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Int J Clin Pract 1999 Jun;102(Suppl and tolerability of sildenafil in Indian males with Jun. Efficacy and treatment of erectile dysfunction: a 12-week, safety of sildenafil citrate for the treatment of flexible-dose study to assess efficacy and safety. Sildenafil improved sexual function in Efficacy and safety of oral sildenafil in the erectile dysfunction. Int J Impot Res treatment of erectile dysfunction: a double-blind, 1998;3(6):184 placebo-controlled study of 329 patients. Int J Clin Pract 1999 with erectile dysfunction after taking the three Jan;102(Jun. Sexual of erectile dysfunction with sildenafil citrate in function and satisfaction in heterosexual couples renal allograft recipients: a randomized, double- when men are administered sildenafil citrate blind, placebo-controlled, crossover trial. Am J (Viagra) for erectile dysfunction: a multicentre, Kidney Dis 2006 Jul;48(1):128-33. Improved confidence, and relationships in men with erectile spontaneous erectile function in men with mild- dysfunction: Results from an international, multi- to-moderate arteriogenic erectile dysfunction center, double-blind, placebo-controlled trial. The effects serotonergic antidepressant-associated erectile of quinapril and atorvastatin on the dysfunction: results from a randomized, double- responsiveness to sildenafil in men with erectile blind, placebo-controlled trial. Comparative trial of treatment satisfaction, Sildenafil in the treatment of antipsychotic- efficacy and tolerability of sildenafil versus induced erectile dysfunction: a randomized, apomorphine in erectile dysfunction--an open, double-blind, placebo-controlled, flexible-dose, randomized cross-over study with flexible two-way crossover trial. Sildenafil citrate improves erectile function and Can atorvastatin improve the response to urinary symptoms in men with erectile sildenafil in men with erectile dysfunction not dysfunction and lower urinary tract symptoms initially responsive to sildenafil? Hypothesis and associated with benign prostatic hyperplasia: a pilot trial results. Do food and dose timing affect the Sildenafil improves sleep-related erections in efficacy of sildenafil? A randomized placebo- hypogonadal men: evidence from a randomized, controlled study. J Sex Med 2007 Jan;4(1):137- placebo-controlled, crossover study of a synergic 44. Self-esteem, confidence and relationship Vardenafil, a new phosphodiesterase type 5 satisfaction of men with erectile dysfunction inhibitor, in the treatment of erectile dysfunction treated with sildenafil citrate: a multicenter, in men with diabetes: a multicenter double-blind randomized, parallel group, double-blind, placebo-controlled fixed-dose study. Sustained efficacy and safety of vardenafil for Evaluating erectile dysfunction: oral sildenafil treatment of erectile dysfunction: a randomized, versus intracavernosal injection of papaverine. Vardenafil of alfuzosin and sildenafil is superior to improved patient satisfaction with erectile monotherapy in treating lower urinary tract hardness, orgasmic function and sexual symptoms and erectile dysfunction. Sildenafil citrate: A safe and effective treatment for erectile dysfunction after renal 184. Nature Clinical Erectile response with vardenafil in sildenafil Practice Nephrology 2007;3(2):80-1. Dose- and tolerability of vardenafil for treatment of dependent effects of testosterone on sexual erectile dysfunction in patient subgroups. Erectile affected by erectile dysfunction: A double-blind, dysfunction after open versus angioplasty randomized, placebo-controlled trial of aortoiliac procedures: a questionnaire survey. J Urol 2003 Oct;170(4 Pt treating erectile dysfunction in a broad population 1):1278-83. Effect history of nonresponse to sildenafil: A time-from- of tadalafil on sexual timing behavior patterns in dosing descriptive analysis. Sustained depression-related improvement with vardenafil efficacy and tolerability with vardenafil over 2 for erectile response study. The esteem and self-confidence in patients with efficacy and safety of flexible-dose vardenafil severe erectile dysfunction. Int J Impot Res 2001 taken 8 hours before intercourse: a randomized, Aug;13(4):192-9. Efficacy erectile dysfunction patients: a RigiScan and and safety of flexible-dose vardenafil in men with pharmacokinetic study. Vardenafil and efficacy of vardenafil, a selective 20-mg demonstrated superior efficacy to 10-mg phosphodiesterase 5 inhibitor, in patients with in Japanese men with diabetes mellitus suffering erectile dysfunction and arterial hypertension from erectile dysfunction. Transplant Proc 2006 administered vardenafil for erectile dysfunction: Jun;38(5):1379-81. Vardenafil improves satisfaction rates, depressive symptomatology, and self- confidence 198. Efficacy results of a randomized, double-blind, 26-week and tolerability of vardenafil in men with mild placebo-controlled pivotal trial. Population dose-response model for tadalafil in the treatment of male erectile dysfunction. Visual loss associated with erectile following bilateral nerve sparing radical dysfunction drugs. Can J Ophthalmol 2007 retropubic prostatectomy: a