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Javaad Zargooshi - One of the best experts on this subject based on the ideXlab platform.
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Male Sexual Dysfunction in unconsummated marriage long term outcome in 417 patients
The Journal of Sexual Medicine, 2008Co-Authors: Javaad ZargooshiAbstract:ABSTRACT Introduction Little research has been conducted about unconsummated marriage (UCM). Aim To report the long‐term outcome of Male Sexual Dysfunction (MSD) in UCM. Methods From 1997 to 2008, 417 couples presented to the author with UCM. The mean UCM duration ranged from 1 hour to 8 years. The median follow‐up was 78.5 months. Main Outcome Measures Self‐reported MSD in UCM based upon clinical history taking. Results In 177 cases, UCM was due to erectile Dysfunction (ED) (86), premature ejaculation (PE) (89), performance anxiety (25), vaginismus (34), hypodesire disorder (6), not knowing the coital technique (8), men who have sex with men (MSM) (2), hypogonadism (1), request by bride to delay coitus (1), and thick hymen (1) (more than one factor involved in many cases). In the remaining 240 cases, UCM was due to being under social pressure to have a quick intercourse while relatives waited behind the door to confirm and celebrate coitus by checking a handkerchief that was placed beneath the bride to become bloody by hymen perforation. Intracavernosal injection (ICI) using papaverine ± phentholamine was used in 239 cases (57.3%); 221 (92.4%) responded. The eight cases who did not know the coital technique responded to sex education. Of the 50 men who were prescribed phosphodiesterase type 5 inhibitors, only 4 responded. Of the 26 men who received clomipramine (21) or fluoxetine (5) for PE, 2 and 1 responded, respectively. Fourteen grooms who did not respond to treatments later consummated spontaneously. No treatment was given to 94 grooms, including men with a diagnosis of psychotic disorder, men with learning difficulties, divorcing patients, and men in obligatory, loveless marriages. Ten untreated patients later consummated spontaneously. Of the 260 patients who consummated either with treatment (236) or spontaneously (24), 58 (22.3%) later presented with Sexual complaints. The remaining 202 did well at a follow‐up. Of the 157 couples who did not respond to treatment or did not receive treatment, 62 were either divorced or divorcing. Conclusion We strongly advise ICI as the first‐line treatment of UCM. Oral therapies of ED and PE, vacuum constriction devices (VCD), and hymenectomy are of limited value. No treatment is indicated in many cases. Most grooms do well Sexually in a long‐term follow‐up. Zargooshi J. Male Sexual Dysfunction in unconsummated marriage: Long‐term outcome in 417 patients. J Sex Med **;**:**–**.
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Male Sexual Dysfunction in Unconsummated Marriage: Long‐Term Outcome in 417 Patients
The Journal of Sexual Medicine, 2008Co-Authors: Javaad ZargooshiAbstract:ABSTRACT Introduction Little research has been conducted about unconsummated marriage (UCM). Aim To report the long‐term outcome of Male Sexual Dysfunction (MSD) in UCM. Methods From 1997 to 2008, 417 couples presented to the author with UCM. The mean UCM duration ranged from 1 hour to 8 years. The median follow‐up was 78.5 months. Main Outcome Measures Self‐reported MSD in UCM based upon clinical history taking. Results In 177 cases, UCM was due to erectile Dysfunction (ED) (86), premature ejaculation (PE) (89), performance anxiety (25), vaginismus (34), hypodesire disorder (6), not knowing the coital technique (8), men who have sex with men (MSM) (2), hypogonadism (1), request by bride to delay coitus (1), and thick hymen (1) (more than one factor involved in many cases). In the remaining 240 cases, UCM was due to being under social pressure to have a quick intercourse while relatives waited behind the door to confirm and celebrate coitus by checking a handkerchief that was placed beneath the bride to become bloody by hymen perforation. Intracavernosal injection (ICI) using papaverine ± phentholamine was used in 239 cases (57.3%); 221 (92.4%) responded. The eight cases who did not know the coital technique responded to sex education. Of the 50 men who were prescribed phosphodiesterase type 5 inhibitors, only 4 responded. Of the 26 men who received clomipramine (21) or fluoxetine (5) for PE, 2 and 1 responded, respectively. Fourteen grooms who did not respond to treatments later consummated spontaneously. No treatment was given to 94 grooms, including men with a diagnosis of psychotic disorder, men with learning difficulties, divorcing patients, and men in obligatory, loveless marriages. Ten untreated patients later consummated spontaneously. Of the 260 patients who consummated either with treatment (236) or spontaneously (24), 58 (22.3%) later presented with Sexual complaints. The remaining 202 did well at a follow‐up. Of the 157 couples who did not respond to treatment or did not receive treatment, 62 were either divorced or divorcing. Conclusion We strongly advise ICI as the first‐line treatment of UCM. Oral therapies of ED and PE, vacuum constriction devices (VCD), and hymenectomy are of limited value. No treatment is indicated in many cases. Most grooms do well Sexually in a long‐term follow‐up. Zargooshi J. Male Sexual Dysfunction in unconsummated marriage: Long‐term outcome in 417 patients. J Sex Med **;**:**–**.
