Novel premature ejaculation, Peyronie's treatments take center stage

May 15, 2007

Sexual dysfunction comprises more than erectile dysfunction, and other conditions that fall into the category often receive a disproportionate amount of public attention.

Key Points

For example, as many as 40% of men have premature ejaculation (PE).

"This can be very distressing to the man and his sex partner, particularly if the partner is not very understanding about the problem," Dr. Mulcahy said. "Men affected by premature ejaculation may ejaculate within seconds of penetration or even before penetration. There are ways to treat the problem, and more potential therapies are being investigated."

A topical compound containing prilocaine and lidocaine led to fair-to-excellent results in more than 90% of a group of men with PE. During the 12-week follow-up period, most men reported that application of the cream 15 minutes prior to intercourse resulted in intravaginal latency time of more than 10 minutes.

The dual neurotransmitter reuptake inhibitor duloxetine was evaluated in men with PE. Their pretreatment intravaginal ejaculatory latency time was less than 1 minute, which increased to 7 to 8 minutes after 2 weeks of daily treatment with duloxetine, 30 mg or 60 mg.

Continuing the clinical evaluation of dapoxetine, a large study of men with moderate-to-severe PE evaluated the effect of treatment on distress related to ejaculation. Half of the patients treated with dapoxetine met criteria for response to therapy, compared to a quarter of placebo-treated patients. More than 90% of dapoxetine responders reported decreased distress related to ejaculation, compared to about half of those in the placebo group.

Increased use of testosterone replacement therapy has been accompanied by increased concern about potential adverse effects, Dr. Mulcahy said. Several AUA presentations focus on outcomes of TRT.

One study evaluated PSA and lipid dynamics associated with TRT. The study involved hypogonadal men followed for up to 5 years. Results showed that the average PSA value did not change significantly in men who did not develop prostate cancer. Total cholesterol decreased significantly, while the average HDL level increased significantly. Investigators recommended regular monitoring of PSA levels during the first 3 years of TRT and use of a lower threshold for prostate biopsy in men whose PSA rises.

Another investigation demonstrated the safety of TRT for symptomatic hypogonadism following radical prostatectomy. PSA level did not change during 1 year of therapy, and symptoms of hypogonadism improved significantly.

New approaches to Peyronie's

Urology investigators continue to evaluate and compare approaches to management of Peyronie's disease, searching for the optimal approach for a given patient.

One study examined outcomes in men who had surgical correction with tunica albuginea placation or plaque incision followed by grafting with pericardial tissue. In patients followed for an average of 5 years, investigators found that both approaches are efficacious, and little recurrent curvature or deterioration of sexual function occurs over time.