Best of AUA 2014: Sexual Function/Dysfunction
Presented by Landon Trost, MD,
• Two studies presented data from the IMPRESS I/II phase III trials of clostridium collagenase histolyticum (CCH [XIAFLEX]). Each trial included two injections of CCH, given 1-3 days apart. The first abstract compared patients who received the second injection 1, 2, or 3 days after the first and noted no difference in outcomes or complications. The second abstract assessed what patients would consider a meaningful change with therapy, finding that 75% of men with Peyronie’s reported meaningful change following treatment that resulted in 25% or greater improvement in penile curvature deformity.
• Erectile function declined after perineal prostate biopsy at 1 month and subsequently resolved and returned to baseline levels at 3 months.
• Among patients undergoing high-intensity focused ultrasound, mean International Index of Erectile Function score went from 19.8 pre-op to 12.5 at 1 month and 18.2 at 12 months. However, phosphodiesterase-type-5 inhibitor use remained elevated at 12 months, suggesting that the data may be underrepresentative.
• A phase IV randomized controlled trial of avanafil (Stendra) found a significant difference in the ability to generate a satisfactory erection in as early as 15 minutes.
• A post-prostatectomy rehab trial evaluating tadalafil (Cialis) once daily, tadalafil on demand, and placebo demonstrated that daily therapy improved sexual function, although this returned to baseline levels after washout. Reduced penile length loss was also observed in the daily tadalafil group.
• There is no benefit to nightly post-prostatectomy ED therapy with sildenafil citrate (Viagra) compared with placebo.
• Reoperation rate of penile prosthesis is highest within the first year of placement. The trend toward inflatable versus malleable prostheses is significantly increasing.
• Markers of neuronal injury and apoptosis are significantly increased early following bilateral cavernous nerve injury.
• Basic science studies evaluated medications that improved erectile function in various models, including pioglitazone (post-RP), PNTX2-06 spider toxin (post-RP), tadalafil (chronic ischemia), melatonin and tadalafil (spinal cord injury), and a cannabinoid 2 receptor agonist (neuropraxia).
• Questionnaires completed by men with Peyronie’s disease indicated that the men had a normal range for mental health. Body image, penile length, and erectile function were significant predictors of greater sexual satisfaction, while penile curvature was not.
• A preliminary feasibility study evaluated the injection of stem cells for the treatment of ED or Peyronie’s disease in a human model. Eight patients underwent treatments for ED. Three-month follow-up in six patients revealed significantly improved peak systolic velocities, and three patients had a complete return to unassisted erections. In the Peyronie’s disease cohort, of five patients, plaques were reduced by 46% to 100% and curvatures were improved by 43% to 100%.
• A review of sensory changes after incision and grafting in Peyronie’s disease patients found that 21% noted a significant sensation loss immediately after surgery up until 1 month. This improved to 3% at 12 months.
• Injection of adipose-derived stem cells in a rat model of chronic Peyronie’s disease restored the collagen III/I ratio.
• Among approximately 1,900 men and women undergoing cystectomy, 92% of men and 51% of women described sexual dysfunction afterwards, with ileal conduit associated with worse outcomes than other forms of reconstruction.
• Premature ejaculation patients undergoing 12 weeks of pelvic floor muscle rehabilitation saw a 4.6-fold increase in intravaginal ejaculatory latency time. The benefits were sustained at 6 months.
• A sickle cell mouse model demonstrated that sialophorin resulted in upregulation of Hif1A, providing a link in the mechanisms between ischemia and uncontrolled smooth muscle relaxation.
• In a cohort of patients with diabetes, low sexual desire was noted in 42% and orgasmic dysfunction in 15% of patients. The main predictors for orgasmic dysfunction were age, bothersome urinary symptoms, sexual activity, and higher AbA1c levels.
• In a rat model of female hypoactive sexual desire disorder, rats were either treated with buproprion, tadalafil, or combined therapy, with all drug groups showing improvements in sexual behavior. The greatest improvements occurred with the combination therapy.
• A review of the citation error rate in the sexual medicine literature found a 31% overall error rate and 6% significant error rate, the latter of which included discrepant conclusions and/or data.UT
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