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Carneiro F, Saito OC, Miranda EP. Standardization of penile hemodynamic evaluation through color duplex-doppler ultrasound. ACTA ACUST UNITED AC 2020; 66:1180-1186. [PMID: 33027442 DOI: 10.1590/1806-9282.66.9.1180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/22/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process. Unfortunately, there is no standard procedure for CDDU conduction, a fact that results in high result-interpretation variability. OBJECTIVE The aims of this review are to promote greater standardization during CDDU of the penis and discuss the fundamental principles for its accurate conduction. METHODS CDDU is initially conducted with the penis in the flaccid state; the whole penis must be assessed (images at B mode) with a high-frequency linear transducer (7.5-18 MHz). Intracavernous injection of vasodilating agents (prostaglandin E1, papaverine, phentolamine) is performed to induce a rigid erection. Serial measurements at different times should be taken during the CDDU session and penile rigidity must be assessed in each evaluation. RESULTS It is important to monitor the erection response after the vasoactive agent (hardness scale), and scanning during the best-quality erection should be contemplated. Manual self-stimulation, audiovisual sexual stimulation (AVSS), and vasoactive agent re-dosing protocols must be taken into account to reduce the influence of psychogenic factors and to help the patient to get the hardest erection possible. Such measurements contribute to the maximal relaxation of the erectile tissue, so the hemodynamic parameters are not underestimated. CONCLUSIONS CDDU is a relevant specialized tool to assess patients with erectile dysfunction; therefore, this guideline will help to standardize and establish uniformity in its conduction and interpretation, taking into consideration the complexity and heterogeneity of CDDU evaluations of the penis.
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Affiliation(s)
- Felipe Carneiro
- Departamento de Radiologia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Osmar Cassio Saito
- Departamento de Radiologia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo P Miranda
- Departamento de Urologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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Medina-Polo J, García-Gómez B, Alonso-Isa M, Romero-Otero J. Clinical guidelines on erectile dysfunction surgery: EAU-AUA perspectives. Actas Urol Esp 2020; 44:289-293. [PMID: 32172988 DOI: 10.1016/j.acuro.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The implantation of a penile prosthesis is considered a third-line treatment and is indicated in patients who do not respond adequately to pharmacotherapy or require definitive treatment. Currently, the most used devices are 3-component penile prostheses, which presently account for more than 90% of the implants used. MATERIAL AND METHODS We reviewed the evidence and the recommendations of the clinical practice guidelines regarding surgery in patients with erectile dysfunction. RESULTS The recommendations of the clinical practice guidelines on surgery in patients with erectile dysfunction are summarized as follows: men with erectile dysfunction should be informed about the option of penile prosthesis implant treatment, commenting on the benefits, risks and consequences; men with erectile dysfunction who have agreed to receive penile prosthesis should be advised on post-surgical expectations; penile prosthesis implants should not be performed in patients with systemic, cutaneous or urinary tract infection; in young men with erectile dysfunction and focal penile or pelvic arterial obstruction who do not have generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction can be considered; in men with erectile dysfunction, penile venous surgery is not recommended. CONCLUSIONS The use of penile prostheses offers high satisfaction rates to both the patient and his partner. However, it is crucial to adequately inform and warn patients about possible complications and consequences.
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Hsieh CH, Hsu GL, Chang SJ, Yang SSD, Liu SP, Hsieh JT. Surgical niche for the treatment of erectile dysfunction. Int J Urol 2019; 27:117-133. [PMID: 31812157 DOI: 10.1111/iju.14157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno-occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno-occlusive dysfunction or mixed type, with corporoveno-occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal smooth muscle and consequential corporoveno-occlusive dysfunction. Current studies support the contention that corporoveno-occlusive dysfunction is an effect rather than the cause of erectile dysfunction. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno-occlusive dysfunction, whatever the mechanism. However, the surgical effectiveness remained debatable and unproven, mostly owing to the lack of consistent hemodynamic assessment, standardized select patient and validated outcome measures, as well as various surgical procedures. Penile vascular surgery has been disclaimed to be the treatment of choice based on the currently available guidelines. However, reports on penile revascularization surgery support its utility in treating arterial insufficiency in otherwise healthy patients aged <55 years with erectile dysfunction of late attributable to arterial occlusive disease. Furthermore, it is noteworthy that penile venous surgery might be beneficial for selected patients with corporoveno-occlusive dysfunction, especially with a better understanding of the innovated venous anatomy of the penis. Penile vascular surgery might remain a viable alternative for the treatment of erectile dysfunction, and could have found its niche in the possibility of obtaining spontaneous, unaided and natural erection.
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Affiliation(s)
- Cheng-Hsing Hsieh
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Geng-Long Hsu
- Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Taipei, Taiwan
| | - Shang-Jen Chang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Stephen Shei-Dei Yang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ju-Ton Hsieh
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
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Aita G, Ros CTD, Lorenzini F, Bertero EB, Cairoli CE, Tustumi F, Bernardo WM. Erectile dysfunction: drug treatment. Rev Assoc Med Bras (1992) 2019; 65:1133-1142. [PMID: 31618326 DOI: 10.1590/1806-9282.65.9.1133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Indexed: 11/21/2022] Open
Affiliation(s)
- Giuliano Aita
- . Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasi
| | | | | | | | | | - Francisco Tustumi
- . Programa Diretrizes da Associação Médica Brasileira, São Paulo, SP, Brasil
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Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh J, Khera M, McVary KT, Miner MM, Nelson CJ, Sadeghi-Nejad H, Seftel AD, Shindel AW. Erectile Dysfunction: AUA Guideline. J Urol 2018; 200:633-641. [PMID: 29746858 DOI: 10.1016/j.juro.2018.05.004] [Citation(s) in RCA: 359] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Arthur L Burnett
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Ajay Nehra
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Rodney H Breau
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Daniel J Culkin
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Martha M Faraday
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Lawrence S Hakim
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Joel Heidelbaugh
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Mohit Khera
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Kevin T McVary
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Martin M Miner
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Christian J Nelson
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | | | - Allen D Seftel
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Alan W Shindel
- American Urological Association Education and Research, Inc., Linthicum, Maryland
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