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Brown G, Somani BK. Atlas of 35 patient reported outcome measures (PROMs) in andrology: a comprehensive overview of literature. World J Urol 2023; 41:371-404. [PMID: 36534155 DOI: 10.1007/s00345-022-04246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Disorders of male sexual health and functioning are complex and can have significant deleterious effects on patients psychological wellbeing and interpersonal relationships. It is well recognised that clinicians have an overall poor understanding of the true effect that disease has on their patients and self-reported patient-reported outcome measures (PROMs) aim to better communicate these issues. PROMs are generally welcomed by patients and their use in this highly sensitive area of clinical practice is well recognised. An atlas of available PROMs for key conditions in andrology is presented in this article. METHODS A comprehensive search of world literature was conducted from the inception of databases to June 2022, to identify male-specific PROMs relevant to four key andrological disorders: hypogonadism, erectile dysfunction, penile curvature and disorders of ejaculation. Each tool was evaluated in narrative format. RESULTS 35 PROMs were identified. 6 were designed for the assessment of hypogonadism, 18 for erectile dysfunction, one for penile curvature and 10 for ejaculatory disorders. In general, PROMs were brief, self-administered and user-friendly. There was sufficient scope and variety in all categories (apart from penile curvature) to give the clinician flexibility in tool selection and find an appropriate tool for different scenarios. CONCLUSION A number of PROMs exist within andrology that can be utilised in both research and clinical settings. PROMs enable subjective evaluation of difficult-to-assess aspects of the patient experience.
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Affiliation(s)
- G Brown
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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Gallo MF, Nguyen NC, Luff A, Luong TN, Le VT, Casterline J, Andridge R. Effects of a Novel Erectogenic Condom on Men and Women's Sexual Pleasure: Randomized Controlled Trial. JOURNAL OF SEX RESEARCH 2022; 59:1133-1139. [PMID: 35060403 PMCID: PMC9300773 DOI: 10.1080/00224499.2021.2024790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We tested whether CSD500 (Futura Medical; Guildford, UK), a novel condom containing erectogenic gel designed to increase penile firmness, penile size, and erection duration, results in greater sexual pleasure. In 2017-2020, we randomized heterosexual couples in Thanh Hoa, Vietnam to use CSD500 (N = 248) or standard condoms (N = 252) and followed them up for six months. Women completed the Quality of Sexual Experience (QSE) scale; men completed the QSE, Sexual Experience Questionnaire (SEX-Q), and 11 condom acceptability items. Female participants' mean age was 32.1 years (SD = 0.24; range 21-46). QSE scores were higher among women (B, 0.12; 95% CI, 0.03-0.21) and men (B, 0.21; 95% CI, 0.08-0.35) in the CSD500 relative to the control arm. SEX-Q scores were higher among men in the CSD500 compared to the control arm (B, 3.22; 95% CI, 1.53-4.91). Higher proportions of men in the CSD500 relative to the control arm reported the condom felt "natural" during sex (68.6% vs. 32.3%; p < .01) and that sex with the condom felt "a lot better" than condomless sex (15.5% vs. 5.3%; p < .01). Compared with standard condoms, CSD500 use was associated with higher reports of sexual pleasure and condom acceptability.
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Affiliation(s)
- M. F. Gallo
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, U.S
| | - N. C. Nguyen
- Department of Obstetrics and Gynecology, Vinmec International Hospital, Hanoi, Vietnam
| | - A. Luff
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, U.S
| | - T. N. Luong
- Thanh Hoa Center for Disease Prevention and Control, Thanh Hoa City, Vietnam
| | - V. T. Le
- Thanh Hoa Center for Disease Prevention and Control, Thanh Hoa City, Vietnam
| | - J. Casterline
- Department of Sociology, College of Arts and Sciences, Ohio State University, Columbus, Ohio, U.S
| | - R. Andridge
- Division of Biostatistics, College of Public Health, Ohio State University, Columbus, Ohio, U.S
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Is it time for a time-out? Progress versus politics in studying the psychosexual implications of penile circumcision. Int J Impot Res 2022; 35:252-255. [PMID: 36042356 PMCID: PMC9427164 DOI: 10.1038/s41443-022-00608-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022]
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Metacognitions in heterosexual, bisexual, and homosexual men: with or without premature ejaculation and erectile dysfunction. Behav Cogn Psychother 2020; 49:612-625. [PMID: 33334382 DOI: 10.1017/s1352465820000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Premature ejaculation (PE) and erectile dysfunction (ED) are prevalent sexual problems, with evidence to suggest variation across sexual orientation. Contributing factors have traditionally been divided into organic and psychological categories. While limited research has found support for the influence of metacognitive beliefs, these studies did not investigate potential differences in sexual orientation. AIM The current study aimed to investigate the differences in metacognitive beliefs in men with or without PE and/or ED and whether these varied according to sexual orientation. METHOD A sample of 531 men was recruited (65 met criteria for PE only, 147 for ED, 83 with PE and ED, and 236 healthy controls). Within this sample, 188 men identified as heterosexual, 144 as bisexual, and 199 as homosexual. Participants completed a cross-sectional online survey consisting of psychometric measures. RESULTS Participants with PE and ED were significantly higher in cognitive confidence, thoughts concerning uncontrollability and danger, and need to control thoughts than PE only, ED only, and healthy controls. Furthermore, the PE only group was significantly higher than healthy controls for cognitive confidence, with the ED significantly higher for thoughts concerning uncontrollability and danger. There were no significant differences between differing sexual orientations for men with/or without PE and/or ED. CONCLUSIONS Congruent with previous research, metacognitive beliefs play a role in PE and/or ED, although this is not exclusive to sexual orientation. The findings highlight that assessment and intervention regarding metacognitive beliefs may be beneficial for men of all sexual orientations with PE and/or ED.