Gerald B Brock - One of the best experts on this subject based on the ideXlab platform.
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Sexual rehabilitation and cancer survivorship a state of art review of current literature and management strategies in Male Sexual Dysfunction among prostate cancer survivors
The Journal of Sexual Medicine, 2013Co-Authors: Eric Chung, Gerald B BrockAbstract:ABSTRACT Introduction The challenges for prostate cancer survivors include the surveillance of prostate cancer recurrence and management of physical, cognitive, Sexual, and socioeconomic quality of life issues. Sexual function remains an important issue in men, who often continue to be interested in sex after prostate cancer treatment. The various post‐prostate cancer treatment‐related Sexual Dysfunctions are penile deformities and erectile Dysfunction (ED); Sexual desire and mental health; ejaculatory and orgasmic Dysfunctions; and changes in partner relationship and dynamics. Aims The aim of this study is to provide state of art review of the various Male Sexual Dysfunctions in prostate cancer survivors and the management strategies in Sexual rehabilitation. Methods and Materials A literature search for English language original and review articles either published or e‐published was performed using PubMed database. Keywords included prostate cancer , prostate cancer treatment , prostate prostatectomy (RP) , Sexual Dysfunction , erectile Dysfunction (ED) , Sexual desire , mental health , ejaculation, orgasmic , climacturia , and relationship . Results There has been considerable volume of publication in recent years on prostate cancer‐related Male Sexual Dysfunction. Penile deformities and ED shared similar pathophysiology and that penile smooth muscle fibrosis ultimately results in structural alterations and end‐organ failure. Penile rehabilitation using oral phosphodiesterase type 5 (PDE5) inhibitors is considered the standard of care especially in patients who received nerve‐sparing RP and should be instituted as soon as possible to protect and prevent corporal endothelial and smooth muscle damage. However, there is no consensus on the exact timing, dose, and duration of PDE5 inhibitors and its impact in non‐nerve‐sparing RP and other forms of prostate cancer treatment modalities. Current literature on hypoactive Sexual desire, ejaculatory, and orgasmic Dysfunctions in patients who received prostate cancer treatment is limited. Psychological and Sexual counseling play an important role in rehabilitation and treatment of various forms of Male Sexual Dysfunctions. Conclusion While several preventive and treatment strategies for the preservation and recovery of Sexual function are available, no specific recommendation or consensus guidelines exist regarding the optimal rehabilitation or treatment protocol. While medical and surgical therapies are effective in erectile function recovery and/or preservation, psychological and Sexual counseling are equally important in Sexual rehabilitation. Chung E and Brock G. Sexual rehabilitation and cancer survivorship: A state of art review of current literature and management strategies in Male Sexual Dysfunction among prostate cancer survivors. J Sex Med 2013;10(suppl 1):102–111.
