Low Intensity Shock Wave Treatment for Erectile Dysfunction-How Long Does the Effect Last?

PURPOSE: We studied the long-term efficacy of penile low intensity shock wave treatment 2 years after an initially successful outcome. MATERIALS AND METHODS: Men with a successful outcome of low intensity shock wave treatment according to the minimal clinically important difference on the IIEF-EF (International Index of Erectile Function-Erectile Function) questionnaire were followed at 6, 12, 18 and 24 months. Efficacy was assessed by the IIEF-EF. Failure during followup was defined as a decrease in the IIEF-EF below the minimal clinically important difference. RESULTS: We screened a total of 156 patients who underwent the same treatment protocol but participated in different clinical studies. At 1 month treatment was successful in 99 patients (63.5%). During followup a gradual decrease in efficacy was observed. The beneficial effect was maintained after 2 years in only 53 of the 99 patients (53.5%) in whom success was initially achieved. Patients with severe erectile dysfunction were prone to earlier failure than those with nonsevere erectile dysfunction. During the 2-year followup the effect of low intensity shock wave treatment was lost in all patients with diabetes who had severe erectile dysfunction at baseline. On the other hand, patients with milder forms of erectile dysfunction without diabetes had a 76% chance that the beneficial effect of low intensity shock wave treatment would be preserved after 2 years. CONCLUSIONS: Low intensity shock wave treatment is effective in the short term but treatment efficacy was maintained after 2 years in only half of the patients. In patients with milder forms of erectile dysfunction the beneficial effect is more likely to be preserved.

Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham Controlled Study.

PURPOSE: We performed sham controlled evaluation of penile low intensity shock wave treatment effect in patients unable to achieve sexual intercourse using PDE5i (phosphodiesterase type 5 inhibitor). MATERIALS AND METHODS: This prospective, randomized, double-blind, sham controlled study was done in patients with vasculogenic erectile dysfunction who stopped using PDE5i due to no efficacy. All patients had an erection hardness score of 2 or less with PDE5i. A total of 58 patients were randomized, including 37 treated with low intensity shock waves (12 sessions of 1,500 pulses of 0.09 mJ/mm(2) at 120 shock waves per minute) and 18 treated with a sham probe. In the sham group 16 patients underwent low intensity shock wave treatment 1 month after sham treatment. All patients were evaluated at baseline and 1 month after the end of treatment using validated erectile dysfunction questionnaires and the flow mediated dilatation technique for penile endothelial function. Erectile function was evaluated while patients were receiving PDE5i. RESULTS: In the low intensity shock wave treatment group and the sham group 54.1% and 0% of patients, respectively, achieved erection hard enough for vaginal penetration, that is an EHS (Erection Hardness Score) of 3 (p <0.0001). According to changes in the IIEF-EF (International Index of Erectile Function-Erectile Function) score treatment was effective in 40.5% of men who received low intensity shock wave treatment but in none in the sham group (p = 0.001). Of patients treated with shock waves after sham treatment 56.3% achieved erection hard enough for penetration (p <0.005). CONCLUSIONS: Low intensity shock wave treatment is effective even in patients with severe erectile dysfunction who are PDE5i nonresponders. After treatment about half of them were able to achieve erection hard enough for penetration with PDE5i. Longer followup is needed to establish the place of low intensity shock wave treatment in these challenging cases.

Low Intensity Extracorporeal Shock Wave Therapy Improves Erectile Function in a Model of Type II Diabetes Independently of NO/cGMP Pathway.

