Faculty Bibliography

INTRODUCTION/BACKGROUND:Over the last several decades, the opioid epidemic has become a national crisis, largely spurred by the spike in the use of prescription painkillers. With the epidemic came a concomitant rise in the incidence of opioid-induced androgen deficiency (OPIAD). Although OPIAD can significantly impact male sexual function and quality of life, it is an overlooked and poorly understood clinical entity that requires more attention from healthcare providers. AIM/OBJECTIVE:The objectives of the current review are to highlight the increasing incidence of OPIAD and the importance of an integrated, multidisciplinary approach to identify and treat patients with the condition. METHODS:This review presents the epidemiology surrounding the current opioid epidemic, with a focus on its origin, followed by a literature review surrounding the pathophysiology, diagnosis, and treatment of OPIAD. MAIN OUTCOME MEASURE/METHODS:Single-center studies were used to determine the safety and efficacy of various opioid and testosterone formulations on analgesia, sexual function, and quality of life. RESULTS:There should be a low threshold for obtaining laboratory studies (testosterone, luteinizing hormone [LH], follicle-stimulating hormone [FSH]) on symptomatic patients who have a history of chronic opioid use. Treatment options include opioid cessation, short-acting opioids, and testosterone replacement therapy (TRT). The patient and physician should weigh the risks and benefits of TRT against more conservative approaches. Options such as clomiphene and anastrozole are available for patients who wish to preserve fertility. CONCLUSION/CONCLUSIONS:Because OPIAD is an underappreciated and underdiagnosed consequence of chronic opioid abuse, healthcare providers should be particularly vigilant for signs of hypogonadism in this patient population. It is reasonable for pain specialists, urologists, and primary care physicians to closely monitor patients on prescription opioids and discuss available options for treatment of hypogonadism. Hsieh A, DiGiorgio L, Fakunle M, et al. Management strategies in opioid abuse and sexual dysfunction: A review of opioid-induced androgen deficiency. Sex Med Rev 2018;6:618-623.

PURPOSE:The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction. MATERIALS AND METHODS:A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1965 to 7/29/17) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of erectile dysfunction. 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. RESULTS:The American Urological Association has developed an evidence-based guideline on the management of erectile dysfunction. This document is designed to be used in conjunction with the associated treatment algorithm. CONCLUSIONS:Using the shared decision-making process as a cornerstone for care, all patients should be informed of all treatment modalities that are not contraindicated, regardless of invasiveness or irreversibility, as potential first-line treatments. For each treatment, the clinician should ensure that the man and his partner have a full understanding of the benefits and risk/burdens associated with that choice.

[This corrects the article on p. 423 in vol. 58.].