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Gruenwald I, Shechter A, Greenstein A. Commentary on: Low frequency neuromuscular electrical stimulation applied to the bulbospongiosus muscle. Int J Impot Res 2024; 36:291-292. [PMID: 37582828 DOI: 10.1038/s41443-023-00723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/11/2023] [Accepted: 06/09/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Ilan Gruenwald
- The Neuro Urology Unit, Rambam Medical Center, Haifa, Israel.
- The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel.
| | - Arik Shechter
- The Neuro Urology Unit, Rambam Medical Center, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel
| | - Alexander Greenstein
- The Neuro Urology Unit, Rambam Medical Center, Haifa, Israel
- The Sachler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Papier I, Chermesh I, Mashiach T, Gruenwald I, Banasiewicz T. Prevalence of the use of oral nutritional supplements among acute inpatients at risk of malnutrition and associated patient characteristics. J Clin Nurs 2024. [PMID: 38379370 DOI: 10.1111/jocn.17076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/30/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
AIM To provide a snapshot of the current use of oral nutritional supplements, its association with inpatient characteristics, and with a focus on the role of nursing monitoring of food intake and implementing nutritional interventions for patients with low intake. DESIGN Retrospective cohort study. METHODS The study collected data from a hospital database regarding oral nutritional supplement initiation and variables of patients hospitalised in internal medicine departments, who did not receive enteral or parenteral nutrition. RESULTS Of the 5155 admissions, 1087 fulfilled the inclusion criteria (47% female; mean age, 72.4 ± 14.6 years; mean length of stay, 14.6 ± 11.4 days). Sufficient food intake reporting was noted in 74.6% of the patients; of these 17% had decreased intake. Oral nutritional supplements and non-oral nutritional supplements groups did not differ in terms of sex, age, length of stay, Charlson Comorbidity Index, proportion of nursing reports, and absence of intake monitoring. Oral nutritional supplements were initiated in 31.9% of patients with a Malnutrition Universal Screening Tool score ≥2 and in 34.6% with decreased food intake. On multivariable analysis, hypoalbuminemia (adjusted odds ratio, 3.70), decreased food intake (adjusted odds ratio, 3.38), Malnutrition Universal Screening Tool score ≥2 (adjusted odds ratio, 2.10), and age <70 years (adjusted odds ratio, 1.56) were significantly associated with oral nutritional supplements use. CONCLUSION The prevalence of oral nutritional intervention was suboptimal in patients at risk of malnutrition during acute hospitalisation, although decreased food intake and Malnutrition Universal Screening Tool score ≥2 independently increased the probability of oral nutritional supplements initiation. RELEVANCE IN CLINICAL PRACTICE Understanding the clinical practice and nursing impact of care management in relation to nutritional intervention can assist in reviewing and improving patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT (ADDRESSING): This study informs clinical management and influences nursing practice standards related to assessing, monitoring, and managing malnutrition risk. IMPACT The study impacts the quality of care for patients at risk of malnutrition. REPORTING METHOD We adhered to the STROBE Checklist for cohort studies. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Irena Papier
- Nursing Administration, Rambam Health Care Campus, Haifa, Israel
| | - Irit Chermesh
- Institute of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Affiliated with Technion-Israel Institute of Technology, the Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Tanya Mashiach
- Department of Epidemiology, Rambam Health Care Campus, Haifa, Israel
| | - Ilan Gruenwald
- Neuro-Urology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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Kaynak Y, Gruenwald I. Long-term effects of combination treatment comprising low-intensity extracorporeal shockwave therapy and tadalafil for patients with erectile dysfunction: a retrospective study. Int J Impot Res 2023:10.1038/s41443-023-00757-7. [PMID: 37644168 DOI: 10.1038/s41443-023-00757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
This study retrospectively examined the effects of low-intensity extracorporeal shockwave therapy and tadalafil on erectile dysfunction patients. 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks, 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months. Group A (1 year), Group B (2 years), Group C (3 years), and Group D (4+ years) were treated patients' follow-up groups. The patients' International Index of Erectile Function-5 (IIEF-5) scores were gathered at the start of treatment via face-to-face interviews and at the end of follow-ups by telephone conversations. IIEF-5 scores and the minimal clinically significant differences were the main outcomes. Mean follow-up length, age, and IIEF-5 scores of the patients were 2 ± 1.16 years, 47.34 ± 12.65 years, and 12.09 ± 3.66 points, respectively. Compared to baseline, treatment increased the median IIEF-5 scores of patients in groups A, B, C, and D by 7 [3-12], 6 [0-8], 7 [1-9], and 6.5 [2.5-10] points, respectively (p = 0.001). 71%, 63%, 65.8%, and 65% of treated patients in groups A, B, C, and D met the minimal clinically significant differences criteria (n = 77). Mild disease patients were 9.14 times more likely to respond to treatment than severe illness patients (OR, 9.14; 95% CI, 1.28-65.46; P = 0.02). Low-intensity extracorporeal shockwave therapy and 5 mg of tadalafil can treat erectile dysfunction for up to 4 years with sustained outcomes. This treatment is optimal for mild illnesses.
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Affiliation(s)
- Yurdaer Kaynak
- Urology Clinic of Private Umit Visnelik Hospital, Eskişehir, Turkey.
