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The article discusses research which examined the effect of regulated automated red cell exchange transfusion (ARCET) in male patients with sickle cell disease (SCD) and recurrent stuttering priapism (SP), an unwanted erection. Topics discussed include management measures for SP, evolution of SP into acute major priapism (MP) which carries a risk of erectile dysfunction (ED), patient characteristics and haematological parameters and improvement experienced by patients after undergoing ARCET.

There are various treatment modalities for erectile dysfunction with different success and satisfaction rates. We aim to compare patient satisfaction with tadalafil, intracavernosal injection, and penile prosthesis implantation in patients with erectile dysfunction. The records of 3448 men with erectile dysfunction were evaluated retrospectively. A total of 356 men with organic erectile dysfunction were enrolled into this study. Of these patients, 132 (37%) received tadalafil 20 mg twice a week for 12 weeks, 106 (30%) patients received tadalafil 5 mg once-daily for 12 weeks, 96 (27%) patients used intracavernosal injection therapy (Bi-mix; papaverine and phentolamine). Moreover, 22 patients underwent penile prosthesis implantation. Patient and partner satisfaction were assessed with International Index of Erectile Function ( IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction ( EDITS) questionnaire. Patients' mean age was 52.4 ± 25.76 (32-71). The etiology of erectile dysfunction was chronic systemic diseases in 133 (44%) and radical prostatectomy in 121 patients (40%). The mean IIEF-5 scores improvement after the treatment was higher in penile prosthesis implantation group (12.4 ± 1.3) compared with tadalafil 5 mg (6.7 ± 1.5) ( p < 0.01), tadalafil 20 mg (6.2 ± 1.5) ( p < 0.01), and intracavernosal injection group (8.4 ± 3.2) ( p < 0.05). The EDITS score was significantly higher in penile prosthesis implantation group (78.2 ± 11.3) compared with intracavernosal injection (60.3 ± 6.3), tadalafil 5 mg (72.5 ± 4.5), and tadalafil 20 mg 70.7 ± 3.4 groups ( p < 0.05). Partners' EDITS scores were 70.1 ± 10 in penile prosthesis implantation group, 50.2 ± 1.5 in intracavernosal injection group, 62.9 ± 7.8 in tadalafil 5 mg, and 61.3 ± 5.3 in tadalafil 20 mg group ( p < 0.05). Erectile dysfunction patients who underwent penile prosthesis implantation seem to be more satisfied compared with tadalafil treatment and intracavernosal injection. Future clinical trials are warranted to confirm our results. [ABSTRACT FROM AUTHOR]

We retrospectively reviewed 51 men who switched to Invicorp intracavernosal therapy following failure of treatment, or development of pain, with alprostadil intracavernosal injections. Invicorp was successful in 61% of alprostadil non‐responders, with no reported penile pain. Three patients (6%) were admitted with priapism which was appropriately treated. Invicorp proved successful in two thirds of the patients who had failed to respond to intracavernosal alprostadil. Invicorp is an excellent alternative for alprostadil non‐responders, proving successful in 61% of this group. Unlike alprostadil injection, Invicorp users did not experience penile pain after the injection and experienced a 50% reduction in incidence of priapism. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the expression of the Rho/Rho-associated protein kinase ( ROCK) pathway in the corpus cavernosum of patients with severe erectile dysfunction ( ED) compared with healthy human corpus cavernosum, and to test the functional effects of two Rho kinase inhibitors ( RKIs) on erectile tissue of patients with severe ED, which did not respond to phosphodiesterase type 5 inhibitors ( PDE5Is). Patients and Methods Human corpus cavernosum samples were obtained after consent from men undergoing penile prosthesis implantation ( n = 7 for organ bath experiments, n = 17 for quantitative PCR [ qPCR]). Potent control subjects ( n = 5) underwent penile needle biopsy. qPCR was performed for the expression of RhoA and ROCK subtypes 1 and 2. Immunohistochemistry staining against ROCK and α smooth muscle actin (α SMA) was performed on the corpus cavernosum of patients with ED. Tissue strips were precontracted with phenylephrine and incubated with 1 μ m of the PDE5I vardenafil or with DMSO (control). Subsequently, increasing concentrations of the RKIs azaindole or Y-27632 were added, and relaxation of tissue was quantified. Results The expression of ROCK1 was unchanged ( P > 0.05), while ROCK2 ( P < 0.05) was significantly upregulated in patients with ED compared with controls. ROCK1 and ROCK2 protein colocalized with α SMA, confirming the presence of this kinase in cavernous smooth muscle cells and/or myofibroblasts. After incubation with DMSO, 10 μ m azaindole and 10 μ m Y-27632 relaxed precontracted tissues with 49.5 ± 7.42% ( P = 0.1470 when compared with vehicle) and 85.9 ± 10.3% ( P = 0.0016 when compared with vehicle), respectively. Additive effects on relaxation of human corpus cavernosum were seen after preincubation with 1 μ m vardenafil. Conclusion The RKI Y-27632 causes a significant relaxation of corpus cavernosum in tissue strips of patients with severe ED. The additive effect of vardenafil and Y-27632 shows that a combined inhibition of Rho-kinase and phosphodiesterase type 5 could be a promising orally administered treatment for severe ED. [ABSTRACT FROM AUTHOR]