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penile doppler sonographic and clinical characteristics in peyronie s disease and or erectile Dysfunction an analysis of 1500 men with Male Sexual Dysfunction
BJUI, 2012Co-Authors: Eric Chung, Ling De Young, Gerald B BrockAbstract:Study Type - Therapy (cohort) Level of Evidence 4 What's known on the subject? and What does the study add? Penile colour Doppler ultrasonography (CDU) can be an invaluable investigative tool to characterize penile abnormalities to complement clinical history and physical examination in the evaluation of men with Peyronie's disease (PD) and/or erectile Dysfunction (ED). Although CDU findings between men with PD and those with ED were not markedly different, subtle differences were observed. The classic penile CDU findings in men with PD comprise tunical thickening, intracavernosal fibrosis, septal fibrosis and intracavernosal calcification, while, in men with ED, low peak systolic velocity and high end-diastolic velocity are found on penile haemodynamics. Previously published studies have focused predominantly on either ED or PD exclusively, or examine the risk of progression to ED in the PD population. To our knowledge, this is the largest and most comprehensive analysis of penile CDU and clinical findings in men with PD and/or ED. The large sample size and multivariable analysis allow meaningful interpretation of the results. This study has found some substantial differences in the penile CDU findings of men with PD and/or ED that have not previously been reported. Although the risk factors of ED may be greater than those for PD, there is crossover in age, cardiovascular risk factors, trauma and penile CDU findings in men with PD and/or ED. OBJECTIVE To explore the differences in penile colour Doppler ultrasonography (CDU) findings between men with Peyronie's disease (PD) and those with erectile Dysfunction (ED). MATERIALS AND METHODS Patients presenting with PD and/or ED who underwent penile CDU were recruited to the study. Patient demographics, comorbidities, International Index of Erectile Function-5 scores, previous therapies and physical findings were documented. Penile curvature, presence of tunical thickening, septal fibrosis, intracavernosal fibrosis and calcification, and cavernosal vascular status were recorded. RESULTS A total of 1500 men underwent penile CDU during the 10-year period. Of these men, 891 men presented with PD and 609 men had ED only. Men with ED had higher rates of diabetes and coronary artery disease (P < 0.05). Isolated tunical thickening was more common in older men and in the PD cohort. The presence of intracavernosal fibrosis correlated strongly with difficulty maintaining erection (P < 0.05). Impaired cavernosal arterial flow was observed in men with decrease penile rigidity and penile pain, while higher end-diastolic velocities were found in men with difficulty maintaining erection and tunical thickening on penile CDU. CONCLUSIONS Men with PD and ED had many similarities and differences on penile CDU. Penile CDU continues to be an invaluable clinical tool in the management of men with Male Sexual Dysfunction.
M Maggi - One of the best experts on this subject based on the ideXlab platform.
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the role of somatic symptoms in Sexual medicine somatization as important contextual factor in Male Sexual Dysfunction
The Journal of Sexual Medicine, 2016Co-Authors: Egidia Fanni, Valentina Boddi, Giovanni Castellini, Alessandra D Fisher, Giovanni Corona, Giulia Rastrelli, Valdo Ricca, Sarah Cipriani, M MaggiAbstract:Abstract Introduction An important feature of somatic symptom disorder is the subjective perception of the physical symptoms and its maladaptive interpretation. Considering that psychological distress is often expressed through somatic symptoms, it is possible that they underlie at least a part of the symptoms in subjects complaining of Sexual Dysfunction. Nevertheless, studies on the impact of somatoform disorders in Sexual Dysfunction are scanty. Aim To define the psychological, relational, and organic correlates of somatic symptoms in a large sample of patients complaining of Sexual problems. Methods A consecutive series of 2833 men (mean age 50.2 ± 13.5 years) was retrospectively studied. Main Outcome Measures Somatic symptoms were assessed using the "somatized anxiety symptoms" subscale of the Middlesex Hospital Questionnaire (MHQ-S). Several clinical, biochemical, psychological, and relational parameters were studied. Patients were interviewed with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with Sexual Dysfunction). Results Among the 2833 patients studied, subjects scoring higher on somatic symptoms were older, more obese, reporting unhealthy lifestyle (current smoking, alcohol consumption), and a lower education (all P P P P Conclusion The present study demonstrates that the presence of somatic symptoms can represent an important contextual factor in the determination of or in the exacerbation of Male Sexual Dysfunction. High levels of somatic symptoms in subjects with Sexual Dysfunction can be related to the Sexual symptom itself. The consequences of this pattern have great clinical relevance in a Sexual medicine setting, considering their severe impact on Sexuality.
