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Objectives: To evaluate the hypothesis that there is an improvement in sexual function following smoking cessation (as smoking is a well‐established risk factor for sexual dysfunction), we analysed the association between cigarette smoking and smoking cessation with sexual function among participants of the REduction by DUtasteride of prostate Cancer Events (REDUCE) study. Subjects and Methods: We analysed baseline data of 6754 men, aged 50–75 years divided into: lifelong non‐smokers, former smokers, and current smokers. We examined total testosterone (TT, normal range ≥10 nmol/L) and sexual function variables: self‐reported sexual activity, low libido, and erectile dysfunction (ED). Differences between current vs non‐smokers and former vs current smokers were analysed using the chi‐square test, linear and logistic regressions. Results: A total of 3069 (45.4%) men were non‐smokers, 2673 (39.6%) former smokers, and 1012 (15%) current smokers. Current smokers were significantly younger than former and non‐smokers (mean age 61.6, 63.2, and 62.7 years, respectively), leaner (mean body mass index 27.0, 27.7, and 27.2 kg/m2, respectively), and had less hypertension (32.4%, 41.6%, and 36.8%, respectively; all P < 0.01). In uni‐ and multivariable analysis, current smokers had higher mean TT than non‐smokers (485.4 vs 451.2 nmol/L, P < 0.001), higher prevalence of low libido (25.6% vs 21.0%, P = 0.002) and ED (31.6% vs 26.0%, P < 0.001) with comparable sexual activity (81.7% vs 82.8%, P = 0.420). In multivariable analysis, former smokers had statistically significantly less prevalence of low libido (odds ratio [OR] 0.8, P = 0.013) and ED (OR 0.8, P = 0.006) compared to current smokers. Conclusion: Cigarette smoking was associated with worse sexual health compared to non‐smokers, while former smokers had better erectile function and libido than current smokers. Smoking cessation may improve male sexual health and counselling on smoking cessation may be considered at the time of sexual health evaluations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the frequency of sexual intercourse and sexual activity of patients after nerve‐sparing (NS) robot‐assisted laparoscopic radical prostatectomy (RARP). Patients and Methods: We prospectively obtained 2‐years longitudinal Expanded Prostate Cancer Index Composite (EPIC) and Sexual Health Inventory for Men (SHIM) score data from 99 patients. We classified the frequency of sexual intercourse and sexual activity as 'none', 'less than once a week', 'about once a week', 'several times a week', and 'daily'. Results: The percentages of patients who took part in sexual activity before and at 3, 6, 9, 12, 18, and 24 months after NS RARP were 55.6%, 27.9%, 38.8%, 42.5%, 44.4%, 41.7%, and 42.1%, respectively. The percentages of patients who took part in sexual intercourse before and at 3, 6, 9, and 12, 18, and 24 months after NS RARP were 41.4%, 9.0%, 13.3%, 16.3%, 16.7%, 22.2%, and 23.7%, respectively. Preoperative sexual status was classified into two groups: those who had sexual intercourse or those who only had sexual activity except sexual intercourse. Sexual function (SF) was investigated longitudinally using the EPIC and SHIM data between the two groups. The SHIM data showed an improvement in SF in the sexual intercourse group, but did not do so in the sexual activity except sexual intercourse group. On the other hand, SF in the EPIC data might reflect the postoperative improvement of SF in the sexual activity except sexual intercourse group. Conclusion: There was a large discrepancy between the percentages of patients taking part in sexual intercourse and sexual activity; therefore, surveys of postoperative SF are recommended to include not only sexual intercourse but also sexual activity. [ABSTRACT FROM AUTHOR]

Objective: To introduce a patient‐reported erection fullness scale (%fullness) after robot‐assisted radical prostatectomy (RARP) as a qualitative adjunct to the five‐item version of the International Index of Erectile Function (IIEF‐5) and as a 90‐day predictor of 2‐year potency outcomes. Patients and Methods: Prospective data were collected from 540 men with preoperative IIEF‐5 scores of 22–25 who underwent RARP by a single surgeon, and of whom 299 had complete data at all time points up to 2 years. In addition to standard assessment tools (IIEF‐5 and erections sufficient for intercourse [ESI]), the men were asked to ‘indicate the fullness you are able to achieve in erections compared to before surgery?’ (range: 0–100%). The primary outcome was prediction of potency (defined as ESI) at 24 months, based on 90‐day %fullness tertile (0–24%, 25–74% and 75–100%). Results: A total of 299 men with complete follow‐up were included in the study. Significant predictors of 24‐month potency included age, body mass index, pathological stage, nerve‐sparing status and %fullness tertiles. When the men (preoperative IIEF‐5 score 22–25) were assessed at 90 days after RARP, 181/299 (61%) had erections inadequate for intercourse. If IIEF‐5 scores of 1–6 were used, 142/181 men (78%) would be targeted for early intervention. By contrast, if 0–24% fullness was used, 88/181 men (49%) would be targeted. If both the IIEF‐5 score and %fullness were used, this would be reduced to 77/181 men (43%). Conclusions: We introduce %fullness as a qualitative adjunct to the IIEF‐5 score, and separately as a 90‐day predictor of 2‐year potency recovery. This initial report is hypothesis‐generating, such that the use of %fullness enables the identification of men who are most likely to benefit from early, secondary intervention. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between self‐reported urinary incontinence (UI) and sexual health in a representative sample of older people. Subjects and Methods: Participants were community‐dwelling women and men aged 50–90+ years from the English Longitudinal Study of Ageing (ELSA) who reported any sexual activity in the last year. The prevalence of UI was assessed both cross‐sectionally (ELSA Wave 6; 2012) and retrospectively over the preceding 8 years (ELSA Waves 2–6; 2004–2012). Sexual activities, difficulties and concerns were assessed using a validated Sexual Relationships and Activities Questionnaire. The association between UI and sexual health outcomes was examined using weighted logistic regressions, with adjustments made for demographic, health, and lifestyle factors. Results: At Wave 6, 391 (20.0%) women and 141 (6.9%) men reported ‘any UI’ in the last 12 months. Compared to those without UI, women with UI reported declines in sexual activity and arousal over the last year, and increased concern about their frequency of sexual activity and ability to become sexually aroused. Men with ‘any UI’ reported declines in sexual desire, increased erectile and orgasm difficulties, and were more concerned about these sexual functions compared to men without UI. Differences in the patterns of association with sexual health were seen, dependent upon whether UI was reported as sporadic or persistent, and also with respect to the duration of retrospectively reported UI. Conclusion: Self‐reported UI was associated with impairment in sexual health in women and men, and mainly linked to recent declines in sexual activity and function along with elevated sexual concerns. Our findings highlight that the sexual health of older people should be considered when managing UI. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the functional erection rate after prostate stereotactic body radiotherapy (SBRT) and to develop a comprehensive prognostic model of outcomes after treatment. Patients and Methods: Between 2008 and 2013, 373 consecutive men with localized prostate cancer were treated with SBRT at a single academic institution as part of a prospective clinical trial or prospective registry. Prospective longitudinal patient‐reported health‐related quality of life (HRQoL) data was collected using the Expanded Prostate Cancer Index Composite (EPIC)‐26 instrument. Functional erections were strictly defined as ‘firm enough for intercourse’ according to EPIC‐26. Detailed comorbidity data were also collected. Logistic regression models were used to predict 24‐ and 60‐month functional erection rates. Observed erection rates after SBRT were compared with those after other radiation therapies (external beam radiation therapy [EBRT] and brachytherapy) using prospectively validated models. Results: The median (interquartile range) follow‐up was 56 (37–73) months and the response rate at 2 years was 84%. For those with functional erections at baseline, 57% and 45% retained function at 24 and 60 months, respectively. On multivariable analysis for 24‐month erectile function, significant variables included higher baseline sexual HRQoL (adjusted odds ratio [aOR] 1.55 per 10 points, 95% confidence interval [CI] 1.37–1.74; P < 0.001) and older age (aOR 0.66 per 10 years, 95% CI 0.43–1.00; P = 0.05). At 60 months, baseline HRQoL and age remained associated with erectile function, along with body mass index (aOR 0.45, 95% CI 0.26–0.78; P < 0.001). The 24‐ and 60‐month models had excellent discrimination (c‐index 0.81 and 0.84, respectively). Erection rates after SBRT were not statistically different from model‐predicted rates after EBRT or brachytherapy for the whole cohort and the cohort with baseline erectile function. Conclusions: Intermediate‐ to long‐term post‐SBRT erectile function results are promising and not significantly different from other radiotherapy techniques. Clinicians can use our prognostic model to counsel patients regarding expected erectile function after SBRT. [ABSTRACT FROM AUTHOR]

