Topic: Erectile Dysfunction

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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Testosterone Replacement and Focal Therapy

Mohit Khera, MD, MBA, MPH, reviews the literature surrounding the safety of testosterone replacement therapy (TRT) following prostate cancer treatment, including after brachytherapy, EBRT, and radical prostatectomy (RP). He also discusses the concept of bipolar androgen therapy (BAT) and the importance of TRT for erectile preservation post-RP.

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Clinical Care Pathway for Anejaculation

John P. Mulhall, MD, the chair of the committee for the American Urological Association (AUA) testosterone guidelines, summarizes indications regarding anejaculation. He explains the anatomical and physiological differences of retrograde ejaculation and failure of emission, and possible etiologies for these symptoms. Furthermore, he reviews the recommendations for diagnosis, management, and use of electroejaculation for semen retrieval.

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