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Introduction This is a comprehensive history of the International Society for Sexual Medicine (ISSM) and its founding organizations regarding the publications, including the journals and the publication committee, and the communication tools of the organization since its inception. Objectives The object of this review is to provide a detailed and comprehensive history of the publication and communication tools of the ISSM and the people who have participated in production of these efforts. Methods Recorded Publication Committee minutes, filed letters, the various journals themselves, printed News bulletins, and Publishers reports to the society served as source documents to produce this history. The author has participated in many of the journal establishments and has kept an extensive personnel file of the events related in this history. All written history has not only relied on personal memories of these events but have been verified from the stored personal files. Printed and website stored journal and News bulletin have served as source material for this history. Also, Power Point presentations by the editors of the journals at the Publication Committee meetings have served as source material. Finally, annual, and semi-annual reports of the Publishers presented at Publication Committee meetings of the ISSM are source material. Results After extensive review of the historical material listed in the Methods section of this abstract, this comprehensive history of the communication efforts of this society has provided a rich and dynamic historical document for this society. Conclusion This extensive, detailed, and comprehensive history of the communication tools of this society help us to record and remember the events and the people involved in this process. Sharing scientific information and information regarding the life of the International Society for Sexual Medicine have been an important function of this society from early. Lewis RW. Comprehensive History of the International Society for Sexual Medicine–Journals and Communication. Sex Med Rev 2021;9:542–567.

There has been a marked increase in testosterone prescriptions in the past decade resulting in a growing need to give practicing clinicians proper guidance on the evaluation and management of the testosterone deficient patient.A systematic review utilized research from the Mayo Clinic Evidence Based Practice Center and additional supplementation by the authors. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions (table 1 in supplementary unabridged guideline, http://jurology.com/).This guideline was developed by a multi-disciplinary panel to inform clinicians on the proper assessment of patients with testosterone deficiency and the safe and effective management of men on testosterone therapy. Additional statements were developed to guide the clinician on the appropriate care of patients who are at risk for or have cardiovascular disease or prostate cancer as well as patients who are interested in preserving fertility.The care of testosterone deficient patients should focus on accurate assessment of total testosterone levels, symptoms, and signs as well as proper on-treatment monitoring to ensure therapeutic testosterone levels are reached and symptoms are ameliorated. Future longitudinal observational studies and clinical trials of significant duration in this space will improve diagnostic techniques and treatment of men with testosterone deficiency as well as provide more data on the adverse events that may be associated with testosterone therapy.

Erectile dysfunction (ED) or impotence is estimated to affect around 20-30 million men in the United States (Rhoden et al, 2002). Vascular etiology is purported to be the most prevalent cause of ED in the elderly population, with venogenic ED being the most common subtype (Shafik et al, 2007; Rebonato et al, 2014). A patient, who developed severe venogenic ED, was referred to interventional radiology after ineffective pharmaceutical treatments. Selective embolization of bilateral external and internal pudendal veins was performed through accessing the deep dorsal vein of penis. Subsequent venogram verified successful embolization with stasis within the outflow of the deep dorsal vein of penis. Close to 6 weeks after the procedure, the patient purports to be able to achieve approximately 65% of full penile erection and complete penile erection with penile stimulation and 0.25 mL injection of alprostadil after 25 minutes.

Plication procedures for the correction of Peyronie’s disease (PD) curvature are management options for PD patients. There are basically three types of procedures: excisional corporoplasty, incisional corporoplasty, and plication-only. This review is a compilation of English literature, peer-reviewed, published articles addressing these types of operations for Peyronie’s curvature correction, not congenital curvature. According to the urology literature, this surgical type was initially used for correction of curvature associated with hypospadias repair or congenital penile curvature. The procedures also, for the most part, historically became an alternative for plaque excision and graft repair, because of the difficulty with such repairs and the often-resultant erectile dysfunction (ED). A brief section traces some of the origins of these various repairs, followed by a brief section on the selection criteria for these types of surgery for the patient with PD penile curvature. We also review the significant articles in which the three types were presented with modifications. Finally, several articles that compare the various surgical repairs are summarized in the order that they appear in the literature. These types of surgery have become a mainstay for the surgical correction of penile curvature due to PD.

BACKGROUND Approximately 70% of all suicides in patients aged >60 years are attributed to physical illness, with higher rates noted in patients with cancer. The purpose of the current study was to characterize suicide rates among patients with genitourinary cancers and identify factors associated with suicide in this specific cohort. METHODS Patients with prostate, bladder, kidney, testis, and penile cancer were identified in the Surveillance, Epidemiology, and End Results database (1988-2010). Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated for each anatomic site. Multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide for each malignancy. RESULTS There were 2268 suicides identified among 1,239,522 individuals with genitourinary malignancies observed for 7,307,377 person-years. The SMRs for patients with cancer were 1.37 for prostate cancer (95% CI, 0.99-1.86), 2.71 for bladder cancer (95% CI, 2.02-3.62), 1.86 for kidney cancer (95% CI, 1.32-2.62), 1.23 for testis cancer (95% CI, 0.88-1.73), and 0.95 for penile cancer (95% CI, 0.65-1.35). On multivariable analysis, male sex was found to be associated with odds of suicide among patients with bladder cancer (OR, 6.63) and kidney cancer (OR, 4.98). Increasing age was associated with suicide for patients with prostate, bladder, and testis cancer (OR range, 1.03-1.06). Distant disease was associated with suicide in patients with prostate, bladder, and kidney cancer (OR range, 2.82-5.43). Among patients with prostate, bladder, and kidney cancer, African American patients were less likely to commit suicide compared with white individuals (OR range, 0.26-0.46). CONCLUSIONS Suicide in patients with genitourinary malignancies poses a public health dilemma, especially among men, the elderly, and those with aggressive disease. Clinicians should be aware of risk factors for suicide in these patients. Cancer 2015;121:1864–1872. © 2015 American Cancer Society.

