Topic: Erectile Dysfunction

Guidelines and Practical Applications: Artificial Urinary Sphincter

William O. Brant, MD, FACS, FECSM, reviews the 2018 American Urological Association (UAU) guidelines and practical approaches in erectile dysfunction (ED) evaluation, diagnosis, and treatment. He examines methods for evaluation and diagnosis, highlighting the psychological impacts of ED and ED’s connection to cardiovascular disease. Dr. Brant also explores specialized tests and multiple treatment options.

Dr. Brant examines other treatment modalities, such as the vacuum erection device, as a low-cost adjunct treatment. He discusses the intraurethral suppository treatment and warns that up to 30 percent of patients experience urethral pain with this option. Dr. Brant then explains the risks of injection options and surgery. He also analyzes the practicality and commitment inherent in penile prostheses, later transitioning to a discussion on the uncommonly performed arterial reconstruction option.

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Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Con

Aditya Bagrodia, MD, FACS, Associate Professor of Urology and Genitourinary Oncology Team Lead at the University of California, San Diego, presents the cons of using PDE5 inhibitors and early penile rehabilitation to treat erectile dysfunction post-radical prostatectomy. In this presentation, Dr. Bagrodia discusses, the known adverse effects of early use of PDE5is in patients, the failure of PDE5is to out-perform placebos, and the strengths and weaknesses of known treatment options for post-operative erectile dysfunction.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Pro.

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The History of Penile Enlargement and the Advent of Penuma

James J. Elist, MD, FACS, a urologist and surgeon in private practice in Beverly Hills, California, explains why a patient may request penile enlargement, lists available treatment options for these patients, and discusses how to screen and select patients for a penile implant. He highlights the importance of the selection and screening process, observing that patients may have unrealistic expectations about how penile enlargement will affect their penis, may need psychological counseling or psychotherapy to address certain feelings about their penis, and may have undergone plastic surgery that affects their options for penile enlargement. Dr. Elist then looks at Penuma®, the first FDA-cleared, patented, and manufactured subcutaneous silicone implant for penile cosmetic corrective surgery. He explains how to perform the quick outpatient surgical procedure, goes over recovery and follow-up details, and considers the benefits of the implant compared to other options. Dr. Elist notes that the Penuma® implant is permanent yet reversible, customizable to patient anatomy, has no effect on erectile function and does not interfere with the urethra, remains accessible across the country, and boasts a strong and long term track record of patient satisfaction and low adverse events.

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Biologics in Sexual Medicine – Controversy and Therapeutic Potential

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology and R. Christian B. Evensen Associate Professor of Urology and Oncology at the James Buchanan Brady Urological Institute of Johns Hopkins Medicine in Baltimore, Maryland, discusses studies on biologics and low-intensity extracorporeal shock wave therapy (Li-ESWT), as well as controversial misinformation surrounding their use in sexual medicine. He reviews the results of a Li-ESWT study which displayed the treatment’s ability to improve symptoms, exercise capacity, and myocardial perforation in patients with severe coronary artery disease without indication for percutaneous coronary intervention or coronary artery bypass graft surgery. He then argues that for-profit stem cell clinics who offer biologic treatment for sexual medicine promise results with no supporting efficacy data, and that the trials these clinics use for support are not well-designed. Dr. Bivalacqua concludes that there is a demonstrated therapeutic potential for biologics, but more research is needed to support their use in sexual medicine and to prove their therapeutic value.

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Disease Modification and Erectile Dysfunction: Stem Cells, Shockwave, and PRP

Mohit Khera, MD, MBA, MPH, discusses the shifting paradigms in modern erectile dysfunction (ED) treatment, as reflected by the 2018 American Urological Association ED guidelines. These paradigms focus on shared decision-making, lifestyle modifications, and the concern for cardiovascular risk. He then describes mechanisms of and initial data on experimental regenerative techniques for treating ED, including low-intensity shockwave therapy, stem cell therapy, and platelet-rich plasma (PRP) therapy.

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New Frontiers in Cavernous Nerve Restorative Therapy to Preserve Erectile Function after Radical Prostatectomy

Arthur L. Burnett II, MD, MBA, FACS, presents the rationale for invoking therapeutic strategies for enhancing erectile function recovery following radical prostatectomy. He assesses possible therapeutic strategies that target the cavernous nerve in order to restoring erectile function and identifies the requirements and future possibilities for penile rehabilitation success.

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Shockwave Therapy for ED: Miracle or Hype?

Alan W. Shindel, MD, MAS, reviews the basic scientific concepts behind low intensity shock wave therapy and the rationale for its use in the management of erectile dysfunction (ED). He discusses existing data from both animal and human models supporting this treatment, as well as the knowledge gaps that must be addressed before adopting it into clinical practice.

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