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Dancet EAF, D'Hooghe TM, Dreischor F, van Wely M, Laan ETM, Lambalk CB, Repping S, Custers IM. The 'Pleasure&Pregnancy' web-based interactive educational programme versus expectant management in the treatment of unexplained subfertility: protocol for a randomised controlled trial. BMJ Open 2019; 9:e025845. [PMID: 31289062 PMCID: PMC6615847 DOI: 10.1136/bmjopen-2018-025845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Many subfertile couples are diagnosed with (relatively) unexplained subfertility and a good prognosis. National professional guidelines (eg, the Netherlands and UK) advise 'expectant management (EM)' for 6-12 months, in which no interaction with healthcare staff is offered. Underpowered studies indicate that face-to-face sex-counselling increases the ongoing pregnancy rates of these couples. In patients with other conditions, web-based interactive educational programmes have the same effect on sexual functioning as face-to-face sex counselling. The 'Pleasure&Pregnancy randomised controlled trial (RCT)' will examine in couples with unexplained subfertility and a good prognosis whether a new web-based interactive educational programme results in a higher chance of naturally conceiving an ongoing pregnancy within 6 months as compared with EM. METHODS AND ANALYSIS A multicentre RCT with cost-effectiveness analysis will include heterosexual couples diagnosed with (relatively) unexplained subfertility and a good prognosis in Dutch and Belgian secondary or tertiary fertility clinics. Couples will be randomised between 6 months of EM and 6 months of the Pleasure&Pregnancy-programme. This new web-based interactive educational programme includes eight progressive modules of information (on the biology of conception and pleasurable sex) and sensate focus, couple communication and mindfulness exercises. Couples are offered interaction with their coaches via email and can take part in three moderated chat sessions with peers. The primary outcome of this RCT is the probability of naturally conceiving an ongoing pregnancy within 6 months after randomisation. Secondary outcomes include time-to-pregnancy, live birth rate, costs, sexual functioning and personal and relational well-being. Analysis will be according to intention to treat. ETHICS AND DISSEMINATION This study has been approved by the Medical Ethical Committees of the Academic Medical Centre (the Netherlands) and the Leuven University Hospital (Belgium). The findings of this RCT will be disseminated through presentations at international scientific meetings and peer-reviewed publications. TRAIL REGISTRATION NUMBER NTR5709; Pre-results.