randomized, double- Feb;42(1):10-2. Efficacy and cavernosum sodium/potassium adenosine treatment satisfaction with on-demand tadalafil triphosphatase activity. Effects A 6-month study of the efficacy and safety of of tadalafil on erectile dysfunction in men with tadalafil in the treatment of erectile dysfunction: diabetes. Diabetes Care 2002 Dec;25(12):2159- a randomised, double-blind, parallel-group, 64. Efficacy, treatment of men in canada with erectile safety, and treatment satisfaction of tadalafil dysfunction: A randomized, double-blind, versus placebo in patients with erectile parallel, placebo-controlled clinical trial. Chronic Comparison of efficacy, safety, and tolerability of treatment with tadalafil improves endothelial on-demand tadalafil and daily dosed tadalafil for function in men with increased cardiovascular the treatment of erectile dysfunction. Efficacy of sexual activity in patients treated with and safety of on-demand oral tadalafil in the 217 treatment of men with erectile dysfunction in 239. A Taiwan: A randomized, double-blind, parallel, randomized, double-blind, placebo-controlled, placebo-controlled clinical study. Int J Determining the earliest time within 30 minutes Radiat Oncol Biol Phys 2006 Oct 1;66(2):439-44. Taehan erectile function in hypogonadal men Pinyogikwa Hakhoe Chapchi 2006;47(8):852-8. Psychosocial outcomes and drug attributes affecting treatment choice in men receiving 232. J Sex function in men with erectile dysfunction: a pilot Med 2006 Jul;3(4):650-61. Tadalafil relieves lower urinary tract does not occur during 6 months of treatment: A symptoms secondary to benign prostatic randomized, double-blind, placebo-controlled hyperplasia. Int J Clin Pract 2006 men with severe erectile dysfunction in tertiary Jul;60(7):812-9. Efficacy and safety of on demand tadalafil in the treatment of East and Southeast Asian men with 245. Predictors of erectile dysfunction: a randomized double-blind, tadalafil efficacy in men with erectile parallel, placebo-controlled clinical study. Efficacy and a multicenter, randomized, double-blind, safety of two dosing regimens of tadalafil and placebo-controlled study. European multicentre study to evaluate the Intracavernosal injection therapy with and tolerability of apomorphine sublingual without sexological counselling in men with administered in a forced dose-escalation regimen erectile dysfunction. Int J Impot Res papaverine/phentolamine in erectile dysfunction 2005 Jan;17(1):80-5. A double Combination therapy for erectile dysfunction: a blind, placebo controlled study of intracavernosal randomized, double blind, unblinded active- vasoactive intestinal polypeptide and controlled, cross-over study of the phenotolamine mesylate in a novel auto-injector pharmacodynamics and safety of combined oral for the treatment of non-psychogenic erectile formulations of apomorphine hydrochloride, dysfunction. Double-blind safety of fixed-dose and dose-optimization multicenter study comparing alprostadil alpha- regimens of sublingual apomorphine versus cyclodextrin with moxisylyte chlorhydrate in placebo in men with erectile dysfunction. Appropriate use of Genital plus audiovisual sexual stimulation exercise testing prior to administration of drugs following intracavernous vasoactive injection for treatment of erectile dysfunction. Atropine role dosage of trimix ingredients and compare its in the pharmacological erection test: study of 228 efficacy and safety with prostaglandin E1. Is Recovery of spontaneous erectile function after there an optimal time for intracavernous nerve-sparing radical retropubic prostatectomy prostaglandin E1 rehabilitation following with and without early intracavernous injections nonnerve sparing radical prostatectomy?
The dropout rate was 29%, with 50% sildenafil at any time after surgery and that they (6/12) discontinuing because of the return of natural should not be hesitant to increase the dose to 100 mg. A study conducted by Nehra and col- patient discontinued the drug at 3 years because of leagues (2000) reported that a combination of silde- side effects. New Oral Therapies Three-Year Update of Sildenafil Myriad new therapeutic agents are emerging for the treatment of sexual dysfunction. Apomorphine Citrate Efficacy and Safety: sublingual has a central mechanism of action; it is Cleveland Clinic Series administered sublingually 20 min prior to expected Data from 41 patients who responded to sildenafil sexual activity. Sildenafil was prescribed at a dose of 50 mg inhibitors with increased potency and selectivity. The drug significantly improved partner satisfaction, and side effects were assessed. Thirty-one percent (9/29) of (2004) studied the efficacy of tadalafil in different these respondents had augmented their dose from 50 doses in a placebo-controlled trial; they reported a Treatment of Erectile Dysfunction / Raina et al. The results of the study identified advantage to this form of therapy (Fraiman et al. Further clinical trials are required to assess the advantage of increasing tissue oxygenation during selectivity, pharmacokinetics, and period of respon- the erection. Porst (1997) compared intraurethral drugs injected into the human corpus cavernosum penis. The