PURPOSE: Erectile dysfunction is highly prevalent in type II diabetes mellitus. Low intensity extracorporeal shock wave therapy improves erectile function in patients with erectile dysfunction of vasculogenic origin, including diabetes. However, its mode of action remains unknown. We investigated the effects of low intensity extracorporeal shock wave therapy compared to or combined with sildenafil on erectile dysfunction in a type II diabetes mellitus model. Our purpose was to test our hypothesis of a mode of action targeting the cavernous nitric oxide/cyclic guanosine monophosphate pathway. MATERIALS AND METHODS: GK rats, a validated model of type II diabetes mellitus, and age matched Wistar rats were treated with low intensity extracorporeal shock wave therapy twice weekly for 3 weeks. Treatment was repeated after a 3-week no-treatment interval. The penis was stretched and dipped in a specifically designed water-filled cage. Shock waves were delivered by a calibrated probe yielding a controlled energy flux density (0.09 mJ/mm(2)). The probe was attached to an electrohydraulic unit with a focused shock wave source, allowing for accurate extrapolation to humans. Following a 4-week washout period erectile function was assessed as well as endothelium dependent and independent, and nitrergic relaxations of the corpus cavernosum of GK rats. RESULTS: Low intensity extracorporeal shock wave therapy significantly improved erectile function in GK rats to the same extent as sildenafil. Treatment effects were potentiated when combined with sildenafil. Shock wave effects were not associated with improved cavernous endothelium dependent or independent, or nitrergic reactivity. CONCLUSIONS: Low intensity extracorporeal shock wave therapy improved erectile function in GK rats. Unexpectedly, this was not mediated by a nitric oxide/cyclic guanosine monophosphate dependent mechanism. Sildenafil increased shock wave efficacy. This preclinical paradigm to deliver low intensity extracorporeal shock wave therapy to the rat penis should help further exploration of the mode of action of this therapy on erectile tissue.

Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study.

PURPOSE: We investigated the clinical and physiological effect of low intensity extracorporeal shock wave therapy on men with organic erectile dysfunction who are phosphodiesterase type 5 inhibitor responders. MATERIALS AND METHODS: After a 1-month phosphodiesterase type 5 inhibitor washout period, 67 men were randomized in a 2:1 ratio to receive 12 sessions of low intensity extracorporeal shock wave therapy or sham therapy. Erectile function and penile hemodynamics were assessed before the first treatment (visit 1) and 1 month after the final treatment (followup 1) using validated sexual function questionnaires and venoocclusive strain gauge plethysmography. RESULTS: Clinically we found a significantly greater increase in the International Index of Erectile Function-Erectile Function domain score from visit 1 to followup 1 in the treated group than in the sham treated group (mean ± SEM 6.7 ± 0.9 vs 3.0 ± 1.4, p = 0.0322). There were 19 men in the treated group who were initially unable to achieve erections hard enough for penetration (Erection Hardness Score 2 or less) who were able to achieve erections sufficiently firm for penetration (Erection Hardness Score 3 or greater) after low intensity extracorporeal shock wave therapy, compared to none in the sham group. Physiologically penile hemodynamics significantly improved in the treated group but not in the sham group (maximal post-ischemic penile blood flow 8.2 vs 0.1 ml per minute per dl, p <0.0001). None of the men experienced discomfort or reported any adverse effects from the treatment. CONCLUSIONS: This is the first randomized, double-blind, sham controlled study to our knowledge that shows that low intensity extracorporeal shock wave therapy has a positive short-term clinical and physiological effect on the erectile function of men who respond to oral phosphodiesterase type 5 inhibitor therapy. The feasibility and tolerability of this treatment, coupled with its potential rehabilitative characteristics, make it an attractive new therapeutic option for men with erectile dysfunction.

Low-intensity extracorporeal shock wave therapy--a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy.

