77 results on '"Sharlip I"'
Search Results
2. 139 Evidence of Correlation of PE Patient and Partner Responses to Effective Therapy
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Wyllie, M., primary and Sharlip, I., additional
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- 2018
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3. 138 Correlation of Changes in IELT and Indices of Sexual Satisfaction in PE Patients
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Wyllie, M.G., primary and Sharlip, I., additional
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- 2018
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4. Debates: Is smoking an independent risk factor for erectile dysfunction?
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Sharlip, I
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- 2001
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5. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus
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Jackson, G. Boon, N. Eardley, I. Kirby, M. Dean, J. and Hackett, G. Montorsi, P. Montorsi, F. Vlachopoulos, C. and Kloner, R. Sharlip, I. Miner, M.
- Abstract
P>A significant proportion of men with erectile dysfunction (ED) exhibit early signs of coronary artery disease (CAD), and this group may develop more severe CAD than men without ED (Level 1, Grade A). The time interval among the onset of ED symptoms and the occurrence of CAD symptoms and cardiovascular events is estimated at 2-3 years and 3-5 years respectively; this interval allows for risk factor reduction (Level 2, Grade B). ED is associated with increased all-cause mortality primarily due to increased cardiovascular mortality (Level 1, Grade A). All men with ED should undergo a thorough medical assessment, including testosterone, fasting lipids, fasting glucose and blood pressure measurement. Following assessment, patients should be stratified according to the risk of future cardiovascular events. Those at high risk of cardiovascular disease should be evaluated by stress testing with selective use of computed tomography (CT) or coronary angiography (Level 1, Grade A). Improvement in cardiovascular risk factors such as weight loss and increased physical activity has been reported to improve erectile function (Level 1, Grade A). In men with ED, hypertension, diabetes and hyperlipidaemia should be treated aggressively, bearing in mind the potential side effects (Level 1, Grade A). Management of ED is secondary to stabilising cardiovascular function, and controlling cardiovascular symptoms and exercise tolerance should be established prior to initiation of ED therapy (Level 1, Grade A). Clinical evidence supports the use of phosphodiesterase 5 (PDE5) inhibitors as first-line therapy in men with CAD and comorbid ED and those with diabetes and ED (Level 1, Grade A). Total testosterone and selectively free testosterone levels should be measured in all men with ED in accordance with contemporary guidelines and particularly in those who fail to respond to PDE5 inhibitors or have a chronic illness associated with low testosterone (Level 1, Grade A). Testosterone replacement therapy may lead to symptomatic improvement (improved wellbeing) and enhance the effectiveness of PDE5 inhibitors (Level 1, Grade A). Review of cardiovascular status and response to ED therapy should be performed at regular intervals (Level 1, Grade A).
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- 2010
6. The impact of infertility on family size in the USA: data from the National Survey of Family Growth
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Breyer, B. N., primary, Smith, J. F., additional, Shindel, A. W., additional, Sharlip, I. D., additional, and Eisenberg, M. L., additional
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- 2010
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7. Debates
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Sharlip, I, primary
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- 2001
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8. Micromethod for determination of lactate dehydrogenase isoenzyme C4 activity in human seminal plasma.
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Butrimovitz, G P, primary, Farina, F, primary, and Sharlip, I, primary
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- 1983
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9. Dissolution of bilateral uric acid calculi causing anuria.
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Eason, A A, Sharlip, I D, and Spaulding, J T
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- 1978
10. Reversible heart block in acute leukemia.
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Maguire, L C, Sharlip, I D, Spaulding, J T, and Tewfik, H H
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- 1978
11. DebatesIs smoking an independent risk factor for erectile dysfunction?
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Sharlip, I
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SMOKING ,IMPOTENCE - Abstract
Focuses on a debate organized by the Sexual Medicine Society of North America Inc. on whether smoking is an independent risk factor for erectile dysfunction. Arguments for the topic; Physicians arguing against the topic.
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- 2001
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12. Diagnostic evaluation of erectile dysfunction in the era of oral therapy.
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Sharlip, I D
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IMPOTENCE , *SPECIFIC medicines - Abstract
Therapy for erectile dysfunction (ED) may be specific to the cause of ED or it may be nonspecific. There are only three causes of ED which have specific therapy: psychogenic, endocrine and certain types of reversible vasculogenic ED. In the era of oral therapy for ED, treatment is not cause-specific in the great majority of patients. For this great majority, only the basic evaluation of ED is needed. Only when there is a strong suspicion that the cause of a patient's ED is endocrine, psychogenic or reversible vascular disease are additional diagnostic tests indicated. In these three categories of patients, specific treatment of the cause of ED can produce a permanent and dramatic improvement in sexual function and satisfaction. [ABSTRACT FROM AUTHOR]
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- 2000
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13. First International Conference on the Management of Erectile Dysfunction Overview consensus statement.
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Eid, J F, Nehra, A, Andersson, K E, Heaton, J, Lewis, R W, Morales, A, Moreland, R B, Mulcahy, J J, Porst, H, Pryor, J L, Sharlip, I D, Wagner, G, and Wyllie, M
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IMPOTENCE ,CONFERENCES & conventions - Abstract
Focuses on the first international conference on the management of erectile dysfunction held in Chicago, Illinois as of March 2000. Participants at the conference; Topics discussed during the conference; Goals of the conference.
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- 2000
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14. FROM RESEARCH TO PRACTICE. [Commentary on] An Exploration of Central Dysregulation of Erectile Function as a Contributing Cause of Diabetic Impotence.
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Sharlip, I. D.
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- 1991
15. Sexual rehabilitation aftertreatment for prostate cancer in Sexual Medicine: Sexual dysfunctions in men and women
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Mulhall J, Bella A, McCullough A, Brock G., BRIGANTI , ALBERTO, Montordi F, R Basson, G Adaikan, E. Becher, F Clayton, F Giuliano, S Khoury, Sharlip I, Mulhall, J, Bella, A, Briganti, Alberto, Mccullough, A, and Brock, G.