Context Pelvic organ-preserving radical cystectomy ( POPRC) for women may improve postoperative sexual and urinary functions without compromising the oncological outcome compared with standard radical cystectomy ( RC). Objective To determine the effect of POPRC on sexual, oncological and urinary outcomes compared with RC in women who undergo standard curative surgery and orthotopic neobladder substitution for bladder cancer. Evidence acquisition Medline, Embase, Cochrane controlled trials databases and clinicaltrial.gov were systematically searched for all relevant publications. Women with bladder cancer who underwent POPRC or standard RC and orthotopic neobladder substitution with curative intent were included. Prospective and retrospective comparative studies and single-arm case series were included. The primary outcomes were sexual function at 6-12 months after surgery and oncological outcomes including disease recurrence and overall survival ( OS) at >2 years. Secondary outcomes included urinary continence at 6-12 months. Risk of bias (RoB) assessment was performed using standard Cochrane review methodology including additional domains based on confounder assessment. Evidence synthesis The searches yielded 11 941 discrete articles, of which 15 articles reporting on 15 studies recruiting a total of 874 patients were eligible for inclusion. Three papers had a matched-pair study design and the rest of the studies were mainly small, retrospective case series. Sexual outcomes were reported in seven studies with 167/194 patients (86%) having resumed sexual activity within 6 months postoperatively, with median (range) patients' sexual satisfaction score of 88.5 (80-100)%. Survival outcomes were reported in seven studies on 197 patients, with a mean follow-up of between 12 and 132 months. At 3 and 5 years, cancer-specific survival was 70-100% and OS was 65-100%. In all, 11 studies reported continence outcomes. Overall, the daytime and night-time continence rates were 58-100% and 42-100%, respectively. Overall, the self-catheterisation rate was 9.5-78%. Due to poor reporting and large heterogeneity between studies, instead of subgroup-analysis, a narrative synthesis approach was used. The overall RoB was high across all studies. Conclusion For well-selected patients, POPRC with orthotopic neobladder may potentially be comparable to standard RC for oncological outcomes, whilst improving sexual and urinary function outcomes. However, in women undergoing RC, oncological and functional data regarding POPRC remain immature and require further evaluation in a prospective comparative setting. [ABSTRACT FROM AUTHOR]

Objectives To compare prostatic urethral lift ( PUL) with transurethral resection of the prostate ( TURP) with regard to symptoms, recovery experience, sexual function, continence, safety, quality of life, sleep and overall patient perception. Patients and Methods A total of 80 patients with lower urinary tract symptoms attributable to benign prostatic hyperplasia ( BPH) were enrolled in a prospective, randomized, controlled, non-blinded study conducted at 10 European centres. The BPH6 responder endpoint assessed symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation and safety. Additional evaluations of patient perspective, quality of life and sleep were prospectively collected, analysed and presented for the first time. Results Significant improvements in International Prostate Symptom Score ( IPSS), IPSS quality of life (QoL), BPH Impact Index ( BPHII), and maximum urinary flow rate ( Qmax) were observed in both arms throughout the 2-year follow up. Change in IPSS and Qmax in the TURP arm were superior to the PUL arm. Improvements in IPSS QoL and BPHII score were not statistically different between the study arms. PUL resulted in superior quality of recovery, ejaculatory function preservation and performance on the composite BPH6 index. Ejaculatory function bother scores did not change significantly in either treatment arm. TURP significantly compromised continence function at 2 weeks and 3 months. Only PUL resulted in statistically significant improvement in sleep. Conclusion PUL was compared to TURP in a randomised, controlled study which further characterized both modalities so that care providers and patients can better understand the net benefit when selecting a treatment option. [ABSTRACT FROM AUTHOR]

Objective To evaluate the 24-month effectiveness of the prostatic urethral lift ( PUL) procedure in men with lower urinary tract symptoms ( LUTS) secondary to benign prostatic hyperplasia ( BPH) assessed through a crossover study. Patients and Methods In all, 53 patients underwent a sham procedure as part of the blinded, randomised L.I.F.T. (Luminal Improvement Following prostatic Tissue approximation for the treatment of LUTS secondary to BPH) study at 19 centres and elected to enrol in this crossover study. The crossover procedure involved placement of permanent implants (UroLift® system) into the prostatic lateral lobes. Patients were followed for 3 months after the sham procedure and then for 24 months after crossover to PUL, with assessments of urinary symptom relief, quality of life (QoL), urinary flow rate, sexual function, and adverse events. Results At 24 months after crossover to PUL, the International Prostate Symptom Score ( IPSS), QoL, BPH Impact Index, and maximum urinary flow rate improved 36%, 40%, 54%, and 77% from baseline, respectively. Each IPSS parameter on average improved significantly from baseline ( P < 0.005) and remained stable throughout follow-up. Symptom response after the sham procedure indicated initial improvement at 1 month with significant decay by 3 months. Adverse events were typically mild to moderate and patients returned rapidly to normal activity. Four patients (8%) required intervention with transurethral resection of the prostate and one patient required additional PUL implants within the 24-month period. There were no reported instances of de novo sustained erectile or ejaculatory dysfunction. Conclusions The PUL procedure is associated with rapid symptom relief, increased urinary flow rate and QoL improvement that remain stable over 24 months. Morbidity is low and sexual function is preserved. [ABSTRACT FROM AUTHOR]