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Affiliation(s)
- Eline A F Dancet
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Postdoctoral fellow, Research Foundation - Flanders, Belgium
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M D'Hooghe
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Felicia Dreischor
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon van Wely
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Obstetrics/Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelius B Lambalk
- Department of Obstetrics and Gynaecology, Reproduction and Development, Amsterdam University Medical Centre, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Sjoerd Repping
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Inge M Custers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Culligan PJ, Haughey S, Lewis C, Priestley J, Salamon C. Sexual Satisfaction Changes Reported by Men After Their Partners' Robotic-Assisted Laparoscopic Sacrocolpopexies. Female Pelvic Med Reconstr Surg 2018; 25:365-368. [PMID: 29494351 DOI: 10.1097/spv.0000000000000574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES This study aimed to compare the preoperative and postoperative sexual satisfaction reported by male sexual partners of women undergoing surgical correction of pelvic organ prolapse. METHODS This was a single-center prospective cohort study. Heterosexual, sexually active English-speaking couples in which the women were planning to undergo robotic-assisted laparoscopic sacrocolpopexy for correction of pelvic organ prolapse were eligible for enrollment in the study. Validated sexual function questionnaires-the Sexual Experience Questionnaire (SEX-Q; Mulhall et al. J Sex Med. 2008) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (Rogers, et al. Int Urogynecol J Pelvic Floor Dysfunct. 2003)-were used to evaluate preoperative and postoperative male and female sexual experience, respectively. These preoperative scores were compared using paired t tests. The Student t and the Mann-Whitney tests were used to compare study-eligible couples with noneligible couples and to compare study participants with nonparticipants. RESULTS During the study enrollment period, 92 couples met the inclusion criteria and 45 of those were enrolled. Complete data sets of preoperative and postoperative questionnaires were obtained for 36 couples. After their partners' successful reconstructive surgery, male study subjects reported improved total SEX-Q scores (mean ± SD, 71 ± 16.7 vs 76.5 ± 17.8; P = 0.025). Within the subscales of the SEX-Q, there was significant improvement between preoperative and postoperative "individual satisfaction" scores (mean ± SD, 65.7 ± 16.8 vs 78.9 ± 17.5; P < 0.0001), but not within the "erectile dysfunction" or "couple satisfaction" subscales. Female partners reported improved Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores after surgery (mean ± SD, 36.6 ± 5.5 vs 40.0 ± 4.6; P = 0.003). CONCLUSIONS Sexually active heterosexual men and women reported improved sexual experience after successful prolapse repair.
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Affiliation(s)
- Patrick J Culligan
- From the Department of Urology, Weill Cornell Medicine Center for Female Pelvic Health, New York, NY
| | - Sean Haughey
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Jennifer Priestley
- Department of Statistics and Analytical Sciences, Kennesaw State University, Kennesaw, GA
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Evaluation of the measurement model and clinically important differences for menopause-specific quality of life associated with bazedoxifene/conjugated estrogens. Menopause 2014; 21:815-22. [DOI: 10.1097/gme.0000000000000176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wittmann D, Northouse L, Crossley H, Miller D, Dunn R, Nidetz J, Montie J, Moyad M, Lavin K, Montie JE. A pilot study of potential pre-operative barriers to couples' sexual recovery after radical prostatectomy for prostate cancer. JOURNAL OF SEX & MARITAL THERAPY 2014; 41:155-168. [PMID: 24405053 PMCID: PMC4506793 DOI: 10.1080/0092623x.2013.842194] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Prostate cancer affects couples' sexual intimacy, but men rarely use recommended proerectile aids. This mixed-methods study aimed to identify couples' preprostatectomy barriers to sexual recovery. Interviews about anticipated sexual recovery were paired with surveys: the Dyadic Assessment Scale, the Protective Buffering Scale, the Expanded Prostate Cancer Index Composite, the Sexual Experience Questionnaire (men), and the Female Sexual Function Index. Potential barriers were derived using Grounded Theory. Quantitative data triangulated qualitative findings. Heterosexual couples (N = 28) participated. Men's average age was 62 years and their partners' average age was 58 years. Preexisting and diagnosis-related barriers included aging-related sexual dysfunction, inadequate sexual problem-solving skills, stressors, worry, avoidance of planning for sexual recovery, and dislike of artificially assisted sex. Participants endorsed moderate/high marital satisfaction (DAS: for men, M = 110.0, SD = 11.4; for partners, M = 114.1, SD = 12.1) and communication (PBS: for men, M = 24.5.2, SD = 6.1; for partners, M = 25.1, SD ± 6.2). Men reported mild erectile dysfunction and incontinence (EPIC sexual function M = 76.6, SD = 21.5, urinary incontinence M = 88.4, SD = 18.2). Men's couple sexual satisfaction was lowest (Sexual Experience Questionnaire: M = 60.1, SD = 26.9). Mean total Female Sexual Function Index was low (M = 21.6, SD = 7.8). Heterosexual couples face prostatectomy-related sexual side-effects having experienced developmental sexual losses. Couples use avoidant strategies to defend against worry about cancer and anticipated prostatectomy-related sexual changes. These potential barriers are modifiable if couples can learn to cope with sexual losses and accept sexual rehabilitation strategies.