| | - Ilan Gruenwald
- Neuro-Urology Unit, Rambam Healthcare Campus, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Gruenwald I, Appel B, Shechter A, Greenstein A. Radiofrequency energy in the treatment of erectile dysfunction-a novel cohort pilot study on safety, applicability, and short-term efficacy. Int J Impot Res 2023:10.1038/s41443-023-00733-1. [PMID: 37592175 DOI: 10.1038/s41443-023-00733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 08/19/2023]
Abstract
The erectile mechanism depends, in part on the intactness of the collagen components in the penis. As such, impaired collagen may have a deleterious effect on erectile function. Radiofrequency energy has been shown to renew and restore spatial structural arrangement of collagen fibers; therefore, treatment of erectile dysfunction with radiofrequency could lead to anatomical and physiological changes at the penile tissue level and could lead to improvement in the erectile mechanism. We conducted this study to assess the effect of radiofrequency treatment on erection quality. We evaluated the safety, applicability, and efficacy of a self-applied, handheld, low-intensity radiofrequency device (Vertica®) in men with moderate and mild-to-moderate organic erectile dysfunction. The treatment protocol consisted of 12 treatments (twice a week during the 1st month, and once a week during the 2nd month), and each participant treated himself individually. Treatment outcomes were evaluated using the International Index of Erectile Function, Erection Hardness Scale, Erectile Dysfunction Index of Treatment Satisfaction, Benefit, Satisfaction & Willingness to continue, Quality of Erection Questionnaire, Sexual Quality of Life questionnaires and specific questions addressing side effects and ease of use. Twenty-eight out of 32 men (mean age 59.5 ± 9.8, range: 41-78 years) completed a one-month follow-up after treatment. Mean International Index of Erectile Function (43.7. ± 7.8 vs. 60.9 ± 10.8, p < 0.01), International Index of Erectile Function -Erection Function domain (16.8 ± 3.1 vs. 24.4 ± 4.4, p < 0.001), and Erection Hardness Scores (2.2 ± 0.8 vs. 3.2 ± 0.5, p = 0.01) were all significantly improved. Fifty percent of patients achieved normal erectile function parameters according to the International Index of Erectile Function -Erection Function domain score >25. High mean scores were achieved in the Erectile Dysfunction Index of Treatment Satisfaction (76.8 ± 20.3), Benefit, Satisfaction & Willingness to continue (4.83 ± 1.1), Quality of Erection Questionnaire (73.4 ± 23.8), and Sexual Quality of Life (67 ± 29.4) questionnaires. No side effects were reported and participants rated the device as very comfortable, simple, and easy to operate.
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Affiliation(s)
- Ilan Gruenwald
- The Neuro-Urology Unit, Rambam Healthcare Campus, Haifa, Israel.
- The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel.
| | - Boaz Appel
- The Neuro-Urology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Arik Shechter
- The Neuro-Urology Unit, Rambam Healthcare Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel
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Shechter A, Mondaini N, Serefoglu EC, Gollan T, Deutsch F, Appel B, Gruenwald I. A novel on-demand therapy for lifelong premature ejaculation using a miniature transperineal electrical stimulator-the vPatch: an as-treated analysis. J Sex Med 2023; 20:22-29. [PMID: 36897239 DOI: 10.1093/jsxmed/qdac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND While premature ejaculation (PE) is a common and disturbing sexual dysfunction in men, current available treatment modalities have limited efficacy and low treatment adherence. AIM To assess the feasibility, safety, and efficacy of the vPatch, a miniaturized on-demand perineal transcutaneous electrical stimulation device for treating PE. METHODS This prospective bicenter international first-in-human clinical study consisted of 2 arms, was sham controlled, and had a randomized double-blind design. In terms of statistical power calculation, 59 patients aged 21 to 56 years (mean ± SD, 39.8 ± 9.28) with lifelong PE were included. During the initial visit, intravaginal ejaculatory latency time (IELT) was measured over a 2-week run-in period. Eligibility was confirmed in visit 2, based on IELT values, medical and sexual history, and patients' individualized sensory and motor activation thresholds during perineal stimulation with the vPatch. Patients were randomized to the active (vPatch) and sham device groups in a 2:1 ratio, respectively. The vPatch device's safety profile was determined by comparing the incidence of treatment-emergent adverse events. During visit 3, IELTs, Clinical Global Impression of Change scores, and Premature Ejaculation Profile questionnaire outcomes were recorded. Primary end points assessed vPatch device efficacy as mean change in geometric mean IELT; each person was compared with himself, with and without the device, and the sham group was compared with the active group. OUTCOMES Outcomes included changes in IELT and Premature Ejaculation Profile before and after treatment, last visit Clinical Global Impression of Change scores, and vPatch safety profile. RESULTS Of 59 patients, 51 completed the study: 34 in the active group and 17 in the sham group. The baseline geometric mean IELT significantly increased from 67 to 123 seconds (P < .01) in the active group, as compared with an insignificant increase from 63 to 81 seconds (P = .17) in the sham group. The increase in mean IELT in the active group was significantly higher than in the sham group (56 vs 18 seconds, P = .01). IELT significantly increased by 3.1 times in the active vs sham group. The mean ratio of fold change (active:sham) was 1.4, significantly different from 1.0 (P = .02). No serious adverse events were reported. CLINICAL IMPLICATIONS Therapeutic use of the vPatch during coitus may become an on-demand, noninvasive, and drug-free treatment for PE. STRENGTHS AND LIMITATIONS To our knowledge, this is the first rigorous study investigating whether transcutaneous electrical stimulation during coitus could improve the symptoms of men with lifelong PE. The study is limited by the small number of patients, the exclusion of patients with acquired PE, the short-term follow up, and the use of a device based on a theoretic mechanism of action. CONCLUSION We demonstrated the possibility to treat lifelong PE by prolonging coitus on demand, using electric stimulation of ejaculation muscles with the vPatch.Clinical trial registration: NCT03942367 (ClinicalTrials.gov).
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Affiliation(s)
- Arik Shechter
- Neurourology Unit, Rambam Health Care Campus, Haifa, Israel.,Department of Family Medicine, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Clalit Health Services, Haifa, Israel
| | - Nicola Mondaini
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Ege Can Serefoglu
- Department of Urology, School of Medicine, Biruni University, Istanbul, Turkey.,Department of Embryology and Histology, Medipol University, Istanbul, Turkey
| | - Tal Gollan
- Virility Medical Ltd, Hod Hasharon, Israel
| | | | - Boaz Appel
- Neurourology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ilan Gruenwald
- Neurourology Unit, Rambam Health Care Campus, Haifa, Israel
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Lauterbach R, Aharoni S, Justman N, Farago N, Gruenwald I, Lowenstein L. The efficacy and safety of a single maintenance laser treatment for stress urinary incontinence: a double-blinded randomized controlled trial. Int Urogynecol J 2022; 33:3499-3504. [PMID: 35195738 PMCID: PMC8864590 DOI: 10.1007/s00192-022-05103-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the efficacy and safety of a single carbon dioxide (CO2) laser maintenance treatment in women previously treated successfully with laser for stress urinary incontinence (SUI), who have demonstrated a decline in treatment effect. METHODS Women aged 40-70 years who experienced temporary significant improvement in symptoms following CO2 laser treatments for SUI were randomized to either the treatment group or the sham treatment control group. Cough test results, 1-h pad weights and scores on the Urogenital Distress Inventory (UDI6), the International Consultation of Incontinence Questionnaire (ICIQ-UI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were obtained at baseline and 3 and 6 months. RESULTS Of 183 women screened, 131 were included in the final analysis. Demographic characteristics and baseline measures in the outcome tests were similar between the groups. Statistically significant improvements were demonstrated in the study compared to the control group at 3 months post-treatment in positive cough test (44.4% vs. 79.4%, P = 0.002), mean pad weight test (2.3 g ± 1.3 vs. 5.6 ± 1.1, P < 0.001), mean UDI-6(24.7 ± 12.1 vs. 45.1 ± 13.6 SD, P = 0.004), mean ICIQ-UI (16.5 ± 4.3 vs. 10.3 + 3.8, P = 0.003) and mean PISQ-12 (21.3 ± 6.8 vs. 36.6 ± 7.5, P = 0.003). However, values at 6 months post-treatment were similar to those at baseline. CONCLUSIONS Our results suggest that a single maintenance laser treatment for reducing symptoms of SUI is transiently effective, well tolerated and safe. This treatment modality provides alternative non-surgical therapy for women with SUI.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel.
