Testosterone depot injection in male hypogonadism: a critical appraisal

Testosterone compounds have been available for almost 70 years, but the pharmaceutical formulations have been less than ideal. Traditionally, injectable testosterone esters have been used for treatment, but they generate supranormal testosterone levels shortly after the 2- to 3-weekly injection interval and then testosterone levels decline very rapidly, becoming subnormal in the days before the next injection. The rapid fluctuations in plasma testosterone are subjectively experienced as disagreeable. Testosterone undecanoate is a new injectable testosterone preparation with a considerably better pharmacokinetic profile. After 2 initial injections with a 6-week interval, the following intervals between two injections are almost always 12-weeks, amounting eventually to a total of 4 injections per year. Plasma testosterone levels with this preparation are nearly always in the range of normal men, so are its metabolic products estradiol and dihydrotestosterone. The “roller coaster” effects of traditional parenteral testosterone injections are not apparent. It reverses the effects of hypogonadism on bone and muscle and metabolic parameters and on sexual functions. Its safety profile is excellent due to the continuous normalcy of plasma testosterone levels. No polycythemia has been observed, and no adverse effects on lipid profiles. Prostate safety parameters are well within reference limits. There was no impairment of uroflow. Testosterone undecanoate is a valuable contribution to the treatment options of androgen deficiency

Frequency of Erectile Dysfunction Following Pelvic Fracture Among Patients Admitted to Two Wits Teaching Hospitals, South Africa

Background: Erectile dysfunction that can range from weak to severe is one of the most important sequelae of pelvic fractures and may be transient or permanent. Importantly, erectile dysfunction is more prevalent when the pelvic fracture is associated with urethral injury. This study aimed to evaluate the frequency of erectile dysfunction post pelvic fracture and determine the frequency of spontaneous recovery of erectile function within the first six months from the time of injury in a South African sample population. Materials and Methods: This study was a cross-sectional study of records of patients who were admitted to the Orthopedic Department at Helen Joseph Academic Hospital and the Male Sexual Dysfunction Clinic at Charlotte Maxeke Johannesburg Academic Hospital, in Johannesburg, South Africa, with a pelvic fracture between July 1, 2011 and April 30, 2015. Results: A total of 53 patients aged between 18 and 80 years (mean: 7.57 ± SD3.45) meeting the study-inclusion criteria participated in the study, of which 50.9% had a B2 type pelvic fracture and 20% had a C type fracture. Of the 53 patients, 43.4% reported erectile dysfunction. The majority (88%) of patients indicated a recovery of erectile function between 2 and 8 months after the injury. However, 86% of those patients were stillsuffering from other forms of sexual impairment like orgasmic dysfunction and lack of sexual satisfaction. Interestingly, sexual desire seemed to be preserved. Patients with sexual dysfunction were more likely to have had a urethral injury as well as a more severe fracture. Conclusions: In our sample of 53 patients, almost half (43.4%) reported sexual dysfunction after a pelvic fracture. Importantly, patients with a severe pelvic fracture and urethral damage should be followed-up after surgery, as the risk of long-term sexual dysfunction is increased in these particular patients

The South African guidelines on enuresis-2017

Introduction: Enuresis (or Nocturnal Enuresis) is defined as discreet episodes of urinary incontinence during sleep in children over 5 years of age in the absence of congenital or acquired neurological disorders. Recommendations: Suggestions and recommendations are made on the various therapeutic options available within a South African context. These therapeutic options include; behavioural modification, pharmaceutical therapy [Desmospressin (DDAVP), Anticholinergic (ACh) Agents, Mirabegron (beta 3-adrenoreceptor agonists), and Tricyclic Antidepressants (TCA)], alternative treatments, complementary therapies, urotherapy, alarm therapy, psychological therapy and biofeedback. The role of the Bladder Diary, additional investigations and Mobile Phone Applications (Apps) in enuresis is also explored. Standardised definitions are also outlined within this document. Conclusion: An independent, unbiased, national evaluation and treatment guideline based on the pathophysiological subcategory is proposed using an updated, evidence based approach. This Guideline has received endorsement from the South African Urological Association, Enuresis Academy of South Africa and further input from international experts within the field

Frequency of Erectile Dysfunction Following Pelvic Fracture Among Patients Admitted to Two Wits Teaching Hospitals, South Africa

Background: Erectile dysfunction that can range from weak to severe is one of the most important sequelae of pelvic fractures and may be transient or permanent. Importantly, erectile dysfunction is more prevalent when the pelvic fracture is associated with urethral injury. This study aimed to evaluate the frequency of erectile dysfunction post pelvic fracture and determine the frequency of spontaneous recovery of erectile function within the first six months from the time of injury in a South African sample population. Materials and Methods: This study was a cross-sectional study of records of patients who were admitted to the Orthopedic Department at Helen Joseph Academic Hospital and the Male Sexual Dysfunction Clinic at Charlotte Maxeke Johannesburg Academic Hospital, in Johannesburg, South Africa, with a pelvic fracture between July 1, 2011 and April 30, 2015. Results: A total of 53 patients aged between 18 and 80 years (mean: 7.57 ± SD3.45) meeting the study-inclusion criteria participated in the study, of which 50.9% had a B2 type pelvic fracture and 20% had a C type fracture. Of the 53 patients, 43.4% reported erectile dysfunction. The majority (88%) of patients indicated a recovery of erectile function between 2 and 8 months after the injury. However, 86% of those patients were stillsuffering from other forms of sexual impairment like orgasmic dysfunction and lack of sexual satisfaction. Interestingly, sexual desire seemed to be preserved. Patients with sexual dysfunction were more likely to have had a urethral injury as well as a more severe fracture. Conclusions: In our sample of 53 patients, almost half (43.4%) reported sexual dysfunction after a pelvic fracture. Importantly, patients with a severe pelvic fracture and urethral damage should be followed-up after surgery, as the risk of long-term sexual dysfunction is increased in these particular patients