The history of sexual medicine as a science is relatively new. This is no attempt to go back into ancient history to examine early practices for treating sexual disorders but starts with the modern era with the work of Masters and Johnson and Kinsey. It would be encyclopedic to include the details from all the contributors who have made this field now science but I have attempted to divide the topic in areas that have made this modern science and to include citations that have comprehensive reference sections that include major contributors. Each of the areas that I have divided this chapter could be a volume in itself. I know that by even doing this that I inadvertently have overlooked a few important contributors. There is a concentration on erectile dysfunction (ED) because from the days of vascular surgery there has been a tremendous explosion of anatomical, physiological, and molecular studies to examine the function of erection, both centrally and in the end organ and to define the pathophysiology of ED. But other sexual disorders in the male have been defined by science within the last 40 years. The focus on sexual disorders in women is relatively new, but it is truly become more scientific as well and I have tried to include references to some key papers that reflect that science. Since the mid-1970s the history has been intense and has led to logarithmic advances which, at best, are only partially discussed in this chapter. This chapter includes brief sections on psychotherapy history, vascular revascularization, penile prostheses, venous surgery, vacuum devices, epidemiology, diagnostic tools, intracavernosal injection therapy, oral therapy of ED, basic science, Peyronie’s disease, priapism, ejaculation problems, hormonal treatment and evaluation, and women’s disorders. I have tried to keep these in some order of when key studies evolved and show how the interaction of one area led to more scientific studies in the other area.

INTRODUCTION AND OBJECTIVES: The effect of venereal disease (VD) during World War I (WWI) was an underappreciated morbidity afflicting American soldiers. Along with mental illness and tuberculosis, VD was one of the most common non-combat related causes for soldier disability. The objective of this study is to review the impact of VD on the American military during WWI and to highlight the role of Hugh Hampton Young in assisting commanding officers in combating VD amongst their ranks. METHODS: A review of medical journals and historical textbooks was performed in order to give a comprehensive dissertation of the impact of VD on the American military during WWI. RESULTS: Prior to American involvement in WWI, prevalence of VD (primarily gonorrhea) among Allied forces was estimated to be 11-25%. Soldiers with gonorrhea were unable to fight and were problematic for commanding officers. VD was mainly the result of unsanctioned brothels in Europe, as soldiers frequented these establishments in an attempt to escape the rigors of war. With the arrival of American soldiers in France and their unregulated use of French prostitutes, General John Pershing became aware of this public health dilemma and immediately notified Secretary of War Newton Baker. Baker, with knowledge of President Wilson’s Presbyterian background and American civilian conservatism, subsequently instituted a policy that commanding officers were responsible for the general health of their soldiers. To aid the commanding officers, General Pershing enlisted the assistance of Urologist Dr. Hugh Hampton Young to Europe in May 1917 as Director of the Division of Urology in the American Expeditionary Force. American soldiers were ordered to be chaste and prohibited from encountering French women. Soldiers found to have VD were subject to irrigation of the bladder and penis with potassium permanganate and threatened with ‘court martial’. Commanders failing to keep VD to a minimum among their soldiers were at risk of losing rank. As a result of these combined efforts the prevalence of VD in the American military decreased after the institution of the policy, and was considerably lower than Allied forces from other countries. CONCLUSIONS: VD was an important public health dilemma for soldiers during WWI resulting in significant morbidity and affecting a soldier’s ability to perform in combat. With the assistance of Hugh Hampton Young, American military leaders were able to institute policies to counter the effects of VD and concomitantly maintain American conservative morals overseas. For his efforts, Dr. Young was promoted to Colonel in 1918 and received the Distinguished Service Medal in 1919.

Recently evidence-based medicine has been applied to comparative epidemiological papers regarding sexual dysfunction that have appeared in the literature. This review is intended to focus the readers on a validated and standardized methodological evidence-based process for preparing such articles. It reviews four key articles that have been published in the English language that have obtained a high evidence-based score for reliability that have included descriptive epidemiology of sexual dysfunctions in men and women in Asia compared to the rest of the world. These four papers are analyzed in detail in order to provide stress of what constitutes evidence-based studies in descriptive epidemiology for sexual function. As can be seen there has not yet been a perfect article that compares the prevalence of sexual function in Asia compared to the rest of the world since there are key methodological problems in the collection of the data. In addition, there is a paucity of incidence studies for sexual dysfunction in Asian populations. The readers are encouraged to use this data in preparation of future descriptive epidemiological studies that involve Asian countries.

Introduction The incidence and prevalence of various sexual dysfunctions in women and men are important to understand to designate priorities for epidemiologic and clinical research. Aim This manuscript was designed to conduct a review of the literature to determine the incidence and prevalence of sexual dysfunction in women and men. Methods Members of Committee 1 of the Fourth International Consultation on Sexual Medicine (2015) searched and reviewed epidemiologic literature on the incidence and prevalence of sexual dysfunctions. Key older studies and most studies published after 2009 were included in the text of this article. Main outcome measures The outcome measures were the reports in the various studies of the incidence and prevalence of sexual dysfunction among women and men. Results There are more studies on incidence and prevalence for men than for women and many more studies on prevalence than incidence for women and men. The data indicate that the most frequent sexual dysfunctions for women are desire and arousal dysfunctions. In addition, there is a large proportion of women who experience multiple sexual dysfunctions. For men, premature ejaculation and erectile dysfunction are the most common sexual dysfunctions, with less comorbidity across sexual dysfunctions for men compared with women. Conclusion These data need to be treated with caution, because there is a high level of variability across studies caused by methodologic differences in the instruments used to assess presence of sexual dysfunction, ages of samples, nature of samples, methodology used to gather the data, and cultural differences. Future research needs to use well-validated tools to gather data and ensure that the data collection strategy is clearly described.

Introduction Definitions of sexual dysfunctions in women and men are critical in facilitating research and enabling clinicians to communicate accurately. Aims To present the new set of definitions of all forms of sexual dysfunction in women and men adopted by the Fourth International Consultation on Sexual Medicine (ICSM) held in 2015. Methods Classification systems, including the International Classification of Diseases, 10th Edition and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , and systems that focus on only specific types of sexual dysfunctions (eg, the International Society for Sexual Medicine definition for premature ejaculation) were reviewed. Main Outcome Measures Evidence-based definitions were retained, gaps in definitions were identified, and outdated definitions were updated or discarded. Where evidence was insufficient or absent, expert opinion was used. Some definitions were self-evident and termed clinical principles. Results The evidence to support the various classification systems was carefully evaluated. A more comprehensive analysis of this evidence can be found in two other articles in this journal that consider the incidence and prevalence and the risk factors for sexual dysfunction in men and women. These data were used to shape the definitions for sexual dysfunction that have been recommended by the 2015 ICSM. Conclusion The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions. As more research and clinical studies are conducted, there likely will be modifications of at least some definitions.