| | - Saar Aharoni
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Naama Farago
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Ilan Gruenwald
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Lauterbach R, Gruenwald I, Ersheed A, Mattar K, Matanes E, Justman N, Amnon A, Lowenstein L. Tension Free Vaginal Tape for Repair of Stress Urinary Incontinence Affects Vaginal Elasticity and Sexual Function. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilan Gruenwald
- Department of Neuro-Urology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Angie Ersheed
- Department of Obstetrics and Gynecology, Ha`emek Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Kamel Mattar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amit Amnon
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Peleg LC, Rabinovitch D, Lavie Y, Rabbie DM, Horowitz I, Fruchter E, Gruenwald I. Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors. Sex Med Rev 2021; 10:91-98. [PMID: 34627736 DOI: 10.1016/j.sxmr.2021.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Post-SSRI sexual-dysfunction (PSSD) is an iatrogenicsyndrome, the underlying neurobiological mechanisms of which areunclear. Symptom onset follows cessation of serotonergicantidepressants i.e. Selective Serotonin and Norepinephrine ReuptakeInhibitors (SSRI's, SNRI's), and Tricyclic antidepressants (TCA's). PSSDsymptoms include genital anesthesia, erectile dysfunction andorgasmic/ejaculatory anhedonia, and should be differentiated fromdepression-related sexual-dysfunction. Recently, accumulated data of numerous case-reports suggest additional non-sexual symptoms including, anhedonia, apathy, and blunted affect. PSSD gained official recognition after the European medical agency concluded that PSSD is a medical condition that persists after discontinuation of SSRI's and SNRI's. OBJECTIVE To review possible underlying neurobiological mechanisms ofthis syndrome, update information on the pathophysiology, present a listof potential risk-factors and discuss potential management options forPSSD. METHODS Extensive literature review on the main symptom-patterns ofthis disorder was undertaken using PubMed. It includes introductoryexplications of relevant neurobiology with the objective of generatinghypothesis. RESULTS Precipitating factors for PSSD include previous exposure to certain drugs, genetic predisposition, psychological stress or chemical stressful reaction to antidepressants along pre-existing medical conditions affecting neuroplasticity. Different theories have been proposed to explain the pathophysiology of PSSD: epigenetic gene expression, dopamine-serotonin interactions, serotonin neurotoxicity and hormonal changes. The diagnosis of PSSD is by excluding all other etiologies of sexual-dysfunction. Treatment is challenging, and many strategies have been suggested without definitive outcomes. We offerthe contours of a future neurobiological research agenda, and propose several underlying mechanisms for the various symptoms of PSSD which could be the foundation for a future treatment algorithm. CONCLUSION There is a need for well-designed neurobiological research in this domain, as well as in the prevalence, pathophysiology, and treatment of PSSD. Practitioners should be alert to the distinctive features of PSSD. Misdiagnosing this syndrome might lead to harmful Sexual Medicine Reviews. Peleg LC, Rabinovitch D, Lavie Y, et al. Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
| | | | | | - Deya M Rabbie
- Ahram Canadian University, Neuropharmacology, 6th of October City, Egypt
| | - Itai Horowitz
- Rambam Healthcare Campus, Psychiatry Department, Haifa, Israel
| | | | - Ilan Gruenwald
- Rambam Healthcare Campus, Neuro-Urology Unit, Haifa, Israel.
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Lauterbach R, Gutzeit O, Matanes E, Linder R, Mick I, Aharoni S, Gruenwald I, Wiener Z, Lowenstein L. Vaginal Fractional Carbon Dioxide Laser Treatment and Changes in Vaginal Biomechanical Parameters. Lasers Surg Med 2021; 53:1146-1151. [PMID: 33834503 DOI: 10.1002/lsm.23405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Vaginal fractional carbon dioxide (CO2 ) laser treatment has emerged in the past two decades as a non-surgical option for vaginal tightening. Mounting evidence supports the effectiveness and safety of this treatment for female sexual dysfunction. A newly developed vaginal tactile imaging (VTI) technique accurately evaluates the biomechanical parameters of the female pelvic floor and vagina, including tissue elasticity, pelvic support, and pelvic muscle function in high definition. In the current study, we evaluated changes in objective biomechanical parameters using VTI, following vaginal CO2 laser treatment for vaginal tightening and sexual dysfunction. STUDY DESIGN/MATERIALS AND METHODS We conducted a prospective cohort between June 2018 and January 2020. Inclusion criteria were vaginal looseness, decreased local sensation during sexual intercourse, and sexual dysfunction. All the participants were treated with a vaginal carbon dioxide laser. They underwent a gynecological evaluation based on the Vaginal Health Index (VHI) and sexual function assessment according to the Female Sexual Function Index (FSFI). Vaginal biomechanical parameters were assessed by VTI. Initial evaluations were performed at the pre-treatment consult visit, 1 week prior to the first treatment and at a 6-month post-treatment follow-up visit. RESULTS Twenty-five women were included in the final analysis. Compared with baseline, the post-treatment mean scores for vaginal elasticity and tightening were higher (54.8 ± 5.2 vs. 41.5 ± 6.3, P = 0.0027 and 1.97 ± 0.25 vs. 1.32 ± 0.31, P = 0.0014, respectively). Post-treatment increases were demonstrated in pelvic muscle contraction strength (25.9 ± 3.5 vs. 16.5 ± 4.2, P = 0.0011) and in reflex pelvic muscle contraction (2.93 ± 0.44 vs. 2.12 ± 0.47, P = 0.0022); the mean FSFI and VHI scores were higher following treatment (28.47 ± 1.73 vs. 21.12 ± 1.58, P = 0.036 and 19.15 ± 1.27 vs. 11.6 ± 0.97, P = 0.0032). CONCLUSIONS The quantification of vaginal biomechanical parameters using VTI technology offers objective evidence of the beneficial effect of vaginal CO2 laser treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Revital Linder
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Ido Mick
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Saar Aharoni
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Ilan Gruenwald
- Neuro-urology Unit, Rambam Medical Center, Technion, Faculty of Medicine, Haifa, 3525408, Israel
| | - Zeev Wiener
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, 3525408, Israel
