Faculty Bibliography

INTRODUCTION/BACKGROUND:Robotically assisted laparoscopic radical prostatectomy (RALP) provides decreased surgical morbidity and faster recovery for patients, but has not significantly changed the incidence of erectile dysfunction and many post RALP patients may require penile prosthesis surgery. AIM/OBJECTIVE:To make physicians aware of the anatomical changes after RALP in comparison to traditional retropubic radical prostatectomy and to make suggestions for safer reservoir placement. MAIN OUTCOME MEASURES/METHODS:Reservoir location after RALP. METHODS:A 68 year-old patient with severe vasculogenic ED refractory to pharmacologic management following RALP underwent a 3-piece penile prosthesis insertion surgery and laparoscopic right lower abdominal hernia repair. Laparoscopy revealed an intraperitoneal reservoir that was overlying the sigmoid colon with multiple diverticula. The reservoir was laparoscopically repositioned in the dependent pelvis away from the diverticula and the pelvic vessels. RESULTS:The patient's postoperative course was uneventful without any postoperative complications (2 year follow up). CONCLUSIONS:The altered anatomy of the space of Retzius following RALP will likely result in significantly more cases of inadvertent intraperitoneal reservoir placement. Surgeons performing inflatable penile prosthesis surgery should be aware of these anatomical changes and prepared to consider ectopic reservoir placement when necessary.

INTRODUCTION/BACKGROUND: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/OBJECTIVE: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.

INTRODUCTION/BACKGROUND:There is a need for state-of-the-art information in the area of sexually transmitted infections (STIs) in relation to sexual function. There are an estimated 60 million people living with and 340 million with treatable STIs. Surveys show sexual problems to be as high as 35% for men and 55% for women; however, there is little research directly assessing relationships between infection and sexual function. AIM/OBJECTIVE:To show that STIs are associated with (and may cause) sexual dysfunction. Conversely, sexual dysfunction can increase patients' risk of STI acquisition. In men, erectile dysfunction (ED) associated with condom use may lead to unsafe sexual practices and, hence, STI acquisition. The role of various therapies including phosphodiesterase type 5 inhibitors in the treatment of ED in positive men taking social drugs will be explored. METHODS:To provide state-of-the-art knowledge concerning sexual function and STIs, representing the opinions of five experts from four countries developed in a consensus process and encompassing a detailed literature review over a 2-year period. MAIN OUTCOME MEASURE/METHODS:Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS:This article highlights major factors causing the spread of STIs and suggests management interventions to prevent further spread of HIV/STIs, focusing on the juxtaposition between STIs and sexual functioning. Women's unique vulnerabilities to HIV/STIs (biological and physiological issues, gender-based violence, gender inequity) and their impact on women's sexual function are reviewed. Similarly, men's unique vulnerabilities to HIV/STIs including condom use, disclosure, voluntary counseling and testing, multiple concurrent sexual partners, and recreational drug use--particularly in homosexual men--are explored, as is the association of prostatitis and sexual function. Lastly, the article reviews the relationship between circumcision and sexual dysfunction. CONCLUSIONS:A multidimensional approach to achieve optimal treatment outcomes should be embraced.