Recreational use of ED medication reduces sexual confidence and satisfaction

Recreational use of ED medication reduces sexual confidence and satisfaction

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Erectile dysfunction (ED) affects about 34 million men in the U.S.A with 9% of men 18 to 39 and up to 70% of men 60 and older. However, in an article by Harte et al published in Journal of Sexual Medicine (2012), men aged 18 to 45 are responsible for the largest increase in the use of Viagra among U.S. adults. From 1998 to 2002, the use by this age category grew 312%. They report a study of 1,207 men with an average age of 22. The men completed an online survey that asked about their sexual functioning in the past four weeks. 72 were recreational (used for perceived enhancement in performance) users of medication used to treat erectile dysfunction, 1111 were non-users and 24 were prescribed theses drugs. They answered questions about their erectile function, orgasm, sexual desire, and their satisfaction with intercourse and overall sex. they also reported their levels of confidence in their ability to get and maintain an erection. Compared to non-users, recreational users reported lower erectile confidence and overall satisfaction.
Although recreational users are a self selected group that may worry more about performance, the authors conclude that recreational use of ED medication reduces sexual confidence, leading to reduced ability and satisfaction.

Spare the adrenal gland during radical nephrectomy

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It has been standard of care to remove the adrenal gland aswell as kidney during radical nephrectomy for suspected renal cancer. However, Finelli et al show that survival is better if it is spared. In an article published in BJUI (2012) they report a study of 1,651 patients with a final pathological diagnosis of T1a RCC, including 490 patients (30%) who had concurrent ipsilateral adrenalectomy. By 10 years, the overall survival was 74.1% with adrenalectomy vs 79.8% when the adrenal was left behind (p<0.001), whilst cancer-specific survival did not differ. In a Cox proportional hazard model, ipsilateral adrenalectomy increased the risk of overall mortality by 23%, but it didn't affect cancer-specific survival.

Surveillance for small renal masses is equally as good as surgery

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In an article by Patel et al published in BJUI (2012) the authors studied 234 patients with suspected renal cancer less than 4cms in size. 71 were treated by surveillance, 41 by radical nephrectomy and 90 by partial nephrectomy. After a median follow up of 34 months over 53% of masses managed by surveillance had not increased in size and only 1 (with multiple tumours) had spread. 20% went on to ablative therapy. Cancer specific survival was 99%, 93% and 97% with overall survival of 83%, 80% and 90% for surveillance, radical and partial nephrectomy groups respectively. The authors conclude that active surveillance of renal masses <4cms is as safe as surgery in the short term.

New American guidelines for the investigation of asymptomatic haematuria

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New guidelines (2012) have been published by the American Urological Association (AUA) for the investigation of symptomatic haematuria. There are several differences between these guidelines and UK guidelines. For example, UK guidelines suggest investigating all patients with cystoscopy over 40 years old, whereas AUA guidelines suggest over 35. AUA guidelines suggest CT urogram or MR urogram imaging, but UK guidelines do not specify. AUA guidelines suggest full reevaluation of persistent asymptomatic haematuria within 3 to 5 years, whereas UK guidelines suggest limited annual reevaluation with blood pressure and urinary protein:creatinine testing, with full evaluation only in the presence of symptoms or visible haematuria.

MRI is useful in selecting patients with localised prostate cancer for treatment with active surveillance

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In an article by Vargas et al published in J Urol (2012), the authors showed that MRI could predict aggressive prostate cancer in patients initially thought to have low risk prostate cancer. Such upgrading is a barrier to the acceptance of active surveillance for men with prostate cancer. A total of 388 consecutive men (mean age 60.6 years, range 33 to 89) with clinically low risk prostate cancer (initial biopsy Gleason score 6 or less, prostate specific antigen less than 10 ng/ml, clinical stage T2a or less) underwent MRI before confirmatory biopsy. Three radiologists independently and retrospectively scored tumour visible on MRI using a 5-point scale (1—definitely no tumour to 5—definitely tumour). Associations between magnetic resonance imaging scores and confirmatory biopsy findings were evaluated.

On confirmatory biopsy, Gleason score was upgraded in 79 of 388 (20%) patients. Magnetic resonance imaging scores of 2 or less had a high negative predictive value (0.96–1.0) and specificity (0.95–1.0) for upgrading on confirmatory biopsy. A magnetic resonance imaging score of 5 was highly sensitive for upgrading on confirmatory biopsy (0.87–0.98).

The authors concluded that MRI was useful in the selection of patients for management with active surveillance.

Screening for prostate cancer decreases the risk of metastatic disease at 12 years follow up.

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In an article by Shroder et al published in Europe Urol (2012), the authors publish results from the European randomised study of screening for prostate cancer. They report that screening significantly reduces the risk of developing metastatic disease in the 76813 men with available data. At 12 years follow up 256 screened men and 410 control men had developed metastasis. This was a relative risk reduction of 30% or 3.1 per 1000 men randomised (42% in the intention to screen analysis).

Screening for prostate cancer using the PSA blood test remains amongst the most controversial subject in Urology, but this data adds significantly to the body of evidence supporting screening.

What is “No Scalpel vasectomy” and does it have advantages?

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“No Scalpel Vasectomy” was developed in China by Dr. Li Shunqiang 40 years ago. Since introduction over 15 million no-scalpel vasectomies have been performed throughout the world. As the name suggests, the “No Scalpel” method does not involve a scalpel, but a small opening is still necessary. The key to this technique is the special small pointed forceps used to create a tiny hole in the skin, instead of a scalpel incision. As with a conventional procedure, the vas deferens is then located and delivered through the hole, before a segment is removed. Generally the hole in the skin is closed with a suture or glue, but may be small enough to be left to heal spontaneously.

Surgeons who perform the No Scalpel method of vasectomy believe that their procedure produces less complications and discomfort with less bruising, smaller vasectomy scars, and faster recovery time. Other Surgeons who continue to use the standard technique may not believe that there is a significant advantage.

Our Consultants perform both Scalpel and No Scalpel Vasectomies, depending on which procedure is most suitable. Please contact us to make an appointment to discuss this further with one of our experienced Consultants. For further information about Vasectomy click here.

Incidence of rare subtypes of prostate cancer

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In an article published in Prostate and Prostatic Diseases the authors describe the relative incidences of rare subtypes of prostate cancer.

Incidence rate per million for rare prostate cancer subtypes

All Caucasian African American Rate ratio P-value
Mucinous 0.61 0.56 1.36 2.81 <0.01 Ductal 0.49 0.49 0.61. 1.24 0.26 Signet cell 0.08 0.07 0.15 1.80 0.14 Neuroendocrine 0.35 0.34 0.51 1.47 0.07 Adenosquamous 0.03 0.03 0.02 0.91 1.00 Adenocarcinoma 586.0 571.9 874.9 1.49 <0.01

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