Objective To assess the understanding of patients, who had previously undergone radical prostatectomy ( RP), about their postoperative sexual function, as clinical experience suggests that some RP patients have unrealistic expectations about their long-term sexual function. Patients and Methods Patients presenting within 3 months of their open RP or robot-assisted laparoscopic prostatectomy ( RALP) were questioned about the sexual function information that they had received preoperatively. Patients were questioned about erectile function ( EF), postoperative ejaculatory status, orgasm, and postoperative penile morphology changes. Statistical analyses were performed to assess for differences between patients who underwent open RP vs RALP. Results In all, 336 consecutive patients (from nine surgeons) with a mean ( SD) age of 64 (11) years had the survey instrument administered (216 underwent open RP and 120 underwent RALP). There were no significant differences in patient age or comorbidity profiles between the two groups. Only 38% of men had an accurate recollection of their nerve-sparing status. The mean ( SD) elapsed time after RP at the time of postoperative assessment was 3 (2) months. RALP patients expected a shorter EF recovery time (6 vs 12 months, P = 0.02), a higher likelihood of recovery back to baseline EF (75% vs 50%, P = 0.01), and a lower potential need for intracavernosal injection therapy (4% vs 20%, P = 0.01). Almost half of all patients were unaware that they were rendered anejaculatory by their surgery. None of the RALP patients and only 10% of open RP patients recalled being informed of the potential for penile length loss ( P < 0.01) and none were aware of the association between RP and Peyronie's disease. Conclusions Patients who have undergone RP have largely unrealistic expectations about their postoperative sexual function. [ABSTRACT FROM AUTHOR]

Objective To investigate sexual function and quality of life in adolescent and adult women with classic bladder exstrophy ( BE). Materials and Methods A two-part observational cross-sectional study with a questionnaire arm and a retrospective case review arm was performed. The study was undertaken in a centre providing a tertiary referral gynaecology and urology service. Outcomes were sexual function and quality-of-life scores. Results A total of 44 patients with BE were identified from departmental databases and included in the study, of whom 28 (64%) completed postal questionnaires. Sexual function scores and quality-of-life visual analogue scales were significantly poorer compared with normative data. Conclusions Bladder exstrophy has a detrimental psychological impact on women. In future, methodical multidisciplinary paediatric follow-up research will help to identify predictors of better and worse adolescent and adult outcomes. Development and evaluation of cost-effective psychological interventions to target specific problems is also warranted. [ABSTRACT FROM AUTHOR]

Objective To assess the clinical effect of the 'prostatic urethral lift' ( PUL) on lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) through a crossover design study., Patients and Methods Men aged ≥50 years with an International Prostate Symptom Score of ≥13, a maximum urinary flow rate ( Qmax) of ≤12 mL/s, and a prostate of 30-80 mL were enrolled into a crossover study after completing a prospective, randomised, controlled, 'blinded' pivotal study in which they were control subjects receiving a sham procedure., Patients were followed for 1 year after crossover PUL at 19 centres in the USA, Canada and Australia. The sham procedure involved rigid cystoscopy with simulated active treatment sounds., PUL involved placing permanent UroLift® ( NeoTract, Inc., Pleasanton, CA, USA) implants into the lateral lobes of the prostate to enlarge the urethral lumen., Urinary symptom relief, health-related quality of life ( HRQL) impact, urinary flow parameters, sexual function, and adverse events were assessed and compared between the sham and PUL using paired statistical analysis., Results Symptom, flow, HRQL and sexual function assessments showed response improvements from baseline results, similar to results from other published studies, and most parameters were markedly improved after PUL vs the sham procedure in the same patients., Symptom, flow, and HRQL improvements were durable over the 12 months of the study., Adverse events associated with the procedure were typically transient and mild to moderate; one patient (2%) required re-intervention with transurethral resection of the prostate in the first year., There were no occurrences of de novo, sustained ejaculatory or erectile dysfunction., Conclusion The PUL can be performed under local anaesthesia, causes minimal associated perioperative complications, allows patients to quickly return to normal activity, provides rapid and durable improvement in symptoms, and preserves sexual function. [ABSTRACT FROM AUTHOR]

Gastrin-releasing peptide ( GRP) acts as an important regulatory peptide in several normal physiological processes and as a growth factor in certain cancers. In this review we provide a comprehensive overview of the current state of knowledge of GRP in urological tissues under both normal and cancerous conditions. GRP and its receptor, GRP- R, are expressed in the normal kidney and renal cancers. GRP can stimulate the growth of renal cancer cells. GRP and GRP- R are expressed in prostate cancer and GRP can stimulate the growth of prostate cancer cell lines. Importantly, GRP is a key neuroendocrine peptide, which may be involved in the progression of advanced prostate cancer and in the neuroendocrine differentiation of prostate cancer. Recent animal studies have shown that GRP and GRP- R are an integral part of male sexual function and play a crucial role in spinal control of erections and ejaculation. [ABSTRACT FROM AUTHOR]

