Peyronie’s Disease is an incurable condition of the tunica albuginea of the penis associated with scarring, plaque formation, and penile deformity on erection. It is often associated with erectile dysfunction. Recent data have supported a familial and genetic predisposition to this chronic condition. The etiology of Peyronie’s Disease is unknown, but is likely associated with multiple micro traumas to the erect penis in men who are susceptible to the scarring typical of Peyronie’s Disease. The treatment of Peyronie’s Disease has improved over the past decade as a result of animal studies and the approval of new medications. In the acute phase of the condition, phosphodiesterase type 5 inhibitors have been shown to have some benefit and are supported by animal studies demonstrating reduced fibrosis of the penis in animal models of Peyronie’s Disease. In the stable phase of the disease, newer injectable agents have shown great promise. Collagenase clostridium histolyticum is approved for the treatment of Peyronie’s plaques by direct injection into the scarred tissue with data showing satisfactory safety and efficacy. Surgical procedures for penile straightening have been refined with improved outcomes in the past decade. For those men with erectile dysfunction and Peyronie’s Disease, penile implants can restore erectile function and form. As a result of the new understanding of the risk factors for Peyronie’s Disease and recent advances in treatment options, the algorithm for the treatment of Peyronie’s Disease has improved outcomes for patients and their partners.

No AccessJournal of UrologyEditorial1 Dec 2007Vascular Risk Factors for Erectile Dysfunctionis companion ofThe Effect of Vascular Risk Factors on Penile Vascular Status in Men With Erectile Dysfunction Culley C. Carson Culley C. CarsonCulley C. Carson Financial interest and/or other relationship with Pfizer, Lilly and GSK. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.09.005AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Vascular Risk Factors for Erectile Dysfunction." The Journal of Urology, 178(6), pp. 2250–2251 References 1 : Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol1994; 151: 54. Link, Google Scholar 2 : The metabolic syndrome and erectile dysfunction: multiple vascular risk factors and hypogonadism. Eur Urol2006; 50: 426. Google Scholar 3 : Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J2006; 27: 2632. Google Scholar 4 : Erectile dysfunction and subsequent cardiovascular disease. JAMA2005; 294: 2996. Google Scholar 5 : Erectile dysfunction as a risk factor for coronary heart disease: implications for prevention. Int J Clin Pract2007; 61: 265. Google Scholar 6 : Erectile dysfunction: a marker of silent coronary artery disease. Eur Heart J2006; 27: 2613. Google Scholar 7 : Relation of erectile dysfunction to angiographic coronary artery disease. Am J Cardiol2003; 91: 230. Google Scholar 8 : Endothelial cell activation in men with erectile dysfunction without cardiovascular risk factors and overt vascular damage. J Urol2004; 171: 1601. Link, Google Scholar 9 : Atorvastatin enhances sildenafil-induced vasodilation through nitric oxide-mediated mechanisms. Eur J Pharmacol2004; 498: 189. Google Scholar 10 : Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol2005; 96: 313. Google Scholar Department of Urology, University of North Carolina, Chapel Hill, North Carolina© 2007 by American Urological AssociationFiguresReferencesRelatedDetailsRelated articlesJournal of Urology15 Oct 2007The Effect of Vascular Risk Factors on Penile Vascular Status in Men With Erectile Dysfunction Volume 178 Issue 6 December 2007 Page: 2250-2251 Advertisement Copyright & Permissions© 2007 by American Urological AssociationMetrics Author Information Culley C. Carson Financial interest and/or other relationship with Pfizer, Lilly and GSK. More articles by this author Expand All Advertisement PDF downloadLoading ...