efficacy and safety doses compared with intraurethral application of of tadalafil: an update. Minidoxil versus nitroglycerine: both treatments favor the injections and find that they Prospective double blind control trial in transcutaneous produce firmer erections. Minidoxil and capsacin: An association ally consider penile prosthesis implantation. Efficacy and solutions consistent with their pathophysiology and Safety of transurethral alprostadil in patients with erectile personal needs. Most patients are prescribed sildenafil dysfunction following radical prostatectomy. Diagnostic realistically advise patients of the long-term efficacy steps in the evaluation of patients with erectile dysfunc- and compliance of our pre-Viagra treatment options tion. Nonoral therapies should be consid- devices for erectile dysfunction: A long-term, prospective ered in the early postoperative period to enhance study of patients with mild, moderate, and severe dys- function. This century will witness Changes in penile morphometrics in men with erectile many additional agents designed for patients with spe- dysfunction after nerve-sparing radical prostatectomy. Effects of sildenafil on the sparing radical prostatectomy lead to better long term relaxation of human corpus cavernosum tissue in vitro return of natural function? Paper presented and on the activities of cyclic nucleotide phosphodi- at the Society for the Study of Impotence Meeting, esterase isoenzymes. Tadalafil in the Study Group: Oral sildenafil in the treatment of erectile treatment of erectile dysfunction following bilateral nerve dysfunction. New England Journal of Medicine, 338, sparing radical retropubic prostatectomy: A randomized, 1397-1404. World Journal at bedtime significantly increases nocturnal erectile activ- of Urology, 10, 68-70. Prostaglandin Leukot Essent Fatty Acids, 60, rethral prostaglandin E1 and sildenafil in the salvage of 169-174. Norepinephrine involvement International Journal of Impotence Research, Suppl 1: in response to intracorporeal injection of papaverine in psy- S38-42. Minimally invasive therapy for tion therapy for post-prostatectomy impotence: an out- erectile dysfunction: Intracavernosal, oral, transdermal/ come analysis. Treatment of men ernosal injection of vasoactive intestinal polypeptide with erectile dysfunction with transurethral alprostadil. Intracavernosal therapy for erectile failure—Impact of Patient acceptance of and satisfaction with an external treatment and reasons for dropout and dissatisfaction. Nitic oxide as a mediator of the corpus cav- Intracavernosal drug-induced erection therapy versus ernosum in response to non cholenergic non adrenergic external vacuum devices in the treatment of erectile dys- neurotransmission. Successful non-invasive management of the 97th Annual Meeting of the American Urological erectile impotence in diabetic men. Treatment of erectile dysfunction after sildenafil citrate after radical prostatectomy. Current Urology Three year update of sildenafil citrate (Viagra) efficacy and Reports, 2(6), 495-503. They can be useful to help diagnosis and to provide a baseline against which to monitor changes in symptoms and response to therapeutic interventions. Dr Hackett provides a guide to the most useful questionnaires in the sexual health area. While generally regarded conditions frequently co-exist in the same as too time-consuming for use in the clinic, patient. Confdence in getting and maintaining for penetration and 4 is a rigid erection erection (Figure 2). Assessment of change with treatment means that no paperwork is involved and an answer is obtained in seconds. Incomplete emptying 0 1 2 3 4 5 How often have you had the sensation of not emptying your bladder? Frequency 0 1 2 3 4 5 How often have you had to urinate less than every two hours? Intermittency 0 1 2 3 4 5 How often have you found you stopped and started again several times when you urinated? We Geoffrey Hackett has been an occasional and impact of therapeutic interventions. Itraconazole possesses structural similarities to ® ketoconazole (Nizoral ) and the mechanism of pharmacological action is similar. The Netherlands Pharmacovigilance Centre Lareb has received reports of erectile dysfunction associated with the use of itraconazole. Reports Until September 30, 2005 Lareb received four reports of erectile dysfunction associated with the use of itraconazole, listed in table 1. In patient B the erectile disturbance persisted during the medication-free interval. Patient D had also experienced erectile dysfunction during previous treatment with terbinafine. No cases of erectile dysfunction have been reported to Lareb in association with the use of ketaconazole. Nederlands Bijwerkingen Centrum Lareb November 2005 Other sources of information Literature A literature search revealed a few reports in which impotence and a decrease in libido have been reported during oral itraconazole therapy [4-6]. No reports on erectile dysfunction as adverse drug reaction of itraconazole were discovered. The literature does not support a similar interference with testosterone synthesis as described for ketoconazole. The mechanism of the antifungal action of itraconazole, like ketoconazole, involves prevention of ergosterol synthesis in fungal cell membranes via inhibition of cytochrome P450. Itraconazole, compared to ketoconazole, has a much higher affinity for fungal cytochrome P450 and binds only weakly to human P450 enzymes. In a study of limited size no clinical or laboratory evidence of impaired human testosterone synthesis could be found in patients treated with itraconazole [8]. Conclusion Lareb received reports of sexual dysfunction specified as erectile dysfunction associated with the use of oral itraconazole for onychomycosis. