Erectile Dysfunction Archives - Grand Rounds in Urology

Biologics in Sexual Medicine – Controversy and Therapeutic Potential

by Trinity J. Bivalacqua, MD, PhD | Aug 2020

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology and R. Christian B. Evensen Associate Professor of Urology and Oncology at the James Buchanan Brady Urological Institute of Johns Hopkins Medicine in Baltimore, Maryland, discusses studies on biologics and low-intensity extracorporeal shock wave therapy (Li-ESWT), as well as controversial misinformation surrounding their use in sexual medicine. He reviews the results of a Li-ESWT study which displayed the treatment’s ability to improve symptoms, exercise capacity, and myocardial perforation in patients with severe coronary artery disease without indication for percutaneous coronary intervention or coronary artery bypass graft surgery. He then argues that for-profit stem cell clinics who offer biologic treatment for sexual medicine promise results with no supporting efficacy data, and that the trials these clinics use for support are not well-designed. Dr. Bivalacqua concludes that there is a demonstrated therapeutic potential for biologics, but more research is needed to support their use in sexual medicine and to prove their therapeutic value.

Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy

by John P. Mulhall, MD | Sep 2019

John P. Mulhall, MD, discusses the significant sexual and non-sexual adverse events of low testosterone resulting from using androgen deprivation therapy (ADT) to treat men with prostate cancer. He emphasizes the need for physicians to counsel patients on long-term expectations and to obtain fully-informed consent prior to the initiation of this therapy.

Disease Modification and Erectile Dysfunction: Stem Cells, Shockwave, and PRP

by Mohit Khera, MD, MBA, MPH | Sep 2019

Mohit Khera, MD, MBA, MPH, discusses the shifting paradigms in modern erectile dysfunction (ED) treatment, as reflected by the 2018 American Urological Association ED guidelines. These paradigms focus on shared decision-making, lifestyle modifications, and the concern for cardiovascular risk. He then describes mechanisms of and initial data on experimental regenerative techniques for treating ED, including low-intensity shockwave therapy, stem cell therapy, and platelet-rich plasma (PRP) therapy.

Novel Oral Pharmacotherapies for ED: Are PDE5 Inhibitors the Final Answer?

by Alan W. Shindel, MD, MAS | Aug 2019

Alan W. Shindel, MD, MAS, discusses the current treatment of erectile dysfunction (ED) with PDE5 inhibitors, as well as the limitations of the currently available drugs for ED patients. He also reviews a number of potential targets for novel ED treatments, including nitric oxide, soluble guanylate cyclase, the RhoA/Rho Kinase/ROCK pathway, and the Sonic Hedgehog protein.

New Frontiers in Cavernous Nerve Restorative Therapy to Preserve Erectile Function after Radical Prostatectomy

by Arthur L. Burnett II, MD, MBA, FACS | Aug 2019

Arthur L. Burnett II, MD, MBA, FACS, presents the rationale for invoking therapeutic strategies for enhancing erectile function recovery following radical prostatectomy. He assesses possible therapeutic strategies that target the cavernous nerve in order to restoring erectile function and identifies the requirements and future possibilities for penile rehabilitation success.

Shockwave Therapy for ED: Miracle or Hype?

by Alan W. Shindel, MD, MAS | Jul 2019

Alan W. Shindel, MD, MAS, reviews the basic scientific concepts behind low intensity shock wave therapy and the rationale for its use in the management of erectile dysfunction (ED). He discusses existing data from both animal and human models supporting this treatment, as well as the knowledge gaps that must be addressed before adopting it into clinical practice.

Erectile Dysfunction: Perspective and Nuance from the 2018 AUA Guidelines

by Alan W. Shindel, MD, MAS | Jul 2019

Alan W. Shindel, MD, MAS, reviews the framework for evaluation and management of erectile dysfunction set forth in the 2018 American Urological Association (AUA) Guidelines. He discusses how physicians can incorporate these guidelines into their practices while still determining the most effective approach for individual patients through shared decision-making.

Update on 2018 AUA Testosterone and ED Guidelines

by Mohit Khera, MD, MBA, MPH | Dec 2018

Mohit Khera, MD, MBA, MPH, introduces the 2018 American Urological Association (AUA) guidelines for testosterone therapy and erectile dysfunction. He also describes inconsistencies between these guidelines and various institutions’ statements regarding these clinical areas.

Male Anorgasmia: From “No” to “Go!”

by Alexander W. Pastuszak, MD, PhD | Nov 2018

Alexander Pastuszak, MD, PhD, reviews the anatomy and physiology relevant to delayed ejaculation and anorgasmia, as well as the causes and diagnosis of these conditions. He also discusses psychosexual and behavioral coaching treatment approaches for these conditions and evidence for pharmacotherapy options.

Testosterone Replacement and Focal Therapy

by Mohit Khera, MD, MBA, MPH | Oct 2018

Mohit Khera, MD, MBA, MPH, reviews the literature surrounding the safety of testosterone replacement therapy (TRT) following prostate cancer treatment, including after brachytherapy, EBRT, and radical prostatectomy (RP). He also discusses the concept of bipolar androgen therapy (BAT) and the importance of TRT for erectile preservation post-RP.

Long-Term Erectile Dysfunction and Urinary Morbidity Following Brachytherapy

by Nelson N. Stone, MD | Jul 2018

Nelson N. Stone, MD, discusses changes in urinary symptoms and erectile function, as measured by the International Prostate Symptom Score (IPPS), at 10 and 15 years following prostate brachytherapy. Subsequently, he advises clinicians on best practices in seed implantation and long-term management to optimize cancer control and minimize adverse symptoms.

Clinical Care Pathway for Anejaculation

by John P. Mulhall, MD | Jun 2018

John P. Mulhall, MD, the chair of the committee for the American Urological Association (AUA) testosterone guidelines, summarizes indications regarding anejaculation. He explains the anatomical and physiological differences of retrograde ejaculation and failure of emission, and possible etiologies for these symptoms. Furthermore, he reviews the recommendations for diagnosis, management, and use of electroejaculation for semen retrieval.

Topic: Erectile Dysfunction

Biologics in Sexual Medicine – Controversy and Therapeutic Potential

Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy

Disease Modification and Erectile Dysfunction: Stem Cells, Shockwave, and PRP

Novel Oral Pharmacotherapies for ED: Are PDE5 Inhibitors the Final Answer?

New Frontiers in Cavernous Nerve Restorative Therapy to Preserve Erectile Function after Radical Prostatectomy

Shockwave Therapy for ED: Miracle or Hype?

Erectile Dysfunction: Perspective and Nuance from the 2018 AUA Guidelines

Update on 2018 AUA Testosterone and ED Guidelines

Male Anorgasmia: From “No” to “Go!”

Testosterone Replacement and Focal Therapy

Long-Term Erectile Dysfunction and Urinary Morbidity Following Brachytherapy

Clinical Care Pathway for Anejaculation

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