Geetu Pahlajani

Vacuum Erection Devices Revisited: Its Emerging Role in the Treatment of Erectile Dysfunction and Early Penile Rehabilitation Following Prostate Cancer Therapy

INTRODUCTION Vacuum erection devices (VEDs) are becoming first-line therapies for the treatment of erectile dysfunction and preservation (rehabilitation) of erectile function following treatment for prostate cancer. Currently, there is limited efficacy of the use of phosphodiesterase type 5 inhibitors in elderly patients, or patients with moderate to severe diabetes, hypertension, and coronary artery disease. AIM The article aims to study the role of VED in patients following prostate cancer therapy. RESULTS Alternative therapies such as VED have emerged as one of the primary options for patients refractory to oral therapy. VED has also been successfully used in combination treatment with oral therapy and penile injections. More recently, there has been interest in the use of VED in early intervention protocols to encourage corporeal rehabilitation and prevention of postradical prostatectomy veno-occlusive dysfunction. This is evident by the preservation of penile length and girth that is seen with early use of the VED following radical prostatectomy. There are ongoing studies to help preserve penile length and girth with early use of VED following prostate brachytherapy and external beam radiation for prostate cancer. Recently, there has also been interest in the use of VED to help maintain penile length following surgical correction of Peyronies disease and to increase penile size prior to implantation of the penile prosthesis. CONCLUSION VEDs can be one of the options for penile rehabilitation after prostate cancer therapy.

Long-term potency after early use of a vacuum erection device following radical prostatectomy

Study Type – Prognosis (case series)
Level of Evidence 4

Early intervention with phosphodiesterase-5 inhibitors after prostate brachytherapy improves subsequent erectile function.

Study Type – Therapy (case series)
Level of Evidence 4

The clinical utility of atypical cytology is significantly increased in both screening and monitoring for bladder cancer when indexed with nuclear matrix protein‐22

To assess atypical cytology as a positive bladder tumour marker and to determine if indexing atypical cytology to nuclear matrix protein‐22 (NMP22) can decrease the false‐positive results or increase the positive predictive value (PPV).

Treatment of erectile dysfunction: update.

Erectile dysfunction (ED) is the inability to achieve and maintain an erection. Erectile function is dependent upon complex interactions of neural and vascular pathways. A major neurotransmitter that facilitates erectile function is nitric oxide. Treatment of ED has expanded to include effective oral agents. Previous ED treatments have consisted of intracavernosal injection, transurethral dilators, and vascular constriction devices. Clinical management of ED will be presented with some discussion on the prostatectomy client.

Laparoscopic surgery for endometriosis-associated infertility: a pathophysiologic approach

Endometriosis has been one of the most confusing gynecological diseases since it was first described. Whereas there is a reasonable body of evidence in literature to demonstrate an association between endometriosis and infertility, a definite cause and effect relationship has not been established. The mechanism by which endometriosis causes infertility remains an enigma. Virtually every aspect of reproduction in women with endometriosis has been investigated and purported to be impaired. Impairment of implantation and pregnancy rates seems to affect women with endometriosis. Whether this is due to poor quality embryos derived from impaired oocytes or endometrial defects or both has been argued. Structural abnormalities of the uterine wall and tube in women with endometriosis have also been described by other researchers. Adding more confusion to this topic is the altered immune function and the peritoneal environment and their detrimental effects on the sperm motility and morphology. This uncertain pathophysiology has resulted in the lack of consensus on the treatment of endometriosis-associated infertility. The aim of this review is to describe the current pathophysiology of endometriosis-related infertility, how laparoscopic surgery may influence fertility rates.

A rigidity question increases the sensitivity of the sexual health inventory of men questionnaire for comparison of phosphodiesterase-5 inhibitor therapies

Geetu Pahlajani, MD, rraina@metrohealth.org, Rupesh Raina, MD, rraina@metrohealth.org, Ashok Agarwal, PhD, agarwaa@ccf.org and Craig D Zippe, MD, verdir@ccf.org. urology, Mary Mount Hospital (Cleveland Clinic Foundation), cleveland, OH, United States, 44125; Med-Peds, Metro Health Medical Center, Cleveland, OH, United States, 44109; Urology, Cleveland Clinic Foundation, cleveland, ohio, United States and Urology, Mary Mount Hospital (Cleveland Clinic Foundation), Cleveland, ohio, United States, 44125.