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in superficial and systemic mycoses. Use of oral ketoconazole to prevent postoperative erections following penile surgery. Adrenal response to corticotrophin and testosterone during long-term therapy with itraconazole in patients with chromoblastomycosis. We would like to thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
Long-term potency afer early use foor muscle exercises and manometric biofeedback for erectle dysfuncton erectile dysfunction help order viagra extra dosage canada. Int J double-blind placebo-controlled trials and the postmarketng safety database benadryl causes erectile dysfunction purchase cheap viagra extra dosage line. Comparatve efectveness of minimally endothelial functon: a randomized erectile dysfunction divorce discount viagra extra dosage 130 mg amex, double-blind erectile dysfunction in a young male order viagra extra dosage 150mg otc, placebo controlled study. Systematc review: comparatve in erectle functon: from pathophysiology to treatment--a systematc review. Efcacy and safety of tadalafl 5 mg once daily for the Virag R, Nollet F, Greco E, Shoukry K. Dynamic echography of the penis in the treatment of erectle dysfuncton afer robot-assisted laparoscopic radical follow-up of impotent patents treated with intracavernous injectons. Package leaflet: Information for the user Alprostadil Recordati 2 mg/g cream Alprostadil Read all of this leaflet carefully before you start using this medicine because it contains important information for you. After application of Alprostadil Recordati the onset of erection is within 5 to 30 minutes. You should not stop taking any prescription medications, unless told to do so by your doctor. What you need to know before you use Alprostadil Recordati Do not use Alprostadil Recordati – if you have underlying disorders such as drop in blood pressure when going from a lying/sitting to a standing position, history of a heart attack, and syncope (dizziness). Warnings and precautions Talk to your doctor or pharmacist before using Alprostadil Recordati if you have a history of the following local effects that have been observed with the use of Alprostadil Recordati: - Prolonged erections lasting >4 hours (priapism) - Symptomatic hypotension (dizziness) - Hepatic and/or renal insufficiency, a lowered dose due to impaired metabolism may be required - Fainting A condom should be used in the following situations: - Your partner is pregnant or breastfeeding - Your partner is of childbearing potential - To prevent sexually transmitted diseases - During oral sex and anal sex Only latex condoms have been studied. Other medicines and Alprostadil Recordati Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. The use of Alprostadil Recordati with other drugs used to treat Erectile Dysfunction have not been studied. Alprostadil Recordati has not been tested for use with penile implants or smooth muscle relaxants such as papaverine; drugs used to induce erections such as alpha blocking drugs (e. There is a risk of priapism (painful prolonged abnormal erection) when used in combination. Although not studied, it is possible that Alprostadil Recordati may have less of an effect when taken in combination with treatments for high blood pressure, decongestants and appetite suppressants. If you are taking drugs to prevent blood clots, do not take Alprostadil Recordati as there may be an increased risk for bleeding or blood found in the urine. In combination with high blood pressure medication, Alprostadil Recordati use may increase symptoms of dizziness and fainting, especially in the elderly. Pregnancy and breast-feeding and fertility There are no data on the use of Alprostadil Recordati in pregnant women. It is not known whether Alprostadil Recordati has an effect on human male fertility. Driving and using machines Alprostadil Recordati may make you feel dizzy or faint. How to use Alprostadil Recordati Always use this medicine exactly as your doctor has told you. Alprostadil Recordati is available in two dosage strengths of 200 and 300 mcg alprostadil in 100 mg of cream. Each Alprostadil Recordati AccuDose container is for single use only and should be properly discarded after use. Talk to your doctor who will instruct you on proper technique for administration and accomodation of your dose. Do not apply Alprostadil Recordati more than 2-3 times a week and only once per 24 hour period. Apply Alprostadil Recordati to the tip of the penis within 5 to 30 minutes prior to attempting intercourse by following the instructions below: 1. Remove the AccuDose container from the foil pouch by tearing