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Affiliation(s)
- Daniela Wittmann
- University of Michigan Department of Urology
- University of Michigan Health System Department of Social Work
| | | | | | | | - Rodney Dunn
- University of Michigan Department of Urology
| | - Jennifer Nidetz
- University of Michigan Health System Department of Social Work
| | | | - Mia Moyad
- University of Michigan Department of Urology
| | - Katie Lavin
- University of Michigan Health System Department of Social Work
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Bushmakin AG, Cappelleri JC, Symonds T, Stecher VJ. Enhanced understanding of the relationship between erection and satisfaction in ED treatment: application of a longitudinal mediation model. Int J Impot Res 2013; 26:20-3. [PMID: 23759829 DOI: 10.1038/ijir.2013.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 03/21/2013] [Accepted: 05/08/2013] [Indexed: 11/09/2022]
Abstract
To apportion the direct effect and the indirect effect (through erections) that sildenafil (vs placebo) has on individual satisfaction and couple satisfaction over time, longitudinal mediation modeling was applied to outcomes on the Sexual Experience Questionnaire. The model included data from weeks 4 and 10 (double-blind phase) and week 16 (open-label phase) of a controlled study. Data from 167 patients with erectile dysfunction (ED) were available for analysis. Estimation of statistical significance was based on bootstrap simulations, which allowed inferences at and between time points. Percentages (and corresponding 95% confidence intervals) for direct and indirect effects of treatment were calculated using the model. For the individual satisfaction and couple satisfaction domains, direct treatment effects were negligible (not statistically significant) whereas indirect treatment effects via the erection domain represented >90% of the treatment effects (statistically significant). Week 4 vs week 10 percentages of direct and indirect effects were not statistically different, indicating that the mediation effects are longitudinally invariant. As there was no placebo arm in the open-label phase, mediation effects at week 16 were not estimable. In conclusion, erection has a crucial role as a mediator in restoring individual satisfaction and couple satisfaction in men with ED treated with sildenafil.
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Affiliation(s)
| | | | - T Symonds
- Market Access, Primary Care Business Unit, Pfizer Ltd, Surrey, Kent, UK
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Abstract
INTRODUCTION With the increase in life expectancy, men's sexual health has become a major concern for elderly couples. Erectile dysfunction (ED) is responsible for a 50 % decrease of sexually active men between 60 and 85. The aim of this study was to identify objective elements to evaluate the influence of age on male sexual health. MATERIALS AND METHOD Data on the effects of aging on men's sexual health have been explored in Medline and Embase using the MeSH keywords: prostate; sexuality and erectile dysfunction; aging. The articles were selected based on their methodology, relevance, date and language of publication. RESULTS ED concerns 64 % of 70 years old patients and up to 77.5 % after 75 years. The screening of this pathology is based on standardized diagnostic tools. The most used of them remains the "International Index of Erectile function" which, in its simplified version with 5 items (IIEF-5 or SHIM), presents at the cutoff score of 21, a sensitivity of 98 %, a specificity of 88 % and a kappa index of 0.82. The ED is often responsible for a decrease in the quality of life for 60 % of elderly couples wishing to pursue sexual activity. Some diagnostic tools, such as the "Self-Esteem And Relationship" (SEAR) questionnaire or the "Sexual Experience Questionnaire" (SEX-Q) assess individual and couple satisfaction. Physiological aging seems to favor erection disorders by the development of an Androgen Deficiency of the Aging Male (ADAM) but pathological aging appears to be primarily responsible. Cardiovascular or neurological diseases and lower urinary tract symptoms (LUTS) are, with the polymedication, modifiable risk factors of ED to systematically screen in elderly subjects. CONCLUSION Many diagnostic tools allow to detect ED and assess the impact on the quality of life of elderly men. The fundamental element of the management of ED is the research of modifiable risk factors including cardiovascular.