Introduction This article presents a review of previous research concerning risk factors for sexual dysfunction in women and men. Aim The aim is to evaluate past research studies to determine the contribution of all risk factors to the development and maintenance of sexual dysfunction among women and men. Methods Studies were organized under a biopsychosocial framework, with the bulk of studies of women and men having investigated the role of biological factors. Main Outcome Measures The outcome measures were the data on factors for sexual dysfunction. Results Many more studies investigated risk factors for sexual dysfunction in men than in women. For women and men, diabetes, heart disease, urinary tract disorders, and chronic illness were significant risk factors for sexual dysfunction. Depression and anxiety and the medications used to treat these disorders also were risk factors for sexual dysfunction in women and men. In addition, substance abuse was associated with sexual dysfunction. Many other social and cultural factors were related to sexual dysfunction in women and men. Conclusion Psychosocial factors are clearly risk factors for sexual dysfunction. Women and men with sexual dysfunction should be offered psychosocial evaluation and treatment, if available, in addition to medical evaluation and treatment. The impact of social and cultural factors on sexual function requires substantially more research. The evidence that erectile dysfunction is a harbinger of other forms of cardiovascular disease is strong enough to recommend that clinical evaluation for occult cardiovascular disease should be undertaken in men who do not have known cardiovascular disease but who develop organic erectile dysfunction, especially in men younger than 70 years.

What's known on the subject? and What does the study add? Phosphoesterase type 5 inhibitors (PDE5is) are considered standard-of-care for the treatment of men with erectile dysfunction. Recommended administration of currently used PDE5is are between 60- to 120-minutes before sexual activity. RigiScan® monitoring has been validated in previous clinical studies of PDE5 inhibitors. Using a highly objective measure of sexual function (RigiScan monitoring), data show that the onset of action of avanafil was rapid. Response to treatment with avanafil was associated most frequently with the earliest time interval tested (20–40 minutes after dosing), compared with sildenafil 50 mg (100 to 120 minutes after dosing). However, avanafil treatments showed some degree of efficacy across all time intervals tested (including 60–80 minutes and 100–120 minutes post-dosing). These results were consistent with data from phase 3 trials which showed a rapid onset of action with avanafil (as early as 15 minutes) and a long duration of effect (up to 6 hours in some patients). Safety results were consistent with those reported in phase 3 trials, and showed that avanafil was well tolerated and adverse events were generally low and mild in severity. Objective To evaluate the safety, efficacy and time course of three doses of avanafil (50 mg, 100 mg and 200 mg) compared with sildenafil 50 mg or placebo, given in conjunction with visual sexual stimulation (VSS) videos in men with mild to moderate erectile dysfunction (ED). Patients and Methods Male patients, 35–70 years of age, with mild to moderate ED of ≥6 months duration, were included in the study. During the course of the study, each patient received placebo, active control (sildenafil 50 mg), and one dose of avanafil (50 mg, 100 mg or 200 mg), all administered in random order at least 72 h apart. RigiScan® (Dacomed Corp., Minneapolis, MN, USA) monitoring was used in conjunction with 20-min VSS videos (20, 60, and 100 min after dosing) to determine the duration of and time to ≥60% penile rigidity, maximum rigidity, tumescent activity units (TAUs), rigidity activity units (RAUs), and responses to the five-point Erection Assessment Scale. Safety assessments included adverse events (AEs), vital sign changes in response to dosing, laboratory results (complete blood counts, chemistry panel, prostate-specific antigen, serum testosterone, prothrombin time and urine analysis) and physical examination findings. Results Eighty-three patients were randomized and received at least one dose of study medication; 82 patients completed the study. Peak response to avanafil occurred in the early interval (20–40 min after dosing), while peak response to sildenafil occurred either in the middle (60–80 min) or late (100–120 min) intervals after dosing. Results were qualitatively similar for all other efficacy endpoints. During the 20–40-min interval, the majority of values for TAUs and RAUs with the avanafil 50-mg, 100-mg and 200-mg treatments were significantly superior to placebo (P < 0.05). Avanafil treatment was generally well tolerated; facial flushing (7–15%) was the most commonly observed AE, and no visual disturbances were reported. Conclusion A favourable safety profile and improvement in sexual function, coupled with rapid onset of action and durability of effect, make avanafil an attractive option for males with ED, especially in the setting of on-demand treatment.

There have been a limited number of epidemiological studies published on sexual disorders in persons from Asia. This paper aims to assess the reports of sexual dysfunction epidemiological studies published in the English language that involved Asian countries. Key points are summarized in this paper from nine epidemiological papers on sexual dysfunction from Asia that were published in the English language. Seven met the criteria for evidence-based studies reaching a Prins score of at least 10 or more. Papers included in this report came from national and regional representative studies in peer review journals. These results for sexual dysfunction in the nine papers are summarized for various sexual dysfunctions in men and women in Asian countries. In three of these, worldwide data were presented in the same paper allowing comparisons with Asian data on prevalence rates. Detailed descriptions from each of these studies are presented in paragraph form. More detailed data on erectile dysfunction (ED) is presented in a tabular form. Collectively, there seems to be a need for country- and population-specific further descriptive and analytical epidemiological studies in all of the sexual disorders from Asia. This critical review paper should help guide these studies for reaching evidence-based literature standards.

