Avanafil for the treatment of erectile dysfunction: a multicenter, randomized, double-blind study in men with diabetes mellitus.

Objective: To prospectively assess the safety and effectiveness of the investigational phosphodiesterase 5 inhibitor avanafil to treat erectile dysfunction in men with diabetes mellitus.

Patients And Methods: This 12-week, multicenter, double-blind, placebo-controlled study conducted between December 15, 2008, and February 11, 2010, randomized 390 men with diabetes and erectile dysfunction 1:1:1 to receive avanafil, 100 mg (n=129), avanafil, 200 mg (n=131), or placebo (n=130). Coprimary end points assessed changes in the percentage of sexual attempts in which men were able to maintain an erection of sufficient duration to have successful intercourse (Sexual Encounter Profile [SEP] 3), percentage of sexual attempts in which men were able to insert the penis into the partner's vagina (SEP 2), and International Index of Erectile Function erectile function domain score.

A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction.

Introduction: Phosphodiesterase type 5 (PDE5) inhibitors have become standard treatment for erectile dysfunction (ED).

Aim: To prospectively evaluate the safety and efficacy of avanafil, a novel PDE5 inhibitor, in men with mild to severe ED.

Methods: In this multicenter, double-blind, Phase 3 trial, 646 subjects were randomized to receive avanafil (50 mg, 100 mg, 200 mg) or placebo throughout a 12-week treatment period.

Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery.

Study Design: Literature review.

Objective: To describe the scientific basis of minimally invasive spine surgery as it relates to posterior lumbar surgery.

Summary Of Background Data: Minimally invasive spine (MIS) surgery is predicated on several basic principles: (1) avoid muscle crush injury by self-retaining retractors; (2) do not disrupt tendon attachment sites of key muscles, particularly the origin of the multifidus muscle at the spinous process; (3) use known anatomic neurovascular and muscle compartment planes; and (4) minimize collateral soft tissue injury by limiting the width of the surgical corridor.

Use of a quantitative pedicle screw accuracy system to assess new technology: Initial studies on O-arm navigation and its effect on the learning curve of percutaneous pedicle screw insertion.

Background: A quantitative screw accuracy system is proposed that allows for high-fidelity discrimination between various methods of pedicle screw insertion. Our purpose was to study the utility of a quantitative screw accuracy scoring system to assess new imaging technologies and their effects on the minimally invasive spine learning curve.

Methods: By use of a hypothetical "perfect screw," a scoring system is proposed that may be used to compare the position of a small number of screws inserted according to a desired optimal position.

Understanding the effects of sildenafil treatment on erection maintenance and erection hardness.

Introduction: Erectile dysfunction (ED) is defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance. Although intuitively related, the link between erection hardness and erection maintenance has not been formally established and quantified.

Aim: To understand the components of erection maintenance through statistical modeling.

Recognizing and treating urogenital atrophy in postmenopausal women.

Urogenital atrophy resulting from postmenopausal estrogen deficiency has numerous clinical effects, including vaginal dryness, sexual dysfunction, urinary incontinence, and recurrent urinary tract infections (UTIs), all of which can cause significant distress and reduction in quality of life. Although nearly one third to one half of postmenopausal women experience these symptoms, they are often overlooked because patients may be reluctant to discuss them and clinicians fail to screen for them. As these symptoms are unlikely to resolve without treatment, the prompt diagnosis and treatment of urogenital atrophy is essential.

Navigation-assisted fluoroscopy in minimally invasive direct lateral interbody fusion: a cadaveric study.

Background: Minimally invasive surgery (MIS) is dependent on intraoperative fluoroscopic imaging for visualization, which significantly increases exposure to radiation. Navigation-assisted fluoroscopy (NAV) can potentially decrease radiation exposure and improve the operating room environment by reducing the need for real-time fluoroscopy. The direct lateral interbody fusion (DLIF) procedure is a technique for MIS intervertebral lumbar and thoracic interbody fusions.

National differences in patient-clinician communication regarding hypoactive sexual desire disorder.

Introduction: Despite greater awareness and openness about sexual problems among women, many patients remain reserved about discussing such problems with their doctor. Clinicians are often reluctant to ask about sexual dysfunction.

Aim: To learn how clinicians can communicate more effectively with patients who have hypoactive sexual desire disorder (HSDD) by exploring the language used by patients and clinicians in the United States, France, and Germany when describing the symptoms, causes, and correlates of HSDD.

Sexual dysfunction in women: what can urologists contribute?

Urologists have led the basic science and clinical research of organic-based issues in male sexual dysfunction. Concerning scientific, evidence-based, biologic-focused information, the field of sexual dysfunction in women is relatively new compared with sexual dysfunction in men. Basic science, epidemiology, physiology, pathophysiology, diagnosis, and treatment data on women's sexual health issues are now more regularly published than ever before, with the urologic community once again leading the way.

The erection hardness score and its relationship to successful sexual intercourse.