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Affiliation(s)
- T Seisen
- Service d'Urologie de l'Hôpital Pitié-Salpêtrière, AP-HP, Université Paris VI, Faculté de médecine Pierre et Marie Curie, France, 83 boulevard de l'Hôpital, 75013 Paris, France
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Determining clinically important changes in range of motion in patients with Dupuytren's Contracture: secondary analysis of the randomized, double-blind, placebo-controlled CORD I study. Clin Drug Investig 2012; 31:791-8. [PMID: 21967070 DOI: 10.1007/bf03256918] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Injectable collagenase Clostridium histolyticum is efficacious in correcting Dupuytren's contracture as assessed by changes in the angle of contracture and range of motion (ROM). However, clinically important changes in ROM have not been evaluated in depth. The objective of this secondary analysis of the CORD I trial was to identify severity levels using baseline ROM, estimate a clinically important difference (CID) for ROM, and link the results to collagenase treatment and patient satisfaction. METHODS In the CORD I trial, patients with Dupuytren's disease and joint contractures ≥20° were randomized to receive a maximum of three collagenase 0.58 mg or placebo injections into the cord of the affected hand at 30-day intervals. The primary endpoint was reduction in contracture to ≤5° 30 days after the last injection (day 30). The secondary endpoints, which are reported in this analysis, were ROM, physician- and patient-rated severity ('normal', 'mild', 'moderate', 'severe') and improvement, and treatment satisfaction. Linear regression was used to model data for severity classification and CID estimation for ROM based on physician and patient ratings. RESULTS At baseline, mean ROM was 43.9° in the collagenase-treated joints (n = 197) and 45.3° in the placebo-treated joints (n = 102). On day 30, mean ROM was 80.7° in the collagenase-treated joints and 49.5° in the placebo-treated joints. The mean increase in ROM was 36.7° in the collagenase-treated joints (p < 0.001) and 4.0° in the placebo-treated joints (not significant). The estimated CID for ROM was 13.5° (95% CI 11.9, 15.1), reflecting a one-category change in severity. The mean increase in ROM exceeded the CID in the collagenase-treated joints but not in the placebo-treated joints; the difference between collagenase treatment and placebo in the mean increase in ROM also exceeded the CID, implying that the improvement with collagenase was clinically relevant. The severity classification for ROM was: ≥67.0° ('normal'), ≥54.3 and <67.0° ('mild'), ≥41.6 and <54.3° ('moderate'), and <41.6° ('severe'). More collagenase- than placebo-treated patients achieved 'normal' (81% vs 25%; p < 0.0001) status, and more collagenase- than placebo-treated patients reported being 'very/quite satisfied' (87% vs 32%; p < 0.001). CONCLUSION Injectable collagenase significantly improves ROM and treatment satisfaction versus placebo. ROM improvements are clinically relevant as well as statistically significant. These data support the potential need to include ROM and physician- and patient-rated severity and satisfaction as standard assessments for Dupuytren's contracture treatment outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00528606; other study identification number: AUX-CC-857 (Auxilium Pharmaceuticals, Inc.).
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Witthaut J, Bushmakin AG, Gerber RA, Cappelleri JC, Le Graverand-Gastineau MPH. Determining clinically important changes in range of motion in patients with Dupuytren's Contracture: secondary analysis of the randomized, double-blind, placebo-controlled CORD I study. Clin Drug Investig 2011. [PMID: 21967070 DOI: 10.2165/11592940-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Injectable collagenase Clostridium histolyticum is efficacious in correcting Dupuytren's contracture as assessed by changes in the angle of contracture and range of motion (ROM). However, clinically important changes in ROM have not been evaluated in depth. The objective of this secondary analysis of the CORD I trial was to identify severity levels using baseline ROM, estimate a clinically important difference (CID) for ROM, and link the results to collagenase treatment and patient satisfaction. METHODS In the CORD I trial, patients with Dupuytren's disease and joint contractures ≥20° were randomized to receive a maximum of three collagenase 0.58 mg or placebo injections into the cord of the affected hand at 30-day intervals. The primary endpoint was reduction in contracture to ≤5° 30 days after the last injection (day 30). The secondary endpoints, which are reported in this analysis, were ROM, physician- and patient-rated severity ('normal', 'mild', 'moderate', 'severe') and improvement, and treatment satisfaction. Linear regression was used to model data for severity classification and CID estimation for ROM based on physician and patient ratings. RESULTS At baseline, mean ROM was 43.9° in the collagenase-treated joints (n = 197) and 45.3° in the placebo-treated joints (n = 102). On day 30, mean ROM was 80.7° in the collagenase-treated joints and 49.5° in the placebo-treated joints. The mean increase in ROM was 36.7° in the collagenase-treated joints (p < 0.001) and 4.0° in the placebo-treated joints (not significant). The estimated CID for ROM was 13.5° (95% CI 11.9, 15.1), reflecting a one-category change in severity. The mean increase in ROM exceeded the CID in the collagenase-treated joints but not in the placebo-treated joints; the difference between collagenase treatment and placebo in the mean increase in ROM also exceeded the CID, implying that the improvement with collagenase was clinically relevant. The severity classification for ROM was: ≥67.0° ('normal'), ≥54.3 and <67.0° ('mild'), ≥41.6 and <54.3° ('moderate'), and <41.6° ('severe'). More collagenase- than placebo-treated patients achieved 'normal' (81% vs 25%; p < 0.0001) status, and more collagenase- than placebo-treated patients reported being 'very/quite satisfied' (87% vs 32%; p < 0.001). CONCLUSION Injectable collagenase significantly improves ROM and treatment satisfaction versus placebo. ROM improvements are clinically relevant as well as statistically significant. These data support the potential need to include ROM and physician- and patient-rated severity and satisfaction as standard assessments for Dupuytren's contracture treatment outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00528606; other study identification number: AUX-CC-857 (Auxilium Pharmaceuticals, Inc.).