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- 2010
16. Proceedings of PRINCETON IV: PDE5 inhibitors and cardiac health symposium.
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Rosen RC, Miner M, Burnett AL, Blaha MJ, Ganz P, Goldstein I, Kim N, Kohler T, Lue T, McVary K, Mulhall J, Parish SJ, Sadeghi-Nejad H, Sadovsky R, Sharlip I, and Kloner RA
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- Humans, Male, Cardiovascular Diseases, Erectile Dysfunction drug therapy, Phosphodiesterase 5 Inhibitors adverse effects, Phosphodiesterase 5 Inhibitors therapeutic use
- Abstract
Introduction: Prior consensus meetings have addressed the relationship between phosphodiesterase type 5 (PDE5) inhibition and cardiac health. Given significant accumulation of new data in the past decade, a fourth consensus conference on this topic was convened in Pasadena, California, on March 10 and 11, 2023., Objectives: Our meeting aimed to update existing knowledge, assess current guidelines, and make recommendations for future research and practice in this area., Methods: An expert panel reviewed existing research and clinical practice guidelines., Results: Key findings and clinical recommendations are the following: First, erectile dysfunction (ED) is a risk marker and enhancer for cardiovascular (CV) disease. For men with ED and intermediate levels of CV risk, coronary artery calcium (CAC) computed tomography should be considered in addition to previous management algorithms. Second, sexual activity is generally safe for men with ED, although stress testing should still be considered for men with reduced exercise tolerance or ischemia. Third, the safety of PDE5 inhibitor use with concomitant medications was reviewed in depth, particularly concomitant use with nitrates or alpha-blockers. With rare exceptions, PDE5 inhibitors can be safely used in men being treated for hypertension, lower urinary tract symptoms and other common male disorders. Fourth, for men unresponsive to oral therapy or with absolute contraindications for PDE5 inhibitor administration, multiple treatment options can be selected. These were reviewed in depth with clinical recommendations. Fifth, evidence from retrospective studies points strongly toward cardioprotective effects of chronic PDE5-inhibitor use in men. Decreased rates of adverse cardiac outcomes in men taking PDE-5 inhibitors has been consistently reported from multiple studies. Sixth, recommendations were made regarding over-the-counter access and potential risks of dietary supplement adulteration. Seventh, although limited data exist in women, PDE5 inhibitors are generally safe and are being tested for use in multiple new indications., Conclusion: Studies support the overall cardiovascular safety of the PDE5 inhibitors. New indications and applications were reviewed in depth., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2024
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17. Challenges facing the urologist in low- and middle-income countries.
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Metzler I, Bayne D, Chang H, Jalloh M, and Sharlip I
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- Adult, Female, Health Care Surveys, Humans, Internationality, Male, Middle Aged, Developing Countries, Income, Poverty, Urology
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Purpose: The challenges in providing urologic care across borders and in resource-constrained settings are poorly understood. We sought to better characterize the impediments to the delivery of urological care in low- and middle-income countries (LMICs) compared to high-income countries (HICs)., Methods: A 70 question online survey in RedCap™ was distributed to urologists who had practiced in countries outside of the United States and Europe categorized by World Bank income groups., Results: 114 urologists from 27 countries completed the survey; 35 (39%) practiced in HICs while 54 (61%) practiced in LMICs. Forty-three percent of urologists received training outside their home country. Most commonly treated conditions were urolithiasis (30%), BPH (15%) and prostate cancer (13%) which did not vary by group. Only 19% of urologists in LMICs reported sufficient urologists in their country. Patients in LMICs were less likely to get urgent drainage for infected obstructing kidney stones or endoscopic treatment for a painful kidney stone or obstructing prostate. Urologists visiting LMICs were more likely to cite deficits in knowledge, inadequate operative facilities and limited access to disposables as the major challenges whereas local LMIC urologists were more likely to cite financial challenges, limited access to diagnostics and support staff as the barriers to care., Conclusions: LMICs lack enough training opportunities and urologists to care for their population. There is disconnect between the needs identified by local and visiting urologists. International collaborations should target broader interventions in LMICs to address local priorities such as diagnostic studies, support staff and financial support.
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- 2020
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18. Tribute to Dr Gorm Wagner, Founding Father of ISSM.
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Goldstein I, Lewis R, and Sharlip I
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- Denmark, History, 20th Century, History, 21st Century, Humans, Male, Physicians history, Reproductive Medicine history, Reproductive Medicine organization & administration, Sexual Health history
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- 2018
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19. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE).
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Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO
- Abstract
Introduction: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts., Aim: The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts., Method: A comprehensive literature review was performed., Results: This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients., Conclusion: Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60-90.
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- 2014
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20. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation.
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Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO
- Abstract
Introduction: The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE., Aim: The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE., Methods: In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted., Results: The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy., Conclusion: The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An evidence-based unified definition of lifelong and acquired premature ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. Sex Med 2014;2:41-59.
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- 2014
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21. SOP conservative (medical and mechanical) treatment of erectile dysfunction.
