Faculty Bibliography

INTRODUCTION/BACKGROUND:Premature ejaculation (PE) is the most common form of male sexual dysfunction. Until very recently, scientific investigation of PE has been hampered by a lack of standardized definitions and objective, validated questionnaires. Small numbers of randomized controlled studies evaluating various treatment options have also added to the challenges facing the clinicians who manage PE. AIM/OBJECTIVE:This article provides a summary of some of the more relevant the peer-reviewed literature pertaining to the medical therapy of premature ejaculation. METHODS:A retrospective review of peer reviewed publications relevant to the field of premature ejaculation and related medical therapies. MAIN OUTCOME MEASURES/METHODS:Review of safety and efficacy of various medical therapies for premature ejaculation. RESULTS:Selective serotonin release inhibitors have been the most promising agents to date. The on-demand "PRN" use of these agents is more convenient, but its efficacy is less well established. Chronic use of this class of medications has been associated with minor, but bothersome side effects. More recently, concern over the risk of an increased suicide rate in young men upon initiation of SSRIs has dampened enthusiasm. Recent experience with the use of Tramadol raises the hope that this might prove to be an agent as effective as SSRIs with less worrisome risk of side-effects. New trials on novel formulations of topical solutions are currently underway in the United States. CONCLUSIONS:Interest in medical therapy for PE is rapidly increasing and reflected in a disproportionate number of publications in this field in the past few years. Clinical research in this field is hampered by the complexity, variability among different men and cultures, and subjectivity of PE. Reliable, appropriately controlled and assessed studies are generally lacking and carefully devised, methodically conducted research is much needed.

The aim of this study is to describe the finding of vicarious excretion of intravascular contrast media in association with endovascular management of an aortic aneurysm and to discuss the clinical significance. Vicarious excretion of intravascular contrast material through the hepatobiliary system will be encountered occasionally following endovascular procedures. Plain abdominal images obtained for the purpose of graft position and structural integrity will increase recognition of this finding. Vicarious hepatobiliary excretion of parenteral contrast media, while associated with renal obstruction or parenchymal pathology, is not pathognomonic for renal pathology.

INTRODUCTION/BACKGROUND:Priapism has been reported as a rare effect of the commonly used alpha 1-antagonists through direct inhibition of the sympathetic input necessary for detumescence. Although previously reported as an adverse event in a patient with spinal cord injury, to the best of our knowledge, terazosin-induced priapism in an otherwise healthy man has not been previously described. AIM/OBJECTIVE:We describe an otherwise healthy man with lower urinary symptoms who developed priapism after ingestion of the commonly prescribed alpha-blocker terazosin. RESULTS:The priapism resolved after a combination of cavernosal aspiration and alpha-agonist administration. CONCLUSION/CONCLUSIONS:Priapism is an extremely rare side effect of alpha-blocker therapy and has previously been described in association with other alpha-blockers, as well as with terazosin, in a spinal cord-injured patient. We report a case of priapism specifically associated with terazosin prescribed for lower urinary tract symptoms in an otherwise healthy man.

INTRODUCTION/BACKGROUND:We describe a 51-year-old man with a history of radiation therapy and large bowel diversion for rectal cancer who underwent an uneventful penile implant surgery for erectile dysfunction that was refractory to conservative therapy. The patient presented with acute left lower extremity swelling and pain a few days after surgery. Workup revealed compression of the pelvic veins by the prosthesis reservoir. AIM/OBJECTIVE:To highlight an avoidable, adverse event related to penile prosthesis reservoirs. METHODS:Retrospective review of a clinical case. RESULTS:The patient underwent repositioning of the reservoir followed by venous thrombectomy and Greenfield filter placement. CONCLUSION/CONCLUSIONS:To the best of our knowledge, this is the first report of an early diagnosis and successful thrombectomy of the external iliac and common femoral vein thrombosis secondary to reservoir compression. Awareness of this possible adverse event and the management strategy are helpful to surgeons who perform penile prosthesis surgery.