INTRODUCTION: Low-intensity shock wave therapy (LI-ESWT) has been reported as an effective treatment in men with mild and moderate erectile dysfunction (ED). AIM: The aim of this study is to determine the efficacy of LI-ESWT in severe ED patients who were poor responders to phosphodiesterase type 5 inhibitor (PDE5i) therapy. METHODS: This was an open-label single-arm prospective study on ED patients with an erection hardness score (EHS) ≤ 2 at baseline. The protocol comprised two treatment sessions per week for 3 weeks, which were repeated after a 3-week no-treatment interval. Patients were followed at 1 month (FU1), and only then an active PDE5i medication was provided for an additional month until final follow-up visit (FU2). At each treatment session, LI-ESWT was applied on the penile shaft and crus at five different anatomical sites (300 shocks, 0.09 mJ/mm(2) intensity at 120 shocks/min). Each subject underwent a full baseline assessment of erectile function using validated questionnaires and objective penile hemodynamic testing before and after LI-ESWT. MAIN OUTCOME MEASURES: Outcome measures used are changes in the International Index of Erectile Function-erectile function domain (IIEF-ED) scores, the EHS measurement, and the three parameters of penile hemodynamics and endothelial function. RESULTS: Twenty-nine men (mean age of 61.3) completed the study. Their mean IIEF-ED scores increased from 8.8 ± 1 (baseline) to 12.3 ± 1 at FU1 (P = 0.035). At FU2 (on active PDE5i treatment), their IIEF-ED further increased to 18.8 ± 1 (P < 0.0001), and 72.4% (P < 0.0001) reached an EHS of ≥ 3 (allowing full sexual intercourse). A significant improvement (P = 0.0001) in penile hemodynamics was detected after treatment and this improvement significantly correlated with increases in the IIEF-ED (P < 0.05). No noteworthy adverse events were reported. CONCLUSIONS: Penile LI-ESWT is a new modality that has the potential to treat a subgroup of severe ED patients. These preliminary data need to be reconfirmed by multicenter sham control studies in a larger group of ED patients.

Is the female G-spot truly a distinct anatomic entity?

INTRODUCTION: The existence of an anatomically distinct female G-spot is controversial. Reports in the public media would lead one to believe the G-spot is a well-characterized entity capable of providing extreme sexual stimulation, yet this is far from the truth. AIM: The aim of this article was to provide an overview of the evidence both supporting and refuting the existence of an anatomically distinct female G-spot. METHODS: PubMed search for articles published between 1950 and 2011 using key words "G-spot," "Grafenberg spot," "vaginal innervation," "female orgasm," "female erogenous zone," and "female ejaculation." Clinical trials, meeting abstracts, case reports, and review articles that were written in English and published in a peer-reviewed journal were selected for analysis. MAIN OUTCOME MEASURE: The main outcome measure of this article was to assess any valid objective data in the literature that scientifically evaluates the existence of an anatomically distinct G-spot. RESULTS: The literature cites dozens of trials that have attempted to confirm the existence of a G-spot using surveys, pathologic specimens, various imaging modalities, and biochemical markers. The surveys found that a majority of women believe a G-spot actually exists, although not all of the women who believed in it were able to locate it. Attempts to characterize vaginal innervation have shown some differences in nerve distribution across the vagina, although the findings have not proven to be universally reproducible. Furthermore, radiographic studies have been unable to demonstrate a unique entity, other than the clitoris, whose direct stimulation leads to vaginal orgasm. CONCLUSIONS: Objective measures have failed to provide strong and consistent evidence for the existence of an anatomical site that could be related to the famed G-spot. However, reliable reports and anecdotal testimonials of the existence of a highly sensitive area in the distal anterior vaginal wall raise the question of whether enough investigative modalities have been implemented in the search of the G-spot.

Is there an association between female urinary incontinence and decreased genital sensation?

AIM: To explore the relationship between urinary incontinence and genital sensory functioning in females with sexual dysfunction disorders. METHODS: A retrospective consecutive chart review was conducted for all women who were referred to our tertiary female urology clinic with a primary complaint of sexual dysfunction between October 1999 and January 2009. Our study sample included 177 women, all of whom underwent a thorough clinical evaluation. Urinary incontinence was diagnosed based on clinical history and physical examination by a urogynecologist. The Genital Thermal and Vibratory Sensory Analyzer (GSA) was used for sensory testing in the genital area. Independent t-test and multivariate linear regression were used for statistical analysis. RESULTS: Of the 177 study patients (median age 34, range 18-68), 63 (36%) had urinary incontinence. Women with urinary incontinence were found to be less sensitive to warm, cold, and vibratory thresholds at both the anterior and the posterior vaginal wall and the clitoral area (P < 0.05). CONCLUSIONS: Women with urinary incontinence and sexual dysfunction are less sensitive to all sensory testing in the genital region than women with sexual dysfunction alone. This relationship may be attributable to afferent nerve damage and the critical role it may play in the etiology of urinary incontinence.