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Porst H, Burnett A, Brock G, Ghanem H, Giuliano F, Glina S, Hellstrom W, Martin-Morales A, Salonia A, and Sharlip I
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- Adult, Age Factors, Aged, Aged, 80 and over, Alprostadil administration & dosage, Alprostadil adverse effects, Alprostadil therapeutic use, Carbolines administration & dosage, Carbolines adverse effects, Carbolines pharmacokinetics, Carbolines therapeutic use, Drug Therapy, Combination, Erectile Dysfunction etiology, Erectile Dysfunction therapy, Humans, Hypogonadism complications, Hypogonadism therapy, Imidazoles administration & dosage, Imidazoles adverse effects, Imidazoles pharmacokinetics, Imidazoles therapeutic use, Male, Middle Aged, Penile Erection drug effects, Phosphodiesterase 5 Inhibitors administration & dosage, Phosphodiesterase 5 Inhibitors adverse effects, Phosphodiesterase 5 Inhibitors pharmacokinetics, Phosphodiesterase 5 Inhibitors therapeutic use, Piperazines administration & dosage, Piperazines adverse effects, Piperazines pharmacokinetics, Piperazines therapeutic use, Pyrimidines administration & dosage, Pyrimidines adverse effects, Pyrimidines pharmacokinetics, Pyrimidines therapeutic use, Risk Factors, Sulfonamides administration & dosage, Sulfonamides adverse effects, Sulfonamides pharmacokinetics, Sulfonamides therapeutic use, Sulfones administration & dosage, Sulfones adverse effects, Sulfones pharmacokinetics, Sulfones therapeutic use, Tadalafil, Triazines administration & dosage, Triazines adverse effects, Triazines pharmacokinetics, Triazines therapeutic use, Vardenafil Dihydrochloride, Yohimbine adverse effects, Yohimbine therapeutic use, Erectile Dysfunction drug therapy
- Abstract
Introduction: Erectile dysfunction (ED) is the most frequently treated male sexual dysfunction worldwide. ED is a chronic condition that exerts a negative impact on male self-esteem and nearly all life domains including interpersonal, family, and business relationships., Aim: The aim of this study is to provide an updated overview on currently used and available conservative treatment options for ED with a special focus on their efficacy, tolerability, safety, merits, and limitations including the role of combination therapies for monotherapy failures., Methods: The methods used were PubMed and MEDLINE searches using the following keywords: ED, phosphodiesterase type 5 (PDE5) inhibitors, oral drug therapy, intracavernosal injection therapy, transurethral therapy, topical therapy, and vacuum-erection therapy/constriction devices. Additionally, expert opinions by the authors of this article are included., Results: Level 1 evidence exists that changes in sedentary lifestyle with weight loss and optimal treatment of concomitant diseases/risk factors (e.g., diabetes, hypertension, and dyslipidemia) can either improve ED or add to the efficacy of ED-specific therapies, e.g., PDE5 inhibitors. Level 1 evidence also exists that treatment of hypogonadism with total testosterone < 300 ng/dL (10.4 nmol/L) can either improve ED or add to the efficacy of PDE5 inhibitors. There is level 1 evidence regarding the efficacy and safety of the following monotherapies in a spectrum-wide range of ED populations: PDE5 inhibitors, intracavernosal injection therapy with prostaglandin E1 (PGE1, synonymous alprostadil) or vasoactive intestinal peptide (VIP)/phentolamine, and transurethral PGE1 therapy. There is level 2 evidence regarding the efficacy and safety of the following ED treatments: vacuum-erection therapy in a wide range of ED populations, oral L-arginine (3-5 g), topical PGE1 in special ED populations, intracavernosal injection therapy with papaverine/phentolamine (bimix), or papaverine/phentolamine/PGE1 (trimix) combination mixtures. There is level 3 evidence regarding the efficacy and safety of oral yohimbine in nonorganic ED. There is level 3 evidence that combination therapies of PDE5 inhibitors + either transurethral or intracavernosal injection therapy generate better efficacy rates than either monotherapy alone. There is level 4 evidence showing enhanced efficacy with the combination of vacuum-erection therapy + either PDE5 inhibitor or transurethral PGE1 or intracavernosal injection therapy. There is level 5 evidence (expert opinion) that combination therapy of PDE5 inhibitors + L-arginine or daily dosing of tadalafil + short-acting PDE5 inhibitors pro re nata may rescue PDE5 inhibitor monotherapy failures. There is level 5 evidence (expert opinion) that adding either PDE5 inhibitors or transurethral PGE1 may improve outcome of penile prosthetic surgery regarding soft (cold) glans syndrome. There is level 5 evidence (expert opinion) that the combination of PDE5 inhibitors and dapoxetine is effective and safe in patients suffering from both ED and premature ejaculation., (© 2013 International Society for Sexual Medicine.)
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- 2013
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22. Summary of the recommendations on sexual dysfunctions in men.
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Montorsi F, Adaikan G, Becher E, Giuliano F, Khoury S, Lue TF, Sharlip I, Althof SE, Andersson KE, 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
- Subjects
- Ejaculation, Erectile Dysfunction pathology, Erectile Dysfunction psychology, Erectile Dysfunction surgery, Evidence-Based Medicine, Humans, Impotence, Vasculogenic pathology, Impotence, Vasculogenic surgery, Male, Penile Induration, Practice Guidelines as Topic, Prostatic Neoplasms, Risk Factors, Testosterone deficiency, Time Factors, Impotence, Vasculogenic psychology
- Abstract
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., (© 2010 International Society for Sexual Medicine.)
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- 2010
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23. International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation.
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Althof SE, Abdo CH, Dean J, Hackett G, McCabe M, McMahon CG, Rosen RC, Sadovsky R, Waldinger M, Becher E, Broderick GA, Buvat J, Goldstein I, El-Meliegy AI, Giuliano F, Hellstrom WJ, Incrocci L, Jannini EA, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, and Tan HM
- Subjects
- Administration, Topical, Analgesics, Opioid therapeutic use, Anesthetics, Local therapeutic use, Antidepressive Agents, Tricyclic therapeutic use, Behavior Therapy, Humans, Hyperthyroidism physiopathology, Male, Medical History Taking, Patient Education as Topic, Physical Examination, Prevalence, Primary Health Care, Prostatitis physiopathology, Quality of Life, Selective Serotonin Reuptake Inhibitors therapeutic use, Sexual Dysfunction, Physiological etiology, Sexual Dysfunction, Physiological physiopathology, Sexual Dysfunction, Physiological psychology, Sexual Partners, Time Factors, Tramadol therapeutic use, Ejaculation physiology, Sexual Dysfunction, Physiological diagnosis, Sexual Dysfunction, Physiological therapy
- Abstract
Introduction: Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE., Aim: Develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method. Review of the literature., Results: This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients., Conclusion: Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years., (© 2010 International Society for Sexual Medicine.)
- Published
- 2010
- Full Text
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24. Baseline characteristics and treatment outcomes for men with acquired or lifelong premature ejaculation with mild or no erectile dysfunction: integrated analyses of two phase 3 dapoxetine trials.
