The conversation about male sexual dysfunction has grown from a whisper to a roar. From Bob Dole to Mike Ditka, erectile dysfunction, or ED, is no longer hush-hush as more men are talking more openly. Non-stop commercials convey help in the bedroom is just a prescription away. And while some 35 million men in this country have found a renewed sex life thanks to the “little blue pill,” Temple urologist Jack Mydlo says men can improve their performance without a visit to the doctor or a drugstore.

“The last thing I want them to do is take a pill and jump in bed because a certain part of the mechanism for erections is psychological. They have to be in the right mood, with the right person and take care of themselves” said Mydlo, MD, professor and chair of the department of urology at the School of Medicine.

Surprisingly, a good percentage of men who seek medical help aren’t even in a relationship.

“About thirty percent of the men who have a penile prosthesis don’t even have a partner,” said Mydlo. “They’re putting the cart before the horse, so to speak, and think they’ll get a partner once they have the implant.

Instead, Mydlo offers simple tips this Valentine’s Day to turn a man’s potency from terrible to terrific.

Stop smoking

Diabetes and high blood pressure restrict blood flow to the penis, leading to erectile dysfunction. But if you can rule those conditions out as causes of ED, the next culprit in line is cigarettes. “The number one thing we can do to stop erectile dysfunction is to stop smoking. It’s the number one environmental cause of ED in our society,” says Mydlo. Again, smoking restricts blood flow. The catch? Don’t expect better erections the minute you stop lighting up. He says it takes 12 to 24 months for better function once you quit the habit.

Control cholesterol

Cholesterol is a trigger of sorts for ED. “Men with a cholesterol level of 240 or higher have almost a twofold increase of ED compared to a man who has lower cholesterol numbers,” says Mydlo. That’s because high levels of cholesterol lead to plaque buildup in tubes (corpa cavernosa) in the penis and arteries, which can greatly reduce blood flow. And no blood flow means no erection. So start exercising and check with your doctor about cholesterol-lowering medications.

Cut back on fat

Obesity is to blame not only for men with self-esteem issues involving their appearance, but also their performance. “Adipose tissue in body fat converts testosterone to estrogen, and lower levels of testosterone can make it difficult for a man to achieve an erection, no matter how many pills they take,” says Mydlo. Losing weight will improve the testosterone to estrogen ratio, which may improve sex drive, or libido, as well as erections. It also decreases cholesterol, which will help improve blood flow.

For some of the 18 million men who have erectile dysfunction, these three tips may do the trick. For others, Mydlo suggests a visit to a urologist to go over options, ranging from pumps to implants to pills, like Viagra. Cialis Levitra (vardenafil). Levitra There is one factor, though, that Mydlo can’t help with but Cupid probably can: finding the right mate.

“They believe if they don’t have good sexual function, who is going to want them? But the truth is, if you don’t have a mental connection with your partner, everything will be for naught.”

Temple University
301 University Services Bldg.1601 N Broad St.
Philadelphia
PA 19122
United States
http:// www.temple.edu

View drug information on Cialis (tadalafil)

VIVUS, Inc. (NASDAQ: VVUS), a pharmaceutical company dedicated to the development and commercialization of novel therapeutic products, today announced it has initiated a second pivotal Phase 3 study of avanafil, its investigational new drug for the treatment of erectile dysfunction (ED). Avanafil is a next-generation, fast-acting, selective, investigational oral phosphodiesterase type 5 (PDE5) inhibitor.

The study, REVIVE-Diabetes (TA-302), is a multicenter, randomized, double-blind, placebo-controlled trial and will evaluate the safety and efficacy of avanafil in the treatment of ED in men with type 1 or type 2 diabetes. Subjects who meet the inclusion criteria will undergo a four-week non-treatment run-in period followed by 12 weeks of treatment. The co-primary endpoints of the study will be improvement in erectile function as measured by changes in the sexual encounter profile (SEP) questions 2 and 3, and improvement in erectile function as measured by the erectile function domain score of the International Index of Erectile Function (IIEF). The SEP is a self-administered patient diary and the IIEF is a patient questionnaire; both are used as standard diagnostic tools to assess erectile dysfunction. REVIVE-Diabetes is the second of three planned pivotal studies in the avanafil Phase 3 development program.