Introduction. Sexual health is an integral part of overall health. Sexual dysfunction can have a major impact on quality of life and psychosocial and emotional well-being. Aim. To provide evidence-based, expert-opinion consensus guidelines for clinical management of sexual dysfunction in men. Methods. An international consultation collaborating with major urologic and sexual medicine societies convened in Paris, July 2009. More than 190 multidisciplinary experts from 33 countries were assembled into 25 consultation committees. Committee members established scope and objectives for each chapter. Following an exhaustive review of available data and publications, committees developed evidence-based guidelines in each area. Main Outcome Measures. New algorithms and guidelines for assessment and treatment of sexual dysfunctions were developed based on work of previous consultations and evidence from scientific literature published from 2003 to 2009. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of medical literature, and cultural and ethical considerations. Results. Algorithms, recommendations, and guidelines for sexual dysfunction in men are presented. These guidelines were developed in an evidence-based, patient-centered, multidisciplinary manner. It was felt that all sexual dysfunctions should be evaluated and managed following a uniform strategy, thus the International Consultation of Sexual Medicine (ICSM-5) developed a stepwise diagnostic and treatment algorithm for sexual dysfunction. The main goal of ICSM-5 is to unmask the underlying etiology and/or indicate appropriate treatment options according to men's and women's individual needs (patient-centered medicine) using the best available data from population-based research (evidence-based medicine). Specific evaluation, treatment guidelines, and algorithms were developed for every sexual dysfunction in men, including erectile dysfunction; disorders of libido, orgasm, and ejaculation; Peyronie's disease; and priapism. Conclusions. Sexual dysfunction in men represents a group of common medical conditions that need to be managed from a multidisciplinary perspective. Montorsi F, Adaikan G, Becher E, Giuliano F, Khoury S, Lue TF, Sharlip I, Althof SE, Andersson K-E, Brock G, Broderick G, Burnett A, Buvat J, Dean J, Donatucci C, Eardley I, Fugl-Meyer KS, Goldstein I, Hackett G, Hatzichristou D, Hellstrom W, Incrocci L, Jackson G, Kadioglu A, Levine L, Lewis RW, Maggi M, McCabe M, McMahon CG, Montague D, Montorsi P, Mulhall J, Pfaus J, Porst H, Ralph D, Rosen R, Rowland D, Sadeghi-Nejad H, Shabsigh R, Stief C, Vardi Y, Wallen K, and Wasserman M. Summary of the recommendations on sexual dysfunctions in men. J Sex Med 2010;7:3572-3588.

I n 1952, Giuseppe Conti published a long paper (45 pages) [1] in which he detailed his anatomic findings on the human penis and proposed a theory to explain the erection phenomenon. In the introduction Conti explained that he conducted the research at the anatomical school of Padua, which had been interested since 1915 in “the structural characteristics of the vessels walls but extended to all the mechanisms that favored, retarded, or diverted the flow of the blood.” Conti justified that he had chosen the research on the blood vessels of the human penis because of the “enormous functional importance of the dynamics of circulation in this organ.” He examined 20 human penises from men ranging in age from newborn to 77 years. The specimens were obtained from autopsied cadavers 24 hours after their death; individuals with visible macroscopic changes of the external genitalia or whose histories might indicate possible lesions of the penis were excluded. Conti made various sections from the pendulous portion of the penis and the glans; the sections were in series, making possible to follow structures for as far as 3–4 mm. The author divided his manuscript into chapters. Chapter 1 was dedicated to introduction, chapter 2 to material and methods. In chapter 3, Conti started with a general consideration of the arteries of the penis and their divisions (artery of the penis, bulbourethral artery, urethral artery, cavernous artery, and dorsal artery). As a result of his observations, Conti stated that he had found, along the entire course of the dorsal artery and the cavernous artery, structures that regulate the blood flow. They were little endoarterial bands formed of muscle and connective tissue (cushions). In chapter 4, Conti summarized his observations on the deep dorsal vein and its collaterals. He had found that “the walls of the veins in the deep network of the penis very often include muscular cushions projecting into the lumen” and “they were more frequent where smaller veins entered into a larger vein; at those points the cushions often had a sphincter-like structure.” In chapter 5, the author gave an explanation of the mechanism of erection based on his findings: “in the flaccid penis, the muscles of the arterial cushions are contracted and the vascular lumen is greatly reduced. During erection, on the other hand, the muscles of the arterial cushions relax. At the same time, the muscles of the venous cushions contract, closing the lumen of the veins, thus preventing the outflow of blood.” Chapter 6 was devoted to the corpus cavernosum and corpus spongiosum. The first was described as a sponge, formed by cavities forming numerous intercommunicating sinuses. Its walls were formed by muscular and connective tissue and lined with endothelium. In the peripheral portion of the corpus cavernosum, located directly beneath the albuginea, Conti described “bloodcontaining spaces which should probably be considered veins.” He classified the sinuses of the corpus cavernosum as a venous segment of arteriovenous anastomoses. According to Conti, the corpus spongiosum was clearly differentiated from the corpus cavernosum; its morphology varied from the dorsal portion of the urethra to the ventral portion and with age. Its sinuses were surrounded by columns with sparse muscular tissue in the newborn. With age, those columns were populated with muscular tissue and a network of elastic fibers. Conti stated that the © 2008 International Society for Sexual Medicine

Objectives Men with previously negative prostate biopsies but continued suspicion for carcinoma present a diagnostic dilemma often managed by saturation prostate biopsy (SPB). We sought to determine the patient characteristics for which repeat biopsy by SPB provides the greatest utility for prostate cancer detection. Methods The records of the men at the state hospital and affiliated Veterans Affairs Medical Center with previously negative prostate biopsy findings who had then undergone SPB were reviewed. The predictors of cancer were analyzed, and those that were significant were included in a multivariate logistic regression model. Results A total of 82 men underwent SPB from November 2001 to March 2006. Their mean age was 61 years (range 43 to 76), and 44 (54%) were white, 37 (45%) were African American, and 1 (1%) was Asian. The mean prostate-specific antigen level at SPB was 9.1 ng/mL (range 1.0 to 34). The number of prior biopsies was one in 43 patients (52%) and two or more in 39 patients (47%). The prostate volume averaged 53 cm 3 (range 12 to 200). SPB included a median of 24 cores (range 24 to 40). Of the 82 patients, 16 (19.5%) were diagnosed with cancer, of whom 10 (63%) elected to undergo radical prostatectomy. The only significant predictors of prostate cancer were the prostate-specific antigen level ( P = 0.009) and prostate volume. The cancer detection rate was 57% for patients with a prostate volume less than 37 cm 3 and 7% for those with larger glands, and the difference was significant on multivariate analysis (odds ratio 31, 95% confidence interval 6 to 158, P Conclusions The results of our study have shown that SPB is an effective diagnostic tool with a high yield for men with persistent suspicion for prostate cancer, prior negative biopsy findings, and a prostate volume less than 37 cm 3 .