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Porst H, McMahon CG, Althof SE, Sharlip I, Bull S, Aquilina JW, Tesfaye F, and Rivas DA
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- Adult, Benzylamines adverse effects, Dose-Response Relationship, Drug, Double-Blind Method, Humans, Male, Middle Aged, Naphthalenes adverse effects, Patient Satisfaction, Quality of Life psychology, Selective Serotonin Reuptake Inhibitors adverse effects, Benzylamines therapeutic use, Ejaculation drug effects, Erectile Dysfunction drug therapy, Naphthalenes therapeutic use, Selective Serotonin Reuptake Inhibitors therapeutic use, Sexual Dysfunction, Physiological drug therapy
- Abstract
Introduction: Premature ejaculation (PE) is classified as an acquired or lifelong condition but data on baseline characteristics and response to treatment of men with acquired or lifelong PE and mild erectile dysfunction (ED) or normal erectile function (EF) is limited., Aim: To present integrated analyses of baseline characteristics and treatment outcomes from phase 3 dapoxetine trials in men with acquired or lifelong PE and mild or no ED., Methods: Data were analyzed from two randomized, double-blind, placebo-controlled, phase 3 clinical trials (International and Asia-Pacific) that evaluated efficacy and safety of dapoxetine (30 mg or 60 mg as needed [PRN]) in patients with PE. Men were ≥18 years, in a stable monogamous relationship for ≥6 months, met DSM-IV-TR criteria for PE for ≥6 months, had an International Index of Erectile Function EF domain score ≥21, and had an intravaginal ejaculatory latency time (IELT) ≤2 minutes in ≥75% of intercourse episodes., Main Outcome Measures: Demographics, sexual history, and PE symptomatology at baseline, and mean IELT and patient-reported outcomes (PROs) at study end (week 12), were analyzed for men with acquired or lifelong PE and mild or no ED (EF score 21-25 vs. ≥26)., Results: Baseline characteristics except duration of PE were similar in men with acquired and lifelong PE, with no other differentiating features by ED status. Dapoxetine treatment improved significantly mean IELT (arithmetic and geometric) and PRO responses (perceived control over ejaculation, satisfaction with sexual intercourse, ejaculation-related personal distress, and interpersonal difficulty) for acquired and lifelong subtypes, but presence of mild ED diminished PRO responsiveness in both subtypes, particularly those with lifelong PE., Conclusions: Baseline characteristics and treatment outcomes were generally similar in men with acquired and lifelong PE. The presence of mild ED appears to be associated with a more modest treatment response, irrespective of lifelong or acquired PE subtype.
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- 2010
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25. Circumcision and the risk of HIV transmission in Africa.
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Sharlip I
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- Africa South of the Sahara, Cross-Sectional Studies, Disease Outbreaks, HIV Infections epidemiology, HIV Infections prevention & control, Health Education, Humans, Incidence, Male, Risk Factors, World Health Organization, Circumcision, Male, Developing Countries, HIV Infections transmission
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- 2008
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26. Rational use of dapoxetine for the treatment of premature ejaculation.
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Sharlip I
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- Ejaculation physiology, Humans, Male, Randomized Controlled Trials as Topic methods, Sexual Dysfunctions, Psychological physiopathology, Benzylamines administration & dosage, Ejaculation drug effects, Naphthalenes administration & dosage, Sexual Dysfunctions, Psychological drug therapy
- Published
- 2008
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27. An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation.
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McMahon CG, Althof S, Waldinger MD, Porst H, Dean J, Sharlip I, Adaikan PG, Becher E, Broderick GA, Buvat J, Dabees K, Giraldi A, Giuliano F, Hellstrom WJ, Incrocci L, Laan E, Meuleman E, Perelman MA, Rosen R, Rowland D, and Segraves R
- Subjects
- Humans, Male, Personal Satisfaction, Sexual Dysfunction, Physiological diagnosis, Sexual Dysfunction, Physiological psychology, Stress, Psychological etiology, Time Factors, Ejaculation physiology, Evidence-Based Medicine, Sexual Dysfunction, Physiological classification, Terminology as Topic
- Abstract
Objective: To develop a contemporary, evidence-based definition of premature ejaculation (PE)., Methods: There are several definitions of PE; the most commonly quoted, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - 4th Edition - Text Revision, and other definitions of PE, are all authority-based rather than evidence-based, and have no support from controlled clinical and/or epidemiological studies. Thus in August 2007, the International Society for Sexual Medicine (ISSM) appointed several international experts in PE to an Ad Hoc Committee for the Definition of PE. The committee met in Amsterdam in October 2007 to evaluate the strengths and weaknesses of current definitions of PE, to critically assess the evidence in support of the constructs of ejaculatory latency, ejaculatory control, sexual satisfaction and personal/interpersonal distress, and to propose a new evidence-based definition of PE., Results: The Committee unanimously agreed that the constructs which are necessary to define PE are rapidity of ejaculation, perceived self-efficacy, and control and negative personal consequences from PE. The Committee proposed that lifelong PE be defined as a male sexual dysfunction characterized by ejaculation which always or nearly always occurs before or within about one minute of vaginal penetration, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy. This definition is limited to men with lifelong PE who engage in vaginal intercourse. The panel concluded that there are insufficient published objective data to propose an evidence-based definition of acquired PE., Conclusion: The ISSM definition of lifelong PE represents the first evidence-based definition of PE. This definition will hopefully lead to the development of new tools and patient-reported outcome measures for diagnosing and assessing the efficacy of treatment interventions, and encourage ongoing research into the true prevalence of this disorder, and the efficacy of new pharmacological and psychological treatments.