Objective To examine long-term quality-of-life, urinary continence and sexual function outcomes in patients diagnosed with bladder exstrophy ( BE)., Patients and Methods A total of 65 patients with BE and follow-up of at least 20 years were identified., After informed consent for inclusion in the study, the patients were asked to complete three validated questionnaires, the Short-Form 36 quality-of-life questionnaire ( SF-36), the International Consultation on Incontinence Questionnaire ( ICIQ) and the International Index of Erectile Function ( IIEF), to assess quality of life, perceived urinary continence and sexual function., Results In all, 21 patients responded to the questionnaires, yielding a 32% response rate., High scores in each of the eight dimensions of the SF-36 reflected a positive perception of quality of life by respondents; calculated scores were compared with those of a normal control group. The only significant difference found between the groups was that the study population perceived their general health to be poorer than those in the control group., High scores on the ICIQ indicate high levels of subjective incontinence in patients, with scores ranging from 0 to 21. Reporting scores of 0 (continent), 12/21 patients perceived their continence to be normal, 9/21 patients had scores >2 (mild), with one patient scoring a 16, and 11 (severe incontinence), patients reported no identifiable leakage during normal activities., There was a 29% response rate for the IIEF (15 patients completed this). IIEF scores were broken down into five dimensions and mean scores were calculated. The mean scores showed mild to moderate dysfunction in each category, including overall satisfaction with sexual experience., Conclusions The patient-reported quality of life in patients with BE was normal in all dimensions, with the exception of perception of general health. Half of the patients reported normal continence and had no complaints of urinary leakage., Sexual function in males was significantly affected across all dimensions, with mild to moderate dysfunction. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The role of the vacuum erection device (VED) has increased with its use in combined therapy with a phosphodiesterase type 5 inhibitor (PDE5i) for penile rehabilitation after radical prostatectomy (RP) and radiotherapy. The advantages of the VED are non-invasive, cost-effective, and a possibility of preventing shrinkage of penis length. Albeit current widespread use of penile rehabilitation programmes for post-RP erectile dysfunction, independent predictors for the rehabilitation participants, as well as for its treatment success have not been fully investigated. In the present study, we have added several new predictors for rehabilitation participation, e.g. African-Americans and higher preoperative sexual function. Conversely, higher preoperative PSA concentrations and the presence of positive surgical margins were predictors for avoidance of rehabilitation. Notably, there was a primary surgeon difference, which had a trend for predicting outcome of the rehabilitation among the participants, implying their surgical technique and follow-up might influence success of the rehabilitation. OBJECTIVES To investigate baseline demographic and clinicopathological characteristics of men who participate in our penile rehabilitation programme after radical prostatectomy (RP)., To determine predictors for participation in rehabilitation, as well as successful rehabilitation outcome using multivariable logistic regression analyses., PATIENTS AND METHODS We analysed data on 2345 consecutive patients who underwent RP between 2001 and 2009 in our institution., The decision to participate in penile rehabilitation using phosphodiesterase type 5 inhibitor (PDE5i) with a vacuum erection device (VED) was based on the patient's choice after post-RP discussions., Rehabilitation success was defined using the following criteria: (i) patients who continued the penile rehabilitation programme and did not switch treatment from PDE5i to other erectile aids, (ii) success was noted in men who had an Expanded Prostate Cancer Index Composite (EPIC) sexual function (SF) score of >75% of the patient's baseline EPIC score, and (iii) patients who answered that they achieved adequate erections with a PDE5i., Logistic regression analysis was used to identify factors associated with treatment participation and its success., RESULTS Of 676 patients, 354 (53.2%) men participated in a penile rehabilitation programme. Among 329 rehabilitation participants with available data, 96 (29.2%) had treatment success., In multivariable regression analysis, African-Americans (odds ratio [OR] 3.47, P < 0.001), and higher preoperative SF (OR 1.02, P < 0.001) were associated with participation in rehabilitation., Higher preoperative PSA concentration (OR 0.50, P= 0.004) and presence of positive surgical margins (OR 0.68, P= 0.042) were found to be independent predictors for non-participation in the rehabilitation., For rehabilitation outcomes, being older at surgery (OR 0.93, P= 0.001) and adjuvant therapy (OR 0.34, P= 0.047) had a negative association with successful outcome., There was a trend in the relationship between primary surgeon and rehabilitation success (OR 1.05, P= 0.053), CONCLUSIONS Those patients who have risk factors, e.g. adverse prostate cancer features, need to be carefully counselled and encouraged to participate in the penile rehabilitation programme., Clinicians could lead patients toward successful outcomes if appropriate surgical techniques and rehabilitation are provided. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (patient's preference) Level of Evidence 2b What's known on the subject? and What does the study add? Erectile dysfunction after radical prostatectomy (RP) continues to cause men significant levels of distress, but few report being satisfied with the erectile aids that are prescribed. Most couples who do seek treatment report difficulty in maintaining sexual activity and intimate relationships. Although inclusion of partners in sexual rehabilitation programmes may be beneficial, partners are usually not included as part of current treatment protocols. Preoperative assessment of a couple's readiness to engage in a sexual rehabilitation programme is needed given that only 41% of patients scheduled for a radical prostatectomy during the study period agreed to be in the study. Results show that although patients have mild erectile function, their partners' overall levels of sexual function suggest a need for further medical evaluation. Patients want their partners to be included in the sexual rehabilitation process but few institutions currently offer couple-based rehabilitation programmes. Although intimacy levels of couples are high preoperatively, there is a need to prospectively determine how these levels are impacted by changes in sexual function postoperatively. OBJECTIVES To evaluate the readiness of couples to engage in a sexual rehabilitation programme (SRP) before radical prostatectomy (RP) and to identify barriers to participation in an SRP after RP., To identify couples' current levels of sexual function and intimacy., PATIENTS AND METHODS Patients completed the International Index of Erectile Function (IIEF) and their partners completed the Female Sexual Function Index (FSFI) to measure sexual function., Couples completed the Miller Social Intimacy Scale (MSIS) to measure intimacy in relationships., All participants were seen by a sexual health clinician after completing the measures to discuss barriers to participation in an SRP, and to receive an education session., RESULTS Study participants comprised 143 patients and 104 partners., Patients <60 years old had significantly higher sexual function ( P < 0.002) compared with those patients aged 60 years and older., Partners' sexual function scores were suggestive of need for further medical evaluation., Partners' participation was cited by patients as important to them enrolling in an SRP., Couples' intimacy levels were strongly correlated ( P < 0.0001)., CONCLUSIONS Results suggest that less than 50% of patients are interested in receiving information about the impact of RP on sexual function before surgery., Female sexual function should be assessed as part of any SRP because they may require medical treatment if they are to support rehabilitation efforts for their spouses., Baseline assessment of a couple's sexual function and willingness to participate in an SRP should be performed preoperatively. [ABSTRACT FROM AUTHOR]

Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Potential risk factors for erectile dysfunction or infertility in patients treated for PUV include chronic renal failure, abnormal prostatic urethra, history of cryptorchidism and recurrent epididymo-orchitis. Sexual or fertility problems have been reported in patients with PUV. This is the largest published study to evaluate systematically sexual function in patients with PUV. In this study, the sexual function and paternity rates were similar to those in a healthy control population. OBJECTIVES To evaluate sexual function and fertility in adult patients treated for posterior urethral valves (PUV) in childhood and to compare these patients with the normal population., To examine if patient characteristics such as chronic renal failure (CRF), history of cryptorchidism and bladder neck incision in childhood have an impact on sexual function., PATIENTS AND METHODS Information on sexual function was assessed using questions from the International Index of Erectile Function (IIEF). In addition, the patients were asked if they had had children or been treated for CRF., Out of 108 adult patients with PUV, 67 (62%) returned the questionnaires., Sexual function in these patients was compared with 201 controls and paternity rates were compared with a national database., RESULTS The mean ( sd) age of the patients and controls was 38 (9) and 38 (7) years, respectively., Six percent of the patients and 9% of the controls reported problems in achieving erection during sexual stimulation and 9% of the patients and 10% of the controls reported problems with the hardness of erection ( P= nonsignificant). Ejaculation was absent in 1/61 sexually active patients (2%)., The only significant risk factor in patients for erectile dysfunction (ED) was increasing age., Thirty-three (49%) of all 67 patients and four (57%) of the seven patients with kidney transplantation had had children. The paternity rates were similar to those in corresponding age groups of the general Finnish population. Eight patients (12%) had attempted to have children without success., CONCLUSIONS Men treated for PUV have a similar prevalence of ED and similar paternity rates to men without PUV., Erectile function and paternity rates can be satisfactory in spite of CRF. [ABSTRACT FROM AUTHOR]