Introduction Intracavernosal injection (ICI) of a vasoactive agent has been an important part of the diagnosis, evaluation, and treatment of erectile dysfunction (ED) since its initial description by Virag in 1982. Aim To review the literature and summarize the use of ICI and its role in the diagnosis, evaluation, and treatment of ED. Methods Literature review. Main Outcome Measure To define the role of ICI's utility in the diagnosis, evaluation, and treatment of ED. Results When used in conjunction with color penile Doppler ultrasound for ED evaluation and diagnosis, ICI helps to detect penile vascular abnormalities and allows for differentiation between the multiple vasculogenic causes of impotence, thus helping clinicians to select the optimal treatment modality for each patient. Patients utilizing ICI continue to report high efficacy and satisfaction rates relative to other treatment options despite ICI's designation as a second‐line therapy since the introduction of oral phosphodiesterase type 5 inhibitors in 1998. In recent years, ICI has also become an important part of penile rehabilitation programs following radical prostatectomy, as regular use of ICI is thought to increase the rate at which patients experience return of spontaneous erection through preservation of penile tissue integrity and prevention of corporeal smooth muscle atrophy. Conclusions ICI of vasoactive agents remains an important tool in treating and diagnosing ED, with high patient satisfaction and efficacy rates. However, the dropout rate for ICI therapy remains relatively high, and it may be associated with priapism, ecchymoses, hematoma formation, and penile fibrosis. Patients should be educated on the benefits and limitations of ICI therapy prior to beginning treatment in order to minimize dropout rates. Additional studies are necessary to better understand the possible long‐term benefits of ICI therapy and how to most effectively structure the penile rehabilitation program after radical prostatectomy. Belew D, Klaassen Z, and Lewis RW. Intracavernosal injection for the diagnosis, evaluation, and treatment of erectile dysfunction: A review. Sex Med Rev 2015;3:11–23.

Objectives To address in a questionnaire-based study the frequency at which fertility is a concern for men when they consider their prostate cancer treatment options. A secondary aim was to assess the rate at which men were informed of the fertility implications of prostate cancer treatment by their physician before their selection of a treatment option. Methods Two questionnaires were used. One questionnaire was distributed to men with localized prostate cancer who had undergone treatment within the past year. These questions addressed whether continence, erectile function, and fertility were discussed with them by their physician during the prostate cancer treatment selection process. The second questionnaire was distributed to men with newly diagnosed prostate cancer and queried their level of concern about the effects of prostate cancer treatment on sexual function, urinary function, and fertility. Results All patients receiving the first questionnaire stated that they were informed of the incontinence and impotence side effects of prostate cancer treatments, but only 8.7% stated that they were informed of the effect that prostate cancer treatments would have on their future fertility. Of the patients completing the second questionnaire, 53.7% responded that incontinence was the side effect of prostate cancer treatment that caused them the most concern, 42.6% stated that erectile dysfunction was the most concerning, and 3.7% listed fertility as the major concern. Conclusions Urologists should consider approaching the topic of infertility when discussing the pros and cons of various prostate cancer therapies with their younger patients.

Treatment of cancer cells with histone deacetylase inhibitors (HDACi) such as suberolylanilide hydroxamic acid (SAHA) activates genes that promote apoptosis. To enhance proapoptotic efficiency, SAHA has been used in combination with radiation, kinase inhibitors and cytotoxic drugs. Although several prostate cells respond to TNFalpha-Related Apoptosis-Inducing Ligand (TRAIL), LNCaP are resistant. This model system was utilized to examine the advantages of combined treatment with SAHA and TRAIL. In LNCaP cells, TRAIL induced synergistic apoptosis when combined even with the lowest dose of SAHA. Treatment with caspase inhibitor confirmed that SAHA-induced apoptosis was mediated through caspases. In addition to induction of apoptosis, SAHA and TRAIL decreased the levels of proapoptotic proteins IKKalpha, IKKbeta and IKKgamma, suggesting that SAHA treatment may reduce the activity of NFkappaB. However, assay for NFkappaB luciferase reporter activity showed highly significant increase in SAHA-treated cells, supporting earlier suggestions that HDACi promotes NFkappaB transcriptional activity. Further analyses to determine the mechanisms by which the combination of SAHA and TRAIL led to synergistic apoptosis indicated that the apoptotic response of LNCaP is due to a complex regulation of death receptor pathway and alterations of NFkappaB activity at several regulatory steps.

Due to its specificity and effectiveness, tumor necrosis factor-α–related apoptosis-inducing ligand (TRAIL) is being tested for cancer therapy. Inhibition of the function of heat shock protein 90 (HSP90) is under clinical trials for cancer therapy. However, some cancer cells are resistant to TRAIL, and at the dose required for inducing apoptosis, geldanamycin, a drug that inhibits HSP90 function, has shown adverse effects. Therefore, our working plan was to identify a sublethal dose of geldanamycin and combine it with TRAIL to induce apoptosis in TRAIL-resistant prostate cancer cells. Treatment of LNCaP with 250 nmol/L geldanamycin inhibited HSP90 function but did not induce significant apoptosis. However, combination of geldanamycin and TRAIL induced highly significant apoptosis in TRAIL-resistant LNCaP cells. In addition to inducing caspase activity and apoptosis, treatment with geldanamycin and TRAIL decreased inhibitor of κB (IκB) kinase (IKK) complex proteins, IKKα, IKKβ, and IKKγ. The loss of IKK affected IκBα/nuclear factor-κB (NF-κB) interaction and reduced nuclear transport of NF-κB, resulting in reduced NF-κB activity. Our data show increase in apoptosis using low, suboptimal dose of geldanamycin when used with TRAIL. These results provide a means to alleviate two problems: resistance to TRAIL and adverse effects of high-dose geldanamycin. [Mol Cancer Ther 5006;5(1):170–8]

Introduction There are few published guidelines for the management of sexual dysfunctions in men and women, despite the prevalence and lack of attention to these problems. Disorders of sexual function in men include erectile dysfunction, orgasm/ejaculation disorders, priapism, and Peyronie's disease. Aim To provide evidence-based and expert-opinion consensus guidelines for the clinical management of men's sexual dysfunctions. Methods An International Consultation in collaboration with major urological and sexual medicine societies assembled over 200 multidisciplinary experts from 60 countries into 17 consultation committees. Committee members established the scope and objectives for each chapter. Following intensive review of available data and publications, committees developed evidence-based guidelines in each area. Main Outcome Measure New algorithms and guidelines for assessment and treatment of men's sexual dysfunction were developed. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of the medical literature, in addition to cultural and ethical considerations. Results Recommendations and guidelines for men's sexual dysfunction are presented. These guidelines were developed as evidence-based, patient-centered, and multidisciplinary in focus. For the clinical assessment and diagnosis of ED, a basic evaluation was recommended for all patients, with optional and specialized testing reserved for special cases. A new treatment algorithm is proposed. This algorithm provides a clinically relevant guideline for managing ED in the large majority of men. New treatment guidelines and algorithms are provided for men's orgasm and ejaculation disorders, including premature ejaculation, retrograde and delayed ejaculation. Finally, expert opinion-based guidelines for the clinical management of priapism and Peyronie's disease are provided. Conclusions Additional research is needed to validate and extend these guidelines. Nonetheless, this summary encompasses the recommendations concerning men's sexual dysfunctions presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28–July 1, 2003.