- Published
- 2008
- Full Text
- View/download PDF
28. Results of vasovasostomy or vasoepididymostomy after failed percutaneous epididymal sperm aspirations.
- Author
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Marmar JL, Sharlip I, and Goldstein M
- Subjects
- Adult, Epididymis, Humans, Infertility, Male etiology, Male, Microsurgery, Middle Aged, Spermatozoa, Infertility, Male surgery, Plastic Surgery Procedures methods, Urologic Surgical Procedures, Male, Vasectomy adverse effects
- Abstract
Purpose: After undergoing vasectomy approximately 4% to 6% of men change their minds and desire more children. In the past they had 2 options: 1) vasectomy reversal and 2) sperm retrieval and intracytoplasmic sperm injection. However, in our practices we began to receive requests for another option: reconstructive microsurgery after failed percutaneous epididymal sperm aspiration., Materials and Methods: In this report we combined our collective experience with 8 patients who requested reconstructive microsurgery after failed percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection., Results: Our intraoperative findings demonstrated minimal trauma to the epididymis resulting from percutaneous epididymal sperm aspiration. At surgery sperm were found in the testicular vas fluid in 10 of 16 vasal units, and vasovasostomy was possible on at least 1 side in 7 of 8 patients. Vasoepididymostomy was possible when needed. Of the 8 couples 4 achieved pregnancy (50%)., Conclusions: Vasovasostomy or vasoepididymostomy is possible after percutaneous epididymal sperm aspiration.
- Published
- 2008
- Full Text
- View/download PDF
29. Ocular safety in patients using sildenafil citrate therapy for erectile dysfunction.
- Author
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Laties A and Sharlip I
- Subjects
- Color Vision Defects chemically induced, Controlled Clinical Trials as Topic, Humans, Male, Purines, Sildenafil Citrate, Sulfones, Vasodilator Agents adverse effects, Visual Acuity, Visual Fields, Erectile Dysfunction drug therapy, Optic Neuropathy, Ischemic chemically induced, Phosphodiesterase Inhibitors adverse effects, Piperazines adverse effects, Vision Disorders chemically induced
- Abstract
Sildenafil citrate improves erectile function in men with erectile dysfunction (ED) by selectively inhibiting cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5), which is present in all vascular tissue. Sildenafil also has a weaker inhibitory action on PDE6, located in the rod and cone photoreceptors. Modest, transient visual symptoms, typically blue tinge to vision, increased brightness of lights, and blurry vision, have been reported with sildenafil use and occur more frequently at higher doses. Visual function studies in healthy subjects and in patients with eye disease suggest that sildenafil does not affect visual acuity, visual fields, and contrast sensitivity. Transient, mild impairment of color discrimination can occur around the time of peak plasma levels. Spontaneous postmarketing reports of visual adverse events, including nonarteritic anterior ischemic optic neuropathy (NAION), have been reported during the 7 years that sildenafil has been prescribed to more than 27 million men worldwide. However, because men with ED frequently have vascular risk factors that may also put them at increased risk for NAION, a causal relationship is difficult to establish. No consistent pattern has emerged to suggest any long-term effect of sildenafil on the retina or other structures of the eye or on the ocular circulation.
- Published
- 2006
- Full Text
- View/download PDF
30. Diagnosis and treatment of premature ejaculation: the physician's perspective.
- Author
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Sharlip I
- Subjects
- Behavior Therapy methods, Coitus, Humans, Male, Quality of Life, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors therapeutic use, Sex Counseling methods, Sex Education methods, Sexual Dysfunction, Physiological drug therapy, Sexual Dysfunction, Physiological prevention & control, Sexual Dysfunction, Physiological psychology, Treatment Outcome, Ejaculation, Physician's Role, Sexual Dysfunction, Physiological diagnosis, Sexual Dysfunction, Physiological therapy
- Abstract
Premature ejaculation (PE) is a common condition associated with significant adverse effects on the sexual and overall quality of life of men with this condition. Behavioral therapies, such as the "squeeze" and "stop-start" techniques, and psychotherapy, have been the mainstay of PE management for many years. However, evidence of their short-term efficacy is limited while support for their long-term benefit is lacking. There are currently no medications licensed specifically for the treatment of PE. This paucity of pharmacological treatment may, in turn, contribute to the absence of systematic procedures for the identification, evaluation, and treatment of PE patients. Current "off-label" pharmacotherapeutic approaches include topical anesthetics, phosphodiesterase-5 inhibitors, and serotonin reuptake inhibitors. Of these, the serotonin reuptake inhibitors show the greatest efficacy and an increasing body of evidence is illuminating their mode of action. Nevertheless, all current "off-label" pharmacotherapeutic approaches fall short of the ideal therapy for PE. In the absence of a cure, such a treatment should be tolerable, inconspicuously used, effective from first dose, rapid in onset of action, and available as a prn-dosing regimen. It is anticipated that agents in development for the specific indication of PE will come closer to this ideal than existing pharmacotherapeutic approaches.
- Published
- 2005
- Full Text
- View/download PDF
31. Pharmacotherapy for erectile dysfunction.
- Author
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Padma-Nathan H, Christ G, Adaikan G, Becher E, Brock G, Carrier S, Carson C, Corbin J, Francis S, DeBusk R, Eardley I, Hedlund H, Hutter A, Jackson G, Kloner R, Lin CS, McVary K, McCullough A, Nehra A, Porst H, Schulman C, Seftel A, Sharlip I, Stief C, and Teloken C
- Subjects
- Apomorphine therapeutic use, Dopamine Agonists therapeutic use, Drug Therapy, Combination, Erectile Dysfunction physiopathology, Erectile Dysfunction psychology, Humans, Isoquinolines, Male, Naltrexone analogs & derivatives, Naltrexone therapeutic use, Naphthyridines therapeutic use, Neuroprotective Agents therapeutic use, Peptides, Cyclic therapeutic use, Phosphodiesterase Inhibitors therapeutic use, Selective Serotonin Reuptake Inhibitors therapeutic use, Sexual Behavior physiology, Sexual Behavior psychology, Trazodone therapeutic use, alpha-MSH analogs & derivatives, alpha-MSH therapeutic use, Erectile Dysfunction drug therapy, Sexual Behavior drug effects
- Abstract
Introduction: Advances in understanding of the biochemistry and physiology of penile erection have led to breakthroughs in pharmacotherapy of erectile dysfunction., Aim: To provide recommendations/guidelines concerning state-of-the-art knowledge for the putative molecular and cellular mechanisms of action of centrally and peripherally acting drugs currently utilized in pharmacotherapy of erectile dysfunction., 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 two-year period. Concerning the Pharmacotherapy for Erectile Dysfunction Committee there were 25 experts from 10 countries., Main Outcome Measure: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate., Results: Selective and potent oral PDE5 inhibitors have significantly more affinity than cGMP and form broader molecular interactions with multiple amino acids, thereby blocking access to cGMP in the catalytic sites of the PDE5 enzyme. PDE5 inhibitors, which vary as to biochemical potency, selectivity and pharmacokinetics, lead to cGMP elevation and relaxation facilitation of penile corpus cavernosum smooth muscle cells following sexual stimulation. Various centrally acting drugs influence sexual behaviour. In particular, the dopaminergic substance apomorphine is a central enhancer that acts in the paraventricular nucleus of the hypothalamus as a dopamine (D2) receptor agonist, induces and increases penile erection responses via disinhibition, following sexual stimulation., Conclusions: There is a need for more research in the pharmacotherapeutic development of central and peripheral agents for safe and effective erectile dysfunction treatment.
