The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician.

Erectile dysfunction (ED) and cardiovascular disease (CVD) share risk factors and frequently coexist, with endothelial dysfunction believed to be the pathophysiologic link. ED is common, affecting more than 70% of men with known CVD. In addition, clinical studies have demonstrated that ED in men with no known CVD often precedes a CVD event by 2-5 years. ED severity has been correlated with increasing plaque burden in patients with coronary artery disease. ED is an independent marker of increased CVD risk including all-cause and especially CVD mortality, particularly in men aged 30-60 years. Thus, ED identifies a window of opportunity for CVD risk mitigation. We recommend that a thorough history, physical exam (including visceral adiposity), assessment of ED severity and duration and evaluation including fasting plasma glucose, lipids, resting electrocardiogram, family history, lifestyle factors, serum creatinine (estimated glomerular filtration rate) and albumin:creatinine ratio, and determination of the presence or absence of the metabolic syndrome be performed to characterise cardiovascular risk in all men with ED. Assessment of testosterone levels should also be considered and biomarkers may help to further quantify risk, even though their roles in development of CVD have not been firmly established. Finally, we recommend that a question about ED be included in assessment of CVD risk in all men and be added to CVD risk assessment guidelines

Disfunci\uf3n er\ue9ctil: causas, evaluaci\uf3n y opciones terap\ue9uticas

La evaluaci\uf3n inicial y el tratamiento de la disfunci\uf3n sexual de los varones han evolucionado para incluir una revisi\uf3n y un estudio m\ue1s extensos. Estos \ufaltimos incluyen ahora estudio del hipogonadismo, de la funci\uf3n eyaculatoria, de s\uedntomas en la porci\uf3n baja de v\uedas urinarias y de la depresi\uf3n (ps\uedquica). La evaluaci\uf3n se puede realizar f\ue1cilmente por medio de cuestionarios. En este art\uedculo se expone el tratamiento de dichas entidades, que incluyen el uso reciente de 5-fosfodiesterasa para tratar la disfunci\uf3n er\ue9ctil. La inclusi\uf3n de la mujer en la evaluaci\uf3n y el esquema terap\ue9utico rendir\ue1 beneficios adicionales y as\ued se podr\ue1n lograr mejores resultados

Prevention of erectile dysfunction after radiotherapy for prostate cancer

With increasing scrutiny of prostate cancer (PCa) diagnosis and treatment, much attention has been given to the morbidity caused by radical prostatectomy (RP) and/or radiotherapy (RT). One of the most common side-effects of either treatment is erectile dysfunction (ED). [1] Approximately, 40% of patients will experience ED after RT for PCa. The post-RT ED causes significant patient dissatisfaction with cancer treatment as well as decrease in patient and partner psychosocial function. [2] To address this issue in patients undergoing RT, Pisansky et al. [3] conducted a prospective, randomized, double-blinded, placebo-controlled trial to assess the efficacy of a phosphodiesterase enzyme-5 inhibitor (PDE5i), tadalafil, as a preventive measure for patients undergoing RT for PCa and found no difference in erectile function between the control and treatment groups

Dartos Fascia Interposition Flap for Penetrating Cavernosal and Urethral Trauma

We present an unusual case of a single gunshot to the genitalia in which the bullet trajectory injured the urethra, corpus cavernosum, and both testicles. All injuries were successfully repaired during initial exploration. Our report serves as a reminder to clinicians to have a high index of suspicion in this circumstance and consider immediate exploration of all the injured areas. We also demonstrate the use of a dartos fascia interposition flap to cover and separate the concomitant urethral and corporal sutures lines. Our dartos flap bolstered the urethral and cavernosal repairs and helped prevent postoperative corporourethral fistula formation

Standards for Clinical Trials in Male Sexual Dysfunctions

Introduction