Study Type - Outcomes (cohort sample) Level of Evidence 2b What's known on the subject? and What does the study add? The study compares the sexual function of men with low-risk prostate cancer who chose active surveillance (expectant management) with similar men who received radiation therapy or radical prostatectomy. The first group appeared to be sexually active more frequently and had less erectile dysfunction. The study was non-randomized. No other studies exist on the effect of active surveillance on sexual function vs other treatment methods. OBJECTIVE To compare sexual function of men with localized prostate cancer (PCa) on active surveillance (AS) with similar patients who received radical therapy., PATIENTS AND METHODS Two groups of men with screening-detected localized PCa were compared. The first were men on AS within the prospective protocol-based Prostate Cancer Research International: Active Surveillance study. The second were men participating in the European Randomized Study of Screening for Prostate Cancer study who had received radical prostatectomy (RP) or radiation therapy (RT)., Questionnaires were completed at two different timepoints after diagnosis or treatment (6 and 12-18 months). These contained 10 items on sexual function, the mental and physical component summary from the Short-Form 12-item health survey, the Center for Epidemiologic Studies Depression scale depression measure and the State Trait Anxiety Inventory general anxiety measure., Sexual function was compared between groups, and determinants were analysed in multivariable analysis, adjusting for baseline differences., RESULTS A total of 65-68% of men on AS, 35-36% of those who underwent RP, 36-37% of those who underwent RT and 36% of men in the RP and RT groups combined (combined Tx) were sexually active., A total of 20-30% of men in the AS group, 86-91% of men in the RP group, 56-60% of men in the RT group and 71-76% of men in the combined Tx group were sexually inactive as a result of erectile dysfunction., A total of 44-51% of men in the AS group, 96% of men in the RP group, 73-76% of men in the RT group and 84-85% of men in the combined Tx group who were sexually active had problems getting or keeping an erection., In multivariable analysis these differences were significant, except for AS vs RT., CONCLUSIONS Men with localized PCa on AS were more often sexually active than similar men who received radical therapy, especially RP. If not sexually active, this was less often attributable to erectile dysfunction for those on AS. If sexually active, this was less often associated with problems getting or keeping an erection for those on AS., The study was non-randomized; the latest advances in RP and RT might impact results. [ABSTRACT FROM AUTHOR]

OBJECTIVE • To evaluate the impact and distribution of a single phosphodiesterase type 5 inhibitor (PDE5 I) dose (udenafil or tadalafil) in prostate tissue and plasma in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS • Thirty BPH patients complaining of erectile dysfunction along with moderateto- severe lower urinary tract symptoms (LUTS) who underwent transurethral resection of the prostate (TURP) were enrolled in the present study. • The patients were randomly divided into the three groups: group 1, TURP without PDE5 Is; group 2, 200 mg of udenafil given 1 h before TURP; and group 3, 20 mg of tadalafil given 1 h before TURP. • We evaluated the concentrations of PDE5-I, cAMP and cGMP in prostate tissues and plasma, and calculated the prostate tissue-to-plasma (T/P) ratio. RESULTS • The concentration of udenafil in prostate tissue and plasma was 2028.6 ± 360.8 ng/g and 463.7 ± 39.1 ng/mL, respectively, and the resulting T/P ratio was 4.4. The tadalafil concentration in prostate tissue and plasma was 385.7 ± 83.8 ng/g and 305.8 ± 41.1 ng/ mL, respectively, and the T/P ratio was 1.3. • Udenafil and tadalafil significantly increased the cAMP and cGMP levels in plasma and prostate tissues. CONCLUSIONS • Udenafil and tadalafil significantly increased cAMP and cGMP levels and were more highly distributed in the prostate than plasma. The T/P ratio of udenafil was higher than tadalafil. • These findings may help in the assessment of the feasibility of using PDE5 Is to concurrently treat both LUTS and erectile dysfunction. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate the effects of weight loss and time post laparoscopic gastric banding surgery (LGB) on urinary and sexual function. MATERIALS AND METHODS 653 females and 145 males who underwent LGB over the last 10 years at a single centre in Australia were contacted by post and asked to complete validated questionnaires. RESULTS The pre-surgery body-mass index (BMI) was higher in males than females (47.3 vs 43.5); 65% of the females and 24% of males previously had some degree of urinary incontinence (UI). There were significant weight and BMI losses in males and females (23.2 kg and 7.51 vs 22.7 kg and 8.28; P < 0.0001). In females there were significant improvements in the ICIQ-SF ( P = 0.0008) and Quality of Life ( P < 0.0001) scores. For each kilogram lost there was a 0.05 improvement in the ICIQ score ( P = 0.03) in females. There were also postoperative improvements in all symptoms of UI and stress incontinence in females but urge incontinence worsened, when adjusted for weight loss. In males there was no improvement in UI with weight loss after LGB. There was no relationship with time and UI in either gender; 83.3% of males reported a degree of ED before LGB. There was improvement in the IIEF score in males post LGB but there was worsening of erectile index ( P = 0.005) and orgasmic function ( P = 0.002) when adjusted for time. More males had started using phosphodiesterase type 5 inhibitors, post-LGB. CONCLUSIONS Surgically induced weight loss by LGB improved overall UI, quality of life and stress incontinence in females but urge incontinence worsened. There was no improvement in UI with weight-loss or overall sexual function after LGB in males. However, erectile index and orgasmic function worsened when adjusted for time. Further evaluation is required by means of larger prospective studies involving urodynamic testing. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (outcomes research) Level of Evidence 2c OBJECTIVE To quantitatively assess the effect of radical prostatectomy (RP) on the specific domains that comprise overall sexual function (SF), focusing on the relationships among these domains and overall SF, and to identify predictors for recovery of SF over time, as a decline in SF and sexual bother (SB) are known potential complications of treatment for prostate cancer. PATIENTS AND METHODS Within the Cancer of the Prostate Strategic Urologic Research Endeavor database, we identified men diagnosed between 1995 and 2001 with localized prostate cancer treated with RP. SF and SB outcomes, measured using the University of California Los Angeles Prostate Cancer Index, were assessed at 6-month intervals for 4 years after RP. RESULTS In all, 620 men met the study criteria; at 6 months after RP, overall and all the specific domains of SF declined, with improvement in most specific domains by 2 years after RP. The greatest declines were in the ability to achieve erections, high-quality erections, and frequent erections; these domains were also most strongly correlated with overall SF. Sexual desire was relatively preserved, and there was a weak correlation between overall SF and sexual desire after RP, when there was the greatest discrepancy between sexual desire and other domains of function. SB showed continued improvement over time to 4 years but was not well correlated with any measurements of SF assessed. Younger age, college education, sexual aid and medication use, the absence of comorbid conditions, and nerve-sparing surgery were predictive of significant recovery of function in several specific domains of SF. CONCLUSIONS RP affects specific domains of SF to differing degrees. Compromised erectile function is most commonly reported among these specific domains and seems to play a more dominant role in determining overall SF, but notably none of the domains of function were closely linked to SB. Because education is protective in the perception of bother, appropriate counselling and the setting of expectations for outcomes in overall and specific domains of SF might lead to improved quality of life after treatment for prostate cancer. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess, using the psychometrically validated Male Sexual Health Questionnaire (MSHQ), the prevalence of ejaculatory dysfunction (EjD) and bother due to EjD in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), and to assess predictors of EjD in this population. PATIENTS AND METHODS In all, 5999 sexually active men with LUTS completed the International Prostate Symptom Score (IPSS) which rates LUTS severity, and the MSHQ long-form, which evaluates seven EjD symptoms and bother due to EjD. Concomitant intake of medical treatments for BPH and previous BPH-related surgery were collected. The impact of treatments on EjD was compared to a control group (i.e. no previous BPH-related surgery and no medical treatment for BPH). The relationship between EjD, bother due to EjD and selected clinical characteristics was analysed using multiple regression analysis. RESULTS EjD was highly prevalent and bothersome in men with LUTS, with decreased force of ejaculation (77.9%) and decreased amount of semen (74.4%) being the most commonly reported symptoms. LUTS severity was the strongest predictor of EjD and bother due to EjD. EjD was considered a problem by 35.6%, 51.6% and 64.1% of men with mild, moderate and severe LUTS, respectively ( P < 0.001). EjD (except pain/discomfort on ejaculation) and bother due to EjD were also strongly related to age. Men with previous BPH-related surgery and men treated with a 5α-reductase inhibitor plus an α1-blocker or tamsulosin alone showed the highest rates of dry ejaculation (67.4%, 57.2% and 52.3%, respectively) compared to controls (31.6%, P < 0.001). Conversely, in men treated with alfuzosin, most EjD symptoms were significantly lower than in controls. Bother due to EjD was also significantly lower with alfuzosin than in controls (34.4% vs 53.1%, P < 0.001) while there was no significant difference for other treatments. CONCLUSIONS EjD is highly prevalent and bothersome in sexually active men with LUTS, and is strongly related to LUTS severity and age. Treatment options for BPH do not have the same effect on EjD. EjD should be considered in the initial evaluation and clinical management of men with LUTS. [ABSTRACT FROM AUTHOR]