- Published
- 2004
- Full Text
- View/download PDF
32. Diagnosing erectile dysfunction.
- Author
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Sharlip ID
- Subjects
- Clinical Laboratory Techniques, Humans, Male, Physical Examination, Practice Guidelines as Topic, Erectile Dysfunction diagnosis
- Abstract
More than 50% of patients who have erectile dysfunction (ED) fit a standard medical and demographic profile: They are at least 50 years old, usually married or in a long-term, monogamous relationship, and they have been troubled by progressive erectile impairment for at least a year. Clinical evaluation of such patients is relatively straightforward: a 3-part history, physical examination, and basic laboratory tests. This article outlines a practical approach to such an evaluation, offers guidelines for evaluating patients who do not fit this profile, and delineates situations in which referral to a specialist may be indicated.
- Published
- 2000
- Full Text
- View/download PDF
33. Evaluation and nonsurgical management of erectile dysfunction.
- Author
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Sharlip ID
- Subjects
- Erectile Dysfunction etiology, Humans, Erectile Dysfunction diagnosis, Erectile Dysfunction therapy
- Abstract
The addition of oral drugs to the armamentarium of therapies for erectile dysfunction promises to dramatically increase the number of men seeking treatment for this condition. It is important to have a rational approach to the diagnostic evaluation of erectile dysfunction and to tailor the evaluation to each patient's goals for his sexual function. It is important also to offer each patient the full array of therapeutic options for erectile dysfunction. This article reviews the outpatient diagnostic work-up and current treatment possibilities for erectile dysfunction. The article also discusses clinical research experience with new forms or oral and topical therapies now being developed for future treatment of erectile dysfunction.
- Published
- 1998
- Full Text
- View/download PDF
34. Does natural erectile function improve following intracavernous injections of vasoactive drugs?
- Author
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Sharlip ID
- Subjects
- Humans, Injections, Male, Penis blood supply, Self Administration, Erectile Dysfunction drug therapy, Penile Erection, Vasodilator Agents administration & dosage
- Abstract
Improvement in natural erections has been reported in approximately 9% of impotent men using intracavernous injections of vasoactive drugs for erection induction. The mechanisms which may account for this improvement are psychogenic, improved cavernous hemodynamics, prostaglandin-induced angiogenesis, improved cavernous oxygenation, cavernous smooth muscle hypertrophy and/or normal episodic fluctuations in erectile function. A review of the basic science literature on this subject reveals several theoretical explanations for this phenomenon but a review of the clinical literature reveals little convincing evidence that physiologic and/or pharmacologic factors are responsible for improvement in natural erections with intracavernous injection therapy. Furthermore, the prevalence of a placebo effect from impotence therapy exceeds the reported rate of improvement in natural or spontaneous erections. The most plausible explanations for spontaneous improvement in erections during or after intracavernous injection therapy are psychogenic and episodic variations in erectile function, rather than physiologic or pharmacologic factors. However, intracavernous injection therapy started soon after radical prostatectomy may have a protective effect in preserving normal cavernous physiology and erectile function in men being treated for prostate cancer.
- Published
- 1997
- Full Text
- View/download PDF
35. Reproductive urology.
- Author
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Sharlip ID
- Subjects
- Cadaver, Ethics, Medical, Humans, Male, Sperm Banks, Sperm Motility, Spinal Cord Injuries complications, Infertility, Male etiology, Infertility, Male therapy
- Published
- 1997
- Full Text
- View/download PDF
36. Can self-injection therapy cure impotence?
- Author
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Sharlip ID
- Subjects
- Animals, Erectile Dysfunction physiopathology, Haplorhini, Humans, Male, Self Administration, Vasodilator Agents administration & dosage, Alprostadil administration & dosage, Alprostadil therapeutic use, Erectile Dysfunction drug therapy, Penile Erection drug effects, Vasodilator Agents therapeutic use
- Published
- 1997
- Full Text
- View/download PDF
37. Clinical guidelines panel on erectile dysfunction: summary report on the treatment of organic erectile dysfunction. The American Urological Association.
- Author
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Montague DK, Barada JH, Belker AM, Levine LA, Nadig PW, Roehrborn CG, Sharlip ID, and Bennett AH
- Subjects
- Humans, Male, Erectile Dysfunction therapy
- Abstract
Purpose: The American Urological Association convened the Clinical Guidelines Panel on Erectile Dysfunction to analyze the literature regarding available methods for treating organic erectile dysfunction and to make practice recommendations based on the treatment outcomes data., Materials and Methods: The panel searched the MEDLINE data base for all articles from 1979 through 1994 on treatment of organic erectile dysfunction and meta-analyzed outcomes data for oral drug therapy (yohimbine), vacuum constriction devices, vasoactive drug injection therapy, penile prosthesis implantation and venous and arterial surgery., Results: Estimated probabilities of desirable outcomes are relatively high for vacuum constriction devices, vasoactive drug injection therapy and penile prosthesis therapy. However, patients must be aware of potential complications. The outcomes data for yohimbine clearly indicate a therapy with marginal efficacy. For venous and arterial surgery, based on reported outcomes, chances of success do not appear high enough to justify routine use of such surgery., Conclusions: For the standard patient, defined as a man with acquired organic erectile dysfunction and no evidence of hypogonadism or hyperprolactinemia, the panel recommends 3 treatment alternatives: vacuum constriction devices, vasoactive drug injection therapy and penile prosthesis implantation. Based on the data to date, yohimbine does not appear to be effective for organic erectile dysfunction and, thus, it should not be recommended as treatment for the standard patient. Venous surgery and arterial surgery in men with arteriolosclerotic disease are considered investigational and should be performed only in a research setting with long-term followup available.
