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ESSM
Today
AUA 2015 New Orleans: Take Home Messages. Sexual Function / Dysfunction
Basic Science
e
Podium 36-02
– Reviewed remodeling and
calcium content in cardiac and pudendal ar-
teries. Similar findings were identified in both
sets of arteries, which fails to support the arte-
rial size hypothesis of why erectile dysfunction
proceeds cardiovascular dysfunction.
e
Podium 36-04
– Demonstrated increases in
tumor necrosis factor alpha following nerve
crush in rats. This podium also significantly
demonstrated a preservation of sympathetic
fibers and impairment of parasympathetic
fibers falling crush.
e
Poster 52-03
– Demonstrated that neural
pericytes function as a cellular regenerator,
which may offer a new target for erectile dys-
function therapy.
e
Podium 36-05
– Pioglitazone enhanced sur-
vival of the pelvic nerve ganglion following
nerve crus in an animal model, suggesting
its role as a neuroprotective agent.
Peyronie’s Disease
AUA Guideline 2015
e
A new guideline statement was released on
Peyronie’s Disease. Three statements were
made on the importance for history and ex-
amination as well as role for intracavernosal
injections with or without penile ultrasound.
Physicians were counseled to only treat the
condition if they had the tools and experience
necessary to treat the condition adequately.
e
Physicians were recommended to discuss
all adverse events with each therapy and to
utilize nonsteroidal anti-inflammatory drugs
for pain as needed.
e
Clinicians were recommended against cer-
tain therapies including vitamin E, tamoxifen,
procarbazine, omega-3 fatty acids, or vita-
min E with l-carnitine. Electromotive therapy
with verapamil, radiotherapy, and shockwave
therapy for treatment of curvature or plaque
size were also recommended against.
e
Collagenase clostridium histolyticum was
recommended as a possible treatment with
modeling for men with 30–90° curvature and
intact erectile function. Intralesional interferon
and veraparmil were also considered as op-
tions for treatment.
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Surgery was indicated for men with stable
disease and erectile function responsive to
medications. Plication and incision/excision
and grafting our option in cases of adequate
penile rigidity.
e
A penile prosthesis is indicated in men with
erectile dysfunction unresponsive to pharma-
cotherapy.
Other Peyronie’s Disease
e
Podium 48-01 – Reviewed the incidence of
Peyronie’s disease following prostatectomy.
Among 276 men, 17.4% developed Pey-
ronie’s disease within three years, with the
majority (9.8%) occurring within the first year.
e
Podium 48-03
– Reviewed outcomes of us-
ing collagen fleece as a grafting material in
290 men undergoing incision in grafting for
Peyronie’s disease (follow-up 37 months).
Outcomes demonstrated improved erectile
function in 23% and unchanged erectile func-
tion in 66%. Decreased glanular sensation
was noted in 7% with an overall increase in
penile length of 0.7 cm.
Trauma
e
Poster 18-19
– Reported retrospective out-
comes of men undergoing repair of penile
fracture at seven European sites. Results
demonstrated worsened erectile function at
one and three months among men surgically
treated greater than eight hours after the ini-
tial presentation to the emergency room.
Female Sexual Function
e
Podium 48-07
– Reviewed data from partners
of men enrolled in the IMPRESS I and II col-
lagenase trials. Thirty women had question-
naires obtained and demonstrated that treat-
ment with collagenase significantly improved
the functionality of the penis as noted by the
partners. Also the sexual dysfunction in the
female partner improved from 75% before
treatment to 33% after treatment.
Zen Trial
e
Podium 40-01
– Follow-up data was provided
on the Zen Trial for endovascular stenting of
penile arterial insufficiency. Outcomes noted
that >4 point improvements on the Interna-
tional Index of Erectile Function occurred
among 60% of patients at three years com-
pared to 70% of patients at six months. This
trial has been prematurely halted by the spon-
soring company for various reasons including
significant difficulty in patient accrual.
Shockwave Therapy
e
Podium 45-10
– A summary of eight studies
reporting outcomes of shockwave therapy
demonstrated very low rate of adverse events
(0.2-0.4%; skin rash, penile dysesthesias).
The patients from all trials demonstrated sig-
nificant improvements in erectile function,
which were maintained at 12 months.
e
Poster 52-06
– Low intensity shockwave ther-
apy in diabetic rats was reported and noted
equivalent improvements to PDE5 inhibitors.
Combination therapy of shockwave and PDE5
inhibitors resulted in better outcomes than
either therapy alone.
e
Podium 36-09
– Shockwave therapy was
performed in type one diabetic rats and noted
restoration of endothelium and smooth mus-
cle content.
Penile Prostheses
e
Podium 02-03
– Positive cultures from non-
clinically infected penile prostheses were
more common in uncoated devices compared
to coated prostheses (35% versus 13%).
e
Podium 26-02
– Outcomes of cultures
performed at the time of penile prosthesis
revision or salvage surgery were reviewed.
Among the cases, 38% had no growth, 43%
gram-positives, 12% gram-negatives, 9%
anaerobes, and 7% Candida species.
e
Podium 48-02
– Outcomes of a subcoronal
incision approach to placement of a penile
prosthesis were reviewed. Among 105 men
undergoing the procedure, 75% were satis-
fied at three months and 3% experienced an
infection.