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Gruenwald I, Gutzeit O, Petruseva A, Gartman I, Lowenstein L. Low-Intensity Shockwave for Treatment of Vestibulodynia: A Randomized Controlled Therapy Trial. J Sex Med 2021; 18:347-352. [PMID: 33419704 DOI: 10.1016/j.jsxm.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Provoked vestibulodynia (PVD) is an exhausting pain syndrome that immensely affects quality of sexual life and consequently negatively affects quality of life. Low-intensity shock wave therapy produces physical forces that lead to pain relief. AIM The aim of this study was to evaluate the feasibility, safety, and efficacy of low-intensity shockwave therapy in patients with provoked vestibulodynia. METHODS This is a double-blinded, randomized, sham-controlled, prospective study of 32 women. The treatment protocol included a series of treatments, performed twice a week for 6 weeks. Each treatment consisted of 500 pulses of low intensity shockwaves (0.09 mJmm2) using the Medispec, ED-1000 shockwave generator or sham. Participants were assessed at the baseline, and at 1 and 3 months after completing all treatments. OUTCOMES Pain was assessed by both subjective and objective measures. The primary outcome was a change in dyspareunia, as assessed by scores on the 10-point visual analog scale. Secondary outcome measures were changes in pain threshold and tolerance, assessed by a quantitative validated algometer test, the Wong-Baker pain FACES scale, the Female Sexual Function Index and the Patients' Global Impression of Change scale. RESULTS From the baseline to 1 month and 3 months after completion of treatment, visual analog scale scores for dyspareunia decreased (8.0 ± 1.4, 5.7 ± 2.3, and 4.4 ± 2.5, respectively, P < .005). For these respective time points, Wong-Baker scores decreased (4.0 ± 0.6, 2.9 ± 1.2, 2.5 ± 1.3, respectively, P < .05); and total Female Sexual Function Index increased (17.9 ± 6.3, 20.9 ± 6.2, 22.5 ± 8, respectively, P < .002). Pain threshold and tolerance measured by the algometer were increased 3 months after completion of the treatment compared with the baseline (69.8 mmHg ± 11.8 vs 22.9 mmHg ± 9.0, P < .01 and 87.7 mmHg ± 35.7 vs 43.3 mmHg ± 14.7, P < .0001, respectively). No changes were observed in any of the measures assessed in the sham group. CLINICAL IMPLICATIONS We found a new effective treatment for alleviating the most bothersome symptom in PVD, pain during penetration and intercourse. This resulted in improved sexual function. STRENGTHS & LIMITATIONS The strengths of this study are the randomized controlled design, the correlated subjective questionnaires, and the use of semiquantitative algometer methodology. The limitations are the relative low number of participants in a single center. CONCLUSION For women with PVD, low-intensity shockwave therapy applied at the introitus is a feasible, safe, and effective treatment option that may have a beneficial effect in pain relief and in sexual function. Gruenwald I, Gutzeit O, Petruseva A, et al. Low-Intensity Shockwave for Treatment of Vestibulodynia: A Randomized Controlled Therapy Trial. J Sex Med 2021;18:347-352.
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Affiliation(s)
- Ilan Gruenwald
- Neuro-Urology Unit, Rambam Medical Center and the Technion, Faculty of Medicine, Haifa, Israel
| | - Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.
| | - Anna Petruseva
- Neuro-Urology Unit, Rambam Medical Center and the Technion, Faculty of Medicine, Haifa, Israel; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Irena Gartman
- Neuro-Urology Unit, Rambam Medical Center and the Technion, Faculty of Medicine, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
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Lauterbach R, Gruenwald I, Matanes E, Matar K, Weiner Z, Lowenstein L. The impact of vaginal hysterectomy and uterosacral ligament suspension on vaginal elasticity and sexual function. Eur J Obstet Gynecol Reprod Biol 2020; 258:29-32. [PMID: 33388488 DOI: 10.1016/j.ejogrb.2020.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/29/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hysterectomy for benign indications has profound effects on both anatomical and physiological pelvic floor and vaginal properties. Vaginal tactile imaging (VTI) enables the quantification of pelvic floor and vaginal biomechanical properties; this enables objective evaluation of various pelvic floor functions. The purposes of this study were to evaluate via VTI, the changes in vaginal elasticity, mobility and strength, before and after hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and high utero-sacral ligament suspension (USLS); and to assess associations with sexual function. The objective of the current study was to evaluate the effect of these procedures on vaginal elasticity and sexual function. STUDY DESIGN This prospective cohort study included women who underwent hysterectomy by vNOTES and USLS for the treatment of pelvic organ prolapse (POP). All the women underwent both pre- and postoperative VTI and sexual function evaluation. Vaginal elasticity and wall mobility, and the contraction strength and tone of levator muscles, were measured prior to and 6 months following surgery using VTI. RESULTS A total of 23 women, mean age 56.5 years, with stage 3-4 POP participated. Vaginal elasticity increased from 27.3 ± 8.8 to 34.8 ± 12 (P < 0.05) and Female Sexual Function Index (FSFI) scores increased from 22.17 ± 1.62 to 28.66 ± 1.51 (P < 0.05). No correlation was observed between these results. A statistically significant decrease in the mobility of the anterior vaginal wall was demonstrated, from 7.98 ± 10.6 to 0.83 ± 7.5 (P < 0.0001). CONCLUSIONS VTI showed improvements in vaginal elasticity, mobility and FSFI scores following hysterectomy and POP repair performed by vNOTES.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Ilan Gruenwald
- Department of Neuro-Urology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Kamel Matar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Neuro-Urology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Lauterbach R, Dabaja H, Matanes E, Gruenwald I, Lowenstein L. The Efficacy and Safety of CO 2 Laser Treatment for Sexual Function and Vaginal Laxity Improvement in Pre-Menopausal Women. Lasers Surg Med 2020; 53:199-203. [PMID: 32458469 DOI: 10.1002/lsm.23263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Vaginal laxity lacks standardized diagnosis and severity criteria. It is considered as a subjective complaint that reflects decreased sexual satisfaction due to vaginal loosening. Treatment modalities have included physiotherapy and plastic surgery. Recently, laser treatments have also gained popularity as a means of relieving gynecological complaints such as pelvic organ prolapse, stress urinary incontinence, and genitourinary syndrome of menopause. The aim of the current study was to evaluate the efficacy of CO2 laser treatment in women for whom a decrease in sexual sensation during intercourse and vaginal loosening were their primary complaints. STUDY DESIGN/MATERIALS AND METHODS For this prospective study, women with reported vaginal laxity and decreased sensation during intercourse were recruited from the Sexual Dysfunction Clinic in our health care campus. Each participant received three outpatient treatments with laser therapy, according to the same protocol. Treatment efficacy was assessed by changes in the Vaginal Health Index (VHI) and Female Sexual Function Index (FSFI). RESULTS Overall, 84 pre-menopause women, with a mean age of 47.7 years, were included in the study. Mean VHI and FSFI were increased significantly at 3 months post-treatment and decreased again at 6 months post-treatment: 11.8 ± 1.6, 13.5 ± 1.1, and 11.8 ± 1.2, respectively, P = 0.013; and 21.3 ± 1.7, 29.9 ± 1.6, and 22.5 ± 1.8, respectively, P = 0.022. The rate of sexual intercourse doubled during the period of maximal treatment effect (P < 0.0001). CONCLUSIONS CO2 laser treatment has both a statistically and clinically significant effect on participants' complaints and sex-life, which wanes by 6 months post-treatment. Laser therapy seems to be safe in the short term, with no serious adverse events reported in the current study. Further studies are warranted to determine the long-term safety and the efficacy of maintenance laser treatments. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Hàalia Hàshnia 8, Technion, Haifa, 3109601, Israel
