ABSTRACT
BACKGROUND: Erectile dysfunction (ED) is a common clinical problem managed in the general practice setting. While the majority of men will find phosphodiesterase-5 (PDE-5) inhibitors effective, there is a subgroup of men who require second and third line therapies. OBJECTIVE: This article provides an overview of ED and its management with particular focus on the group of patients in whom oral agents fail. DISCUSSION: Erectile dysfunction is a multifactorial condition that affects approximately 40% of Australian men. The incidence of ED is age related however, it shares common risk factors with cardiovascular disease and metabolic disorders. The management of ED should begin with an assessment of cardiovascular risk factors, advice on lifestyle modification, and a trial of PDE-5 inhibitors. Second line therapies include intracavernosal injections and vacuum erection devices, while third line therapy entails penile implants. Factors that influence treatment success include partner inclusion, good patient selection, as well as ongoing support and education.
Subject(s)
Erectile Dysfunction/epidemiology , Erectile Dysfunction/therapy , Phosphodiesterase Inhibitors/therapeutic use , Testosterone/therapeutic use , Administration, Oral , Adult , Australia/epidemiology , Erectile Dysfunction/diagnosis , Follow-Up Studies , Humans , Injections, Intralesional , Male , Middle Aged , Penile Erection/drug effects , Penile Prosthesis , Risk Assessment , Treatment Outcome , Vasodilator Agents/therapeutic useABSTRACT
BACKGROUND: Postprostatectomy stress urinary incontinence (PPSUI) is a clinically significant problem with an incidence of 3-60%. OBJECTIVE: This article discusses the indications and efficacy of current and evolving surgical therapies for PPSUI as a guide for general practitioners. DISCUSSION: Surgical intervention can be considered for bothersome PPSUI persisting longer than 12 months for which conservative therapy has failed. Careful preoperative assessment and counselling is necessary to select appropriate candidates for surgical intervention. When considering the success of various therapies for PPSUI, patient satisfaction is often related to the magnitude of incontinence pad reduction, rather than absolute pad usage per day. Currently, there are several surgical therapies available for PPSUI including bulking agents, the artificial urinary sphincter (AUS-800) and male sling devices. The AUS-800 remains the gold standard for moderate to severe PPSUI, however, sling devices demonstrate promising short to intermediate term results.
