Bruno Giammusso

AMS Three–Piece Inflatable Implants for Erectile Dysfunction: A Long–Term Multi–Institutional Study in 200 Consecutive Patients

Objectives: The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three–piece inflatable implants and their impact on patient–partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions.Methods: Patient charts included in the study were collected and extensively assessed to record pre– and intraoperative data and postoperative complications. All patients and 120 partners were then seen often in the office at a mean follow–up of 59 months (range 6–130) and they were extensively questioned about function of the device and its impact on the couple’s sexual life.Results: At the long–term follow–up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17%) cases, respectively. Postoperative sexual activity was considered excellent, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients’ complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners’ main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan–Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex type of cylinders compared to the CX type of cylinders.Conclusions: AMS three–piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postoperative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long–term, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.

Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study

Peyronies disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature. However, only few monocentric studies are available in the current literature and this is the first national multicentric study focusing on this new treatment. In five Italian centres, 135 patients have completed the treatment with three injections of CCH using Ralphs shortened modified protocol. The protocol consisted of three intralesional injections of CCH (0.9 mg) given at 4‐weekly intervals in addiction to a combination of home modelling, stretching and a vacuum device on a daily basis. An improvement in the angle of curvature was recorded in 128/135 patients (94.8%) by a mean (range) of 19.1 (0–40)° or 42.9 (0–67)% from baseline (p < 0.001). There was also a statistically significant improvement in all IIEF and PDQ questionnaires subdomains (p < 0.001 in all subdomains). This prospective multicentric study confirms that the three‐injection protocol is effective enough to achieve a good result and to minimize the cost of the treatment.

Predictors of treatment success after collagenase Clostridium histolyticum injection for Peyronie's disease: development of a nomogram from a multicentre single-arm, non-placebo controlled clinical study

To build a nomogram able to predict treatment success after collagenase Clostridium histolyticum (CCH) for Peyronies disease (PD).

Male sexual distress: from definition to clinical approach

Objectives The Italian Society of Andrology recently described Male Sexual Distress (MSD) as a new condition. A self-administered ad-hoc questionnaire, the Sexual Distress Evaluation Questionnaire for Men (SDEQ-M), has been subsequently validated. Our present aim is to perform a Study on Prevalence, Risk Factors and Quality of Life in male people affected by Sexual Distress attending Andrology Clinics across Italy. Materials and Methods Type of study: naturalistic, cross-sectional, multicentric. Enrollment: sequential, at Andrology Specialist Clinics. Expected number of centers involved: 50, throughout Italy. Inclusion Criteria: age >18, subjects affected with ED or MSD, informed consent signature. Used scales: SDEQ-M; International Index of Erectile Function (IIEF); Quality of erections (Erection Hardness Score, Quality of Erection Questionnaire); Quality of life (EQ-5D Questionnaire); Life Satisfaction Scale. Results Total expected number of enrolled subjects: 1000 men. An interim report of the study will be presented at the Congress. Discussion Sexual Distress sufferers have impairment of their sexual health, with possible significant impact on their emotional, mental and social well-being. The Italian Society of Andrology feels that it is the duty of the Sexual Medicine specialist to acknowledge the requests for help presented also by these sufferers. This study is instrumental in further elucidating the implications of Sexual Distress, through: investigation of its prevalence, identification of possible risk factors, measurement of the quality of life of men affected by Sexual Distress.