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conflicts within the family and within the couple as contextual factors in the determinism of Male Sexual Dysfunction
The Journal of Sexual Medicine, 2015Co-Authors: Valentina Boddi, Egidia Fanni, Giovanni Castellini, Alessandra D Fisher, Giovanni Corona, M MaggiAbstract:Abstract Introduction The deterioration of a couple's relationship has been previously associated with impairment in Male Sexual function. Besides a couple's dystonic relationship, other stressors can unfavorably influence dyadic intimacy. A largely neglected etiopathogenetic factor affecting couple Sexuality is the frustration caused by conflicts within the family. Aim To evaluate the possible associations between Male Sexual Dysfunction (SD) and conflictual relationships within the couple or the family. Methods A consecutive series of 3,975 men, attending the Outpatient Clinic for SD for the first time, was retrospectively studied. Conflicts within the family and within the couple were assessed using two standard questions: “Are there any conflicts at home,” and “Do you have a difficult relationship with your partner?” respectively, rating 0 = normal relationships, 1 = occasional quarrels, and 2 = frequent quarrels or always. Main Outcome Measures Several clinical, biochemical, and psychological (Middlesex Hospital Questionnaire) parameters were studied. Results Among the 3,975 patients studied, we observed a high prevalence of conflicts within the family and within the couple (32% vs. 21.2%). When compared with the rest of the sample, subjects reporting both type of conflicts showed a higher prevalence of psychiatric comorbidities. Hence, all data were adjusted for this parameter and for age. Family and couple conflicts were significantly associated with free floating anxiety, depression symptoms, and with a higher risk of subjective (self‐reported) and objective (peak systolic velocity at the penile color Doppler ultrasound Conclusions This study indicates that the presence of often unexplored issues, like conflicts within the family or within the couple, can represent an important contextual factor in the determinism of Male SD. Boddi V, Fanni E, Castellini G, Fisher AD, Corona G, and Maggi M. Conflicts within the family and within the couple as contextual factors in the determinism of Male Sexual Dysfunction. J Sex Med 2015;12:2425–2435.
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lack of Sexual privacy affects psychological and marital domains of Male Sexual Dysfunction
The Journal of Sexual Medicine, 2014Co-Authors: Valentina Boddi, Alessandra D Fisher, Giovanni Corona, Elisa Maseroli, Giulia Rastrelli, Emmanuele A Jannini, Valdo Ricca, Edoardo Mannucci, M MaggiAbstract:Abstract Introduction Sexual Dysfunctions (SDs) are dictated by predisposing, precipitating, maintaining, and contextual factors, the latter of which can help Sexual problems to emerge. Even if the lack of Sexual privacy is one of the most common contextual issues, it has not been extensively studied. Aim Investigation of Sexual privacy in a large sample of men consulting for SD was the aim of this study. Methods A consecutive series of 3,736 men, attending the outpatient clinic for SD for the first time, was retrospectively studied. Privacy during Sexual intercourse was investigated with the following question, “During the last three months, have you had enough privacy during your Sexual activity?” and rated 0 = yes, 1 = sometimes, 2 = rarely, and 3 = never. Main Outcome Measures Several clinical, biochemical, and psychological (Middlesex Hospital Questionnaire [MHQ]) parameters were studied. Results Among the 3,736 patients studied, 83.9% reported enough privacy during Sexual intercourse, while 8.6%, 5.7%, and 1.7% declared a decrease of Sexual privacy of increasing severity. Lack of Sexual privacy was associated with ejaculatory Dysfunctions and with the inability to maintain an erection during intercourse. Subjects reporting lack of Sexual privacy had a higher risk of relational and intrapsychic impairments, as well as psychopathology at MHQ questionnaire, even after adjusting for confounders. Fatherhood was associated with Sexual privacy issues only in the lowest quartiles. In subjects without children, the absence of cohabitation with the partner was associated with an increasing risk of not having enough privacy (hazard ratio [HR] = 1.837 [1.269–2.659], P = 0.001); data confirmed, after stratification for age, only in the youngest subjects (I quartile HR = 2.159 [1.211–3.848], P = 0.009). Conclusions This study indicates that Sexual privacy is often a poorly investigated item, which is important to evaluate in Male SD. Boddi V, Fisher AD, Maseroli E, Rastrelli G, Corona G, Jannini E, Ricca V, Mannucci E, and Maggi M. Lack of Sexual privacy affects psychological and marital domains of Male Sexual Dysfunction. J Sex Med 2014;11:431–438.