“There has not been a new treatment option for men with ED in more than five years,” stated Andrew McCullough, MD, associate professor of clinical urology, NYU School of Medicine and REVIVE-Diabetes clinical investigator. Early data suggest that avanafil may provide a fast-acting therapy with a short half-life, which, if approved, may represent a noteworthy advance for the millions of men living with ED and searching for new options.”

Diabetes is one of the most common causes of ED; clinical data suggest that at least 50 percent of diabetic men will experience difficulties with erectile function. Men with diabetes are up to three times more likely to have ED than non-diabetic men and appear to experience it earlier in life. The significance of ED increases with the severity and duration of diabetes as well as with advanced age.

“Evidence suggests that there is room for significant improvement in the current treatment of ED,” Charles Bowden, MD, senior director, clinical development for VIVUS. “We’re pleased with the promising results demonstrated thus far with avanafil, and with the momentum behind our Phase 3 program. Enrollment in our first pivotal study, REVIVE, initiated in December to evaluate avanafil in ED, is ongoing. REVIVE-Diabetes will be conducted at many of the same sites as REVIVE.”

It is expected that this study will enroll approximately 375 patients at about 30 sites in the United States. Subjects are instructed to attempt sexual intercourse 30 minutes after taking avanafil, with no restrictions on food or alcohol consumption. REVIVE-Diabetes will study two doses of avanafil. More information about the trial can be found at http://www.clinicaltrials.gov.

As previously disclosed, VIVUS has entered into a $30 million funding collaboration with Deerfield Management to fund the Phase 3 program.

About Erectile Dysfunction

Erectile dysfunction, or ED, the inability to attain or maintain an erection sufficient for intercourse, was reported by 35% of men between the ages of 40 to 70 in the United States, according to an independent study, with the incidence increasing with age. ED, frequently associated with vascular problems, is particularly common in men with diabetes and in those who have had a radical prostatectomy for prostate cancer. PDE5 inhibitors, which inhibit the breakdown of cyclic guanosine monophosphate, have been shown to be effective treatments for ED.

Worldwide sales in 2008 of PDE5 inhibitor products for ED were estimated, based on reports from the companies that market these products, to be in excess of $3.7 billion, including approximately $1.9 billion in reported sales of Viagra, approximately $1.5 billion in reported sales of Cialis and approximately $300 million in reported sales of Levitra. VIVUS believes that based on the aging baby boomer population and the desire to maintain an active sexual lifestyle, the market for PDE5 inhibitors will continue to grow.

Avanafil Phase 2 Data

VIVUS previously reported positive results from the Phase 2 studies of avanafil. Following a four-week, non-treatment, run-in period, 284 patients were treated for 12 weeks with placebo or avanafil at various doses. The primary endpoints used to assess treatment efficacy included the percentage of erections sufficient for vaginal penetration and the percentage of erections lasting long enough for successful intercourse. Avanafil produced erections sufficient for vaginal penetration on 76, 79, 80 and 84 percent of sexual attempts on the 50, 100, 200 and 300 mg doses, respectively (p<0.05). Erections lasting long enough for successful intercourse were achieved on 54, 59, 62 and 64 percent of attempts, respectively (p<0.0001). Patients were instructed to attempt sexual intercourse 30 minutes after taking avanafil, with no restrictions on food or alcohol consumption. Avanafil was well tolerated at all doses, with headache being the most commonly recorded adverse event. There were no reports of visual disturbances. Previous studies have suggested that avanafil may be taken twice a day for those patients that desire sexual intercourse more frequently than once per day.

