Sexual dysfunction: Protocol decreases opioid requirements in IPP patients

The AUA 2018 sexual dysfunction take-home messages also included a novel end-to-side nerve grafting procedure for men with post-radical-prostatectomy ED as well as the finding that use of a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor does not appear to change the adverse effect profile of flibanserin (Addyi). The take-homes were presented by Nelson Bennett, Jr., MD, of Northwestern University Feinberg School of Medicine, Chicago.

• Researchers implemented an alternate multimodal analgesia protocol to decrease opioid requirements for inflatable penile prosthesis patients. The men received acetaminophen, gabapentin, and meloxicam prior to surgery. They then received a pudendal and penile block during the procedure. Afterwards, pain was controlled by acetaminophen, gabapentin, and meloxicam, with narcotics for breakthrough pain. They saw a significant decrease in all pain scores as well as the amount of narcotics prescribed for these patients.
• The AUA released new guidelines on the diagnosis and treatment of testosterone deficiency and diagnosis and treatment of erectile dysfunction.
• On linear regression, time since awakening was not associated with changes in serum testosterone levels in shift workers. There were no significant variations in testosterone levels observed in either morning or afternoon blood draws.
• In a study of human corpus cavernosum tissue, eugonodal testosterone levels indirectly and specifically mediated corporal relaxation via downstream stimulation of nNos, eNos, and cGMP.
• Mice subjected to S-nitrosoglutathione reductase deficiency had significantly smaller litter sizes and smaller testicles, as well as decreased epididymal sperm concentration and motility.
• Transpelvic magnetic stimulation is a novel therapy to enhance penile blood flow. Rabbits were subjected to an electrical field around the pelvis and underwent penile ultrasound. Rabbits that had electrical field stimulation showed a significant increase in peak systolic velocity and a decrease in end-diastolic velocity.
• Researchers presented data on a novel end-to-side nerve grafting procedure for men with post-radical-prostatectomy erectile dysfunction. Erectile function increased significantly; 64% of men who previously had ED were able to obtain erections. In addition, 45% of patients were able to get erections without the use of phosphodiesterase-type-5 inhibitors.
• A multi-institutional international study evaluated 133 patients undergoing penile implant surgery (inflatable or malleable implant). There was a statistically significant increase in not only the length but also the girth of the penis after implantation of the prosthesis. In inflatable prostheses, length increased by 0.6 cm and girth by 1.7 cm. In the malleable group, length increased by 0.2 cm and girth by 0.7 cm.
• Plaque calcification significantly reduces the success of collagenase clostridium histolyticum (XIAFLEX) therapy for Peyronie’s disease. Greater baseline and ventral direction increase the chance of ≥20% curvature improvement.
• In rats with Peyronie’s disease, researchers examined the antifibrotic effect of the anti-transplant drug mycophenolate mofetil (MMF). Rats were either given nothing or TGF beta to induce a plaque. MMF was given 7 or 30 days after induction. Histochemical assessment found fragmentation and degradation of elastin in the tunica albuginea prior to treatment with MMF. The process of degradation and fragmentation was completely reversed by MMF in the 7-day group, and there was even a normal restoration of architecture in the 30-day group.
• The use of a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor does not appear to change the adverse effect profile of flibanserin (Addyi).
• Daily use of ospemifene (Osphena) improves the quality of the genitourinary tissue in the vulva, vestibule, urethral meatus, and vagina, as assessed by prospective vulvoscopy.