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ESSM
Today
Interview with Prof. Meuleman
to penile shortening. With respect to treatment,
many modalities have been experimented with
during the last 3 decades to resolve the plaques,
most with little to zero effect. Recently, injectable
collagenase clostridium histolyticum (Xiaflex
®
)
has been approved by the FDA for Peyronie’s dis-
ease. The substance is injected into the plaques
in 6 treatment cycles of 2 weekly injections fol-
lowed by a program of penile stretching and
remodeling.
In a recent large randomized controlled trial in
which 8 times collagenase was injected in the
plaque, followed by manual remodeling of the
penis, the average improvement of the curva-
ture was 34% (on average 14,8 degrees less
deviation). The Peyronie’s disease symptom-
bother-score appeared to improve significantly.
The question is whether men with severe cur-
vature are sufficiently satisfied with this rela-
tively modest improvement in curvature and if
injection with collagenase may prevent surgical
treatment. Once the deformity has stabilized and
the patient’s sexual function is impaired, I would
suggest surgery. Either a plication-technique or
a grafting technique, depending on the severity
of the malformation and the length of the penis.
JIMS:
Prof. MEULEMAN, regarding the latest
controversy about Testosterone replacement
therapy & cardiovascular risk, what is your
personal opinion about that?
In this respect I want to highlight three studies.
First of all an open-access study of Lin Xue et al
presenting data from a met analysis. The conclu-
sion is “that the effect of testosterone on cardio-
vascular events varies with the source of funding.
Overall and particularly studies not funded by
the pharmaceutical industry, exogenous tes-
tosterone increased the risk of cardiovascular
events”. Another study in NEJM shows that “the
application of a testosterone gel in older men
with limitations in mobility and chronic disease is
associated with increased risks of cardiovascular
adverse events”. And finally, the experience from
a registry of low T centers is that testosterone is
safe in young men who do not have significant
risk-factors. The general picture I draw from
these publications is that it is safe in younger
men without risk-factors and that one should be
cautious in older frail men.
JIMS:
And last but not least, which do you
consider the most important challenges for
our specialty (Sexual Medicine) and for our
society (ESSM) in the next 5 years?
The greatest challenge for sexual medicine and
ESSM is to survive in an era where the interest of
the pharmaceutical industries in sexual medicine
is declining and health authorities are inclined
to subsidize new developments in oncology and
cardiovascular medicine much more that quality
of life issues such as sexuality. Therefore, the
best way forward is to focus on prevention of
sexual dysfunction and life-style modification.
It was a great pleasure to interview you;
I am convinced that your points of view, fruits
of a lifetime devoted to your work, will be
highly appreciated by our readers. Thanks
once again.
AUA 2015 New Orleans:
Take Home Messages. Sexual Function / Dysfunction
by Landon Trost
landon trost, Md
Mayo Clinic, Rochester, MN
United States of America
trost.landon@mayo.eduSexual medicine was well represented at the
2015 American Urologic Association Annual
Meeting held in New Orleans, Louisiana, USA.
There were over 100 podiums and posters and
greater than 60 lectures, plenaries, courses,
videos, and guidelines presented.
ERECTILE DySFUNCTION
Penile Ultrasound
e
Abstract 43-02
– The location of ultrasound
probe placement on the penis had a signifi-
cant impact on outcomes. The more distal
the probe was placed, the higher the arterial
insufficiency noted. Similarly the more distal
the probe was placed on the penis the rate
of venoocclusive dysfunction declined.
e
Abstract 43-07
– Vascular risk factors did
not predict hemodynamic results on penile
ultrasound.
e
Abstract 43-09
– If a patient did not achieve
an erection which matched the stretched
penile length at the time of ultrasound, this
independently predicted venoocclusive dys-
function.
e
Abstract 43-18
– Audio and visual stimula-
tion did not impact the total erectile rigidity or
number of intracavernosal injections required
to achieve a rigid direction prior to ultrasound.