About VIVUS

VIVUS is a biopharmaceutical company developing innovative, next-generation therapies to address unmet needs in obesity, diabetes and sexual health. The company’s lead product in clinical development, Qnexa™, is expected to complete Phase 3 clinical trials for the treatment of obesity in 2009. Qnexa is also in Phase 2 clinical development for the treatment of type 2 diabetes. In the area of sexual health, VIVUS is in Phase 3 development with avanafil, a potentially best-in-class PDE5 inhibitor, and in Phase 2 development of Luramist™ for the treatment of hypoactive sexual desire disorder (HSDD) in women. MUSE® (alprostadil), a first generation therapy for the treatment of ED, is already on the market and generating revenue for VIVUS. For more information about the company, please visit http://www.vivus.com.

Certain statements in this press release are forward-looking within the meaning of the Private Securities Litigation Reform Act of 1995. These statements may be identified by the use of forward-looking words such as “anticipate,” “believe,” “forecast,” “estimated” and “intend,” among others. These forward-looking statements are based on VIVUS’ current expectations and actual results could differ materially. There are a number of factors that could cause actual events to differ materially from those indicated by such forward-looking statements. These factors include, but are not limited to, substantial competition; uncertainties of patent protection and litigation; uncertainties of government or third party payer reimbursement; reliance on sole source suppliers; limited sales and marketing efforts and dependence upon third parties; risks related to the development of innovative products; and risks related to failure to obtain FDA clearances or approvals and noncompliance with FDA regulations. As with any pharmaceutical under development, there are significant risks in the development, regulatory approval and commercialization of new products. There are no guarantees that future clinical studies discussed in this press release will be completed or successful or that any product will receive regulatory approval for any indication or prove to be commercially successful. VIVUS does not undertake an obligation to update or revise any forward-looking statement. Investors should read the risk factors set forth in VIVUS’ Form 10-K for the year ended December 31, 2007 and periodic reports filed with the Securities and Exchange Commission

VIVUS

Pfizer’s inaugural Asia Pacific Sexual Health and Overall Wellness (AP SHOW) survey has uncovered staggering levels of sexual dissatisfaction, with 60% of men and around 60% of women in Australia saying they are not very satisfied with their sex lives.

Erectile Dysfunction (ED) continues to be a key cause of dissatisfaction. The AP SHOW survey, conducted in 13 Asia Pacific nations, found that men with ’suboptimal erections’, (erections that are not as hard as they could be) are less satisfied with sex and other aspects of the sexual experience.

There is also evidence of an association between optimal erectile function and men’s and women’s overall outlook on life, attitudes about sex and men’s sexual health and performance.

54% of men with optimal erectile function say that it is ‘very true’ that they feel good about their relationships compared to 47% of men with suboptimal erections. Among women, this difference is significantly more pronounced - 65% of women whose partners have optimal erection function say that it is ‘very true’ that they feel good about their relationships, compared to only 32% of women whose partners have suboptimal erections.

The survey also found that men and women who are ‘completely’ or ‘very satisfied’ with sex are more than three times more likely to feel good about their relationships and life overall compared to those who are only ’somewhat’ or ‘not at all satisfied’ with sex.

It is an area where GPs can make a significant difference, yet as few as 30% of men with ED seek help from their doctor. [i]

Dr Rosie King, Sexual Health Physician, Sydney Centre for Sexual and Relationship Therapy, Sydney, Australia said, “A person’s willingness to talk about sexual health and performance is heavily influenced by diverse cultural beliefs and practices - most patients and even doctors are uncomfortable initiating such discussions. Therefore, a great many people remain untreated.”

“GPs are aware of the importance of erectile function to the overall health and wellbeing of male patients and their partners. So, overcoming communication barriers about sexual health is crucially important,” said Dr King. “The more physicians discuss sexual problems, the more comfortable they’ll be.”

“If a GP suspects a patient may have erection problems, there are sensitive ways to broach the subject. GPs can also help patients know that they are willing to discuss these issues even before they enter the consulting room by creating an open practice environment.”

This might include placing brochures on sexual health and ED in the waiting room, offering a questionnaire that patients can fill out while waiting for their consultation or displaying posters in the waiting area and examination rooms to indicate a GPs interest in the sexual wellbeing of their patients.

