ESSM Newsletter # 39

19 ESSM Today Have You Read? Best of the Best: Clinical Research by Bruno Jorge Pereira and Nuno Louro Men’s Health Rochira V., Antonio L., Vanderschueren D. EAA Clinical Guideline on Management of Bone Health in the Andrological Outpatient Clinic. Andrology 2018 Mar;6(2):272-285. Male osteoporosis is now a well-recognized medical disorder with established clinical guidelines for both diagnosis and manage- ment. Andrologists should therefore be aware of the potential silent presence of osteoporosis in men with confirmed hypogonadism. Such bone health assessment should include medi- cal history and physical examination related to fracture risk. Furthermore, dual-energy absorp- tiometry is indicated to evaluate fracture risk in men with hypogonadism. Regarding treatment, besides general measures to prevent or man- age male osteoporosis testosterone replace- ment can be initiated but data on its efficacy in preventing fractures is lacking. Thus, additional anti-osteoporotic may be needed, especially in men with very low testosterone who are at high risk of bone loss or in men not able to receive testosterone replacement. Sexual Function Awad M.A., Gaither T.W., Murphy G.P., et al. Cycling, and Male Sexual and Urinary Func- tion: Results from a Large, Multinational, Cross-Sectional Study. J Urol. 2017 Oct 13 [Epub ahead of print]. Cyclists were recruited to complete a survey through Facebook advertisements and out- reach to sporting clubs. Swimmers and run- ners were recruited as a comparison group. Cyclists were categorized into low and high intensity cyclists. Participants were queried using SHIM, IPSS and NIH-CPSI. Complete survey responses 3.932 were included. Cy- clists had no worse sexual or urinary functions than swimmers or runners but cyclists were more prone to urethral stricture. Increased time standing while cycling and a higher handle- bar height were associated with lower odds of genital sores and numbness. Erectile Dysfunction Corona G., Maggi M., Jannini E.A. EDEUS, a Real-Life Study on the Users of Phospho- diesterase Type 5 Inhibitors: Prevalence, Perceptions, and Health Care-Seeking Be- havior among European Men with a Focus on 2 nd Generation Avanafil. Sex Med 2018; 6:15-23. This study evaluated the real-life character- istics and unmet needs of men with ED, its impact on well-being, and treatment rates across Europe. IIEF-15 with study-specific, self-constructed questions was used. 940 subjects were considered. Subjects using on- demand PDE5is were designated “performers” (60%) without a formal ED diagnosis or “pa- tients” with a medical diagnosis. Patients were older than performers, with more self-reported comorbidities; patients used a higher PDE5i dosage and purchased it from official phar- macies more often than performers did. The survey shows two different attitudes toward ED and PDE5i use: for recreational use and without a medical prescription or with a formal diagnosis and medical prescription. Avanafil, a 2 nd -generation PDE5i with a good balance between efficacy and tolerability profile, is more frequently prescribed by doctors than self-prescribed compared with other PDE5is. Ralph D.J., Eardley I., Taubel J., et al. Efficacy and Safety of MED2005, a Topical Glyceryl Trinitrate Formulation, in the Treatment of Erectile Dysfunction: A Randomized Crosso- ver Study. J Sex Med 2018; 15:167-175. Current treatments for erectile dysfunction (ED) have some limitations. This study evaluated the efficacy and tolerability of MED2005, a 0.2% glyceryl trinitrate topical gel, administered on demand, in the treatment of ED. This rand- omized, double-blinded, placebo-controlled, phase II crossover trial involved 232 men with ED and their partners. Efficacy was assessed by the IIEF, SEP and GAQ. Overall, 23.1% of patients showed a clinically relevant (>4-point) increase in IIEF-EF scores after treatment with MED2005. Significant effects of MED2005 were seen primarily in patients with mild ED. The start of erection was noticed within 5 and 10 minutes in 44.2% and 69.5%, respectively. The most commonly reported adverse events during MED2005 were headache (7.9%) and nasopharyngitis (5.7%). These findings suggest that topical glyceryl trinitrate could be a useful treatment option in ED but further studies are warranted to investigate the efficacy of higher doses, thereby improving clinical significance, especially in cases of moderate and severe ED. Sexual Rehabilitation Siena G., Mari A., Canale A., et al. Sexual Rehabilitation After Nerve-Sparing Radical Prostatectomy: Free-of-Charge Phospho- diesterase Type 5 Inhibitor Administration Improves Compliance to Treatment. J Sex Med 2018; 15:120-123. This prospective study intended to compare sexual rehabilitation outcomes in patients with low risk of erectile dysfunction and minimal comorbidities who received PDE5Is Nuno Louro, MD Department of Urology Hospital of Porto University of Porto Porto, Portugal nunorlouro@gmail.com Bruno Jorge Pereira, MD, FEBU, FECSM Department of Urology University of Beira Interior (FCS-UBI) Covilhã, Portugal brunoalexpereira@gmail.com