Who's afraid of the G-spot?

INTRODUCTION: No controversy can be more controversial than that regarding the existence of the G-spot, an anatomical and physiological entity for women and many scientists, yet a gynecological UFO for others. METHODS: The pros and cons data have been carefully reviewed by six scientists with different opinions on the G-spot. This controversy roughly follows the Journal of Sexual Medicine Debate held during the International Society for the Study of Women's Sexual Health Congress in Florence in the February of 2009. MAIN OUTCOME MEASURE: To give to The Journal of Sexual Medicine's reader enough data to form her/his own opinion on an important topic of female sexuality. RESULTS: Expert #1, who is JSM's Controversy section editor, reviewed histological data from the literature demonstrating the existence of discrete anatomical structures within the vaginal wall composing the G-spot. He also found that this region is not a constant, but can be highly variable from woman to woman. These data are supported by the findings discussed by Expert #2, dealing with the history of the G-spot and by the fascinating experimental evidences presented by Experts #4 and #5, showing the dynamic changes in the G-spot during digital and penile stimulation. Experts #3 and #6 argue critically against the G-spot discussing the contrasting findings so far produced on the topic. CONCLUSION: Although a huge amount of data (not always of good quality) have been accumulated in the last 60 years, we still need more research on one of the most challenging aspects of female sexuality.

Standards for clinical trials in male sexual dysfunctions.

INTRODUCTION: Clinical trials in male sexual dysfunction (MSD) are expanding. Consequently, there is a need for consensus standards in this area. AIM: To develop an evidence-based, state-of-the-art consensus report on standards for clinical trials in MSD. METHODS: A literature review was performed examining clinical trials in erectile dysfunction (ED), premature ejaculation (PE), delayed/absent ejaculation, libido disorders/loss of desire, hypogonadism, and Peyronie's disease, focusing on publications published in the last 20 years. This manuscript represents the opinions of eight experts from seven countries developed in a consensus process. This document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. MAIN OUTCOME MEASURE: Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS: According to experience and recent publications in dealing with clinical trials in sexual dysfunction, recommendations have been made for conducting trials in patients with ED, PE, delayed ejaculation, libido disorders, hypogonadism, and Peyronie's disease. CONCLUSIONS: It is important that future clinical trials are conducted using standards upon which investigators can rely when reading manuscripts or conducting new trials in this field.

Summary of the recommendations on sexual dysfunctions in men.

INTRODUCTION: Sexual health is an integral part of overall health. Sexual dysfunction can have a major impact on quality of life and psychosocial and emotional well-being. AIM: To provide evidence-based, expert-opinion consensus guidelines for clinical management of sexual dysfunction in men. METHODS: An international consultation collaborating with major urologic and sexual medicine societies convened in Paris, July 2009. More than 190 multidisciplinary experts from 33 countries were assembled into 25 consultation committees. Committee members established scope and objectives for each chapter. Following an exhaustive review of available data and publications, committees developed evidence-based guidelines in each area. Main Outcome Measures. New algorithms and guidelines for assessment and treatment of sexual dysfunctions were developed based on work of previous consultations and evidence from scientific literature published from 2003 to 2009. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of medical literature, and cultural and ethical considerations. RESULTS: Algorithms, recommendations, and guidelines for sexual dysfunction in men are presented. These guidelines were developed in an evidence-based, patient-centered, multidisciplinary manner. It was felt that all sexual dysfunctions should be evaluated and managed following a uniform strategy, thus the International Consultation of Sexual Medicine (ICSM-5) developed a stepwise diagnostic and treatment algorithm for sexual dysfunction. The main goal of ICSM-5 is to unmask the underlying etiology and/or indicate appropriate treatment options according to men's and women's individual needs (patient-centered medicine) using the best available data from population-based research (evidence-based medicine). Specific evaluation, treatment guidelines, and algorithms were developed for every sexual dysfunction in men, including erectile dysfunction; disorders of libido, orgasm, and ejaculation; Peyronie's disease; and priapism. CONCLUSIONS: Sexual dysfunction in men represents a group of common medical conditions that need to be managed from a multidisciplinary perspective.

