Ethnicity and age as factors in sildenafil treatment of erectile dysfunction

IntroductionSildenafil has been evaluated in >16 000 men with erectile dysfunction (ED) in doubleâ blind, placeboâ controlled trials.AimTo assess efficacy and safety of sildenafil in ED by ethnicity (white, black Asian) and age (â ¤45, 46â 60, â ¥61 years).MethodsData were pooled from 38 doubleâ blind, placeboâ controlled, flexibleâ dose trials. Most had starting sildenafil doses of 50 mg once daily, ~1 hour before sexual activity, with adjustment to 100 or 25 mg as needed.Main Outcome MeasuresChange from baseline in International Index of Erectile Function erectile function (IIEFâ EF) domain score assessed with analysis of covariance and a Global Assessment Question (GAQ; â Did the treatment improve your erections?â ) at endpoint assessed with logistic regression analysis.Results4120 and 3714 men received sildenafil and placebo, respectively (2740 and 2671 White; 407 and 385 Black; 973 and 658 Asian). For sildenafil vs. placebo groups, overall treatment differences for IIEFâ EF domain and GAQ were significant for each ethnic and age group (P<.0001); significant treatmentâ byâ ethnicity and treatmentâ byâ age interactions were also observed for change in IIEFâ EF domain scores (P<.05), with differences significantly greater for White vs. Black (P<.0001), White vs. Asian (P=.0163), and Asian vs. Black (P=.0036) men. A significant treatmentâ byâ ethnicity interaction was observed for GAQ (P=.0004). The OR comparison for GAQ was significantly greater (P=.0001) with sildenafil vs. placebo in White (OR=11.2) or Asian (OR=12.4) men vs. Black men (OR=5.1). Adverseâ event rates were generally similar, with some age variations.ConclusionsSildenafil is effective and wellâ tolerated regardless of ethnicity or age; however, treatment effects can vary.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137386/1/ijcp12945_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137386/2/ijcp12945.pd

Primary mucinous adenocarcinoma of renal pelvis in solitary pelvic kidney

Mucinous adenocarcinoma of the renal pelvis is a rare tumor. We report the case of a fifty-three-year-old man with this unusual cancer and review the literature. Usual features of this tumor include long duration of symptoms, an association with calculi and hydronephrosis, and a preoperative appearance of an inflammatory condition.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31071/1/0000748.pd

Urologic laparoscopy with a new blunt-tipped trocar: Safe, rapid access without the use of fascial sutures

Fifteen patients underwent successful laparoscopic procedures where a new blunt-tipped trocar was used both to gain initial access to and to insufflate the abdominal cavity. The use of this new trocar obviates the need for the use of the Veress needle and appears to be both time-saving and possibly safer. Unlike the Hasson-type trocar, the blunt trocar technique does not require the use of fascial sutures for prevention of air leaks.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31560/1/0000487.pd

Absence of Antisperm Antibodies in Anejaculatory Men

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96435/1/j.1939-4640.1990.tb00162.x.pd

A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75555/1/j.1742-1241.2007.01491.x.pd

The utility of lockout valve reservoirs in preventing autoinflation in penile prostheses

Introduction : Autoinflation is a troublesomecomplication following penile prosthesisplacement that may be potentiated by prevesicalscarring following radical prostatectomy. Weevaluated the frequency of autoinflation andother complications following penile prosthesisplacement in radical prostatectomy patients andcontrols as a surrogate to establishing theutility of lockout reservoirs in preventingautoinflation. Methods : 139 prostheses (including 14with lockout reservoirs) were placed in 132 men(including 35 post-prostatectomy patients) overa 5 1 / 2 year period at our institution. Outcomesassessed include postoperative complicationsand the need for revision or replacement of theprosthesis. Multivariable regression analysiswas used to determine the association ofpatient, device-specific, and perioperativecharacteristics with these outcomes. Results : There was no difference in thepostoperative complication and re-operationrates between post-prostatectomy patients andcontrols (both p > 0.77). The incidence ofautoinflation in post-prostatectomy patientsand controls was 3% and 5%, respectively( p > 0.99). Patients with prior prostheseswere 3 times as likely to develop apostoperative complication or requireprosthesis revision ( p = 0.02). Conclusion : Penile prostheses are welltolerated in post-prostatectomy patients withcomparable outcomes to those men with organicerectile dysfunction. The frequency ofautoinflation does not appear to be increasedin post-prostatectomy patients. Initialresults with the lockout valve reservoir inpreventing autoinflation are encouraging thoughadditional study is warranted to justify theirroutine use.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43865/1/11255_2004_Article_5119589.pd