fully down the seal from the middle of the top edge. Grasp the tip of the penis with one hand and gently manipulate to widen the opening of the penis. Note: if you are not circumcised, first retract and hold the foreskin back prior to widening the opening of the penis. Note: do not insert the tip of the AccuDose container in to the opening of the penis. Hold the penis in an upright position for approximately 30 seconds to allow the cream to penetrate. The amount of extra cream will vary depending on the patient and it is not unusual that half of the dose will remain at the edge of the opening. Do not use a second AccuDose to compensate for cream not expelled in to the opening of the penis. Any excess cream covering the opening may be rubbed gently in to the opening and skin surrounding the application site with the tip of a finger. Remember each Alprostadil Recordati dose is good for a single administration only. Replace the cap on the AccuDose container and place in the opened foil sachet, fold and discard in accordance with local requirements. Children and adolescents Alprostadil Recordati is not indicated for children or men below 18 years of age. If you use more Alprostadil Recordati than you should Overdose with Alprostadil Recordati requiring treatment has not been reported. Overdose with Alprostadil Recordati may result in a drop in blood pressure, fainting, dizziness, persistent pain in the penis, and possible prolonged erection lasting longer than 4 hours. If you have any further questions on the use of this medicine, ask your doctor or pharmacist. If you get a long-lasting erection of more than 4 hours, contact your doctor immediately. Your doctor may reduce your dose of Alprostadil Recordati and disontinue your treatment. Common side effects (may affect more than 1 in 10 patients): You: – mild to moderate local aching, burning or pain and redness of the penis, – rash, – genital pruritus, – penile oedema – inflammation of the glans penis (balanitis) – penile tingling, throbbing numbness, burning Your partner: -Mild vaginal burning or itching, vaginitis This effect may be due to the drug or to the act of vaginal penetration. Uncommon but potentially serious side effects (may affect up to 1 in 100 patients): You: – light-headedness/dizziness – prolonged erection for more than 4 hours – fainting – low blood pressure or rapid pulse – pain at the application site or in extremity – urethral stenosis – increase in sensitivity – penile itching – genital rash – scrotal pain – fullness in genital – lack of sensation to penis – Urinary tract inflammation Your partner: vulvovaginal pruritus *Increased sexual/physical activity in combination with Alprostadil Recordati my increase the risk of heart attack or stroke in patients with underlying disease/risk factors (see Section 2). If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist. Duration of side effects: Most effects are short acting and resolve within 1-2 hours Reporting of side effects If you get any side effects, talk to your doctor. You can also report side effects directly via the national reporting system listed in Appendix V. How to store Alprostadil Recordati Keep this medicine out of the sight and reach of children. Unopened sachets may be kept out of the refrigerator by the patient, at a temperature below 25°C for up to 3 days prior to use. Alprostadil Recordati is available in unit cartons with four (4) single dose containers. The other ingredients are purified water; ethanol, anhydrous; ethyl laurate; hydroxypropyl guar gum; dodecyl-2-N,N-dimethylaminopropionate hydrochloride; potassium dihydrogen phosphate; sodium hydroxide, for pH adjustment; phosphoric acid, for pH adjustment. Marke ting Authorisation Holder and Manufacturer Marketing Authorization holder Recordati Ireland Limited Raheens East, Ringaskiddy Co. Cork Tel +353 (0) 21 4379 400 Fax +353 (0) 21 4379 2800 Manufacturer Recordati Industria Chimica e Farmaceutica S. After administration you can engage in foreplay, which helps arousal and the process of developing an erection. An effective dose of Alprostadil Recordati should produce an erection sufficient for sexual intercourse. However, the actual duration will vary from patient to patient and the dose of the drug. Alprostadil Recordati may not create an erection comparable to those you experienced when you were younger. Some patients may experience some mild pain, a burning sensation, and aching in the penis or groin area.