Gregory A. Broderick - One of the best experts on this subject based on the ideXlab platform.
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Oral Pharmacotherapy for Male Sexual Dysfunction - Oral pharmacotherapy for Male Sexual Dysfunction
2020Co-Authors: Gregory A. BroderickAbstract:Oral pharmacotherapy for Male Sexual Dysfunction , Oral pharmacotherapy for Male Sexual Dysfunction , کتابخانه دیجیتال جندی شاپور اهواز
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Evaluation of Male Sexual Dysfunction
Cancer and Sexual Health, 2020Co-Authors: Gregory A. BroderickAbstract:The management of Male Sexual Dysfunction and specifically erectile Dysfunction (ED) has seen major changes in each decade since the 1970s thanks to the discovery that a papaverine injection could produce erection, the NIH Consensus Statement which defined ED in 1992, advances in minimally invasive diagnostics, and the development of orally effective erectogenic class of drugs, the phosphodiesterase type-5 inhibitors (PDE-5 Inhs). As a result the health care professionals most frequently consulted have also changed from the psychologists to the urologists and now to the primary care clinicians (PCC), who are the most frequent prescribers of the PDE-5 Inhs. The evaluation and management of Male Sexual Dysfunctions may come under the purview of many different providers besides PCCs including cardiology, urology, endocrinology, psychiatry, psychology, and neurology and allied health care professionals. Unfortunately, many providers are reluctant to ask patients about Sexual health. Identification of Sexual Dysfunctions has been hampered by traditional and difficult to overcome barriers: embarrassment, lack of expertise in Sexual history taking, concerns about the safety of ED treatments, and lack of time. Studies have documented both patient and physician misconceptions [1].
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premature ejaculation on defining and quantifying a common Male Sexual Dysfunction
The Journal of Sexual Medicine, 2006Co-Authors: Gregory A. BroderickAbstract:ABSTRACT Introduction Premature ejaculation (PE) and its individual and relationship consequences have been recognized in the literature for centuries. PE is one of the most common Male Sexual Dysfunctions, affecting nearly one in three men worldwide between the ages of 18 and 59 years. Until recently, PE was believed to be a learned behavior predominantly managed with psychoSexual therapy; however, the past few decades have seen significant advances in understanding its etiology, diagnosis, and management. There is, as yet, no one universally agreed upon definition of PE. Aim To review five currently published definitions of PE. Methods The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24–26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. Main Outcome Measure Data were utilized from the World Health Organization, the American Psychiatric Association, the European Association of Urology, the Second International Consultation on Sexual Dysfunctions, and the American Urological Association. Results The current published definitions of PE have many similarities; however, none of these provide a specific “time to ejaculation,” in part because of the absence of normative data on this subject. While investigators agree that men with PE have a shortened intravaginal ejaculatory latency time (IELT; i.e., time from vaginal penetration to ejaculation), there is now a greater appreciation of PE as a multidimensional Dysfunction encompassing several components, including time and subjective parameters such as “control,”“satisfaction,” and “distress.” Conclusion There is a recent paradigm shift away from PE as a unidimensional disorder of IELT toward a multidimensional description of PE as a biologic Dysfunction with psychosocial components. Broderick GA. Premature ejaculation: On defining and quantifying a common Male Sexual Dysfunction.