OBJECTIVE To describe the prevalence of sexual dysfunction and evaluate risk factors in patients just diagnosed with non-muscle-invasive bladder cancer (NMI UC), who have the prospect of an intensive surveillance scheme by cysto-urethroscopy to detect tumour recurrences. PATIENTS AND METHODS We conducted a cross-sectional survey on 150 patients just diagnosed with primary or recurrent NMI UC. Patients were participating in a randomized clinical multicentre trial (CEFuB), comparing two surveillance schemes. Patients were asked to complete questionnaires at study entry 3 months before the start of the study-surveillance scheme (demographic characteristics, a validated visual analogue scale, and validated subset of questions on sexual function and performance derived from QLQ-BLS-24). The results were compared with those from an age-and gender-matched healthy population. RESULTS The response rate was 95% (142/150); 61% (87/142) of the respondents were sexually active in the previous 4 weeks after diagnosis, 66% (70/105) of men and 46% (17/37) of women. Although libido was not negatively affected, 54% (47/87) of the patients had a sexual dysfunction, and 23% (17/73) were afraid to inflict harm on their partner by sexual contact. Sexually active patients perceived a higher state of general health ( P = 0.03). CONCLUSIONS The prevalence of sexual dysfunction in patients with NMI UC is very high (54%) compared with an age- and gender-matched healthy population (20–45%). No predictors for sexual dysfunction were found. These patients and partners would benefit from proper sexual information in the outpatient clinic. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess the perceptions of healthy men of their genital anatomy and sexual sensitivity, along with the re-test reliability of these ratings, in a new self-reported questionnaire, the Self-Assessment of Genital Anatomy and Sexual Function, Male (SAGASF-M). SUBJECTS AND METHODS Eighty-one healthy, sexually active, men aged 22–57 years (median 33), with no history of genital surgery, completed the SAGASF-M. This questionnaire comprises written text and images enabling men to rate details of their genital appearance, overall genital erotic and pain sensitivity, orgasm intensity, and effort required for achieving orgasm through stimulation of specified areas around the glans and shaft of the penis, scrotum and anus, along with the contribution of other sexually sensitive areas of the body. Anatomical locations were compared for the functional ratings by mixed-model analysis of variance (anova). A second sample of 38 healthy men (median age 26 years, range 22–64) from the same source completed the SAGASF-M twice with an interval of 2 weeks. RESULTS There was little variability in anatomy ratings. Ratings of overall penile sensitivity to sexual stimulation gave higher values of ‘sexual pleasure’ for penile stimulation by the partner than by self ( P = 0.002) and marginally higher ratings of ‘orgasm intensity’ by partner stimulation ( P = 0.077), but there were no corresponding differences on ratings of ‘effort needed to reach orgasm’ or of ‘discomfort/pain’. Overall discrimination between genital areas was highly significant (mixed-modelanova, P = 0.001) for ratings of ‘sexual pleasure’, ‘orgasm intensity’ and ‘orgasm effort’, but was not significant for ‘discomfort/pain’. Ranked by degree of ‘sexual pleasure’, the area ‘underside of the glans’ was highest, followed by ‘underside of the penile shaft’, ‘upper side of the glans’, ‘left and right sides of the glans’, ‘one or both sides of the penis’, ‘upper side of the penile shaft’, ‘foreskin’ (11 subjects), ‘skin between the scrotum and anus’, ‘back side of the scrotum’, ‘front side of the scrotum’, and ‘around anus’, but not all pair differences were significant. The rank order was similar for ‘orgasm intensity’, but less similar and with fewer significant pair differences for ‘orgasm effort’. Overall discrimination of other body parts that help orgasm when touched/stimulated was also highly significant ( P = 0.001) and included (in order of degree) scrotum, ear, skin between scrotum and anus, neck, breast/nipples, buttocks, anus (exterior skin), anus (inside with penetration), wrist, and axilla, but many pair differences were not significant. In the reliability study, which was limited to the 45 function items with sufficient variability and sample size, the re-test reliability values (Pearson r) were distributed as follows: seven were ≥0.80, 16 ≥0.70, 15 ≥0.60, four ≥0.50, two ≥0.40, and one ≥0.30. CONCLUSION The SAGASF-M discriminates reasonably well between various genital and nongenital areas in terms of erotic sensitivity, when administered to genitally unoperated men varying widely in age and socio-economic level. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate prospectively the sexual function of patients undergoing cryosurgery as a primary radical treatment for localized prostate cancer, as the development of 17 G cryotherapy probes has improved the delivery of this treatment, but one of the side-effects of cryosurgery is the development of erectile dysfunction (ED). PATIENTS AND METHODS Between July 2003 and May 2008, 53 patients were treated using an argon-based third-generation cryotherapy system (Oncura, Arlington Heights, IL, USA). Prospective data were collected at 6 weeks, 3 months, then 3-monthly up to 1 year and subsequently 6-monthly. Patients were followed up for up to 54 months, with a median (mean) follow-up 36 (30.5) months. RESULTS All 53 patients were followed after receiving cryosurgery as primary treatment for prostate cancer; 51 (96.3%) had ED at 6 weeks while two (3.7%) were experiencing partial erections. By 9 months one (2.4%) of 42 patients was fully potent using phosphodiesterase type-5 inhibitors, and six (14.3%) were experiencing partial erections. By 18 months eight (21%) of 39 patients followed up had regained full potency and by 24 months eight (24%) of 33 patients were fully potent and three (9%) experienced partial erections. CONCLUSION While ED is a significant side-effect of cryotherapy, a considerable proportion of patients who have no ED before treatment (39%) recover full sexual function afterward. Focal nerve-sparing cryosurgery might be the way forward in an attempt to preserve erectile function in men who had no ED before treatment. Erectile aids should be made available for those patients for whom sexual dysfunction compromises the quality of their life and relationships. [ABSTRACT FROM AUTHOR]

