Urological Survey Male and Female Sexual Function and Dysfunction; Andrology Re: A Validated Age-Related Normative Model for Male Total Testosterone Shows Increasing Variance but No Decline after Age 40 Years T. W. Kelsey, L. Q. Li, R. T. Mitchell, A. Whelan, R. A. Anderson and W. H. Wallace School of Computer Science, University of St. Andrews, St. Andrews, and School of Medicine and MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh and Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom PLoS One 2014; 9: e109346.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.02.062 available at http://jurology.com/ Editorial Comment: Using model selection and validation analysis of data identified and extracted from 13 studies, the authors derive and validate a normative model of total testosterone across the life span in healthy men. Total testosterone peaks (mean 2.5th to 97.5th percentile) at 15.4 nmol/l (range 7.2 to 31.1) at an average age of 19 years, and decreases in the average individual to 13.0 nmol/l (6.6 to 25.3) by age 40 years but there is no evidence of a further reduction in mean total testosterone with increasing age through old age. However, there is an increased variation in total testosterone levels after age 40 years. These data are at odds with many other data sets that demonstrate an age related decline in serum testosterone levels. Further studies will be needed to clarify this issue. Allen D. Seftel, MD
Re: Malleable Penile Prosthesis is a Cost-Effective Treatment for Refractory Ischemic Priapism T. J. Tausch, L. C. Zhao, A. F. Morey, J. A. Siegel, M. J. Belsante, C. A. Seideman and J. R. Flemons Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas J Sex Med 2014; Epub ahead of print.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.02.063 available at http://jurology.com/ Editorial Comment: The authors retrospectively reviewed the records of patients undergoing malleable penile prosthesis (MPP) placement for refractory ischemic priapism (RIP) between 2007 and 2013. During the 6-year study period 14 men underwent MPP placement acutely for refractory priapism, of whom 13 presented with RIP and 1 had stuttering priapism during a 14-day hospitalization. Etiologies included sickle cell anemia (4 of 13 patients, 29%), medication induced priapism (3 of 14, 21%) and idiopathic disease (7 of 14, 50%). Average preoperative duration of RIP was 82 hours, with considerable consumption of health care resources. Average estimated cost was $83,818, with 4 emergency room visits (range 1 to 27), 2 hospitalizations (1 to 5), 1.5 shunt procedures (1 to 3), 5 irrigation and drainage procedures using phenylephrine injection (2 to 20)
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and 5 days of hospitalization (2 to 14). All patients were discharged home within 24 hours of MPP surgery. These data are reassuring and suggest that insertion of an MPP should be an option for patients with RIP. Allen D. Seftel, MD
Suggested Reading Roghmann F, Becker A, Sammon JD et al: Incidence of priapism in emergency departments in the United States. J Urol 2013; 190: 1275.
Re: High Submuscular Placement of Urologic Prosthetic Balloons and Reservoirs: 2-Year Experience and Patient-Reported Outcomes P. H. Chung, A. F. Morey, T. J. Tausch, J. Simhan and J. F. Scott Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas Urology 2014; 84: 1535e1540.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.02.064 available at http://jurology.com/ Editorial Comment: The authors present their updated experience and patient reported outcomes of high submuscular (HSM) placement of urological prosthetic balloons and reservoirs (UPBRs) between 2011 and 2013. A total of 146 patients underwent 158 HSM implantations, with use of inflatable penile prosthesis reservoirs in 93 and artificial urinary sphincter balloons in 65. Patients completed a standardized survey at a mean of 3.2 months postoperatively (range 1.1 to 23.4) and were last followed at a mean of 5.5 months (1.1 to 28.7). Overall UPBRs caused no bother in 149 cases (94%) and resulted in a satisfactory outcome in 151 (96%). Individuals were unable to palpate UPBRs in 126 cases (80%) and could minimally palpate UPBRs in 26 cases (16%). These data suggest that HSM is feasible and that the outcome of HSM placement is reasonable. Allen D. Seftel, MD
Suggested Reading Oberlin DT, Matulewicz RS, Bachrach L et al: National practice patterns for treatment of erectile dysfunction with penile prosthesis implantation. J Urol 2014; Epub ahead of print.
Re: High Patient Satisfaction of Inflatable Penile Prosthesis Insertion with Synchronous Penile Plication for Erectile Dysfunction and Peyronie’s Disease P. H. Chung, J. F. Scott and A. F. Morey Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas J Sex Med 2014; 11: 1593e1598.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.02.065 available at http://jurology.com/ Editorial Comment: The aim of this study was to show the efficacy of inflatable penile prosthesis (IPP) insertion and synchronous penile plication for correcting penile curvature and erectile dysfunction in patients with Peyronie disease. A retrospective review was performed of all patients who underwent IPP insertion with synchronous penile plication at this tertiary care center between 2010 and 2013. A total of 18 patients with a mean age of 63 years underwent IPP insertion with synchronous penile plication. Patients presented with dorsal (11 patients), lateral (2) and biplanar curvature (5). Mean preoperative curvature was 39 degrees (range 30 to 60) and was corrected on average to less than 5 degrees (5 to 12) using a median of 4 plication sutures (3 to 6). Of 15 patients completing a postoperative satisfaction survey at a mean of 11 months all reported improvement in their overall condition and penile curvature, although 1 with biplanar deformity reported minor