Can stronger pelvic muscle floor improve sexual function?

INTRODUCTION AND HYPOTHESIS: This study aims to evaluate the association between pelvic floor muscle (PFM) strength and sexual functioning. METHODS: Retrospective chart review of consecutive all women who were referred with a primary complaint of sexual dysfunction. Women underwent standardized clinical evaluation including pelvic muscle strength which was ranked from 0 (weak) to 2 (strong). The duration of pelvic muscle contraction was also recorded in seconds. Sexual function was evaluated by using a validated questionnaire, the Female Sexual Function Index (FSFI). RESULTS: One hundred seventy-six women with a mean age of 37 +/- 11 years were included. Women with strong or moderate PFM scored significantly higher on the FSFI orgasmic and arousal domains than women with weak PFM (5.4 +/- 0.8 vs. 2.8 +/- 0.8, and 3.9 +/- 0.5 vs. 1.7 +/- 0.24, respectively; P < 0.001). The duration of PFM contraction was correlated with FSFI orgasmic domain and sexual arousal (r = 0.26, P < 0.001; r = 0.32, P < 0.0001, respectively). CONCLUSIONS: Our findings suggest that both the orgasm and arousal function are related to better PFM function.

Effect of chronic sildenafil treatment on penile endothelial function: a randomized, double-blind, placebo controlled study.

PURPOSE: Although the effect of phosphodiesterase type 5 inhibitors on endothelial function in the systemic circulation has been extensively studied, its effect on penile endothelial function remains unexplored. Therefore, we evaluated the effect of daily sildenafil on penile endothelial function. MATERIALS AND METHODS: A total of 60 patients with erectile dysfunction were randomized blindly to daily placebo or 50 mg sildenafil for 4 weeks. Penile and forearm blood flow as well as endothelial function indices were measured at baseline and after 4 weeks using venoocclusive strain gauge plethysmography for both organs. Sequential changes in flow, maximal blood flow and area under the curve induced by reactive hyperemia after 5 minutes of transient ischemia were considered indices of endothelial function. RESULTS: There were 34 patients treated with sildenafil and 19 on placebo who completed the study. The general characteristics of both groups were comparable. Mean +/- SEM baseline penile blood flow was 6.2 +/- 1.4 and 7.0 +/- 0.6 ml/dl per minute for the placebo and sildenafil groups, respectively (p = 0.54). Baseline forearm blood flow was similar in both groups. At baseline penile AUC was 420 +/- 50 and 520 +/- 50 (p = 0.18), and in the forearm it was 445 +/- 40 and 410 +/- 40 (p = 0.45) for the placebo and sildenafil groups, respectively. After 4 weeks on the assigned drug penile blood flow increased to 11.2 +/- 2 ml/dl per minute in the sildenafil group (p = 0.02) and remained unchanged in the placebo group. After 4 weeks penile AUC increased to 720 +/- 65 in the sildenafil group (0.04) and remained unchanged in the placebo group. Placebo and sildenafil did not affect the indices of forearm endothelial function. CONCLUSIONS: Daily sildenafil significantly improves penile blood flow and penile endothelial function indices without causing any relevant systemic effects.

Is there a place for conservative treatment in Peyronie's disease?