- Published
- 1996
- Full Text
- View/download PDF
38. Infertility.
- Author
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Sharlip ID
- Subjects
- Cryopreservation, Humans, Injections, Male, Semen Preservation, Seminal Vesicles, Spermatozoa, Suction, Infertility, Male therapy
- Published
- 1996
- Full Text
- View/download PDF
39. New options for managing severe oligospermia and azoospermia.
- Author
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Sharlip ID
- Subjects
- Acute Disease, Fertilization in Vitro methods, Humans, Male, Sperm Count, Oligospermia therapy
- Published
- 1996
40. Urology.
- Author
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Sharlip ID
- Published
- 1996
41. What is the best pregnancy rate that may be expected from vasectomy reversal?
- Author
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Sharlip ID
- Subjects
- Female, Humans, Male, Sperm Count, Sperm Motility, Treatment Outcome, Pregnancy, Sterilization Reversal, Vasovasostomy
- Abstract
Pregnancy rates after vasectomy reversal vary among different reporting surgeons. To study those patients who are most likely to achieve pregnancy after vasectomy reversal, and to eliminate the effect of variations in surgical technique and operative findings on surgical outcome, the pregnancy rate after vasectomy reversal was calculated in men who achieved completely and consistently normal postoperative semen analyses (sperm concentration 20 x 10(6)/ml. or more and sperm motility 50% or greater). Of 95 patients who met the study criteria 58 (61.1%) achieved pregnancy and 37 (30.9%) did not. Including an allowance for some patients who will achieve pregnancy beyond the study-followup, it is concluded that the maximum pregnancy probability for vasectomy reversal is approximately 67%. Failure to achieve pregnancy in approximately a third of the patients may be explained by partner infertility, epididymal dysfunction and sperm antibodies. Studies that report pregnancy chances in excess of two-thirds must have different patient demographics and/or different methods of statistical analysis.
- Published
- 1993
- Full Text
- View/download PDF
42. Case report: treatment of congenital vas obstruction with sperm aspiration, nonstimulated in vitro fertilization, and nonsurgical tubal embryo transfer.
- Author
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Steinleitner A, Sharlip I, Lambert H, Garcia M, and Nachtigall R
- Subjects
- Adult, Cleavage Stage, Ovum, Epididymis, Female, Humans, Male, Oligospermia etiology, Pregnancy, Embryo Transfer methods, Fertilization in Vitro, Oligospermia therapy, Semen, Vas Deferens abnormalities
- Published
- 1992
- Full Text
- View/download PDF
43. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group.
- Author
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Belker AM, Thomas Aj Jr, Fuchs EF, Konnak JW, and Sharlip ID
- Subjects
- Americas, Biology, Birth Rate, Clinical Laboratory Techniques, Demography, Developed Countries, Diagnosis, Family Planning Services, Fertility, Genitalia, Genitalia, Male, North America, Physiology, Population, Population Dynamics, Seminal Vesicles, Sterilization, Reproductive, United States, Urogenital System, Pregnancy Rate, Semen, Sperm Count, Sterilization Reversal, Vasectomy
- Published
- 1992
44. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group.
- Author
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Belker AM, Thomas AJ Jr, Fuchs EF, Konnak JW, and Sharlip ID
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Humans, Male, Microsurgery statistics & numerical data, Middle Aged, Pregnancy, Reoperation, Sperm Count, Time Factors, Vas Deferens physiology, Fertility, Vasovasostomy statistics & numerical data
- Abstract
During a 9-year period 1,469 men who underwent microsurgical vasectomy reversal procedures were studied at 5 institutions. Of 1,247 men who had first-time procedures sperm were present in the semen in 865 of 1,012 men (86%) who had postoperative semen analyses, and pregnancy occurred in 421 of 810 couples (52%) for whom information regarding conception was available. Rates of patency (return of sperm to the semen) and pregnancy varied depending on the interval from the vasectomy until its reversal. If the interval had been less than 3 years patency was 97% and pregnancy 76%, 3 to 8 years 88% and 53%, 9 to 14 years 79% and 44% and 15 years or more 71% and 30%. The patency and pregnancy rates were no better after 2-layer microsurgical vasovasostomy than after modified 1-layer microsurgical procedures and they were statistically the same for all patients regardless of the surgeon. When sperm were absent from the intraoperative vas fluid bilaterally and the patient underwent bilateral vasovasostomy rather than vasoepididymostomy, patency occurred in 50 of 83 patients (60%) and pregnancy in 20 of 65 couples (31%). Neither presence nor absence of a sperm granuloma at the vasectomy site nor type of anesthesia affected results. Repeat microsurgical reversal procedures were less successful. A total of 222 repeat operations produced patency in 150 of 199 patients (75%) who had semen analyses and pregnancy was reported in 52 of 120 couples (43%).