“When talking about sexual health topics with patients, it is extremely important to establish a rapport that enables an open discussion. During such discussions, it is important to communicate several key points to a patient with suboptimal sexual performance including:

- GPs do treat sexual health and that sexual health is an important part of general health. Satisfactory sexual health and performance is associated with emotional wellbeing and overall good health.

- Suboptimal erections are a common problem, affecting more than 50% of men aged 40 to 70 years [ii].

- Erection problems and suboptimal erections are not a normal part of aging. An older male has just as much right to normal sexual functioning as younger men.

- Suboptimal erections can be due to an underlying illness or medication, and is not always due to psychological factors alone. Suboptimal erections often have a mixed aetiology, both organic and psychological. Concomitant physical disease is an important cause of suboptimal erections.

- Effective and convenient treatments are available and international medical consensus has affirmed that in suitable patients with suboptimal erections or ED, oral medications should be the first-line treatment. [iii]

Notes

- Data from 3,957 sexually active men and women (2,016 males and 1,941 females), from the general public, was gathered for this survey1 This included 101 males and 108 females surveyed nationwide in Australia.

- The AP SHOW survey respondents were aged between 25-74 years and had had sexual intercourse at least once in the past 12 months, (female respondents had to have sex with a member of the opposite sex)

- The 13 Asian countries/regions surveyed included Australia, China, Hong Kong, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, and New Zealand

- Face-to-face interviews (a self completed questionnaire), were conducted in China, India, and Thailand
- An online self-administered method was used in Australia, Hong Kong, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, and New Zealand

- The AP SHOW survey was conducted from May to July 2008, by Harris Interactive, an independent market research company, and was sponsored by a non-restricted, educational grant from Pfizer Global Pharmaceuticals

References:
1 Data on file, Pfizer Global Pharmaceuticals.

About Pfizer Australia

Pfizer Australia is the nation’s leading research-based health care company, investing over $A50m in local research and development annually. It develops, manufactures and markets innovative medicines for both humans and animals. For more information visit http://www.pfizeraustralia.com.au

Source
Amy O’Hara
Media Communications Assistant
Public Affairs & Policy
Pfizer Australia
http://www.pfizeraustralia.com.au

UroToday.com - The report, one of four published articles from a population-based cross-sectional study principally on male erectile dysfunction (ED), is based on the responses of 1,580 participants to questions on their alcohol drinking behaviour. To assess the effects of alcohol on erectile function was not the primary objective of the study.

The finding that alcohol consumption within the current guidelines for low-risk drinking was associated with lower odds of ED provides rationale for counseling alcohol drinkers with ED in day-to-day clinical practice. Men with ED need not harbour a sense of guilt about their past or current drinking if they consume alcohol within guidelines.

This should not be interpreted as encouragement for non-drinkers to commence alcohol drinking. A decision by a non-drinker to commence drinking warrants careful consideration and informed decision, as it may be associated with multiple medical, socioeconomic and other implications, some of which could be serious.

Written by Kew-Kim Chew, MD as part of Beyond the Abstract on UroToday.com

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

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Copyright © 2009 - UroToday

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

The panel initially covering the topic of Erectile Dysfunction have broadened the scope of their guidelines and have taken in the treatment of premature ejaculation in their updated document.

Since the prior limited update of this guideline considerable data have become available regarding the various drugs on the market for the treatment of erectile dysfunction. The current guidelines include information on the efficacy and non-responders to PDE5 inhibitors, combination and continuous dosage and also touches on drug preference.

Most patients who had to undergo a (nerve-sparing) radical prostatectomy suffer from varying degrees of erectile dysfunction. For a considerable number of these patients PDE5 inhibitors offer improvement.

In their guidelines the panel clearly stress the need for a professional assessment of all patients presenting with ED, where also psychological aspects have to be taken into account. Self-medication and the recreational use of what in many countries are still prescription medications without taking possible side-effects into account are not advocated.