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Affiliation(s)
- Jörg Witthaut
- Hand Surgery Department, University Hospital, Uppsala, Sweden.
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Mulhall JP, Kaminetsky JC, Althof SE, Goldstein I, Creanga DL, Marfatia A, Symonds T, Budhwani M. Correlations with satisfaction measures in men treated with phosphodiesterase inhibitors for erectile dysfunction. Am J Mens Health 2011; 5:261-71. [PMID: 21406491 DOI: 10.1177/1557988310389165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This literature review examined the relationship of erectile function to patient satisfaction. Published correlation coefficients (r values) were sought between patient-reported outcomes (PROs; i.e., instruments/questionnaires) assessing erection or erectile function and PROs assessing individual sexual satisfaction, satisfaction in the context of the couple or relationship, or satisfaction with erection. The U.S. National Library of Medicine's PubMed database was searched for English-language, randomized, double-blind, placebo-controlled trials of treatment with a phosphodiesterase type 5 inhibitor in men with erectile dysfunction (ED) who were not selected for any concomitant disease. Trials that reported correlations between an ED-specific and psychometrically validated PRO for an erection/erectile function concept and for a selected satisfaction concept were included. All correlations were positive, with almost all r values >.50. The positive relationship between results on erection/erectile function PROs and results on satisfaction PROs is probably reinforced bidirectionally such that improved erection/erectile function improves satisfaction, which further improves erection and/or erectile function.
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Affiliation(s)
- John P Mulhall
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Hardness, function, emotional well-being, satisfaction and the overall sexual experience in men using 100-mg fixed-dose or flexible-dose sildenafil citrate. Int J Impot Res 2010; 22:284-9. [PMID: 20596083 PMCID: PMC3056480 DOI: 10.1038/ijir.2010.17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prescribing information for sildenafil citrate (VIAGRA, Pfizer, New York, NY, USA) recommends flexible dosing (50 mg initially, adjusted to 100 or 25 mg based on effectiveness and tolerability) in most men with erectile dysfunction (ED). In many men, however, 100 mg may be the most appropriate initial dose because it would reduce the need for titration and could prevent discouragement and treatment abandonment should 50 mg be insufficient. Results of two previously published double-blind, placebo-controlled sildenafil trials of similar design except for a fixed-dose vs flexible-dose regimen were analyzed. Relative to the flexible-dose, approximately one-third more men were satisfied with an initial and fixed dose of 100 mg. In addition, tolerability was similar, and improvements from baseline in outcomes on validated, ED-specific, patient-reported questionnaires were either similar (erectile function and the percentage of completely hard and fully rigid erections) or greater (emotional well-being and the overall sexual experience). The similarity in outcomes is not surprising given that almost 90% of the men in the flexible-dose trial titrated to 100 mg after 2 weeks. These data suggest prescription of an initial dose of 100 mg for men with ED, except in those for whom it is inappropriate.
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Sheen MC, Sheu HM, Jang MY, Chai CY, Wang YW, Wu CF. Advanced Penile Verrucous Carcinoma Treated With Intra-Aortic Infusion Chemotherapy. J Urol 2010; 183:1830-5. [PMID: 20303107 DOI: 10.1016/j.juro.2009.12.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Maw-Chang Sheen
- Department of Surgery, Divisions of Surgical Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Hamm-Ming Sheu
- Department of Dermatology, National Cheng-Kung University Hospital, Tainan, Taiwan, Republic of China
| | - Mei-Yu Jang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Chee-Yin Chai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Yi-Wen Wang
- Department of Surgery, Divisions of Surgical Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Chih-Fung Wu
- Department of Surgery, Divisions of Surgical Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
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Porst H, McMahon CG, Althof SE, Sharlip I, Bull S, Aquilina JW, Tesfaye F, Rivas DA. 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. J Sex Med 2010; 7:2231-2242. [PMID: 20412423 DOI: 10.1111/j.1743-6109.2010.01820.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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Affiliation(s)
- Hartmut Porst
- Private Urology and Andrology Practice and Hospital, Hamburg, Germany.
