ESSM Newsletter # 37

12 ESSM Today Have you read ? Best of the Best: Clinical by Nicola Mondaini dr. nicola Mondaini Associate Editor Department of Urology Ospedale Santa Maria Annunziata (Ponte a Niccheri) Via dell’Antella, 58 – Bagno a Ripoli Florence, Italy mondatre@hotmail.com INDURATIO PENIS PLASTICA Abdel Raheem A et alt: Safety and effective- ness of collagenase clostridium histolyticum (CCH) (Xiapex ® ) in the treatment of Peyronie’s Disease using a new modified shortened pro- tocol . BJU Int. 2017 Jun 14. To evaluate the efficacy and safety of collagenase clostridium histolyticum (CCH) (Xiapex ® , Xiaflex ® ) in the treatment of Peyronie’s disease (PD) using a new modified treatment protocol which aims at reducing the number of injections needed and reducing patient visits, thus reducing the cost and duration of treatment. A prospective study of 53 patients with PD who had treatment with CCH at a single center using a new modified protocol. The angle of curvature assessment after an intra- cavernosal injection of PGE1, IIEF and Peyronie’s disease questionnaires (PDQ) were performed at baseline and at week 12 (4 weeks after the last injection). The global assessment of PD question- naire was performed at week 12. Under a penile block of 10ml of plain lignocaine 1%, a total of 3 intra-lesional injections of CCH (0.9 mg) were given at 4 weekly intervals using a new modified injection technique. In between injections patients used a combination of home modelling, stretch- ing and a vacuum device on a daily basis in order to mechanically stretch the plaque. Investigator modelling was not performed. The mean penile curvature at baseline was 54° (30 – 90°). Of the 53 patients in the study, 51 patients (96.2%) had an improvement in the angel of curvature with a mean value of 17.36° (0°– 40°) or 31.4% from baseline (0 – 57%) after 3 CCH injections. The end mean curvature was 36.9° (12 °– 75°; p<0.001). There was an improvement in each of the IIEF questionnaire domains, all 3 PDQ domains and the global as- sessment of PD questionnaire. CCH was well tol- erated by all patients with only mild and transient local adverse events.The new shortened protocol using CCH treatment is safe, effective and cost efficient. The results of using only 3 CCH in- jections according to this modified protocol are comparable to those of the clinical trials which used 8 CCH injections. This article is protected by copyright. All rights reserved. ERECTILE DYSFUNCTION Corona G et alt: Sexual dysfunction in subjects treated with inhibitors of 5 α -reductase for benign prostatic hyperplasia: a comprehen- sive review and meta-analysis. Andrology. 2017 Apr 28. Despite their efficacy in the treatment of be- nign prostatic hyperplasia, the popularity of inhibitors of 5 α -reductase (5ARIs) is limited by their association with adverse sexual side ef- fects. The aim of this study was to review and meta-analyze currently available randomized clinical trials evaluating the rate of sexual side effects in men treated with 5ARIs. An exten- sive Medline Embase and Cochrane search was performed including the following words: ‘finasteride’, ‘dutasteride’, ‘benign prostatic hy- perplasia’. Only placebo-controlled randomized clinical trials evaluating the effect of 5ARI in subjects with benign prostatic hyperplasia were considered. Of 383 retrieved articles, 17 were included in this study. Randomized clinical tri- als enrolled 24,463 in the active and 22,270 patients in the placebo arms, respectively, with a mean follow-up of 99 weeks and mean age of 64.0 years. No difference was observed between trials using finasteride or dutasteride as the ac- tive arm considering age, trial duration, pros- tate volume or International Prostatic Symptoms Score at enrollment. Overall, 5ARIs determined an increased risk of hypoactive sexual desire [OR = 1.54 (1.29; 1.82); p < 0.0001] and erectile dysfunction [OR = 1.47 (1.29; 1.68); p < 0.0001]. No difference between finasteride and dutasteride regarding the risk of hypoac- tive sexual desire and erectile dysfunction was observed. Meta-regression analysis showed that the risk of hypoactive sexual desire and erectile dysfunction was higher in subjects with lower Qmax at enrollment and decreased as a function of trial follow-up. Conversely, no effect of age, low urinary tract symptom or prostate volume at enrollment as well as Qmax at end-point was observed. In conclusion, present data show that the use of 5ARI significantly increases the risk of erectile dysfunction and hypoactive sexual desire in subjects with benign prostatic hyperplasia. Patients should be adequately informed before 5ARIs are prescribed. ORGASMIC DYSFUNCTION Orgasmic dysfunction after radical prostatectomy Capogrosso P et alt: Orgasmic Dysfunction after Radical Prostatectomy. World J Mens Health. 2017 Apr;35(1):1-13. In addition to urinary incontinence and erectile dysfunction, several other impairments of sexual function potentially occurring after radical pros- tatectomy (RP) have been described; as a whole, these less frequently assessed disorders are referred to as neglected side effects. In particular, orgasmic dysfunctions (ODs) have been reported in a non-negligible number of cases, with detri- mental impacts on patients’ overall sexual life. This review aimed to comprehensively discuss the prevalence and physiopathology of post-RP ODs, as well as potential treatment options. Orgasm-associated incontinence (climacturia) has been reported to occur in between 20% and 93% of patients after RP. Similarly, up to 19% of patients complain of postoperative orgasm-associated pain, mainly referred pain at the level of the penis. Moreover, impairment in the sensation of orgasm or even complete anorgasmia has been reported in 33% to 77% of patients after surgery. Clinical and surgical factors including age, the use of a nerve-sparing technique, and robotic surgery have been vari- ably associated with the risk of ODs after RP, although robust and reliable data allowing for