The panel consists of an expert group chaired by E. Wespes and includes E. Amar, I. Eardley, F. Giuliano, D. Hatzichristou, K. Hatzimouratidis, F. Montorsi and Y. Vardi.

Updated guidelines

A number of updated guidelines will be presented at the 24th Annual Congress of the European Association of Urology (EAU) held in Stockholm, from 17 through 21 March. The abridged versions - Pocket Guidelines which are based on the extended text documents will also be available in Stockholm to all EAU members.

Production of clinical guidelines is one of the core activities of the organisation. Close to 150 experts split up over 18 different topic-oriented panels, are involved in this ongoing process. Guidelines aim to present the best evidence available on a given pathology and provide a standardized approach to the treatment of urological conditions. Ultimately, healthcare professionals must make their own decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge and expertise.

European Association of Urology
http://www.uroweb.org

South Asians with type 2 diabetes are significantly more at risk of losing their eyesight and losing it at an earlier age, compared to White Europeans with the same condition.

A UK study carried out by the University of Warwick shows diabetic retinopathy (damage to the retina) is more prevalent in South Asians and occurs earlier than in White European people with diabetes.

The study, published in the latest issue of Diabetes Care, looked at 1.035 patients with type 2 diabetes, 421 were of South Asian origin and 614 were White Europeans. The results showed 45% of South Asians had retinopathy, compared to 37% of White Europeans, and 16% of the South Asian group had sight threatening retinopathy, compared to 12% White Europeans.

South Asian diabetes patients were also significantly younger than the White European group. The average age of the South Asian group at diagnosis of diabetes was 53 years, compared to 57 years for White Europeans. The study also suggested South Asians developed diabetic retinopathy about seven years earlier than White Europeans.

This study is part of the UK Asian Diabetes Study, a randomised controlled trial designed to evaluate the benefits of an enhanced diabetes care package for people of South Asian ethnicity with type 2 diabetes in Coventry and Birmingham.

For this project, researchers collected clinical data from 10 GP practices in the Foleshill area of Coventry. Details on risk factors including blood pressure, duration of diabetes, age at onset of diabetes and cholesterol were recorded.

One of the study’s authors Professor Sudhesh Kumar, Professor of Medicine, Diabetes & Endocrinology at Warwick Medical School, said the results emphasised the need for effective screening and earlier diagnosis of diabetes among the South Asian population.

He said: “The South Asian participants in this study had significantly higher systolic and diastolic blood pressures and cholesterol levels. Systematic screening for retinopathy, combined with intensive management of diabetes, including reduction of blood glucose and blood pressure, could help to reduce the incidence of visual impairment and blindness in ethnic minority groups across the world, addressing an important health inequality.”

In adults, the systolic pressure should be less than 120 mmHg and the diastolic pressure should be less than 80 mmHg. In this study, the South Asian participants recorded 144 mmHg systolic pressure and 84 mmHg diastolic pressure.

Professor Kumar added: “Health care professionals in developed and developing countries need to be aware of the potential contribution of diabetic retinopathy to visual loss in South Asian communities.”

Fellow author Dr Paul O’Hare, from Warwick Medical School, said: “Screening for diabetic retinopathy is becoming more systematic across the UK and the developed world. However, coverage rates and uptake among ethnic minority groups in inner city areas may be much lower than those for white Europeans. We need to address this to try and rectify these important health inequalities.”

Diabetes Care, volume 32, number 3, March 2009

Warwick University
http://www.warwick.ac.uk

Men with premature ejaculation who used a topical spray five minutes before intercourse were able to delay their orgasm six times longer than normal, according to a study in the April issue of BJU International.

Three hundred men with clinically diagnosed lifelong premature ejaculation (PE) from 31 centres in the UK, Czech Republic, Hungary and Poland, were randomised into two groups. Two hundred used the PSD502 spray, which contains 7.5mg of lidocaine and 2.5mg of prilocaine, and 100 used a placebo spray with no active ingredients.