Objective: Prostate cancer and its treatments, particularly androgen deprivation therapy (ADT), affect both patients and partners. This study assessed how prostate cancer treatment type, patient mood, and sexual function related to dyadic adjustment from patient and partner perspectives.Methods: Men with prostate cancer (n = 206) and partners of men with prostate cancer (n = 66) completed an online survey assessing the patients' mood (profile of mood states short form), their dyadic adjustment (dyadic adjustment scale), and sexual function (expanded prostate cancer index composite).Results: Analyses of covariance found that men on ADT reported better dyadic adjustment compared with men not on ADT. Erectile dysfunction was high for all patients, but a multivariate analysis of variance found that those on ADT experienced greater bother at loss of sexual function than patients not on ADT, suggesting that loss of libido when on ADT does not mitigate the psychological distress associated with loss of erections. In a multiple linear regression, patients' mood predicted their dyadic adjustment, such that worse mood was related to worse dyadic adjustment. However, more bother with patients' overall sexual function predicted lower relationship scores for the patients, while the patients' lack of sexual desire predicted lower dyadic adjustment for partners.Conclusions: Both patients and partners are impacted by the prostate cancer treatment effects on patients' psychological and sexual function. Our data help clarify the way that prostate cancer treatments can affect relationships and that loss of libido on ADT does not attenuate distress about erectile dysfunction. Understanding these changes may help patients and partners maintain a co-supportive relationship. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The authors reflect on the search for the fountain of youth in relation to pharmacological interventions for enhancement of sexual desire, performance, and drive. The authors state that nitric oxide (NO) helps in the development of penile erection for persons with erectile dysfunction (ED) in which the cyclic guanosine monophosphate is stimulated in smooth muscle cells. They also note the international market condition of antiaging products and services.

The diseases of the lower urinary tract are traditionally divided into abnormalities of storage and abnormalities of emptying. The targets for therapy were the organs most responsible for influencing storage and emptying. Modern understanding places the symptomatic status of the patient as the overriding criterion for treatment. It also accommodates a broader understanding of multiple and overlapping systems. Symptoms of voiding dysfunction have been clearly shown to be associated with symptoms of other genitourinary disease, for example, erectile dysfunction (ED). Treatment of voiding dysfunction has also been shown to have effects (adverse or beneficial) in these other domains. Thus, the symptoms of lower urinary tract disease (LUTD) that have to be considered now as targets relevant to these therapies include ED, ejaculatory dysfunction, sexual desire, sexual pain disorders and female sexual dysfunction. The anatomic, neural and endocrine systems that support these symptomatic functions and dysfunctions span the range from the urogenital smooth muscle to the hypothalamus, the bladder sensory output to the micturition centre and growth factors to androgens. Potentially important targets also include vascular and spinal structures, sex hormones and nitric oxide as well as the obvious genes, enzymes and receptors. The epidemiological studies prove the convergence of LUTD when viewed through the lens of the current patient-related outcomes and problem constructs. This convergence serves as a clear guidance to include wide ranging outcome instruments in all future studies with compounds being investigated for the treatment of LUTD. Out of these will come evidence of expected and unexpected collateral effects. The convergence should open the possibility to a different business model for developing therapeutic concepts. The blockbuster drug for a monolithic indication may be supplemented by agents with single or multiple pathway activity with smaller parallel targets. Using an approach based on patient reported outcomes to therapeutic targets not only widens the range of conditions, but also the patient types who can be considered as having LUTD.British Journal of Pharmacology (2006) 147, S2–S13. doi:10.1038/sj.bjp.0706620 [ABSTRACT FROM AUTHOR]

