3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 adherence. Before starting PDE5i, the clinician should provide instructions tomaximize benefits and efficacy. Dose titration is essential to achieve the best efficiency withminimal adverse events. Referral tomental health professionals should not be overlooked; performance anxiety and communication between partners need to be addressed to achieve full success. Treatments such as transurethral alprostadil, ICI, or VED should be offered in case that PDE5i fails or there are contraindications to use of such medication. In- office injection tests should be utilized before initiating therapies like transurethral alprostadil or ICI to establish an effective dose andmonitor adverse effects. In-office trials also help patients gain confidence with technique and facilitate adherence. If non-surgical options fail, penile prosthesis implantation should be discussed. The clinician should review the short and long term expectations of penile prosthesis implantation with the patient and his partner in-depth due to the irreversible consequence of surgery. Therehavebeenmanyemerging therapiesdeveloped for ED treatment over the last decade. Some of these innovative and novel therapies, such as SCT, gene therapy, and PRP, may indeed replace or regenerate the endothelial, neuronal, and smooth muscle cells in the penis. However, the long term implications of these therapies are unknown. Well-designed randomized controlled studies adopting standardized protocols and including larger study populations are needed. An algorithm for the management principles of patient presenting with ED is described in Figure 1. Onanother note, newpharmacologic agents targeting underlying pathophysiologies such as guanylate cyclase activators, NOdonors, andRhoA/Rho-kinase inhibitors are promising therapies based on preclinical studies. Improvements in novel surgical techniques using tissue transplants and new device-based treatments such as novel drug or drug delivery systems may be implemented as ED therapies in the future. Disclosures Dr. Serkan Karakus has no disclosures. Dr. Arthur L. Burnett is an investigator for Boston Scientific, Coloplast, Endo Pharmaceuticals, National Institutes of Health, and Pfizer. He is a consultant for Futura Medical, Novartis Pharmaceuticals, and Urology Times Editorial Council. He is an associate editor for International Urology and Nephrology (journal) and Andrology (journal). Boston Scientific financially supports, in part, the Sexual Medicine fellowship program in The Brady Urological Institute at Johns Hopkins in Baltimore. References 1. Aytac IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999;84(1):50-56. 2. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol 2000;163(2):460-463. 3. Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M. Themultinational men’s attitudes to life events and sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. CurrMedResOpin 2004; 20(5):607-617. 4. Braun MH, Sommer F, Haupt G, Mathers MJ, Reifenrath B, Engelmann UH. Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical “aging male” symptoms? Results of the “CologneMale Survey”. EurUrol 2003;44(5):588-594. 5. Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol 2011;58(13):1378-1385 6. Yang CM, Shen YC, Weng SF, Wang JJ, Tien KJ. Increased risk of dementia in patients with erectile dysfunction: a population- based, propensity score-matched, longitudinal follow-up study. Medicine (Baltimore) 2015;94(24):e990. 7. Hodges LD, Kirby M, Solanki J, O’Donnell J, Brodie DA. The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract 2007;61(12):2019-2025. 8. Burnett AL, NehraA, Breau RH et al. Erectile dysfunction: AUA Guideline. J Urol 2018;200(3):633-641. 9. Maiorino MI, Bellastella G, Esposito K. Lifestyle modifications and erectile dysfunction: what can be expected? Asian J Androl 2015;17(1):5-10. 10. Hatzimouratidis K, SaloniaA,AdaikanGet al. Pharmacotherapy for erectile dysfunction: recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2016;13(4):465-488. 11. Hatzimouratidis K, Hatzichristou DG. A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient? Drugs 2005;65(12):1621-1650. 12. Limoncin E, Gravina GL, Corona G et al. Erectile function recovery inmen treatedwith phosphodiesterase type 5 inhibitor administrationafter bilateral nerve-sparing radical prostatectomy: Asystematic reviewof placebo-controlled randomized trialswith trial sequential analysis. Andrology 2017;5(5):863-872. 13. Yang L, Qian S, Liu L et al. Phosphodiesterase-5 inhibitors could be efficacious in the treatment of erectile dysfunction after radiotherapy for prostate cancer: Asystematic review and meta-analysis. Urol Int 2013;90(3):339-341. 14. Vardi M, Nini A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev 2007;CD002187. 15. Liao X, Qiu S, Bao Y, Wang W, Yang L, Wei Q. Comparative efficacy and safety of phosphodiesterase type 5 inhibitors for erectile dysfunction in diabetic men: A Bayesian network meta-analysis of randomized controlled trials. World J Urol 2019;37(6):1061-1074. 16. Burnett AL. Molecular pharmacotherapeutic targeting of PDE5 for preservation of penile health. J Androl 2008;29(1):3-14. 17. Corona G, Razzoli E, Forti G, Maggi M. The use of phosphodiesterase 5 inhibitors with concomitant medications. J Endocrinol Invest 2008;31(9):799-808. 18. Setter SM, Iltz JL, Fincham JE, Campbell RK, Baker DE. Phosphodiesterase 5 inhibitors for erectile dysfunction. Ann Pharmacother 2005;39(7-8):1286-1295. 19. Langtry HD, Markham A. Sildenafil: a review of its use in erectile dysfunction. Drugs 1999;57(6):967-989. Karakus AND Burnett 34