- Published
- 1991
- Full Text
- View/download PDF
45. The role of vascular surgery in arteriogenic and combined arteriogenic and venogenic impotence.
- Author
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Sharlip ID
- Subjects
- Erectile Dysfunction diagnosis, Humans, Male, Methods, Vascular Diseases diagnosis, Erectile Dysfunction etiology, Erectile Dysfunction surgery, Vascular Diseases complications
- Abstract
Currently, the only procedure that may be ready for clinical application in arteriogenic impotence is the retrograde revascularization operation for patients who have been shown to have localized obstruction of the internal pudendal artery. This applies almost exclusively to young healthy men with impotence due to pelvic trauma. The concept that perineal trauma causes localized obstruction of the penile artery is controversial. Because the best candidates for penile revascularization are young healthy men with localized, rather than diffuse, arterial pathology and with the absence of vascular risk factors, the overall role for treatment of arteriogenic or combined arteriogenic and venogenic impotence by penile revascularization is very limited. For patients with impotence following pelvic and possibly perineal trauma, as well as occasional patients with arteriosclerosis who wish to be considered for penile revascularization, evaluation should begin with screening intracavernous pharmacodiagnosis using papaverine with or without phentolamine, or prostaglandin E1. If a poor response occurs, identification of venous pathophysiology by cavernosometry and identification of arterial pathophysiology by dynamic infusion cavernosometry and/or duplex sonography of the corpus cavernosum should be undertaken. If there is no venous pathology, penile arteriography must be done to design an anatomically rational revascularization operation. In the future, improved results of penile vascular surgery may occur if we can develop a clearer understanding of the physiology and pathophysiology of erection, improved diagnostic techniques, and a better selection of surgical candidates.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1990
46. Intraoperative observations during vasovasostomy in 334 patients.
- Author
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Belker AM, Konnak JW, Sharlip ID, and Thomas AJ Jr
- Subjects
- Granuloma etiology, Humans, Intraoperative Period, Male, Spermatozoa, Vas Deferens pathology, Sterilization Reversal, Vas Deferens surgery, Vasectomy
- Abstract
This initial report from the Vasovasostomy Study Group concerns intraoperative data obtained during vasovasostomy from 639 vasa in 334 patients. These data are related to the obstructive interval (time from vasectomy to vasovasostomy) and to the presence or absence of histologically proved sperm granuloma at the old transected testicular end of the vas (vasectomy site). Rates of sperm absence from vas fluid at the testicular end increased with longer obstructive intervals and with absence of a sperm granuloma. If sperm were present in fluid at the testicular end of the vas, the quality was poorer when the obstructive interval lengthened and when sperm granuloma was absent. Vas luminal diameters at the testicular end were smaller when a sperm granuloma was present. These observations support the theory that a sperm granuloma at the vasectomy site may have a beneficial, pressure-releasing effect that could be favorable prognostically for fertility after vasovasostomy.
- Published
- 1983
- Full Text
- View/download PDF
47. The significance of intravasal azoospermia during vasovasostomy: answer to a surgical dilemma.
- Author
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Sharlip ID
- Subjects
- False Negative Reactions, Humans, Male, Microsurgery methods, Oligospermia surgery, Sperm Count, Vas Deferens surgery
- Published
- 1982
- Full Text
- View/download PDF
48. Penile arteriography in impotence after pelvic trauma.
- Author
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Sharlip ID
- Subjects
- Adult, Erectile Dysfunction diagnostic imaging, Humans, Male, Angiography, Erectile Dysfunction etiology, Pelvis injuries, Penis blood supply
- Abstract
A patient who was impotent following pelvic trauma was evaluated by penile artheriography. The study revealed bilateral disruption of the internal pudendal artery at the level of the urogenital diaphragm. It is concluded that impotence in this case is vasculogenic, although it is not possible to eliminate conclusively the possibility of neurogenic factors. Evaluation of more patients with this new technique of penile arteriography is necessary to establish the frequency of vasculogenic impotence in pelvic trauma. A review of the current literature revealed that impotence is approximately 10 times more common after conventional retropubic urethral realignment for acute prostatomembranous disruption compared to treatment by cystostomy tube alone. Analysis of the pertinent neurovascular anatomy suggests that when impotence is caused by surgical dissection of the periprostatic region the pathogenesis probably is neurogenic because of injury to the prostatic plexus and/or cavernous nerves, and it may be irreversible.
- Published
- 1981
- Full Text
- View/download PDF
49. Relationship of gross appearance of vas fluid during vasovasostomy to sperm quality, obstructive interval and sperm granuloma.
- Author
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Sharlip ID, Belker AM, Konnak JW, and Thomas AJ Jr
- Subjects
- Granuloma pathology, Humans, Male, Sperm Motility, Time Factors, Vasectomy, Wound Healing, Exudates and Transudates analysis, Spermatozoa cytology, Sterilization Reversal, Vas Deferens surgery
- Abstract
To study its intraoperative significance the gross appearance of the vas fluid found during vasovasostomy was compared to the quality of sperm in the fluid, obstructive interval and presence or absence of a histologically proved sperm granuloma. Data were obtained from 648 vasa in 340 patients. As the gross appearance increased in opacity, there was a small decrease in the proportion of morphologically normal, motile sperm (23 to 7 per cent) and a corresponding small increase in the proportion of sperm without tails (2 to 12 per cent). These minor trends had statistical but no intraoperative surgical significance. There was no variation in the proportion of vas fluid azoospermia with gross appearance. There was no significant difference in the gross appearance of the vas fluid with increasing obstructive interval. Finally, the presence or absence of a sperm granuloma had no effect on the gross appearance of the vas fluid, and the appearance had no predictive value relative to sperm granuloma. We conclude that the gross appearance of the vas fluid should not be used as a basis for operative decision-making during vasovasostomy.
- Published
- 1984
- Full Text
- View/download PDF
50. Vasovasostomy: comparison of two microsurgical techniques.
- Author
-
Sharlip ID
- Subjects
- Evaluation Studies as Topic, Humans, Male, Sperm Count, Microsurgery methods, Vasectomy methods
- Abstract
An easier technique of microsurgical vasovasostomy, a modified one-layer anastomosis, is compared to double-layer anastomosis. In this preliminary report there is no difference between the modified one-layer and double-layer techniques in per cent of patients postoperatively obtaining normal sperm count and pregnancy. Since the modified one-layer technique is easier, faster, and less expensive, this technique deserves further clinical experience and evaluation.
- Published
- 1981
- Full Text
- View/download PDF
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