| | - Hanin Dabaja
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Hàalia Hàshnia 8, Technion, Haifa, 3109601, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Hàalia Hàshnia 8, Technion, Haifa, 3109601, Israel
| | - Ilan Gruenwald
- Department of Neuro-Urology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Hàalia Hàshnia 8, Technion, Haifa, 3109601, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Hàalia Hàshnia 8, Technion, Haifa, 3109601, Israel
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Shechter A, Serefoglu EC, Gollan T, Springer S, Meiry G, Appel B, Gruenwald I. Transcutaneous functional electrical stimulation-a novel therapy for premature ejaculation: results of a proof of concept study. Int J Impot Res 2019; 32:440-445. [PMID: 31570825 DOI: 10.1038/s41443-019-0207-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 02/02/2023]
Abstract
Premature Ejaculation (PE) is a very common and disturbing sexual dysfunction in men. Currently available treatment modalities are associated with limited efficacy and low treatment adherence. In this prospective, single-blinded, self-controlled study, we evaluated the efficacy and safety of transcutaneous electrical stimulation (TES) for the treatment of (PE). We included 23 patients aged 20-60 (mean: 38.7) with lifelong PE. On the first visit, we delivered either TES or sham treatment to the perineum, based on the enrollment order. For stimulation, we used a commercial neuromuscular electrical stimulation device. The patients were invited for the second visit after at least 7 days for receiving the alternating treatment. During the treatment sessions, the patients were left alone in a privet silent room to masturbate and a stopwatch was used to measure their masturbation ejaculatory latency time (MELT). The patients also filled-out safety questionnaires after each visit and on each of the 3 following days. Of the 20 patients who completed the study, 17 (85%) experienced prolonged MELT under TES compared with the sham treatment. Mean MELT values increased 3.5-folds under TES (p = 0.0009). We demonstrated a significant increase in MELT in lifelong PE patients using TES. This therapeutic option may have the potential to become an on-demand treatment option for PE. Future studies with wireless devices are needed to confirm the efficacy and safety of this treatment concept during intercourse.
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Affiliation(s)
- Arik Shechter
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel. .,Department of Family Medicine, Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Clalit Health Services, Haifa, Israel.
| | - E C Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | | | - Shmuel Springer
- Physical Therapy Department, Faculty of Health Sciences Ariel University, Ariel, Israel
| | | | - Boaz Appel
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Ilan Gruenwald
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
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Capogrosso P, Frey A, Jensen CFS, Rastrelli G, Russo GI, Torremade J, Albersen M, Gruenwald I, Reisman Y, Corona G. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019; 16:1490-1505. [PMID: 31447380 DOI: 10.1016/j.jsxm.2019.07.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/05/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Low-intensity shockwave therapy (LISWT) has been investigated for the treatment of uroandrological disorders including erectile dysfunction (ED), Peyronie's disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with controversial findings. AIM To review the evidence on LISWT for ED, PD, and CP/CPPS and provide clinical recommendations on behalf of the European Society of Sexual Medicine. METHODS Medline and Embase databases were searched for randomized clinical trials (RCTs), meta-analyses and open-label prospective or retrospective studies investigating the effect of LISWT on ED, PD, or CP/CPPS. OUTCOMES The panel provided statements on clinically relevant questions concerning LISWT: (i) treatment efficacy, (ii) treatment protocol, (iii) clinical indications, and (iv) safety. The level of evidence was provided according to the Oxford 2011 criteria and graded using the Oxford Centre for Evidence-Based Medicine recommendations. RESULTS 11 RCTs and 5 meta-analyses investigated LISWT for ED. RCTs provided controversial results on the efficacy of LISWT and were affected by high heterogeneity and the small number of patients included. Pooled-data analysis showed an overall positive effect in terms of erectile function improvement but reported small estimates and included a largely heterogeneous cohort of patients. 4 RCTs and 1 meta-analysis assessed LISWT for PD. All trials showed positive findings in terms of pain relief but no effect on penile curvature and plaque size. Inclusion criteria vary widely among studies, and further investigation is needed. 5 RCTs investigated LISWT for CP/CPPS. Data showed a possible effect on pain relief, although there is no evidence supporting that pain relief was maintained or any improvement in pain over time. CLINICAL IMPLICATIONS LISWT needs to be further investigated in the context of sexual medicine and is almost but not yet ready for clinical practice. STRENGTHS AND LIMITATIONS All studies have been evaluated by a panel of experts providing recommendations for clinical practice. CONCLUSIONS LISWT is a safe and well-tolerated procedure but its efficacy for the treatment of ED is doubtful and deserves more investigation. Patients reporting pain associated with PD may benefit from LISWT, although no effect is expected on disease progression. LISWT is not a primary treatment for CP/CPPS, but it may be considered as an option to relieve pain. Capogrosso P, Frey A, Jensen CFS, et al. Low-Intensity Shock Wave Therapy in Sexual Medicine-Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1490-1505.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology; Ospedale San Raffaele, Vita-Salute University, Milano, Italy.