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But if the cancer is growing into or very close to the nerves, the surgeon will need to remove them. If both nerves are removed, you won’t be able to have spontaneous erections, but you might still be able to have erections using some of the aids described below. If the nerves on only one side are removed, you might still have erections, but the chance is lower than if neither were removed. If neither nerve bundle is removed you might have normal erections at some point after surgery. Your ability to have an erection after surgery depends on your age, your ability to get an erection before the operation, and whether the nerves were cut. All men can expect some decrease in the ability to have an erection, but the younger you are, the more likely it is that you will keep this ability. Surgeons who do many radical prostatectomies tend to report lower impotence rates than doctors who do the surgery less often. A wide range of impotency rates have been reported in the medical literature, but each man’s situation is different, so the best way to get an idea of your chances for recovering erections is to ask your doctor about his or her success rates and what the outcome is likely to be in your case. If your ability to have erections does return after surgery, it often returns slowly. During the first few months, you will probably not be able to have a spontaneous erection, so you may need to use 12 ____________________________________________________________________________________American Cancer Society cancer. Most doctors feel that regaining potency is helped along by trying to get an erection as soon as possible once the body has had a chance to heal (usually several weeks after the operation). These drugs won’t work if both nerves that control erections have been damaged or removed. Common side effects of these drugs are headache, flushing (skin becomes red and feels warm), upset stomach, light sensitivity, and runny or stuffy nose. It can be injected almost painlessly into the base of the penis 5 to 10 minutes before intercourse or placed into the tip of the penis as a suppository. You might have side effects, such as pain, dizziness, and prolonged erection, but they are not usually serious. The air is sucked out of the pump, which draws blood into the penis to produce an erection. The erection is maintained after the pump is removed by a strong rubber band placed at the base of the penis. There are several types of penile implants, including those using silicone rods or inflatable devices. For more on coping with erection problems and other sexuality issues, see Sexuality for 6 the Man With Cancer. Changes in orgasm: After surgery, the sensation of orgasm should still be pleasurable, but there is no ejaculation of semen – the orgasm is “dry. Loss of fertility:Radical prostatectomy cuts the vas deferens, which are the pathways between the testicles (where sperm are made) and the urethra (through which sperm leave the body). Your testicles will still make sperm, but they can’t leave the body as a part of the ejaculate. But if it is a concern for you, you might want to ask your doctor about “banking” your sperm before 7 the operation. Lymphedema: This is a rare but possible complication of removing many of the lymph nodes around the prostate. Lymph nodes normally provide a way for fluid to return to the heart from all areas of the body. When nodes are removed, fluid can collect in the legs or genital region over time, causing swelling and pain. Lymphedema can usually be treated with physical therapy, although it may not go away completely. Change in penis length: A possible effect of surgery is a small decrease in penis length. This is probably due to a shortening of the urethra when a portion of it is removed along with the prostate. Inguinal hernia: A prostatectomy increases a man’s chances of developing an inguinal (groin) hernia in the future. Sexual function following radical prostatectomy: Influence of preservation of neurovascular bundles. A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. Comparative study of inguinal hernia repair after radical prostatectomy, prostate biopsy, transurethral resection of the prostate or pelvic lymph node dissection. Last Medical Review: August 1, 2019 Last Revised: August 1, 2019 Radiation Therapy for Prostate Cancer Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on 1 the stage of the prostate cancer and other factors, radiation therapy might be used: q As the first treatment for cancer that is still just in the prostate gland and is low 2 grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy. Types of radiation therapy the main types of radiation therapy used for prostate cancer are: q External beam radiation q Brachytherapy (internal radiation) (Another type of radiation therapy, in which a medicine containing radiation is injected into the body, is described in Treating Prostate Cancer Spread to the Bone. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone. You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time — getting you into place for treatment — takes longer. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues. Radiation beams are then shaped and aimed at the prostate from several directions, which makes it less likely to damage surrounding normal tissues and organs. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity (strength) of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This appears to help deliver the radiation even more precisely and results in fewer side effects. It uses a machine that delivers radiation quickly as it rotates once around the body. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days. Proton beam radiation therapy Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. The machines needed to make protons are very expensive, and they aren’t available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time. Bowel problems: Radiation can irritate the rectum and cause a condition called 4 radiation proctitis. This can lead to diarrhea , sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Some men develop urinary incontinence after treatment, which means they can’t control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence.
