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Preface

The first edition of Male Sexual Function: A Guide to Clinical Management was published in 2001. Since that time, two new oral medications for erectile dysfunction (ED), Vardenafil (Levitra®) and Tadalafil (Cialis®), have been introduced.

Links between ED and lower urinary tract symptoms have been postulated, advances in the basic science of erectile physiology have occurred, and the appreciation of ED as a form of endothelial dysfunction and a harbinger of other more potentially lethal forms of vascular disease has become more widespread. In some instances, third-party payers have reduced or eliminated coverage for ED treatments in an attempt to cut costs. They have classified sexual activity as "recreational," "lifestyle," or not medically necessary, but have failed to appreciate the negative consequences of ED, such as depression with all of its ramifications.

Male Sexual Function: A Guide to Clinical Management, Second Edition is a comprehensive overview of the field of male sexual function and includes a chapter on female sexual dysfunction, an emerging field with a very high incidence in the population and an ever-growing following.

The goal is to educate all disciplines in the facts of sexual function and dysfunction in the hope that practitioners will feel comfortable assessing and counseling patients about their sexual needs and concerns and will be able to treat basic problems with easily prescribed therapies and know when and where to refer more complex cases. More money is now spent on advertising ED drugs than any other medical product in the world. Viagra® is the second most recognized product in the world after Coke®. Patients know that treatments are available and, with more openness in discussing sexual matters, are less hesitant to discuss these with their physician. Polls have shown that an overwhelming majority of patients (96%) believe that ED should be treated and 75% feel that physicians should address this area in a comprehensive evaluation. Hence, it behooves practitioners to become familiar with this area and to keep up to date on the latest developments. Male Sexual Function: A Guide to Clinical Management, Second Edition should accomplish that goal.

John J. Mulcahy, md, PhD

Contents

Preface v

List of Contributors ix

1 Normal Anatomy and Physiology 1

Paul Milhoua, Daniel Lowe, and Arnold Melman

2 Epidemiology of Erectile Dysfunction 47

Ridwan Shabsigh

3 Cardiac Issues Related to Erectile Dysfunction 61

Thorsten Reffelmann and Robert A. Kloner

4 How a Primary Care Clinician Approaches Erectile Dysfunction 77

Richard Sadovsky and Kevin Custis

5 Psychosocial Aspects Related to Erectile Dysfunction 105

Michael A. Perelman

6 Hormonal Evaluation and Treatment 123

Jeremy P. W. Heaton and Alvaro Morales

7 Radical Prostatectomy and Other Pelvic Surgeries: Effects on Erectile Function 135

Muammer Kendirci, Jeffrey Bejma, Wayne J. G. Hellstrom

8 Drugs That Affect Male Sexual Function 155

Benjamin K. Yang and Craig F. Donatucci

9 Neurogenic Sexual Dysfunction in Men and Women 195

Kazem M. Azadzoi and Mike B. Siroky

10 Female Sexual Dysfunction 227

Irwin Goldstein

11 Evaluation of the Patient With Erectile Dysfunction 253

Jeffrey C. La Rochelle and Laurence A. Levine

12 Oral Therapy for Erectile Dysfunction 271

Raymond W. Pak and Gregory A. Broderick

13 Intracavernosal Injection of Vasoactive Agents 287

Alice K. Tsao and Ajay Nehra

14 Topical and Intra-Urethral Therapy 303

John C. Hairston, Edgardo Becher, and Kevin T. McVary

15 Vacuum Erection Devices 323

Hunter Wessells

16 Penile Implants 331

Steven K. Wilson and John J. Mulcahy

17 Peyronie's Disease: History and Medical Therapy 381

J. Slade Hubbard and Culley C. Carson

18 Peyronie's Disease: Surgical Therapy 401

Gerald H. Jordan

19 Vascular Surgery for Erectile Dysfunction 419

William O. Brant, Anthony J. Bella, Maurice M. Garcia, and Tom F. Lue

20 Priapism 435

Lawrence S. Hakim

21 Ejaculatory Disorders 447

Chris G. McMahon

22 Gene Therapy for Erectile Dysfunction 467

Thomas R. Magee, Jacob Rajfer, and Nestor F. Gonzalez-Cadavid

Index 485

Contributors

Kazem M. Azadzoi, md • Departments of Urology and Pathology, Boston University

School of Medicine, Boston, MA Edgardo Becher, md • Centro de Diagnostico Urologico, Buenos Aires, Argentina Jeffrey Bejma, md • Department of Urology, Tulane University Health Science Center, New Orleans, LA

Anthony J. Bella, md • Department of Urology, University of California,

San Francisco, CA William O. Brant, md • Department of Urology, University of California, San Francisco, CA