Introduction Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts. Aim To provide recommendations/guidelines concerning state-of-the-art knowledge for the epidemiology/risk factors of sexual dysfunctions in men and women. Methods An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Epidemiology/Risk Factors Committee, there were seven experts from four countries. Main Outcome Measure Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. Results Standard definitions of male and female sexual dysfunctions are needed. The incidence rate for erectile dysfunction is 25–30 cases per thousand person years and increases with age. There are no parallel data for women's sexual dysfunctions. The prevalence of sexual dysfunction increases as men and women age; about 40–45% of adult women and 20–30% of adult men have at least one manifest sexual dysfunction. Common risk factor categories associated with sexual dysfunction exist for men and women including: individual general health status, diabetes mellitus, cardiovascular disease, other genitourinary disease, psychiatric/psychological disorders, other chronic diseases, and socio-demographic conditions. Endothelial dysfunction is a condition present in many cases of erectile dysfunction and there are common etiological pathways for other vascular disease states. Increasing physical activity lowers incidence of ED in males who initiate follow-up in their middle ages. Conclusions There is a need for more epidemiologic research in male and female sexual dysfunction.

Studies from this laboratory have demonstrated that RhoA/Rho-kinase signaling mediates vasoconstriction in the penile circulation of the rat and that erection results from inhibition of this activity with Y-27632. In prior animal studies, Y-27632 was administered to the rats by intracavernous injection. To determine if topical application of the Rho-kinase inhibitor is an effective mode of delivery, Y-27632 was applied to the surface of the tunica albuginea or to the glans penis and surrounding skin in intact or castrated rats. Both sites of drug administration resulted in a marked increase in the erectile response both with and without stimulation of the autonomic innervation of the penile vasculature. Although high doses of the drug were found to reduce systemic blood pressure, topical administration of the Rho-kinase inhibitor, in appropriate doses, may have clinical value for the treatment erectile dysfunction.

There are two ways to establish that androgens play a major role in the function and integrity of erectile tissue: (1) discussing a number of physiology and molecular biology studies that have been published from experiments in animals and (2) reporting the effect of androgens on penile tissue, or in many cases the lack of androgen, in man. A variety of animal models, and also human studies, have shown the existence of androgen receptors in the corpora cavernosa. The penile erectile response in the laboratory rat is androgen dependent, and the active androgen appears to be dihydrotestosterone. There are several articles that describe the androgenic regulation of nitric oxide synthase (the enzyme responsible for production of nitric oxide), the primary agent controlling the erectile cycle. There have been few reports showing a direct end organ dependency of androgen for erectile function in the human corpora cavernosa, although there is plenty of evidence demonstrating that low or absent androgens affect a man's ability to have an erection in a sexual situation. Thus, in man androgen dependency for cavernous tissue smooth muscle function is still debatable. Extrapolating animal dependency of androgens for molecular activity in the penile tissue remains the most reasonable suggestion for androgen dependency of the cavernous tissue in man.

The involvement of antihypertensive therapy in the pathology of hypertension associated male erectile dysfunction is unclear. Stroke prone spontaneously hypertensive rats (SHRSP) were treated chronically with the angiotensin converting enzyme (ACE) inhibitor captopril or placebo, normotensive rats served as controls. Mean arterial and intracavernosal pressure were measured during the induction of erection by autonomic ganglion stimulation. SHRSP-placebo treated rats were hypertensive and had a blunted erectile response. Captopril treatment returned both the blood pressure and erectile response to control levels. Therefore, ACE inhibitor therapy may not be responsible for the erectile dysfunction observed in treated hypertensive subjects.

Approximately 70% of all suicides in patients aged60 years are attributed to physical illness, with higher rates noted in patients with cancer. The purpose of the current study was to characterize suicide rates among patients with genitourinary cancers and identify factors associated with suicide in this specific cohort.Patients with prostate, bladder, kidney, testis, and penile cancer were identified in the Surveillance, Epidemiology, and End Results database (1988-2010). Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated for each anatomic site. Multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide for each malignancy.There were 2268 suicides identified among 1,239,522 individuals with genitourinary malignancies observed for 7,307,377 person-years. The SMRs for patients with cancer were 1.37 for prostate cancer (95% CI, 0.99-1.86), 2.71 for bladder cancer (95% CI, 2.02-3.62), 1.86 for kidney cancer (95% CI, 1.32-2.62), 1.23 for testis cancer (95% CI, 0.88-1.73), and 0.95 for penile cancer (95% CI, 0.65-1.35). On multivariable analysis, male sex was found to be associated with odds of suicide among patients with bladder cancer (OR, 6.63) and kidney cancer (OR, 4.98). Increasing age was associated with suicide for patients with prostate, bladder, and testis cancer (OR range, 1.03-1.06). Distant disease was associated with suicide in patients with prostate, bladder, and kidney cancer (OR range, 2.82-5.43). Among patients with prostate, bladder, and kidney cancer, African American patients were less likely to commit suicide compared with white individuals (OR range, 0.26-0.46).Suicide in patients with genitourinary malignancies poses a public health dilemma, especially among men, the elderly, and those with aggressive disease. Clinicians should be aware of risk factors for suicide in these patients.