Every time they had intercourse during the three-month study period, each couple measured the time from vaginal penetration to ejaculation with a stopwatch. The men were asked to abstain from sexual activity or masturbation for 24 hours before each recorded encounter.

The time from penetration to ejaculation increased from an average of 0.6 minutes to 3.8 minutes in the medicated group and to just 1.1 minutes in the placebo group.

When these figures were adjusted to take account of any variations between the two groups, these showed that the treatment group were able to last 6.3 times longer after penetration when they used the spray. The placebo group lasted 1.7 times longer.

“Premature ejaculation can be a very distressing condition for men and can cause distress, frustration and make them avoid sexual intimacy” says lead researcher Professor W Wallace Dinsmore from the Royal Victoria Hospital, Belfast, UK.

The research team used the evidence-based definition of lifelong PE developed by the International Society for Sexual Medicine to select their study subjects. This states that ejaculation occurs within about one minute of vaginal penetration in the majority of encounters.

“Because this definition was only launched in 2008, studies have yet to determine the prevalence of lifelong PE in the male population” says Professor Dinsmore. “But previous research suggests that as many as 40% of men will experience premature ejaculation at some time in their lives.”

The 300 men who took part in the phase three, multicentre, double-blind, randomised study had an average age of 35. The majority had used other treatments before, the most common being oral antidepressants.

After three months of treatment the researchers reported that:

– 90% of the men in the treatment group were able to delay ejaculation for more than one minute following vaginal penetration, compared with 54% in the placebo group.

– 74% of men in the treatment group managed to last more than two minutes before ejaculation, compared with 22% in the placebo group.

– 62% of men in the treatment group said their orgasms were ‘good’ or ‘very good’ after three months, compared with 20% before the study started. The figures for the placebo group were slightly lower at the end (19%) than at the start (21%).

– 66% of men in the treatment group said the medication was ‘good’ or ‘excellent’ compared with 15% in the placebo group.

– A significantly higher percentage of the patients and partners in the treatment group reported improvements when it came to perceived control, personal distress, satisfaction with sexual intercourse and interpersonal difficulties.

– There were no serious adverse events reported during the study. Adverse treatment-related reactions were reported by five men and six women from the treatment group and one man from the placebo group. The most common problems were loss of erection and a burning sensation in the vagina.

“Our study shows that when the PSD502 spray was applied to the man’s penis five minutes before intercourse it improved both sexual performance and sexual satisfaction, which are key factors in treating premature ejaculation” says Professor Dinsmore.

“It was well tolerated by both patients and their partners, with no systemic side effects and a low incidence of localised effects and was rated favourably by the majority of users.

“We believe that this shows that PSD502 offers significant advantages over other therapies being developed for the treatment of premature ejaculation.”

Source: Wiley - Blackwell

Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that although surveyed primary care physicians (PCPs) are generally satisfied with the efficacy of available phosphodiesterase type 5 (PDE5) inhibitors such as Pfizer’s ED drugs and Bayer Healthcare/Schering-Plough/GlaxoSmithKline’s Levitra (vardenafil), they are less satisfied with the efficacy of this drug class in difficult-to-treat patient subpopulations. PCPs’ satisfaction with available PDE5 inhibitors on key measures of clinical efficacy suggests that opportunity exists for improvement in the treatment of erectile dysfunction patients with comorbid conditions such as hypertension and diabetes.

The new report entitled Erectile Dysfunction: Physicians Seek Improvements in Efficacy for Underserved Patients and Product Differentiation on Onset and Duration of Action finds that a therapy that provides greater improvement in erectile function than Levitra in patients with hypertension and that is priced at a five percent discount to Levitra would earn a 50 percent patient share in the United States and a 40 percent patient share in Europe, according to surveyed U.S. primary care physicians and European general practitioners.

Additionally, while there are several second-generation PDE5 inhibitors in clinical trials for the treatment of erectile dysfunction, interviewed experts do not expect these agents to provide efficacy superior to that of currently marketed drugs in this class. The report also finds that limited reimbursement for erectile dysfunction drugs and the availability of less-expensive generic versions of Viagra beginning in 2012, will constrain the uptake of emerging PDE5 inhibitors.