| | - Chris G McMahon
- Australian Centre for Sexual Health, St. Leonards, Sydney, NSW, Australia
| | - Stanley E Althof
- Case Western Reserve University School of Medicine, Center for Marital and Sexual Health of South Florida, West Palm Beach, FL, USA
| | - Ira Sharlip
- University of California, San Francisco, CA, USA
| | - Scott Bull
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
| | - Joseph W Aquilina
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
| | - Fisseha Tesfaye
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
| | - David A Rivas
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
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Kriston L, Günzler C, Rohde A, Berner MM. Is one question enough to detect female sexual dysfunctions? A diagnostic accuracy study in 6,194 women. J Sex Med 2010; 7:1831-41. [PMID: 20233277 DOI: 10.1111/j.1743-6109.2010.01729.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Literature shows that recognition of sexual dysfunctions in women is insufficient and existing instruments to aid detection are mostly too extensive to be used in routine practice. AIM To develop a brief and accurate screening instrument to detect female sexual dysfunctions in routine care. METHODS The initial item pool for the index test consisted of 15 items. In a 4-year period, a total of 12,957 persons filled out the test on a specifically designed web-site. Six thousand one hundred ninety-four complete data sets could be used for statistical analysis. The validated German version of the Female Sexual Function Index (FSFI-d) served as reference standard to estimate the accuracy of the screening test. In order to test several possible ways of combining items a multi-step procedure employing univariate analyses, multiple logistic regression, and classification and regression tree analysis was applied to a learning sample and cross-validated in a test sample. MAIN OUTCOME MEASURES Diagnostic performance (sensitivity, specificity, positive and negative predictive value, accuracy, diagnostic odds ratio as well as adjusted odds ratio) of the items and resulting models to discriminate women with sexual dysfunction from those without were calculated. RESULTS One dichotomous question for overall satisfaction proved to show high accuracy as a stand-alone instrument and played also a central role in multivariate models. It may be recommended as a one-question screening test (76.4% sensitivity and 76.5% specificity in the test sample). A hierarchical two-question test yielded higher sensitivity (93.5%) and lower specificity (60.1%). A slightly more extensive version consists of five questions (83.1% sensitivity and 81.2% specificity). CONCLUSIONS Despite some methodological limitations of our study all developed tests showed acceptable to good diagnostic performance, all are very short and could therefore be easily implemented into routine care. Further tests of psychometric properties in other settings are needed.
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Affiliation(s)
- Levente Kriston
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
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Smith A, Lyons A, Ferris J, Richters J, Pitts M, Shelley J. Are sexual problems more common in men who have had a vasectomy? A population-based study of Australian men. J Sex Med 2009; 7:736-42. [PMID: 19878443 DOI: 10.1111/j.1743-6109.2009.01565.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION It is not known whether sexual problems are currently more prevalent among men who have had a vasectomy compared with those who have not had a vasectomy. AIM To investigate whether vasectomized men are more likely to report experiencing a range of sexual problems than nonvasectomized men and to assess their overall sexual and relationship satisfaction. METHODS A population-based survey of 3,390 Australian men's sexual experiences was conducted using computer-assisted telephone interviewing. MAIN OUTCOME MEASURES Proportions of vasectomized and nonvasectomized men who: (i) reported a sexual problem for at least 1 month during the last 12 months; and (ii) rated their sexual and relationship satisfaction as either extremely satisfying or not extremely satisfying. RESULTS Vasectomy was reported by 25.1% of men, almost 70% of whom were aged 40-59 years. Vasectomized men were more likely to be married, live in regional areas, and speak English at home. Having a vasectomy was not associated with any specific sexual problem, such as lacking interest in sex or taking too long to reach orgasm. Vasectomized men (10.8%) were slightly more likely than nonvasectomized men (8.2%) to report problems maintaining an erection, but this difference disappeared when age and other socio-demographic variations were taken into account. Although vasectomized men (33.7%) were just as likely as nonvasectomized men (33.0%) to be extremely satisfied sexually, they were significantly more likely to be extremely satisfied with their relationship overall (48.3% vs. 42.9%). CONCLUSION Our findings suggest that sexual problems are no more prevalent among vasectomized men than they are among nonvasectomized men.
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Affiliation(s)
- Anthony Smith
- Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, Australia.