| | - Anders Frey
- Department of Urology, University of Southern Denmark, Esbjerg and Odense, Denmark
| | | | - Giulia Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | | | | | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, University of Leuven, Leuven, Belgium; Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Ilan Gruenwald
- Neuro-urology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Yacov Reisman
- Men's Health Clinic, Amstelland Hospital, Amsterdam, The Netherlands
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
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Gruenwald I, Bistritchi S, Tal R. PO-01-036 Results of salvage microsurgery for sperm extraction in Azoospermia couples. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Appel B, Yehiely Cohen R, Gruenwald I. HP-08-003 Penile curvature: Conservative versus surgical treatment? J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gruenwald I, Spector A, Shultz T, Lischinsky D, Kimmel E. The beginning of a new era: treatment of erectile dysfunction by use of physical energies as an alternative to pharmaceuticals. Int J Impot Res 2019; 31:155-161. [DOI: 10.1038/s41443-019-0142-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 02/07/2023]
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Vainrib M, Stav K, Gruenwald I, Gilon G, Aharony S, Gross M, Bluvshtein V, Kauffman Y. [POSITION STATEMENT FOR INTERMITTENT CATHETERIZATION OF URINARY BLADDER]. Harefuah 2018; 157:257-261. [PMID: 29688647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A position paper presents the standpoint of the Israeli Urological Association on clean intermittent catheterization (CIC) for all physicians and nurses. The position paper is based on international guidelines and professional literature and is adapted to medical activities in Israel. CIC is indicated for the treatment of temporary/permanent disability in the emptying of the bladder, which is expressed by large post-voided urine/urine retention and related complications. There are a few contra-indications for CIC (low bladder volume or compliance, pressure sores/external infection of the urethra, anatomical, functional or cognitive disorder that does not allow to perform CIC, recurrent macrohematuria or urethrorrhagia, urethral pain that does not allow frequent catheterization, patient unwillingness to perform CIC by himself or by another person). There are alternatives to performing CIC permanent urethral or suprapubic catheter, urinary tract diversion, sphincterotomy. Before starting to perform CIC, the patient should be verified as being able to perform CIC and adhere to a predetermined schedule. It is recommended to perform the CIC at regular intervals during the day. During training and early stages of the CIC, it is recommended to catheter every 4-6 hours to assess bladder volume at these time intervals (urinary volume per catheterization). It is recommended to record drinking volumes, voiding volumes, and catheterization volumes for adjusting and timing the CIC. In order to determine the right number of catheterizations, several factors should be taken into account, such as the patient's ability to void, bladder capacity, and various urodynamic variables. In some cases additional therapy might be administered to reduce bladder pressure. If a patient cannot perform CIC on his own, a caregiver or a family member may be instructed to perform the procedure. The Committee described the methods and techniques to perform CIC and described possible complications (although rare) such as urinary tract infections (UTI), urethral and/or bladder damage, and the difference between a condition of asymptomatic bacteriuria and UTI. The Committee recommends that preventive antibiotic treatment should not be given to CIC patients. Antibiotic treatment should be given only in the case of UTI. The Committee recommends active participation of medical, nursing, social workers, family members and direct caregivers to improve the quality of life of CIC patients. Long-term follow-up is needed to diagnose and prevent complications of CIC/underlying disease leading to CIC. Different follow-up tests should be performed based on underlying disease, complications or changes in patient symptoms. The Committee described different types of catheters and recommends that the use of single-use catheters is preferable. Pre-shielding should be used before using the catheters without external coating.
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Affiliation(s)
| | - Kobi Stav
- Department of Urology, Assaf Harofeh Medical Center, Tzrifin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ilan Gruenwald
- Division of Neurourology, Rambam Health Care Campus, Haifa
- Ruth and Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa
| | - Gabriel Gilon
- Institute of Urology, Rabin Medical Center - Beilinson, Petah Tikva
| | - Shahar Aharony
- Institute of Urology, Rabin Medical Center - Beilinson, Petah Tikva
| | - Miki Gross
- Ruth and Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa
- Department of Urology, Emek Medical Center, Afula
| | - Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana
| | - Yakova Kauffman
- Department of Urology, Sheba Medical Center, Tel-Hashomer, Ramat Gan
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Kitrey ND, Vardi Y, Appel B, Shechter A, Massarwi O, Abu-Ghanem Y, Gruenwald I. Low Intensity Shock Wave Treatment for Erectile Dysfunction-How Long Does the Effect Last? J Urol 2018; 200:167-170. [PMID: 29477719 DOI: 10.1016/j.juro.2018.02.070] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE We studied the long-term efficacy of penile low intensity shock wave treatment 2 years after an initially successful outcome. MATERIALS AND METHODS Men with a successful outcome of low intensity shock wave treatment according to the minimal clinically important difference on the IIEF-EF (International Index of Erectile Function-Erectile Function) questionnaire were followed at 6, 12, 18 and 24 months. Efficacy was assessed by the IIEF-EF. Failure during followup was defined as a decrease in the IIEF-EF below the minimal clinically important difference. RESULTS We screened a total of 156 patients who underwent the same treatment protocol but participated in different clinical studies. At 1 month treatment was successful in 99 patients (63.5%). During followup a gradual decrease in efficacy was observed. The beneficial effect was maintained after 2 years in only 53 of the 99 patients (53.5%) in whom success was initially achieved. Patients with severe erectile dysfunction were prone to earlier failure than those with nonsevere erectile dysfunction. During the 2-year followup the effect of low intensity shock wave treatment was lost in all patients with diabetes who had severe erectile dysfunction at baseline. On the other hand, patients with milder forms of erectile dysfunction without diabetes had a 76% chance that the beneficial effect of low intensity shock wave treatment would be preserved after 2 years. CONCLUSIONS Low intensity shock wave treatment is effective in the short term but treatment efficacy was maintained after 2 years in only half of the patients. In patients with milder forms of erectile dysfunction the beneficial effect is more likely to be preserved.