Summary This study evaluated the problem of premature ejaculation (PE) in patients treated for erectile dysfunction. The aim was to compare the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the management of primary PE and PE associated with sildenefil treatment. Eighty-seven patients with PE seen over a period of 17 months were recruited into this prospective study. They were categorized into two groups: primary PE (GPI) and PE in sildenefil-treated patients (GPII). All patients recruited into GPII had erectile dysfunction (ED) that was successfully treated with sildenefil citrate for at least a year. Both groups of patients were given sertraline 50 mg 4 h before expected time of sex. The minimum follow-up was 6 months. The ejaculation latency before and after treatment of the two groups were compared. The sexual satisfaction scores of the patients in the two groups were also sought and analysed. Twenty-eight percent of patients with ED who were successfully treated with sildenefil developed PE. Subjects in group GPI were younger and have less comorbid factors than those in group GPII. There was no significant difference in the mean ejaculation latency for both groups (46 vs. 34.6 sec for GPI and GPII, respectively). However, there was highly significant difference in the ejaculation latency between the two groups after treatment with sertraline for 6 months (247.2 vs. 111.6 sec for GPI and GPII, respectively). There was also significant difference in the sexual satisfaction score for group GPI post-treatment, but not for GPII. No significant side-effect of sertraline was reported from patients in both groups. Successful treatment of ED could not assure sexual satisfaction. At least a quarter of sildenefil treated ED patients might develop PE which would continue to frustrate these patients sexually. While selective serotonin re-uptake inhibitors (SSRIs) was effective in the management of primary PE, they were not as effective in patients with... [ABSTRACT FROM AUTHOR]

The article discusses how the phosphodiesterase inhibitor Vardenafil increases the killing effect of Epigallocatechin gallate (EGCG) on Chronic lymphocytic leukaemia (CLL) cells. Topics include information on CLL, the usage of PDE5 inhibitors for anti-erectile dysfunction therapy and how the treatment scope for CLL patients has been significantly changed by B-cell receptor pathway inhibitors.

A historical survey of operative interventions and flawed techniques for treatment of erectile dysfunction is presented. The purpose and functioning of the three-vessel anastomosis are discussed, with emphasis on some avoidable faults that may occur during the operation. [ABSTRACT FROM AUTHOR]

Prostaglandin E1 (PGE1) is currently the vasoactive drug of choice for intracavernous self-injection therapy in the treatment of erectile dysfunction. PGE1 is often said to have a low incidence of side-effects. However, real long-term follow-up reports are rare. Here, a report is presented on 32 patients who joined a long-term self-injection programme in which they used PGE1 for a minimum of 5 years under standardized protocol conditions. All these patients had an organic aetiology of erectile dysfunction, and their mean age was 58.7 ±8. 6years. The period of observation was on average 75.4 ± 16.9 months, and the PGE1 dosage 13.5 ± 5.9 lag. A total of 6799 injections were registered. The average number of injections was 213 ± 127 per patient, which is 2.8 injections per month and patient. As regards side-effects, haematomas were registered in 1.9% of the patients and five cases of prolonged erection (0.07%) caused by unauthorized redosing were noted. Three patients developed reversible penile nodules. In 10 patients, the initial dosage had to be increased. Five patients dropped out after 5 years, none of them due to treatment complications. It is concluded that PGE1 self-injection therapy is a simple and reliable method for long-term use with hardly any side-effects. The patients do not stop treatment because of complications. [ABSTRACT FROM AUTHOR]

After a critical review of prevalence data, psychosocial determinants and psychosomatic aspects in the diagnosis and treatment of erectile dysfunction are discussed (with reference to age-related changes). Widely used laboratory assessments are responsive to psychological factors (e.g. anxiety). Inclusion of the partner in the diagnostic process may change the clinical picture and the treatment recommendations considerably. As illustrated by penile prosthetis treatment and self-injection of vasoactive substances, acceptance and success of widely used surgical and medical treatments depend largely upon tile patient's expectations, and the adaptation of the couple to the procedure. Even in cases with a clear organic pathology, fluctuations in erectile functioning may be attributable to psychological influences. As recent psychotherapeutic and psychoeducational approaches underscore, erectile failure is best conceived as a final common pathway of somatic, lifestyle, psychological and partnership determinants. These should be taken into account in comprehensive diagnostic and treatment formulations if the goal of therapy is not only to produce rigid erections, but to increase sexual satisfaction. [ABSTRACT FROM AUTHOR]

Responds to a comment made by Gordon Williams on an article about erectile dysfunction (ED). Importance of recognizing the drug levels used when quoting experimental electrophysiological data in isolated heart models; Use of Viagra in treating ED.