METHODS: A retrospective review of 176 patients who underwent surgical intervention for Peyronie’s Diesase between 2005 and 2013 was performed. Thirty-seven patients who underwent simultaneous IPP with Gore-Tex graft were identified; these patients had progressive failure of medical therapy for ED & history of penile curvature, or significant penile curvature found at time of IPP placement. Patient demographics, plaque characteristics, perioperative data and post-operative results are included at a median follow-up of 5.5 months. RESULTS: Mean age was 61 years (47-81) and 97.3% of patients were Caucasian; a majority (67.6%) were non-hispanic. Surgical history revealed prior radical prostatectomy in 6 and cystoprostatectomy in 1 patient. Two patients (5.4%) had prior plaque incision and grafting procedures (temporalis fascia, n1⁄41; cadaveric pericardium, n1⁄41). Median duration of symptoms of 24 months (6-216). Plaque severity was >60 in 29 patients (78.4%), and >90 in 4 patients (10.4%). Corporal waisting was found in 8 patients. Dorsal deviation was managed via infrapubic approach in 33 patients; ventral deviation was managed penoscrotally in 4 (10.8%). Biplanar plaques were found in 15 patients (40.5%). Median OR time was 159 minutes. AMS 700 systems were used in all patients, including CX (n1⁄43) and Ultrex/LGX cylinders (n-34). (American Medical Systems, MN). Median length of stay was 1 day (1-2). Median duration to prosthesis use was 4 weeks (3-8). All patients had functionally straight erections permitting intercourse. Three patients (8.1%) experienced post-operative paresthesia, resolving between 3-12 months. No patient experienced mechanical failure, cylinder aneurysm, or infection of the prosthesis or graft. CONCLUSIONS: AMS CX and LGX cylinders demonstrated durability and no infectious complications when used in conjunction with other synthetic material. For patients with ED and penile curvature, IPP placement with concomitant plaque incision and Gore-Tex grafting represents a highly efficacious surgical option with minimal morbidity.

The erectile response of the penis depends on a balance between vasoconstrictor agents which cause cavernosal smooth muscle to contract limiting blood inflow, and vasodilators which relax cavernosal smooth muscle leading to increased blood inflow and erection. This review emphasizes the role of vasoconstrictors in the penis and shows that both endothelin-1 (ET-1) and the alpha-adrenergic agonist, methoxamine (METHOX) exert strong vasoconstrictor actions in the cavernosal circulation. We recently reported the vasoconstrictor actions of exogenous ET-1 and METHOX to be mediated by the RhoA/Rho-kinase pathway in the cavernosal circulation. While it is widely held that the nitric oxide-cyclic GMP-protein kinase G (NO-cGMP-PKG) pathway mediates vasorelaxation and penile erection, the interaction between this pathway and the vasoconstrictor process remains to be fully elucidated. Our studies also have shown that, during erection, the vasoconstrictor action of METHOX and ET-1 are inhibited and that NO is likely responsible for this inhibition. We hypothesize that the NO-cGMP-PKG pathway controls erection by acting in two distinct ways-by lowering intracellular levels of calcium leading to vasorelaxation and by inhibiting Rho-kinase mediated vasoconstriction.

A recent report from this laboratory (Chitaley K, Wingard C, Webb R, Branam H, Stopper V, Lewis R, and Mills T. Nature Medicine 7: 119–122, 2001) showed that inhibition of Rho-kinase increased the erectile response (intracavernosal pressure and mean arterial pressure) by a process that does not require nitric oxide or cGMP. The present study investigated whether vasoconstrictor agents, which are active in the penis, act via the Rho-kinase pathway. Western analysis revealed RhoA and Rho-kinase protein in the penis. Treatment with the selective Rho-kinase inhibitor Y-27632 significantly increased the magnitude of the erectile response. Intracavernous administration of endothelin-1 (ET-1; 50 pmol) or methoxamine (10 μg/kg) reduced the erectile response to autonomic stimulation. If Y-27632 was given before ET-1 or methoxamine, the vasoconstrictor effect was reduced, and intracavernosal pressure and mean arterial pressure remained elevated. However, when given after methoxamine, Y-27632 had a reduced vasodilatory effect, and Y-27632 had no vasodilatory effect when given after ET-1. These findings suggest that ET-1 and methoxamine increase Rho-kinase activity in the cavernous circulation and support the hypothesis that the vasoconstriction that maintains the penis in the nonerect state is mediated, in part, by the Rho-kinase pathway.

To assess the efficacy and safety of Viagra (sildenafil citrate) in male outpatients with erectile dysfunction and patient and partner satisfaction with treatment using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS).A total of 247 patients with erectile dysfunction of broad-spectrum etiology were treated in a randomized, double-blind, parallel-group, multicenter study conducted at outpatient clinics. Patients receiving oral sildenafil (25, 50, and 100 mg) were compared with patients receiving placebo during a 12-week period. The principal efficacy measures were responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) on the International Index of Erectile Function and three global efficacy questions. Patient and partner satisfaction with treatment were assessed, for the first time, using the EDITS questionnaire.Efficacy scores for the International Index of Erectile Function questions and the global efficacy questions were significantly higher for patients receiving sildenafil than for those receiving placebo (P0.001). Both patients and partners receiving sildenafil also had significantly higher EDITS scores than those receiving placebo (P0.001). Adverse events were chiefly mild or moderate. Two patients receiving sildenafil and none receiving placebo discontinued treatment because of adverse events.Sildenafil was an effective, well-tolerated treatment for erectile dysfunction in an outpatient setting. Partner evaluations corroborated patient assessments. The results from the EDITS questionnaire indicated that after 12 weeks of receiving sildenafil both patients and partners reported higher levels of treatment satisfaction relative to placebo.

This brief review examines the history of the intraurethral (IU) pharmacotherapy for the treatment of erectile dysfunction (ED). Emphasis is placed on the design, study endpoints and results of a limited number of clinical trials undertaken with PGE(1)-MUSE to demonstrate the efficacy of this unique delivery system. Next, the theory of the iontophoretic technique of drug delivery is discussed. Clinical data collected while applying these methods are presented, but are thus far limited to treatment of patients with Peyronie's disease. Iontophoresis as a drug delivery alternative may gain popularity with ED patients who fail other types of therapy or in patients with other penile disorders. International Journal of Impotence Research (2000) 12, Suppl 4, S86-S90.