INTRODUCTION: Peyronie's disease (PD) is a relatively common disorder affecting middle aged men. Conservative nonsurgical treatments include oral, topical, and intra-lesional pharmacotherapies, vacuum stretching, and mechanical traction. METHODS: Four people with expertise and/or interest in the area of PD were asked to contribute their opinions with regard to the safety and efficacy of nonsurgical conservative treatments. MAIN OUTCOME MEASURE: To provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine. RESULTS: Of the four experts writing on the topic, one believes a combination of medical therapy and penile traction has positive potential for curvature. Another feels that although medical therapies have potential to alleviate pain, there is little evidence to show that they help with curvature or that penile traction helps. A third expert proposes dividing the disease into phases, where patients in the acute phase may benefit from conservative therapy, whereas patients whose disease is stable require surgical intervention. The last expert agrees that the therapy should depend on the stage of the disease, but believes like the first expert that there is a role for traction therapy for patients with stable disease. CONCLUSION: There is a need for guidelines for nonsurgical therapies for patients with PD, but there is a paucity of evidence as to their efficacy.

The p300 event-related potential technique for libido assessment in women with hypoactive sexual desire disorder.

INTRODUCTION: There is a need for an objective technique to assess the degree of hypoactive sexual desire disorder (HSDD). Recently, we described such a methodology (event-related potential technique [ERP]) based on recording of p300 electroencephalography (EEG) waves elicited by auditory stimuli during synchronous exposure to erotic films. AIMS: To compare sexual interest of sexually healthy women to females with sexual dysfunction (FSD) using ERP, and to explore whether FSD women with and without HSDD would respond differently to two different types of erotic stimuli-films containing (I) or not containing (NI) sexual intercourse scenes. METHODS: Twenty-two women with FSD, of which nine had HSDD only, and 30 sexually healthy women were assessed by the Female Sexual Functioning Index. ERP methodology was performed applying erotic NI or I films. MAIN OUTCOME MEASURES: Significant differences in percent of auditory p300 amplitude reduction (PR) in response to erotic stimuli within and between all three groups for each film type. RESULTS: PRs to each film type were similar in sexually healthy women (60.6% +/- 40.3 (NI) and 51.7% +/- 32.3 [I]), while in women with FSD, reduction was greater when viewing the NI vs. I erotic films (71.4% +/- 41.0 vs. 37.7% +/- 45.7; P = 0.0099). This difference was mainly due to the greater PR of the subgroup with HSDD in response to NI vs. I films (77.7% +/- 46.7 vs. 17.0% +/- 50.3) than in the FSD women without HSDD group or the sexually healthy women (67.5% +/- 38.7 vs. 50.4% +/- 39.4 respectively), P = 0.0084. For comparisons, we used the mixed-model one-way analysis of variance. CONCLUSIONS: Differences in neurophysiological response patterns between sexually healthy vs. sexually dysfunctional females may point to a specific inverse discrimination ability for sexually relevant information in the subgroup of women with HSDD. These findings suggest that the p300 ERP technique could be used as an objective quantitative tool for libido assessment in sexually dysfunctional women.

The status of penile enhancement procedures.

PURPOSE OF REVIEW: Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmorphism). This fact by itself leads to controversy regarding the true indications for penile enhancement procedures in men without micropenis. RECENT LITERATURE: One of the typical aspects of penile enhancement is the lack of true methodological evaluation of the more commonly performed procedures. Even recently, only few solid scientific studies are available which can shed some light on results and outcome of these controversial procedures. SUMMARY: Although some additional data has emerged during the past year, there is still no consensus in regard to indications and surgical techniques used for penile augmentation or penile girth enhancement. There is further need for more studies to provide a better overview of the value and worthiness of these procedures.

Observations relating to urinary sensation during detrusor overactivity.