Eric Chung - One of the best experts on this subject based on the ideXlab platform.
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Sexual rehabilitation and cancer survivorship: a state of art review of current literature and management strategies in Male Sexual Dysfunction among prostate cancer survivors.
The journal of sexual medicine, 2020Co-Authors: Eric Chung, Gerald BrockAbstract:The challenges for prostate cancer survivors include the surveillance of prostate cancer recurrence and management of physical, cognitive, Sexual, and socioeconomic quality of life issues. Sexual function remains an important issue in men, who often continue to be interested in sex after prostate cancer treatment. The various post-prostate cancer treatment-related Sexual Dysfunctions are penile deformities and erectile Dysfunction (ED); Sexual desire and mental health; ejaculatory and orgasmic Dysfunctions; and changes in partner relationship and dynamics. The aim of this study is to provide state of art review of the various Male Sexual Dysfunctions in prostate cancer survivors and the management strategies in Sexual rehabilitation. A literature search for English language original and review articles either published or e-published was performed using PubMed database. Keywords included prostate cancer, prostate cancer treatment, prostate prostatectomy (RP), Sexual Dysfunction, erectile Dysfunction (ED), Sexual desire, mental health, ejaculation, orgasmic, climacturia, and relationship. There has been considerable volume of publication in recent years on prostate cancer-related Male Sexual Dysfunction. Penile deformities and ED shared similar pathophysiology and that penile smooth muscle fibrosis ultimately results in structural alterations and end-organ failure. Penile rehabilitation using oral phosphodiesterase type 5 (PDE5) inhibitors is considered the standard of care especially in patients who received nerve-sparing RP and should be instituted as soon as possible to protect and prevent corporal endothelial and smooth muscle damage. However, there is no consensus on the exact timing, dose, and duration of PDE5 inhibitors and its impact in non-nerve-sparing RP and other forms of prostate cancer treatment modalities. Current literature on hypoactive Sexual desire, ejaculatory, and orgasmic Dysfunctions in patients who received prostate cancer treatment is limited. Psychological and Sexual counseling play an important role in rehabilitation and treatment of various forms of Male Sexual Dysfunctions. While several preventive and treatment strategies for the preservation and recovery of Sexual function are available, no specific recommendation or consensus guidelines exist regarding the optimal rehabilitation or treatment protocol. While medical and surgical therapies are effective in erectile function recovery and/or preservation, psychological and Sexual counseling are equally important in Sexual rehabilitation. © 2013 International Society for Sexual Medicine.
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Sexual rehabilitation and cancer survivorship a state of art review of current literature and management strategies in Male Sexual Dysfunction among prostate cancer survivors
The Journal of Sexual Medicine, 2013Co-Authors: Eric Chung, Gerald B BrockAbstract:ABSTRACT Introduction The challenges for prostate cancer survivors include the surveillance of prostate cancer recurrence and management of physical, cognitive, Sexual, and socioeconomic quality of life issues. Sexual function remains an important issue in men, who often continue to be interested in sex after prostate cancer treatment. The various post‐prostate cancer treatment‐related Sexual Dysfunctions are penile deformities and erectile Dysfunction (ED); Sexual desire and mental health; ejaculatory and orgasmic Dysfunctions; and changes in partner relationship and dynamics. Aims The aim of this study is to provide state of art review of the various Male Sexual Dysfunctions in prostate cancer survivors and the management strategies in Sexual rehabilitation. Methods and Materials A literature search for English language original and review articles either published or e‐published was performed using PubMed database. Keywords included prostate cancer , prostate cancer treatment , prostate prostatectomy (RP) , Sexual Dysfunction , erectile Dysfunction (ED) , Sexual desire , mental health , ejaculation, orgasmic , climacturia , and relationship . Results There has been considerable volume of publication in recent years on prostate cancer‐related Male Sexual Dysfunction. Penile deformities and ED shared similar pathophysiology and that penile smooth