Objectives To determine the efficacy, safety, and treatment satisfaction of tadalafil 20 mg for erectile dysfunction (ED) in patients evaluated at tertiary-care academic centers. Methods In this randomized, double-blind, placebo-controlled trial, patients were randomly allocated to receive fixed-dose tadalafil 20 mg (n = 146) or placebo (n = 49) for 12 weeks. Efficacy was assessed by the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and Global Assessment Question (GAQ); patient and partner treatment satisfaction by the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and SEP; and safety by adverse events, laboratory values, and vital signs. Results Mean baseline IIEF erectile function (EF) domain was 12.98. Fifty-one percent of enrolled patients had severe baseline ED, and 82% had organic ED. Pre-existing, ED-associated comorbid conditions were common. When compared with patients treated with placebo, those receiving tadalafil reported significant improvement from baseline in the IIEF EF domain (P <0.001), successful penetration attempts (SEP question 2; P <0.001), successful intercourse (SEP question 3; P <0.001), and all secondary efficacy outcomes (P <0.001). Patients and their sexual partners were also significantly more satisfied with tadalafil treatment (P <0.001), including overall satisfaction (P <0.001) and length of time the treatment worked (P <0.001). Mild or moderate headache, dyspepsia, and myalgia were the most frequent treatment-emergent adverse events reported. Conclusions Tadalafil significantly improved erectile function and patient and partner satisfaction and was well tolerated. These results were observed in a tertiary-care, academic center population with a high incidence of severe, organic ED, and comorbid medical conditions, factors known to compromise erectile function and treatment outcome.

Erectile dysfunction (ED) is an associated morbidity for men with chronic renal failure. An understanding of the epidemiology, anatomy, physiology, and treatment options for ED can greatly improve the quality of life for men with chronic renal failure. There are psychological and physiological causes for erectile dysfunction. Once the key features leading to the patient's loss of potency have been identified, appropriate treatment plans can be instituted, often with successful outcomes. The purpose of this article is to assist the nephrology interdisciplinary team in the management of ED by reviewing possible causes, available studies, and treatment options for their patients.

Aims of the study: Minimally invasive therapy for erectile dysfunction (ED) has changed the frequency of penile prosthesis surgery. The purpose of this study is to describe the changes in frequency, hospital stay, hospital charges and penile prosthesis type in North Carolina. Materials and Methods: The data source was a statewide hospital discharge database which includes data on hospitalized patients for all 151 hospitals in North Carolina. Results: From 1988–1993, 2354 patients underwent implantation of penile prostheses. The total number of penile prostheses implanted has declined over this six year period. Similarly, hospital stay has declined from an average of 4.03–2.96 d with a 46.6% decrease in total hospital days. Despite this change in hospital stay, hospital charges rose significantly from an average of $7252.48 to $12 842.18 driving total charges from $2 973 516.80 to $3 826 969.60 (1993) representing a 28.7% increase. Conclusions: Minimally invasive therapy and changes in reimbursement have had a major impact on the number of patients undergoing penile prosthesis implantation for ED. This downward trend may continue as more treatment options develop from the marked increase in research in this field. However, this may result in an increase of patients seeking treatment overall.

Objectives. Significant obesity is considered to be a relative contraindication to laparoscopic surgery. This study reviews the complications encountered in massively obese patients undergoing urologic laparoscopic surgery.Methods. Body mass index (BMI) was used as an objective index to indicate massive obesity. Eleven institutions compiled retrospective data on 125 patients having a BMI greater than 30. Procedures performed included 76 pelvic lymph node dissections, 14 nephrectomies, 7 bladder neck suspensions, and 28 miscellaneous procedures.Results. For the group as a whole, the mean BMI was 35.1 (range 30.1 to 57.2). Mean operative time was 202 minutes (range 60 to 480). Conversion to open surgery occurred in 15 of the 125 patients (12%). Complication rates (minor and major) were 22% (27 occurrences in 125 patients) intraoperatively and 26% (33 occurrences in 125 patients) postoperatively. The major complications included 2 trocar injuries to abdominal wall vessels, 1 bladder injury, 3 peripheral nerve injuries, 1 dysrhythmia, 1 deep vein thrombosis, 1 wound seroma, 1 nephrocutaneous fistula, 1 incisional hernia, and I death.Conclusions. In this review, complication rates for urologic laparoscopic surgery on massively obese patients were higher than in the general population undergoing laparoscopic surgery (0.3% to 21%).