A study of sexuality recommendations are presented: and health among older adults in the United States. Erectile dysfunction in a large managed care organization with a quantity limit and coronary risk factors. Prevalence of Peyronie’s premature ejaculation: report of the International Society for disease in men over 50-y –old from Southern Brazil. Sexual dysfunction among older adults: Prevalence and risk factors from a nationally 14. Practicing quality of life after in men and women: a cross sectional population survey. Prevalence and evaluation of health problems- impact of neurovascular bundle preservation. International injections of prostaglandin E1 for erectile dysfunction: differences in the epidemiology of male erectile dysfunction. Help-seeking behavior induced sexual dysfunction during treatment with for sexual problems: the global study of sexual attitudes moclobemide, paroxetine, sertraline, and venlafaxine. Characteristics of erectile dysfunction in Saudi barriers to seeking treatment for erectile dysfunction: a patients. Inluences of erectile on smoking and erectile dysfunction socioeconomic dysfunction on daily life and general attitudes toward committee, sexual medicine society of North America, treatments. Duration of erectile dysfunction and J Urol 2001;166:1624- its relationship to treatment seeking and satisfaction with 29. The economics of Viagra: a new blockbuster drug responsiveness of the Self-Esteem and Relationship raises important questions about what is viewed as medical questionnaire in erectile dysfunction. Female sexuality and sexual dysfunction: initial history and physical examination to establish the are we stuck in the learning curve? Current practice and resource utilization in men diagnosed with premature ejaculation. Addis G, Spector R, Shaw E, Musumadi L and Dhanda C Ann Intern Med 2000;132:933-937. The physical, social and psychological impact of priapism on adult males with sickle cell disorder. Coverage of sildenail citrate by employers and health plans: lower than expected pharmacy 85. Cost implication of unrestricted access to sildenail citrate in four employer group prescription 86. Urinary retention and post-void residual urine in men: separating truth from tradition. Hypoactive 30 Amend to 109 Sexual Desire Disorder in menopausal women: a survey of 32 Amend to 111 Western European women. J Sex Med 2007;4 Suppl for Female Sexual Dysfunction Journal of Sex & Marital 3:211-9. Curtis L, Unit Costs of Health and Social Care 2008, Personal and Social Services Research Unit accessed online at http://www. Physician attitudes regarding Hypoactive Sexual Desire Disorder in a primary care clinic: a pilot study. Sexual problems reported by men and women in 28 countries: results of the Global Study of Sexual Attitudes and Behaviours. Attitudes towards partner interactions of women with low sexual desire: preliminary results of a multinational study of 1,402 women. The effect of a cognitive-behavioral treatment program on hypoactive sexual desire in women. Testosterone treatment for Hypoactive Sexual Desire Disorder in postmenopausal women. Sexual problems are prevalent in men and women Other diagnostic approaches are briely considered of different ethnic and social backgrounds, ages and and readers are referred to more detailed description health statuses, as shown in numerous recent epi-- in other chapters. Overview and basic principles of sexual problems are often neglected in clinical practice evaluation B. Overview of stan-- sexual problems or concerns with a physician due dardized sexual function scales and question-- to a sense of frustration, confusion, embarrassment naires, as well as broader outcome (HqL, treat-- or distress; moreover, patients often feel that phy-- ment satisfaction) measures in men and women. It is also essential to consider patients’ Such a strategy would improve not only doctor- rights and the goals of diagnostic procedures; these patient communications and treatment outcomes, deinitions, which are speciied as follows, permit us but most importantly, it would lead to the develop-- not only to provide a broad framework of scientiic ment of educational materials and curricula to pro-- understanding, but also to establish core principles vide practicing physicians across specialties with for the development of a simpliied and broadly the needed skills to meet modern patients’ needs applicable diagnostic and treatment algorithm. Initially, principles of sexual evalu-- widely accepted deinitions of health and sexual ation are presented and a diagnostic and treatment health, deining also sexual rights. Sexual medicine attempts to improve sexual health through the prevention, diagnosis, “Health is a state of complete physical, mental and treatment, and rehabilitation of conditions or dis-- social well-being and not merely the absence of eases that involve: disease or