muscle fibrosis ultimately results in structural alterations and end‐organ failure. Penile rehabilitation using oral phosphodiesterase type 5 (PDE5) inhibitors is considered the standard of care especially in patients who received nerve‐sparing RP and should be instituted as soon as possible to protect and prevent corporal endothelial and smooth muscle damage. However, there is no consensus on the exact timing, dose, and duration of PDE5 inhibitors and its impact in non‐nerve‐sparing RP and other forms of prostate cancer treatment modalities. Current literature on hypoactive Sexual desire, ejaculatory, and orgasmic Dysfunctions in patients who received prostate cancer treatment is limited. Psychological and Sexual counseling play an important role in rehabilitation and treatment of various forms of Male Sexual Dysfunctions. Conclusion While several preventive and treatment strategies for the preservation and recovery of Sexual function are available, no specific recommendation or consensus guidelines exist regarding the optimal rehabilitation or treatment protocol. While medical and surgical therapies are effective in erectile function recovery and/or preservation, psychological and Sexual counseling are equally important in Sexual rehabilitation. Chung E and Brock G. Sexual rehabilitation and cancer survivorship: A state of art review of current literature and management strategies in Male Sexual Dysfunction among prostate cancer survivors. J Sex Med 2013;10(suppl 1):102–111.
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penile doppler sonographic and clinical characteristics in peyronie s disease and or erectile Dysfunction an analysis of 1500 men with Male Sexual Dysfunction
BJUI, 2012Co-Authors: Eric Chung, Ling De Young, Gerald B BrockAbstract:Study Type - Therapy (cohort) Level of Evidence 4 What's known on the subject? and What does the study add? Penile colour Doppler ultrasonography (CDU) can be an invaluable investigative tool to characterize penile abnormalities to complement clinical history and physical examination in the evaluation of men with Peyronie's disease (PD) and/or erectile Dysfunction (ED). Although CDU findings between men with PD and those with ED were not markedly different, subtle differences were observed. The classic penile CDU findings in men with PD comprise tunical thickening, intracavernosal fibrosis, septal fibrosis and intracavernosal calcification, while, in men with ED, low peak systolic velocity and high end-diastolic velocity are found on penile haemodynamics. Previously published studies have focused predominantly on either ED or PD exclusively, or examine the risk of progression to ED in the PD population. To our knowledge, this is the largest and most comprehensive analysis of penile CDU and clinical findings in men with PD and/or ED. The large sample size and multivariable analysis allow meaningful interpretation of the results. This study has found some substantial differences in the penile CDU findings of men with PD and/or ED that have not previously been reported. Although the risk factors of ED may be greater than those for PD, there is crossover in age, cardiovascular risk factors, trauma and penile CDU findings in men with PD and/or ED. OBJECTIVE To explore the differences in penile colour Doppler ultrasonography (CDU) findings between men with Peyronie's disease (PD) and those with erectile Dysfunction (ED). MATERIALS AND METHODS Patients presenting with PD and/or ED who underwent penile CDU were recruited to the study. Patient demographics, comorbidities, International Index of Erectile Function-5 scores, previous therapies and physical findings were documented. Penile curvature, presence of tunical thickening, septal fibrosis, intracavernosal fibrosis and calcification, and cavernosal vascular status were recorded. RESULTS A total of 1500 men underwent penile CDU during the 10-year period. Of these men, 891 men presented with PD and 609 men had ED only. Men with ED had higher rates of diabetes and coronary artery disease (P < 0.05). Isolated tunical thickening was more common in older men and in the PD cohort. The presence of intracavernosal fibrosis correlated strongly with difficulty maintaining erection (P < 0.05). Impaired cavernosal arterial flow was observed in men with decrease penile rigidity and penile pain, while higher end-diastolic velocities were found in men with difficulty maintaining erection and tunical thickening on penile CDU. CONCLUSIONS Men with PD and ED had many similarities and differences on penile CDU. Penile CDU continues to be an invaluable clinical tool in the management of men with Male Sexual Dysfunction.