INTRODUCTION/BACKGROUND:Growing evidence has linked circumcision with some protection against HIV infection. Should nations with a high HIV infection rate encourage male circumcision? METHODS:Four people with expertise and/or interest in the area of circumcision and HIV were asked to contribute their opinions. MAIN OUTCOME MEASURE/METHODS:To provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine. RESULTS:Three clinical trials in Africa showed the benefit of circumcision in reducing HIV incidence in men. Sadeghi-Nejad cites these, but balances this with the pandemic in India, and the cultural implications of circumcision. Pollack cites these studies as well, but reinforces the World Health Organization and UNAIDS recommendations that male circumcision should not replace safe sex. As a Nigerian, Aisuodionoe-Shadrach discusses the indirect ways in which circumcision can reduce the spread of HIV, and advocates the surgery, although he proposes infant circumcision may be wiser. Ira Sharlip, President of the International Society for Sexual Medicine, explains some of the physiology involved while again citing the three recent African studies. He questions who would be circumcised and who would perform the procedure if pro-circumcision policies were adopted. CONCLUSION/CONCLUSIONS:While three clinical trials in Africa were halted after it became evident that circumcision was beneficial in protecting against HIV, further information on the health risks and benefits of male circumcision is needed. Ethical decisions need to be made and medical recommendations developed before circumcision can be considered for HIV prevention.

INTRODUCTION/BACKGROUND:Although more invasive than some of the other currently available therapies, penile prosthesis surgery has the advantages of high patient satisfaction rates and avoidance of systemic adverse events in the vast majority of cases. AIM/OBJECTIVE:This article provides a review of the more widely used implants and some of the more frequently encountered complications of penile prosthesis surgery. METHODS:A retrospective review peer reviewed publications relevant to the field of penile prosthesis surgery. MAIN OUTCOME MEASURES/METHODS:Review of historical milestones and newer penile prostheses, as well as a review of prosthesis surgery complications. RESULTS:Improved designs and materials have resulted in decreased incidence of mechanical failures or infectious complications while simultaneously simplifying the operation of these devices. CONCLUSIONS:Penile prosthesis surgery remains an excellent alternative for restoring erectile function to those in whom medical therapies such as phosphodiesterase inhibitors are contraindicated or who have failed more conservative measures.

Erectile dysfunction (ED) is defined as the persistent or repeated inability, for a duration of at least 6 months, to attain or maintain an erection sufficient for satisfactory sexual performance. Aging, along with the comorbidities that are often associated with aging, may independently or synergistically contribute to ED. There may be several psychogenic or organic causes for ED. The causes and evaluation of ED are discussed, with particular consideration of sonographic techniques for evaluation. © 2007 Elsevier Inc. All rights reserved.

INTRODUCTION/BACKGROUND:We reviewed the most recent advances in the genetics of male infertility focusing on Y chromosome microdeletions. MATERIALS AND METHODS/METHODS:We searched the literature using the PubMed and skimmed articles published from January 1998 to October 2007. The keywords were the Y chromosome, microdeletions, male infertility, and azoospermia factor (AZF). The full texts of the relevant articles and their bibliographic information were reviewed and a total of 78 articles were used. RESULTS:Three regions in the long arm of the Y chromosome, known as AZFa, AZFb, and AZFc, are involved in the most frequent patterns of Y chromosome microdeletions. These regions contain a high density of genes that are thought to be responsible for impaired spermatogenesis. In 2003, the Y chromosome sequence was mapped and microdeletions are now classified according to the palindromic structure of the euchromatin that is composed of a series of repeat units called amplicons. Although it has been shown that the AZFb and AZFc are overlapping regions, the classical AZF regions are still used to describe the deletions in clinical practice. CONCLUSION/CONCLUSIONS:Y chromosome microdeletions are the most common genetic cause of male infertility and screening for these microdeletions in azoospermic or severely oligospermic men should be standard. Detection of various subtypes of these deletions has a prognostic value in predicting potential success of testicular sperm retrieval for assisted reproduction. Men with azoospermia and AZFc deletions may have retrievable sperm in their testes. However, they will transmit the deletions to their male offspring by intracytoplasmic sperm injection.