OBJECTIVE To examine the effect of changes in quality of life (QoL) and levels of sexual function on decisional regret after surgical treatment of localized prostate cancer. PATIENTS AND METHODS Patients who decided to have a radical prostatectomy (RP) were assessed for health-related QoL using the general European Organization for Research and Treatment of Cancer C30 instrument and disease-specific prostate cancer module, and sexual function using the abbreviated International Index of Erectile Function-5 before and 1 year after RP. Decision control was measured before RP, and decisional regret 1 year afterward, using measures mailed to participants 1 year after treatment. RESULTS Of 130 respondents (mean age 62 years), 4% expressed regret over their decision to have surgery. Physical and social functioning, and finances, were compromised, while emotional functioning and treatment-related symptoms improved by 1 year. Higher levels of decisional regret were correlated with decreases in role and social functioning, increased pain and financial difficulty (all P < 0.01). Sexual function was decreased ( P < 0.001) after treatment. Men reported feeling less masculine, having less sexual enjoyment, difficulty in getting and maintaining an erection, and discomfort when being sexually intimate after surgery. Mean scores of decisional regret were similar among patients who reported assuming either active (84%) or collaborative (11%) roles in treatment decision-making. Men who assumed a passive role reported the most variability and highest scores on decision regret. CONCLUSIONS Few men regretted having RP at 1 year after treatment, even though some QoL functions and domains were significantly affected. Ongoing assessment of the effect of surgical treatment on sexual function, sexuality and masculinity certainly deserves further exploration with this group of cancer survivors. [ABSTRACT FROM AUTHOR]

There are two very interesting paediatric urology papers; in the first, authors from London describe the long-term functional outcomes of female genital reconstruction in childhood, and in the second, authors from Italy present a morphological and manometric study of VUR. [ABSTRACT FROM AUTHOR]

Associate Editor Michael G. Wyllie Editorial Board Ian Eardley, UK Jean Fourcroy, USA Sidney Glina, Brazil Julia Heiman, USA Chris McMahon, Australia Bob Millar, UK Alvaro Morales, Canada Michael Perelman, USA Marcel Waldinger, Netherlands OBJECTIVE To examine the rates of stress urinary incontinence (SUI) and erectile dysfunction (ED), and of associated bother, in men with no evidence of prostate cancer who participated in a prostate cancer-screening event. SUBJECTS AND METHODS A cohort of 366 men with no established diagnosis of prostate cancer completed a questionnaire addressing SUI, ED and associated bother. Socio-economic status and presence of comorbidities were also examined. RESULTS The mean (range) age of the men was 54.8 (33–80) years; 90% of the men (271) had no SUI, and 76% (231) reported no urinary bother. Conversely, 62% (189) reported some degree of ED and 27% (82) some degree of sexual bother. Urinary bother ( P < 0.001), erectile function ( P < 0.001), and sexual bother ( P < 0.02) were associated with age. Of all the men, 36% had one or more comorbidities. Men with one or more comorbidities had worse erectile function than those men with no comorbidity ( P < 0.05). CONCLUSION Few studies address normative values of SUI and ED rates in men with no established diagnosis of prostate cancer. We quantified the rate of SUI and it was practically negligible. Conversely, some degree of ED affected most of the present screened population. These data may be used as baseline references to evaluate the magnitude of functional and bother detriments after various prostate treatments. [ABSTRACT FROM AUTHOR]

Lower urinary tract symptoms (LUTS) and male sexual dysfunction are highly prevalent in ageing men, and are strongly linked. Various treatment strategies for benign prostatic hyperplasia (BPH)/LUTS may affect sexuality, with differences between drug classes and between drugs within a same class. The 5α-reductase inhibitors, finasteride and dutasteride, are associated with a greater risk of erectile dysfunction (ED), ejaculatory dysfunction (EjD) and decreased libido than is placebo. α1-adrenoceptor blockers (alfuzosin, doxazosin, tamsulosin, terazosin) show an incidence of decreased libido and ED closely similar to placebo, but differ in their impact on ejaculation, tamsulosin being associated with a higher incidence of EjD (10%) than other α1-adrenoceptor blockers (0–1%) and placebo (1%), which is unrelated to retrograde ejaculation or higher efficacy. A randomized, placebo-controlled, cross-over study conducted in healthy volunteers showed that tamsulosin 0.8 mg once daily markedly decreased mean ejaculate volume in almost 90% of subjects, with 35% having no ejaculation. By contrast, there was no lack of ejaculation in subjects receiving alfuzosin 10 mg once daily or placebo. Sperm concentrations in urine after ejaculation were similar for the three treatment groups, confirming that the EjD with tamsulosin was unrelated to retrograde ejaculation. It may be related to a peripheral effect on seminal vesicles and/or the vas deferens. A central effect is also plausible, as tamsulosin shows a strong affinity for 5HT1A- and D2-like receptors, both of which are involved in the central command of ejaculation. In conclusion, because treatment options for managing BPH have different effects on sexuality, the sexual dimension should be considered when assessing patients’ expectations and the choice of treatment. [ABSTRACT FROM AUTHOR]

In the first of these mini-reviews the selection of therapy for the maintenance of sexual function in patients with BPH is outlined, along with an explanation of how altered regulation of neurotransmitters, especially noradrenaline, may underlie the syndrome of LUTS and sexual dysfunction. Other mini-reviews outline the current status of robotic surgery to treat renal and adrenal disorders, and its future applications, and the potential use of the nitric oxide/cGMP pathway as a potential target to treat BOO associated with benign prostatic enlargement. Finally, the capacity to be creative in academic departments is extolled as a core property of academicians, and its surfacing described as having the potential to revitalize individuals and departments. [ABSTRACT FROM AUTHOR]

The article presents recent advances in the knowledge and treatment of erectile dysfunction. Recent advances in the treatment of erectile dysfunction have increased patient and practitioner awareness of other sexual problems, particularly ejaculatory disorders (EjD). Fertility is a major concern in the younger man, but EjD can cause considerable distress to men of all ages about their sexual function. In a recent survey of 12,815 men aged 50-80 years, 46% had an ejaculatory disturbance. The most common disorder is premature ejaculation (PE), with prevalence rates of 30 to 40%. Retarded ejaculation and orgasmic disorders are also a concern in 2.5% of patients of Great Britain.