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Loran OB, Ströberg P, Lee SW, Park NC, Kim SW, Tseng LJ, Collins S, Stecher VJ. ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Sildenafil Citrate 100 mg Starting Dose in Men with Erectile Dysfunction in an International, Double-Blind, Placebo-Controlled Study: Effect on the Sexual Experience and Reducing Feelings of Anxiety About the Next Intercourse Attempt. J Sex Med 2009; 6:2826-35. [DOI: 10.1111/j.1743-6109.2009.01428.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moncada I, Martínez-Jabaloyas JM, Rodriguez-Vela L, Gutiérrez PR, Giuliano F, Koskimaki J, Farmer IS, Renedo VP, Schnetzler G. Emotional changes in men treated with sildenafil citrate for erectile dysfunction: a double-blind, placebo-controlled clinical trial. J Sex Med 2009; 6:3469-77. [PMID: 19796051 DOI: 10.1111/j.1743-6109.2009.01514.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) has been associated with several comorbidities and can cause significant loss of quality of life and self-esteem. AIM In men with ED, to use the validated Self-Esteem and Relationship (SEAR) questionnaire to evaluate changes in self-esteem associated with sildenafil treatment of ED and to assess changes dependent on concomitant comorbid conditions. METHODS This was a 14-week, international, randomized, parallel-group, double-blind, flexible-dose (25, 50, or 100 mg), placebo-controlled study of sildenafil in men aged >or=18 years with a clinical diagnosis of ED (score <or= 21 on the Sexual Health Inventory for Men). MAIN OUTCOME MEASURES The primary outcome was the change in the SEAR Self-Esteem subscale score from baseline to the end of treatment. Secondary outcomes were the change in SEAR component scores stratified by ED comorbidity, the change in the International Index of Erectile Function (IIEF) domain scores and in the intercourse success rate, and the response to the global efficacy assessment and to the global satisfaction assessment. RESULTS A total of 841 patients were included in the intent-to-treat efficacy analysis (559 sildenafil, 282 placebo). Patients randomized to sildenafil had significantly greater change scores from baseline to the end of treatment on all components of the SEAR and all domains of the IIEF (P < 0.0001) compared with placebo. This finding was also consistent for all SEAR components when stratified by each ED comorbidity. In the sildenafil group, the improvement in the mean Self-Esteem subscale score correlated with improvements in the mean Erectile Function domain score (r = 0.6338, P < 0.0001). CONCLUSIONS The physiologic and emotional benefits of sildenafil in the treatment of ED were confirmed, overall and in men with comorbid hypertension, hyperlipidemia, benign prostatic hypertrophy, and/or depression. Using both the IIEF and the SEAR questionnaires provides a more complete assessment of ED.
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Rubio-Aurioles E, Sand M, Terrein-Roccatti N, Dean J, Longworth J, Eardley I, Brock G, Lee J, Arango de Montis I, Rampazzo-Bonaldo C. Female Assessment of Male Erectile Dysfunction Detection Scale (FAME): Development and Validation. J Sex Med 2009; 6:2255-70. [DOI: 10.1111/j.1743-6109.2009.01348.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tan HM, Marumo K, Yang DY, Hwang TIS, Ong ML. Sex among Asian men and women: The Global Better Sex Survey in Asia. Int J Urol 2009; 16:507-14; discussion 514-5. [DOI: 10.1111/j.1442-2042.2009.02283.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gruenwald I, Leiba R, Vardi Y. Effect of Sildenafil on Middle-Aged Sexually Active Males with No Erectile Complaints: A Randomized Placebo-Controlled Double-Blind Study. Eur Urol 2009; 55:969-76. [DOI: 10.1016/j.eururo.2008.04.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 04/22/2008] [Indexed: 11/25/2022]
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Cappelleri JC, Bushmakin AG, Symonds T, Schnetzler G. Scoring Correspondence in Outcomes Related to Erectile Dysfunction Treatment on a 4-Point Scale (SCORE-4). J Sex Med 2009; 6:809-19. [DOI: 10.1111/j.1743-6109.2008.01155.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buvat J, Hatzichristou D, Maggi M, Farmer I, Martínez-Jabaloyas JM, Miller PJ, Schnetzler G. Efficacy, tolerability and satisfaction with sildenafil citrate 100-mg titration compared with continued 50-mg dose treatment in men with erectile dysfunction. BJU Int 2008; 102:1645-50. [DOI: 10.1111/j.1464-410x.2008.07908.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cappelleri JC, Stecher VJ. An assessment of patient-reported outcomes for men with erectile dysfunction: Pfizer's perspective. Int J Impot Res 2008; 20:343-57. [PMID: 18368055 DOI: 10.1038/ijir.2008.8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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