AIMS: To describe the temporal relationship between increases in lower urinary tract (LUT) sensation and changes in detrusor and/or urethral pressures measured in real time. METHODS: We reviewed 33 multichannel urodynamic tracings that included a continuous recording of LUT sensation and that demonstrated detrusor overactivity incontinence (DOI) or detrusor overactivity (DO). Four physicians reviewed each urodynamic tracing and reached agreement about the temporal relationship between LUT sensation and detrusor contraction. RESULTS: Median age was 60 (36-82) years. Fourteen (42%) had urodynamic diagnoses of mixed incontinence, 18 (55%) had DOI, and 1 (3%) had DO without DOI. We reviewed 119 episodes of detrusor overactivity from the 33 recordings. We found no difference in change in sensation level when comparing DO episodes with DOI episodes or between different urodynamic diagnoses (P > 0.5). There was no dominant temporal pattern seen for the whole group (P = 0.84), that is, there was no evidence that the change in sensation level was more likely to occur before, during, or after DO/DOI episodes. When evaluating the changes in the urethral pressure, the most common pattern seen was an increase in sensation level after a fall in urethral pressure, but no dominant pattern was seen. CONCLUSIONS: Our findings suggest that increased LUT sensation during DO/DOI is not reliably caused by measurable alterations in bladder or urethral pressure.

Validation of a real-time urodynamic measure of urinary sensation.

OBJECTIVE: The purpose of this study was to test the feasibility and validity of a continuous measurement of urinary sensation during cystometry. STUDY DESIGN: Subjects continuously recorded their level of urinary sensation during cystometry with the use of urodynamic diagnoses and responses to the Medical Epidemiologic and Social Aspects of Aging (MESA) and Urinary Distress Inventory (UDI) scales. Trends in urinary sensation recordings by increasing percentage of maximum cystometric capacity (MCC) were captured and compared with the use of growth curves. RESULTS: Fifty-one women participated: 18 patients had detrusor overactivity incontinence (DOI); 15 patients had urodynamic stress incontinence; 9 patients had mixed incontinence, and 9 patients did not demonstrate incontinence. In the volume range between 35% and 75% of MCC, the mean sensation level was higher in the DOI group than the other groups (P < .04). Urge sensation at 50% of MCC correlated with UDI and MESA urge subscales (rho = 0.34, p < .03 and rho = 0.39, p < .02). CONCLUSION: This study demonstrates that the Urgeometer measurement is feasible and correlates with urodynamic diagnosis and the severity and bother from urge incontinence.

Are premature ejaculation symptoms curable?

INTRODUCTION: While premature ejaculation (PE) is the most common sexual dysfunction in men under 40, there is currently no government-approved therapy for its treatment. Is a cure possible? METHODS: Four experts in the area of PE and its treatment were asked to contribute their opinions. MAIN OUTCOME MEASURE: To provide food for thought, discussion, and possible further research in a poorly understood area of sexual medicine. RESULTS: Differences among the different types of PE, and the ability to cure them are discussed. One expert examines the possible differences in lifelong and acquired PE as an explanation as to why treatment for the former does not carry over after termination of treatment whereas the latter can be treated successfully. The second and third experts break PE into four categories, explaining that those forms that are curable at present are not true PE or are based on anxiety. The last expert discusses the potential of a combined clinical and research platform to better understand the relative contributions of biological, behavioral, and couple factors to the disorder for potential curability. CONCLUSION: Improved understanding of the types of PE and their various etiologies and pathophysiologies would improve the potential for cure.

Cavernosometry: is it a dinosaur?

INTRODUCTION: Is cavernosometry a useful tool in treating men with erectile dysfunction? METHODS: Five people with expertise and/or interest in the area of cavernosometry were asked to contribute their opinions. MAIN OUTCOME MEASURE: To provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine. RESULTS: While one urologist feels dynamic infusion cavernosography and cavernosometry seem to have found their place in history, another believes it is time to separate these tests and look at cavernosometry alone and its relevance to the use of duplex Doppler ultrasound, both useful tools in assessing surgical candidates. Three clinicians agree that cavernosography and cavernosometry have a role in specific cases, particularly before revascularization surgery. CONCLUSION: Cavernosometry may not be a useful tool for the average clinician treating erectile dysfunction, but serves a purpose for the specialist.