment with 60 mg dapox-
etine 1-3 hours before sexual intercourse results
in a greater increase intravaginal ejaculatory
latency time (IELT) respect to paroxetine. The
authors conclude that treatment with 30 mg of
dapoxetine demand does not exceed the daily
treatment with paroxetine and suggests that the
starting dose of dapoxetine treatment in cases
of severe PE should be 60 mg.