Male sexual dysfunction and infertility associated with neurological disorders

Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury. Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate

Prospective Evaluation of Patient Satisfaction, and Surgeon and Patient Trainer Assessment of the Coloplast Titan One Touch Release Three‐Piece Inflatable Penile Prosthesis

Introduction.  A single‐armed, prospective, multicenter international study evaluated the redesigned Coloplast Titan One Touch Release (OTR) pump inflatable penile prosthesis. The OTR pump has a unique release valve that permits deflation of the implant with one squeeze of opposing touch pads. Aims.  To assess the impact of a new penile prosthesis design, the Titan OTR, on patient ease of operation. Furthermore, to assess patient satisfaction, surgeon acceptance, and the ease with which patients were trained in device operation in the clinic setting. Methods.  A total of 113 eligible patients from eight centers were recruited from men presenting with erectile dysfunction without prior prosthetic implantation. The subjects had a mean age of 61 years, and had a number of comorbidities, including diabetes (31.9%), hypertension (34.5%), and Peyronie's disease (23.9%). All underwent implantation of the study device. Main Outcome Measures.  Questionnaires were used to capture patient satisfaction as well as physician feedback on ease of implantation and patient education. A paired analysis was completed for patient satisfaction at 6 (N = 96) and 12 (N = 90) months. Results.  Overall satisfaction with the device was 90.6% and 90.0% at 6 and 12 months, respectively. The primary end point, ease of deflation, was seen in 70.8% and 73.3% at these two time points, with the 12‐month value statistically better than historical controls. Physicians overwhelmingly reported straightforward/simple intraoperative product preparation (97.3%) and equivalent or easier training compared with their previous pump of choice (96.4%). Adverse events for all subjects (N = 113) included removal of the device in four cases (3.5%) for infection and one case for chronic pain (0.8%). Conclusions.  The Titan OTR represents an advance in penile prosthetic technology that is well accepted by patients and physicians. The study design allowed for realistic evaluation of the new technology aimed at enhancing clinical outcomes. Ohl DA, Brock G, Ralph D, Bogache W, Jones L, Munarriz R, Levine L, and Ritenour C. Prospective evaluation of patient satisfaction, and surgeon and patient trainer assessment of the Coloplast Titan One Touch Release three‐piece inflatable penile prosthesis. J Sex Med 2012;9:2467–2474.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93661/1/j.1743-6109.2012.02819.x.pd

Patient‐reported outcomes from a single‐centre prospective post‐marketing study on Collagenase Clostridium Histolyticum injections for Peyronie’s disease

The aim of this study was to evaluate patient‐reported outcomes of Collagenase Clostridium Histolyticum (CCHi) for Peyronie’s Disease. Patients treated with 2–4 cycles of CCHi between 01/2016 and 08/2018 were asked to fill out the “bother domain” of the Peyronie’s Disease Questionnaire (PDQ) at scheduled appointments for injections. CCHi cycles involved two injections (0.58 mg) separated by 48–72 hr. During the study, 34 patients were treated, seven patients were excluded due to incomplete baseline values. Mean (standard deviation) PDQ bother domain baseline score was 11.1 (2.6). ANOVA demonstrated statistically significant effects of injections (p < .001) with a decrease in PDQ bother domain scores 6 weeks after the 1st cycle (9.9 [3.3], p = .013), 6 weeks after the 2nd cycle (8.2 [4.0], p = .009) and 6 weeks after the 3rd cycle (6.5 [3.6], p < .001). After 2–4 cycles of CCHi treatment, patients reported changes in penile curvature as “Worse” (0), “No Change” (2), “Little decrease” (10), Decrease (10) and “Significant decrease” (4). After completion of CCHi treatment, 82% of patients still reported that vaginal intercourse was difficult or impossible. Patients with Peyronie’s Disease undergoing CCHi treatment reported statistically significant decreases in PDQ bother domain scores. However, most patients still report difficulty with intercourse after treatment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163382/2/and13733_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163382/1/and13733.pd