To evaluate the efficacy and safety of two doses (10 and 15 mg) of alfuzosin once daily and tamsulosin (0.4 mg) once daily, compared with placebo, in men with benign prostatic hyperplasia (BPH). In this randomized, double-blind, placebo-controlled, multicentre study, 625 patients were randomized to receive alfuzosin 10 or 15 mg once daily, tamsulosin 0.4 mg once daily (active reference), or matching placebo for 12 weeks, with no initial dose titration. The study was designed to compare each of the three active treatments with the placebo group. Primary outcome measures were mean changes from baseline in the International Prostate Symptom Score (IPSS) and peak urinary flow rate (Qmax) at 12 weeks, compared with placebo, using one-way analysis of variance. Because Qmax data were not normally distributed, median changes from baseline were also compared for Qmax. Pair-wise comparisons were conducted using the Dunnett correction for quantitative variables and Bonferroni-Holm correction for categorical variables, allowing for multiple treatment group comparisons. Alfuzosin 10 mg significantly improved urinary tract symptoms compared with placebo, with a mean (sd) change from baseline in the IPSS of− 6.5 (5.2) vs− 4.6 (5.8) for placebo (adjusted P = 0.007); there was a trend toward a difference between alfuzosin 15 mg, with a mean (sd) change from baseline in IPSS of− 6.0 (5.6), and placebo (adjusted P = 0.050). The mean change from baseline in IPSS with tamsulosin 0.4 mg, at− 6.5 (5.6), vs placebo was also significant (adjusted P = 0.014). The median change from baseline in Qmax was significantly increased with both alfuzosin doses and with tamsulosin (all adjusted P = 0.02 vs placebo). Both doses of alfuzosin were well tolerated, with dizziness the most frequent adverse event (placebo, 4%; alfuzosin 10 mg, 6%; 15 mg, 7%; tamsulosin, 2%); the respective incidence rates of sexual function adverse events were 0%, 3%, 1% and 8%. Treatment with alfuzosin 10 mg significantly improved urinary symptoms and Qmax compared with placebo and was well tolerated. There were also significant improvements over placebo with the active reference, tamsulosin 0.4 mg. The incidence of sexual function adverse events was higher with tamsulosin than with placebo. The benefit-to-risk profile of alfuzosin 10 mg once daily appeared to be reduced with a higher dose (15 mg). [ABSTRACT FROM AUTHOR]

The therapeutic goal of treating benign prostatic hyperplasia (BPH) through early detection and effective therapy is to relieve the symptoms, improve patients’ quality of life, decrease postvoid residual urine volume, and prevent the associated morbidity when the condition remains untreated.á1-Adrenoreceptor antagonists, e.g. doxazosin, terazosin, tamsulosin and alfuzosin, relax the bladder outlet to improve urinary flow, by reducing prostatic smooth muscle tone through the blockade of sympathetic adrenergic receptors. Doxazosin gastrointestinal therapeutic system (GITS) is a controlled-release formulation developed to enhance the pharmacokinetic profile of the drug while simultaneously minimizing possible adverse effects and reducing the need for dose titration. While both doxazosin standard and GITS are indicated for hypertension, they are also useful in the pharmacologically or naturally normotensive patient with BPH. In a cross-over trial comparing doxazosin GITS and tamsulosin, doxazosin gave a significantly greater improvement from baseline in symptoms. Results from recent trials (e.g. Medical Therapy of Prostatic Symptoms, MTOPS) showed that doxazosin was significantly more effective than the 5á-reductase inhibitor finasteride in relieving lower urinary tract symptoms, irrespective of prostate volume. The MTOPS trial showed clearly that over the long term, the combination of doxazosin and finasteride was more effective than either agent alone in significantly improving symptoms and reducing the clinical progression of BPH. Both doxazosin standard and GITS are well-tolerated, long-term therapies that are equally effective in younger and older men, and not associated with causing sexual dysfunction. [ABSTRACT FROM AUTHOR]

To identify the preferences for sexual information resources of patients before and after definitive treatment for early-stage prostate cancer with either radical prostatectomy (RP) or brachytherapy. These results support the need for physicians to offer patients access to information on the effect of treatment for early-stage prostate cancer on erectile function before and after treatment. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of various treatments for benign prostatic hyperplasia (BPH) on sexual function. Patients and methods In a longitudinal multicentre study carried out in the Netherlands, 670 consecutive patients with BPH (aged >=50 years) were examined at baseline and 9 months after inclusion. All patients completed a questionnaire about symptomatology, bothersomeness and sexual function before and after treatment. Other diagnostic information was retrieved from the medical records. Results At baseline, 49–59% of the population (mean age 66 years) reported normal potency and 69% a normal libido. Outcomes at 9 months were stratified by type of treatment, i.e. surgery in 207, α-blockers in 43, finasteride in 47 and watchful waiting in 234 men. Patients with multiple or other treatments (131) or recent surgery (eight) were excluded from the analyses. For the four sexual items included, 84% of the patients reported no changes. All treatments showed both improvement and deterioration in 3–14% and 0–16% of the patients, respectively. Conclusion For sexual function, most patients remained stable after treatment for BPH, while positive and negative changes occurred in equal proportions for all treatments. These results question the previously reported high incidence of sexual adverse events, particularly after surgical intervention. [ABSTRACT FROM AUTHOR]

Objective. To determine whether men with premature ejaculation who fail to respond to 25 mg clomipramine as needed improve when taking 10–30 mg clomipramine daily. Subjects and methods Four men with premature ejaculation whose ejaculation latencies increased minimally or not at all when taking 25 mg clomipramine as needed participated in a prospective 12-week study consisting of four treatment phases, beginning with baseline (0 mg) and progressing through increasing daily doses of 10, 20, and 30 mg clomipramine. The subjects maintained daily logs of their sexual activities and estimated their ejaculatory response, sexual arousal and penile rigidity during intercourse. The subjects were contacted 8–15 weeks after the experiment to assess their satisfaction with and continued use of clomipramine. Results There was a dose-response effect on ejaculatory latency with increasing levels of clomipramine; 30 mg increased the latency from 25 s to 220 s, a clinically significant increase. In addition, 30 mg taken daily was significantly more effective than 25 mg as required. Other variables of sexual response (sexual interest, arousal and penile rigidity) were unaffected. At follow-up all four subjects expressed satisfaction and three continued the dose. Conclusion Men with premature ejaculation who do not respond to clomipramine ‘as required’ are probably not insensitive to pharmacological treatment, but may simply require higher doses or a different regimen. All four subjects improved when taking daily clomipramine at varying doses. These results suggest that if initial treatment is unsuccessful, 20–30 mg daily clomipramine should be considered. [ABSTRACT FROM AUTHOR]

Investigates the effects of nonsteroidal antiandrogens on serum testosterone levels in patients with advanced prostate cancer who wish to retain sexual interest and function. Theoretical basis for preserving sexual interest and function with nonsteroidal antiandrogens; Assessment of sexual interest in patients with prostate cancer; Treatment of erectile dysfunction in patients with prostate cancer.