inirmity”. Sexuality is inluenced by the in-- teraction of multiple factors, including biological, Three basic principles underlie the management of psychological, social, economic, political, cultural, sexual problems in both men and women; when taken ethical, legal, religious and spiritual, and historical together, these three principles provide a balanced factors. Human sexuality can include multiple di-- and integrated approach to clinical evaluation and mensions, including thoughts, fantasies, desires, treatment of sexual problems and dysfunctions. While sexuality can include all of these dimensions, not all of them are always experi-- Table 1: Management principles in sexual enced or expressed [16]. It aims to measure outcomes Table 2: the interactive process of patient-centered in an objective and quantiiable way, while often ne-- care. This applies particularly in the case of sex-- 1 Exploring both the disease & illness experience ual medicine. Patient-centered 6 Being realistic medicine assumes a holistic approach that takes into account not only the biological dimension of Table 3: Summary of Cultural Competencies. Ad-- disease, but also its psychological and social impli-- opted from [22] cations, in accordance with the deinition of health Medical cultural competencies provided by the World Health organization [20]. When patients do 4 awareness of one’s own prejudices and tendency to stereotype not understand what their healthcare providers are offering or telling them, and when providers either do 5 ability to transfer information in a way the not speak the patient’s language or are insensitive patient can understand and to use external help (e. The ield of cultural 6 ability to adapt to new situations lexibly and competence focuses on overcoming language bar-- creatively. Table 3 [22] summarizes the essential biologicalindings,although thepatient mayfeel that cultural competencies that apply to sexual medicine he/she has a sexual problem, due to interpersonal, and should be incorporated in every sexual medicine psychological or social problems. In deining patient-centered care in sexual medi-- cine, the following criteria should be considered: 2. Evidence-based medicine is the integration of best available research evidence with clinical expertise A person may have a speciic dysfunction, such as and patient values [23]. Although not applicable in every case, ers the currently available diagnostic approaches for indings from controlled trials, patient registries and sexual dysfunction in the context of evidence-based systematic reviews can inform the decision-making literature in support of their use. In selecting among avail-- and patient-centered medicine are viewed as able diagnostic and treatment options, clinicians highly complementary and equally applicable in and patients should both evaluate the potential the clinical management of sexual dysfunction. Gender stereotypes have also hampered and treatment options that are available, in order understanding and appropriate diagnostic evaluation to participate actively in the decision-making pro-- in women, as terms like “frigidity” have been used in-- cess. Since it is evident that available treatments discriminately in psychoanalysis and other branches and diagnostic approaches for sexual dysfunction of medicine. Fortunately, sexual medicine in recent are proliferating, the patient should be given every years has become more aware and sensitive to the opportunity to choose among available options, and need for gender equality and the need for a uniied to determine which option its best to his/her special management approach. Patients’ needs vary also in their preference below, we propose a uniied, step-wise manage-- for information and involvement in the decision-mak-- ment approach for both men and women with sexual ing process, and for this reason the approach should problems. This is ultimately why on the algorithm presented by this Committee in the communication is the royal pathway to both evi-- previous Consultation [14]. Par- options according to men/women’s individual needs (patient-centered medicine), using the best available Table 4: the goals of the diagnostic procedures. Goals of diagnostic procedures the irst step includes the basic evaluation; 1 increase certainty about presence/absence medical, sexual and psychosocial history are of disease mandatory for every patient, while focused physical exam and laboratory tests are highly recommended; 2 deine disease severity step 2 includes the interpretation of the indings 3 monitor clinical course and identiication of needs for specialized tests. In 4 assess prognosis – risk/stage within the majority of the patients optional tests are not diagnosis necessary. Figure 2: Impact of the diagnostic steps on the management strategy for erectile dysfunction. Finally, step 5 refers to the important diagnostic procedures were necessary in only 1 out phase of follow-up, emphasizing that the overall of 5 patients [27]. However, physicians may make goal of treatment is improvement of patient’s the inal decision either to proceed with specialized subjective sexual well being and not merely relief tests/referral or to treatment [28].