Introduction: The Erection Hardness Score (EHS), recently validated, was developed in 1998 as a simple (one-item) method to quantify erection outcome data. Although it is intuitive that erection hardness and successful sexual intercourse (SSI) are related, the link has not been directly established.

Objective: To evaluate the relationship between erection hardness (assessed by EHS) and SSI, establishing the EHS as a clinically useful tool.

Surgeons' perceptions of spinal navigation: analysis of key factors affecting the lack of adoption of spinal navigation technology.

Background: Computer-assisted spinal navigation allows for real time localization of surgical instruments in multiple views. Its use decreases radiation exposure and clears the surgical field of the C-arm fluoroscope. Despite these advantages, spinal navigation has yet to gain general acceptance among spine surgeons.

Bicycle riding, perineal trauma, and erectile dysfunction: data and solutions.

Significant clinical and basic science advances in the field of sexual medicine have facilitated investigation of the link between endothelial dysfunction and erectile dysfunction. Most sexual medicine practitioners accept the premise that in aging men with risk factors such as increased waist circumference, diabetes, hypertension, hypogonadism, hypercholesterolemia, and insulin insensitivity, a higher prevalence of erectile dysfunction reflects systemic vasculopathy that often first presents as abnormal erectile function. Endothelial dysfunction in the pudendal, common penile, and cavernosal arterial bed can occur secondary to pelvic, perineal, or penile trauma in young men without traditional systemic vascular risk factors.

A clinical paradigm for the combined management of androgen insufficiency and erectile dysfunction.

Androgen insufficiency and erectile dysfunction are highly prevalent medical disorders in aging men who have associated multiple risk factors. Good clinical practice requires the use of appropriate strategies for patient- and goal-directed diagnosis and treatment. This article focuses on a rational, evidence based clinical management paradigm that combines diagnosis and treatment of men who have androgen insufficiency and erectile dysfunction.

A three-dimensional theoretical model of the relationship between cavernosal expandability and percent cavernosal smooth muscle.

Introduction: Percent corporal smooth muscle content, a traditional predictor of corporal veno-occlusive function, is invasive and clinically assessed by histomorphometric analyses of erectile tissue biopsies. Cavernosal "expandability" which may be a more physiologically relevant parameter is a measure of work performed to achieve penile erection, and as a consequence, an indicator of the ability to approach maximum penile volume at low intracavernosal pressure.

Aim: To demonstrate that cavernosal "expandability" determined by noninvasive methodology can replace the determination of percent smooth muscle.

Testosterone increases blood flow and expression of androgen and estrogen receptors in the rat vagina.

Introduction: The mechanisms by which testosterone modulates female genital sexual arousal responses are poorly understood.

Aim: To investigate the effects of testosterone on vaginal blood flow and the expression of estrogen and androgen receptor proteins in the rat vagina.

Methods: Mature female Sprague-Dawley rats were sham-operated (intact) or ovariectomized.

Combined laparoscopic/endoscopic anvil placement for the performance of the gastroenterostomy.

Background: We developed the laparoscopic gastric bypass in 1993 and first reported the technique and results in 1994. The technique for the gastroenterostomy was derived from the method used in the percutaneous endoscopic gastrostomy tube placement. Some have questioned the safety of this technique, and alternatives have been proposed.

Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3-60 month follow-up.

Background: The authors have performed the laparoscopic gastric bypass since 1993 and perform about one-half of bariatric cases laparoscopically. Since our initial report, several groups throughout the world have preformed the gastric bypass laparoscopically, with various modifications.

Method: Prospectively, we followed and recorded the results of our laparoscopic patients.

Clinical experience with passive-fixation coradial bipolar endocardial pacing leads. ThinLine Clinical Investigators.

Bipolar, transvenous, passive-fixation leads (ThinLine, Sulzer Intermedics Inc., Angleton, TX, USA) incorporating coradial individually coated conductor coils, and a redundant external 55D polyurethane insulation sheath were developed. The diameter of the new leads (< 5 Fr) is in the range of available unipolar leads and is considerably smaller than conventional bipolar pacing leads.

Pregnancy following gastric bypass for morbid obesity.

Background: Women who suffer from morbid obesity are often infertile. If these women are able to become pregnant, they are considered high risk because of the hypertension, diabetes and other associated risk factors. Following the pregnancy is difficult due to limitations of the physical examinations.

Confirmation of the beneficial effects of brief coincubation of gametes in human in vitro fertilization.

Objective: To confirm whether brief exposure of human oocytes to spermatozoa in vitro results in equivalent fertilization rates and possibly better quality embryos than overnight coincubation and to determine if there was a difference in outcome with regard to the type of culture medium used.

Design: Prospective distribution of gametes between treatments in sequential patients.

Setting: Assisted reproductive technology program in private hospital.

Development and implementation of a perioperative autologous service program.

Several months after we initiated our PAS program, the AABB scrutinized our policy and procedure manual. At the same time, the JCAHO conducted an inspection of our blood bank and its standards. Both reviews were positive, which provided all of us involved in the PAS program with a tremendous sense of accomplishment.