Best of AUA 2013: Sexual Function/Dysfunction

July 1, 2013

Robert C. Dean, MD, presents the take home messages on sexual function/dysfunction from the AUA annual meeting in San Diego.

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Presented by Robert C. Dean, MD

Walter Reed National Military Medical Center, Washington


• Findings from the phase III IMPRESS (Investigation for Maximal Peyronie’s Reduction Efficacy and Safety Studies) I and II studies found that collagenase clostridium histolyticum (CCH [Xiaflex]) treatment for Peyronie’s disease led to a 28.1% to 39.1% improvement in penile curvature from baseline as compared to placebo. A separate presentation of IMPRESS data found there was a significantly greater number of composite responders (≥20% improvement in penile curvature and ≥1 point improvement in Peyronie’s improvement score) in the treatment arm compared with placebo.

• CCH achieves high rates of improvement in penile curvature regardless of disease duration or level of plaque calcification.

• Intralesional CCH displayed a favorable safety profile, resulting in eight nonfatal serious adverse events in 954 patients.

• Testing of a smartphone application for taking and transmitting photos for measurement of penile curvature and narrowing in Peyronie’s disease showed high inter-test and intra-observer reliability.

• A large phase III trial of androgen replacement therapy showed significant improvement in quality of life; significant decrease in waist size and triglycerides; significant increase in muscle mass volume of the legs and whole body; significant improvement in hemoglobin; no significant change in body mass index, bone mineral density, handgrip strength, glycated hemoglobin, or serum PSA; and no difference from control group with respect to severe adverse events.

• High body mass index, type 2 diabetes, and erectile dysfunction are highly predictive (p<.001) of hypogonadism.

• Evaluation of hormonal activity and ejaculation showed that testosterone increased in all men across all age groups following ejaculation, and pre-ejaculation follicle-stimulating hormone predicted bulbocavernosus muscle thickness. Investigators concluded that testosterone and FSH levels are positive markers of ejaculatory function.

• Long-term testosterone replacement therapy did not raise prostate cancer risk in a cohort of 722 men followed for a mean 8.7 years.

• Testosterone concentrations in compounded products from 10 compounding pharmacies in Canada varied significantly within samples from each pharmacy and between pharmacies.

• Comparison of infrapubic versus transcrotal placement of inflatable penile prosthesis showed that the transcrotal approach was associated with longer implant, increased proximal dilation, and longer rear tip extenders (p<.0001).

• A comparison of a series of revision penile prosthesis and artificial sphincter surgery in which the initial reservoir was not removed (“drained and retained”) showed no difference in infection rate compared with first-time prosthetic replacement.

• An investigational penile prosthesis made of nickel-titanium memory alloy alternates between flaccid and erect states by application of heat, requiring no pump or reservoir. Buckling strength and lateral bending are comparable to those of modern inflatable prostheses, and forces are the same or better than inflatable prostheses, as are mechanical properties.

• Sildenafil citrate (Viagra) use before and after radiation therapy yields significant improvement in erectile function preservation.

• Fifty percent of patients with an ischemic priapism duration of <24 hours regained erectile function when treated with the T-shunt procedure. After 48 hours of ischemic priapism duration, no patient regained erectile function following the procedure.

• Increasing age was the only predictor of worsening sexual function for men undergoing active surveillance for prostate cancer.

• Many websites on TRT have poor-quality medical information, little mention of potential side effects, and minimal involvement of urologists or endocrinologists.UT


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