BACKGROUND Published data indicate that antiprogestins and antiestrogens could inhibit prostate cancer cell growth in vitro and in vivo. The main objective of the present studies was to explore the role of bcl2 and TGFβ1 for induction of apoptosis in LNCaP prostate cancer cells growing in culture as a treatment response to the antiprogestin, mifepristone, and the antiestrogen, 4-hydroxytamoxifen. METHODS In vitro cell viability (cytotoxicity), DNA fragmentation, and changes in the expression of bcl2 and TGFβ1 proteins were assessed using the sulforhodamine B protein dye-binding assay, specific ELISA, and competitive inhibition assays. RESULTS Both steroid antagonists induced a significant time- and dose-dependent cell growth inhibition (cytotoxicity). This inhibition of viable cells was associated with a significant increase in DNA fragmentation (apoptosis), downregulation of bcl2, and induction of TGFβ1 protein. Abrogation of the mifepristone- and 4-hydroxytamoxifen-induced cytotoxicity by TGFβ1-neutralizing antibody and by the addition of mannose-6-phosphate confirmed the correlation between induction of active TGFβ1 and subsequent prostate cancer cell death. The effect of mifepristone was not significantly reduced or prevented by occupying the progesterone or glucocorticoid receptors by their corresponding high-affinity native ligands. On the contrary, the effect of a combination of mifepristone with progesterone or hydrocortisone on the increase in DNA fragmentation, bcl2 downregulation, and induction of TGFβ1 protein was additive and significantly different (P < 0.05) from the effect of mifepristone monotherapy. CONCLUSIONS Our data suggest that mifepristone and tamoxifen are effective inducers of apoptosis and may represent nonandrogen-ablation, novel therapeutic approaches to overcome a potential intrinsic apoptosis resistance of androgen-independent prostate cancer cells. Prostate 43:31–42, 2000. © 2000 Wiley-Liss, Inc.

BACKGROUND Antiprogestins are a promising new class of mammary tumor inhibitors with a unique mechanism of action. Previously published results also suggest a tumor-inhibitory effect of antiprogestins in prostate cancer models. The objective of the present studies was to determine whether androgen-sensitive and androgen-insensitive variants of the well-characterized LNCaP human prostate cancer cell line exhibit stable differences in their sensitivity to in vivo antitumor activity of the antiprogestin, mifepristone. METHODS Exponentially growing LNCaP, LNCaP-C4, and LNCaP-C4-2 prostate cancer cells in culture were mixed with Matrigel and injected subcutaneously (s.c.) into the flank of 6–8-week-old male nude mice. The tumors were permitted to grow until they reached a volume of 270–300 mm3. The animals were then randomly assigned to two groups. One group received mifepristone (50 mg/kg/day s.c.). Control animals were treated with vehicle. Tumor volume was determined every 4 days. After 28 days of treatment, the tumors were harvested and wet weights were determined. RESULTS The inoculated tumor cells produced progressively growing tumors in male nude mice. However, the androgen-insensitive LNCaP-C4-2 cells showed the most aggressive and most rapid growth rate and shortest time to tumor progression. The tumors derived from the LNCaP-C4 cells exhibited a higher rate of tumor growth as compared with those derived from the parental androgen-sensitive LNCaP cells. In all three models, mifepristone treatment caused a significant retardation of tumor progression: after 28 days of treatment, about 50% inhibition of tumor weight was observed in the mifepristone treatment groups (P < 0.05) compared with the corresponding control groups. CONCLUSIONS This is the first report demonstrating significant antitumor activity of mifepristone in both androgen-sensitive and androgen-insensitive variants of the LNCaP human prostate cancer model in nude mice. These results suggest a potential clinical benefit of the use of antiprogestins as a novel nonandrogen ablation therapeutic approach in the management of prostate cancer. Prostate 42:99–106, 2000. © 2000 Wiley-Liss, Inc.

Ongoing studies in this laboratory have used the castrated rat, with and without testosterone replacement, to investigate how androgens maintain the erectile response. The high intracavernosal pressures during erection depend on both an increase in the rate at which blood flows into the sinuses of the corpus cavernosum and a decrease in the rate at which blood flows out (veno-occlusion). Accordingly, our studies investigated androgenic regulation of the arterioles that regulate inflow and of the intracavernosal muscle that regulates the veno-occlusive mechanism controlling outflow. The results of these studies show that castration causes a decline in the rate of inflow and that androgen replacement reverses this decline. The decline in inflow in the castrated rats is also reversed by the administration of a nitric oxide donor drug, suggesting that the androgen may regulate inflow by increasing the synthesis of nitric oxide. Testosterone also appears to regulate outflow by controlling the sensitivity of the erectile mechanisms to norepinephrine, considered to be the principle vaso-constrictor neurotransmitter in the erectile response. Taken together, the results of these studies suggest that androgens control the erectile response by altering the synthesis and action of the neurotransmitters that normally alter the state of contraction and relaxation of smooth muscle in the erectile tissue.

Purpose: We describe a surgical modification of the Nesbit procedure to correct Peyronie's disease, and compare the results of this procedure with those of 2 other surgical techniques.Materials and Methods: In 30 patients a vertical incision in the tunica albuginea was closed in a horizontal fashion with permanent suture knots buried beneath the tunica in a running looped fashion, resulting in watertight closure with no exposed suture material. A standard Nesbit procedure and plaque excision with a polyethylene terephthalate mesh reinforced silicone sheet patch graft were done in 28 cases each.Results: Elimination of penile curvature, patient satisfaction and postoperative impotence rates were not statistically different for standard and modified Nesbit procedures. However, plaque excision and synthetic patch grafting resulted in less elimination of curvature (61%, p = 0.004), a lower rate of satisfaction (30%, p = 0.00002) and a higher incidence of impotence after surgery (18%, p = 0.04). The mod...

Based upon physical presence at most of the historical moments of the development of the International Society for Sexual Medicine (ISSM), extensive personal records on meetings and correspondence associated with the business and the work of the International Society for Sexual and Impotence Research and the ISSM, and information provided by the business office of the ISSM, a review paper was created to present to the reader an accurate history of the ISSM. The article is divided into the early beginnings of the idea of the field of sexual medicine, followed by the organization of what was to become eventually the International Society for Sexual Medicine, description of the development of biennial meetings and some of the major events that occurred at these meetings, a description of officers and leaders of the society and some of their key contributions, other meetings that the ISSM was actively involved in in the field of sexual medicine, a detailed discussion of publications and communications of the organization, and finally a description of the involvement of the ISSM with the recognition of scientific achievement and research in the field. This history is indeed very rich and unique for the parallelism to the development of the entire field of sexual medicine as a true science. The author has spent a great deal of time in making sure that there is written material that substantiates the history that is outlined in this document. It is provided to the reader as a true historical perspective on the ISSM. Lewis RW. The International Society for Sexual Medicine: A rich history and a bright future. Sex Med Rev 2013; 1:65-75.