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Affiliation(s)
- Noam D Kitrey
- Urology Department, Sheba Medical Center, Ramat-Gan, Israel.
| | - Yoram Vardi
- Urology Department, Sheba Medical Center, Ramat-Gan, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Boaz Appel
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Arik Shechter
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Omar Massarwi
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | | | - Ilan Gruenwald
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
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Fisher WA, Gruenwald I, Jannini EA, Lev-Sagie A, Lowenstein L, Pyke RE, Reisman Y, Revicki DA, Rubio-Aurioles E. Standards for Clinical Trials in Male and Female Sexual Dysfunction: III. Unique Aspects of Clinical Trials in Male Sexual Dysfunction. J Sex Med 2017; 14:3-18. [PMID: 28065358 DOI: 10.1016/j.jsxm.2016.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022]
Abstract
This series of articles, Standards for Clinical Trials in Male and Female Sexual Dysfunction, began with the discussion of a common expected standard for clinical trial design in male and female sexual dysfunction, a common rationale for the design of phase I to IV clinical trials, and common considerations for the selection of study population and study duration in male and female sexual dysfunction. The second article in this series discussed fundamental principles in development, validation, and selection of patient- (and partner-) reported outcome assessment. The third and present article in this series discusses selected aspects of sexual dysfunction that are that are unique to male sexual dysfunctions and relevant to the conduct of clinical trials of candidate treatments for men.
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Affiliation(s)
- William A Fisher
- Department of Psychology and Department of Obstetrics and Gynaecology, Western University, London, ON, Canada.
| | - Ilan Gruenwald
- Department of Urology, Director, Neurourology Unit, Rambam Medical Center, Haifa, Israel
| | - Emmanuele A Jannini
- Endocrinology and Medical Sexology, Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | | | - Yakov Reisman
- Medical Director Sexuality Clinics, Amstelland Hospital, Amstelveen, The Netherlands
| | | | - Eusebio Rubio-Aurioles
- Asociación Mexicana para la Salud Sexual, AC, and Universidad Nacional Autónoma de México, Mexico City, Mexico
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Fisher WA, Gruenwald I, Jannini EA, Lev-Sagie A, Lowenstein L, Pyke RE, Reisman Y, Revicki DA, Rubio-Aurioles E. Standards for Clinical Trials in Male and Female Sexual Dysfunction: II. Patient-Reported Outcome Measures. J Sex Med 2017; 13:1818-1827. [PMID: 27914562 DOI: 10.1016/j.jsxm.2016.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 11/27/2022]
Abstract
The second article in this series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, focuses on measurement of patient-reported outcomes (PROs). Together with the design of appropriate phase I to phase IV clinical trials, the development, validation, choice, and implementation of valid PRO measurements-the focus of the present article-form the foundation of research on treatments for male and female sexual dysfunctions. PRO measurements are assessments of any aspect of a patient's health status that come directly from the patient (ie, without the interpretation of the patient's responses by a physician or anyone else). PROs are essential for assessing male and female sexual dysfunction and treatment response, including symptom frequency and severity, personal distress, satisfaction, and other measurements of sexual and general health-related quality of life. Although there are some relatively objective measurements of sexual dysfunction (ie, intravaginal ejaculatory latency time, frequency of sexual activity, etc), these measurements do not comprehensively assess the occurrence and extent of sexual dysfunction or treatment on the patient's symptoms, functioning, and well-being. Data generated by a PRO instrument can provide evidence of a treatment benefit from the patient's perspective.
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Affiliation(s)
- William A Fisher
- Department of Psychology and Department of Obstetrics and Gynaecology, Western University, London, ON, Canada.
| | - Ilan Gruenwald
- Department of Urology, Director, Neuro-urology Unit, Rambam Medical Center, Haifa, Israel
| | - Emmanuele A Jannini
- Endocrinology and Medical Sexology, Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | | | - Yakov Reisman
- Medical Director Sexuality Clinics, Amstelland Hospital, Amstelveen, The Netherlands
| | | | - Eusebio Rubio-Aurioles
- Asociación Mexicana para la Salud Sexual, AC, and Universidad Nacional Autónoma de México, Mexico City, Mexico
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Rabinowitz D, Lowenstein L, Gruenwald I. Fear of Vaginal Penetration in the Absence of Pain as a Separate Category of Female Sexual Dysfunction: A Conceptual Overview. Rambam Maimonides Med J 2017; 8:RMMJ.10293. [PMID: 28467769 PMCID: PMC5415362 DOI: 10.5041/rmmj.10293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Functional sexual pain disorders in women are a particular challenge to the gynecologist, inasmuch as phobic avoidance and guarding on the part of the patient lead to difficulties in the gynecological examination and diagnosis. In some such cases examination may even be impossible. Vaginismus is the commonly diagnosed etiology of such cases. This article offers an overview of vaginismus and approaches to its treatment but also examines a subset of penetration-avoidant patients who do not appear to have a pain component. We have reviewed this separate category conceptually and clinically, and propose that this case subset be separated from the diagnosis of vaginismus and designated as vaginal penetration phobia (VPP).We further propose that this category be diagnosed as one of several possible presentations of phobic disorder, under the rubric of mental health disorder, and thus be separated from gynecology. The nosological implications are raised.