Gregory A. Broderick, md • Department of Urology, Mayo Clinic, Jacksonville, FL Culley C. Carson, md • Division of Urology, Department of Surgery, University of North Carolina, Chapel Hill, NC Kevin Custis, md • Department of Family Practice, Downstate Medical Center,

SUNY, Brooklyn, NY Craig F. Donatucci, md • Division Of Urology, Department of Surgery, Duke

University Medical Center, Durham, NC Maurice M. Garcia, md • Department of Urology, University of California,

San Francisco, CA Irwin Goldstein, md • The Journal of Sexual Medicine, Milton, MA Nestor F. Gonzalez-Cadavid, phd • Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA John C. Hairston, md • Department of Urology, Northwestern University, Chicago, IL Lawrence S. Hakim, md, facs • Department of Urology, Cleveland Clinic Florida, Weston, FL

Jeremy P. W. Heaton, md • Department of Urology, Queens University, Kingston, Ontario, Canada

Wayne J. G. Hellstrom, md • Department of Urology, Tulane University Health

Science Center, New Orleans, LA J. Slade Hubbard, md • Division of Urology, Department of Surgery, University of North Carolina, Chapel Hill, NC Gerald H. Jordan, md • Department of Urology, East Virginia Medical School, Norfolk, VA

Muammer Kendirci, md • Department of Urology, Tulane University Health Science

Center, New Orleans, LA Robert A. Kloner, md • Division of Cardiovascular Medicine, Department of Medicine, Heart Institute, Good Samaritan Hospital, University of Southern California, Keck School of Medicine, Los Angeles, CA Jeffrey C. La Rochelle, md • Department of Urology, Rush University Medical Center, Chicago, IL

Laurence A. Levine, md • Department of Urology, Rush University Medical Center, Chicago, IL

Daniel Lowe, md • Department of Urology, Montefiore Medical Center, Bronx, NY

Tom F. Lue, md • Department of Urology, University of California, San Francisco, CA Thomas R. Magee, PhD • Department of Urology, David Geffen School of Medicine,

University of California, Los Angeles, CA Chris G. McMahon, mbbs, FAChSHM • Australian Center for Sexual Health,

St. Leonards, New South Wales, Australia Kevin T. McVary, md • Department of Urology, Northwestern University, Chicago, IL Arnold Melman, md • Department of Urology, Albert Einstein College of Medicine, Bronx, NY

Paul Milhoua, md • Department of Urology, Montefiore Medical Center, Bronx, NY Alvaro Morales, md • Department of Urology, Queens University, Kingston, Ontario, Canada

John J. Mulcahy, md, PhD • Professor Emeritus of Urology, Indiana University

Medical Center, Indianapolis, IN Ajay Nehra, md • Department of Urology, Mayo Clinic, Rochester, MN Raymond W. Pak, md, PharmD • Department of Urology, Mayo Clinic, Jacksonville, FL Michael A. Perelman, PhD • Departments of Psychiatry and Urology, The New York

Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY Jacob Rajfer, md • Department of Urology, David Geffen School of Medicine,

University of California, Los Angeles, CA Thorsten Reffelmann, md • Division of Cardiovascular Medicine, Good Samaritan

Hospital, University of Southern California, Keck School of Medicine, Los Angeles, CA Richard Sadovsky, md • Department of Family Practice, Downstate Medical Center,

SUNY, Brooklyn, NY Ridwan Shabsigh, md • Urology Department, College of Physicians and Surgeons of Columbia University, New York, NY Mike B. Siroky, md • Department of Urology, Boston University School of Medicine, Boston, MA

Alice K. Tsao, md • Department of Urology, Mayo Clinic, Rochester, MN Hunter Wessells, md • Department of Urology, Harborview Medical Center,

University of Washington, Seattle, WA Steven K. Wilson, md • Department of Urology, University of Arkansas for Medical

Sciences, Little Rock, AK Benjamin K. Yang, md • Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC

1 Normal Anatomy and Physiology

Paul Milhoua, md, Daniel Lowe, md, and Arnold Melman, MD

Summary

This chapter focuses on the human penis and its structure and function. Corporal architecture and vascular anatomy are reviewed in the context of penile physiology and erection. The functional neuroanatomy governing penile erection, flaccidity, emission, and ejaculation is addressed, and attention is given to molecular mechanisms and signal transduction germane to penile erection and flaccidity. Smooth muscle physiology and the major players involved in the regulation of muscle tone are reviewed. This chapter also focuses on the modes of erectile response as well as the relevant central and spinal pathways.

Key Words: Erection; flaccidity; smooth muscle; Rho kinase; Maxi K; nitric oxide; endothelin; norepinephrine.

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