“Most therapies for erectile dysfunction do not qualify for reimbursement by third-party payers,” said Decision Resources Analyst Kathryn Benton, B.S. “As a result, many patients pay out-of-pocket for treatment — this will be among the factors that will cause premium-priced emerging therapies to struggle to capture market share.”

About the Report

Erectile Dysfunction: Physicians Seek Improvements in Efficacy for Underserved Patients and Product Differentiation on Onset and Duration of Action is a DecisionBase 2009 report. DecisionBase 2009 is a decision-support tool that provides in-depth analysis of unmet need, physician expectations of new therapies and commercial dynamics to help pharmaceutical companies optimize their investments in drug development.

The report can be purchased by contacting Decision Resources. Members of the media may request an interview with an analyst.

About Decision Resources

Decision Resources is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources, Inc. company.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions.

All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.

Source: Decision Resources

UroToday.com - The concept behind nerve grafting is to make use of one’s own nerves, which play a minimal functional role, as conduits to promote the regrowth of new nerve fibers. In certain patients with prostate cancer, the nerves crucial for erectile function (cavernous nerves) may need to be cut in the interest of removing high-risk cancer. In these situations, the genitofemoral nerve can be interposed (grafted) as a conduit to promote regrowth of new nerve fibers. Our study examined the feasibility and success of this in patients with prostate cancer as well as those with bladder cancer, in which the prostate is also removed.

Although ours was a relatively small study, its strength lies in that we used a person independent from the surgeon who performed the surgery to assess patients on their outcomes. We found detectable rates of erectile potency in 38% of patients with a single bundle of nerves cut then grafted compared to 30% when both nerve bundles are cut and grafted. It is important to keep in mind that these patients may or may not have been using a medication that assists in erectile function such as Viagara®, Cialis (tadalafil) or Levitra (vardenafil). 

The important direction from this study is the attention it has drawn for the need to conduct a larger, randomized-controlled study to make final conclusions. Nevertheless, the study has reiterated that Urologic surgeons can perform this procedure. We recommend that the option for cavernous nerve interposition grafting should be discussed with select patients including those undergoing surgery for bladder cancer.

Written by Raj Satkunasivam, Sree Appu, Rami Al-Azab, Karen Hersey, Gina Lockwood, Joan Lipa and Neil E. Fleshner as part of Beyond the Abstract on UroToday.com

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday.com

Copyright © 2009 - UroToday

Tadalafil may improve lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH). Researchers from Nashville, Dallas, San Antonia and Indianapolis presented these findings during the 104th Annual Scientific Meeting of the American Urological Association (AUA).

In this study, researchers randomly separated 200 men, with an age equal to or older than 40 years and at least a six month diagnosis of BPH-LUTS with an International Prostate Symptom Score (IPPS) greater than or equal to 13, into two groups taking either 20 mg of tadalafil once daily or a placebo. After 12 weeks of treatment, the men taking tadalafil experienced improved detrusor pressure at urinary flow rate, peak flow rate (Qmax), bladder capacity, post-void residual volume and bladder voiding efficiency. Relative symptom improvement in the IPSS also was significantly better in the tadalafil group. At the end of the study, the proportion of obstructed patients in the placebo group increased, while the proportion in the tadalafil group decreased.

“Dr. Dmochowski, the study author, and colleagues have added further evidence to the growing body of research that suggests that in addition to their well known effect on erectile dysfunction, PDE-5 inhibitors may be able to help with management of bladder outlet symptoms as well. This is an exciting concept for men’s health,” said Anthony Y. Smith, MD, an AUA spokesman.

Dmochowski, R; Roehrborn, C; Kraus, S; Klise, S. Changes in bladder outlet obstruction index in men with signs and symptoms of benign prostatic hyperplasia treated with tadalafil. J Urol, suppl. 2009: 181, 4, abstract 1924.

Source:
Lacey Dean

American Urological Association