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Affiliation(s)
- David Rabinowitz
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ilan Gruenwald
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Heah N, Leow J, Chong W, Gruenwald I, Tan R. 226 Low Intensity Extracorporeal Shockwave Therapy in the Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.11.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fisher WA, Gruenwald I, Jannini EA, Lev-Sagie A, Lowenstein L, Pyke RE, Reisman Y, Revicki DA, Rubio-Aurioles E. Standards for Clinical Trials in Male and Female Sexual Dysfunction: I. Phase I to Phase IV Clinical Trial Design. J Sex Med 2016; 13:1805-1817. [DOI: 10.1016/j.jsxm.2016.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/28/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
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Lowenstein L, Mustafa S, Gartman I, Gruenwald I. Effect of Midurethral Sling Surgery on Vaginal Sensation. J Sex Med 2016; 13:389-92. [PMID: 26944464 DOI: 10.1016/j.jsxm.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/05/2015] [Accepted: 01/10/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previous studies have reported changes in the sensory functioning of the vagina in women with pelvic floor disorder. AIM To evaluate vaginal and clitoral sensation before and after surgery with trans-obturator tape (TVT-O, Ethicon Johnson & Johnson). METHODS Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoris 1 day before and 12 ± 4 months after surgery. MAIN OUTCOME MEASURES Differences in thresholds to warm, cold, and vibratory sensations at a predetermined anatomic area of the genital region. RESULTS Twenty-two women were admitted for midurethral sling surgery, and four were lost to follow-up. For the remaining 18 (mean age = 52 years, range = 37-65), we found a significant sensory decrease at the clitoral region to cold, warm, and vibratory stimuli after surgery. In contrast, in the anterior vaginal wall, there was a significant decrease only to warm stimuli after surgery. CONCLUSION TVT-O can cause sensory loss in the clitoral and anterior vaginal wall region that can be measured and quantified. The effect of such sensory loss on sexual function and quality of sexual life needs further investigation.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Susana Mustafa
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Irena Gartman
- Neurourology Division, Department of Urology, Rambam Medical Center, Haifa, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ilan Gruenwald
- Neurourology Division, Department of Urology, Rambam Medical Center, Haifa, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Gruenwald I, Vardi Y, Gartman I, Juven E, Sprecher E, Yarnitsky D, Miller A. Sexual dysfunction in females with multiple sclerosis: quantitative sensory testing. Mult Scler 2016; 13:95-105. [PMID: 17294617 DOI: 10.1177/1352458506071134] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction and objectives Female sexual dysfunction (FSD) is highly prevalent (45–74%) in multiple sclerosis (MS) patients. Quantitative sensory testing (QST) has recently been used to assess normal neural function of the female genitalia. In this study we used QST for assessment of the genital neural function of female MS patients. Materials and methods We examined 41 female MS patients aged 21–56, with 10 years median disease duration. Each patient had a neurological examination, and evaluation of sexual function (SF) by both questionnaire and a focused interview. QST wasperformed at the clitoris and vagina for temperature and vibratory stimuli, by method of limits. Results By questionnaire, 25 patients (61%) had FSD; the most common complaints were decreased libido (61%) and orgasmic disturbances (54%). Sensory deficit was very common–significant correlations were found between high sensory thresholds and FSD parameters; the most significant correlation was between clitoral vibratory sensation and orgasmic dysfunction (r=0.423, P=0.006). Another interesting significant association was found between cerebellar deficit and orgasmic dysfunction (P=0.0012). Conclusions This study suggests that QST of the genitalia, specifically clitoral vibration, may be a useful test for detecting sexual dysfunction in MS patients, and supports an important role of the cerebellum in SF.
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Affiliation(s)
- Ilan Gruenwald
- Neuro-Urology Unit, Rambam Medical Center, Haifa, Israel.
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Gruenwald I, Appel B, Yehieli-Cohen R. HP-07-005 The effect of a stem cell suspension injected to the corpora cavernosa of diabetic rats on erectile function. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Appel B, Massarwa O, Gruenwald I. HP-01-001 Low-intensity shockwave treatment for ED patients at least one year after radical prostatectomy - phase IIb study. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zu'bi F, Ofer Y, Amnipor D, Gruenwald I, Kol S, Amiel G, Tal R. P-01-069 Sperm cryopreservation and utilization in men with testicular cancer. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gruenwald I, Gartman I. P-02-005 The fear of sexual interaction: a poorly recognized reason for visits to the women’s sexual dysfunction clinic. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lowenstein L, Mustafa-Mikhail S, Gartman I, Gruenwald I. The effect of pelvic organ prolapse repair on vaginal sensation. Int Urogynecol J 2016; 27:915-8. [PMID: 26740196 DOI: 10.1007/s00192-015-2910-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate vaginal and clitoral sensation before and after robotic sacrocolpopexy for the repair of pelvic organ prolapse. METHODS Twenty-two women, mean age 63 years (range 41-77), were admitted for robotic sacrocolpopexy repair of pelvic organ prolapse; 4 were lost to follow-up. Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina (anterior and posterior areas) and clitoris 1 day before and a mean of 12 ± 4 months following surgery. Student's paired t test was used to compare sensory thresholds before and after surgery. RESULTS For the 18 women who completed follow-up, sensitivity was significantly higher after surgery (sensory threshold decreased) at the clitoral and vaginal regions, to cold and warm stimuli. In contrast, the vaginal and clitoral vibratory sensory thresholds did not change significantly following surgery. CONCLUSION The repair of pelvic organ prolapse by robotic sacrocolpopexy could potentially play a role in restoring clitoral and vaginal wall sensation. The effects of these sensory changes on sexual function and the quality of sexual life need further investigation.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics & Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel.,Department of Urology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel
| | - Susana Mustafa-Mikhail
- Department of Obstetrics & Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel. .,Department of Urology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel.
| | - Irena Gartman
- Division of Neurourology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
| | - Ilan Gruenwald
- Division of Neurourology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
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Kitrey ND, Gruenwald I, Appel B, Shechter A, Massarwa O, Vardi Y. Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham Controlled Study. J Urol 2015; 195:1550-1555. [PMID: 26694904 DOI: 10.1016/j.juro.2015.12.049] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE We performed sham controlled evaluation of penile low intensity shock wave treatment effect in patients unable to achieve sexual intercourse using PDE5i (phosphodiesterase type 5 inhibitor). MATERIALS AND METHODS This prospective, randomized, double-blind, sham controlled study was done in patients with vasculogenic erectile dysfunction who stopped using PDE5i due to no efficacy. All patients had an erection hardness score of 2 or less with PDE5i. A total of 58 patients were randomized, including 37 treated with low intensity shock waves (12 sessions of 1,500 pulses of 0.09 mJ/mm(2) at 120 shock waves per minute) and 18 treated with a sham probe. In the sham group 16 patients underwent low intensity shock wave treatment 1 month after sham treatment. All patients were evaluated at baseline and 1 month after the end of treatment using validated erectile dysfunction questionnaires and the flow mediated dilatation technique for penile endothelial function. Erectile function was evaluated while patients were receiving PDE5i. RESULTS In the low intensity shock wave treatment group and the sham group 54.1% and 0% of patients, respectively, achieved erection hard enough for vaginal penetration, that is an EHS (Erection Hardness Score) of 3 (p <0.0001). According to changes in the IIEF-EF (International Index of Erectile Function-Erectile Function) score treatment was effective in 40.5% of men who received low intensity shock wave treatment but in none in the sham group (p = 0.001). Of patients treated with shock waves after sham treatment 56.3% achieved erection hard enough for penetration (p <0.005). CONCLUSIONS Low intensity shock wave treatment is effective even in patients with severe erectile dysfunction who are PDE5i nonresponders. After treatment about half of them were able to achieve erection hard enough for penetration with PDE5i. Longer followup is needed to establish the place of low intensity shock wave treatment in these challenging cases.
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Affiliation(s)
- Noam D Kitrey
- Urology Department, Sheba Medical Center, Tel-Hashomer, Israel.
| | - Ilan Gruenwald
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Boaz Appel
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Arik Shechter
- Department of Family Medicine, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Clalit Health Services, Haifa, Israel
| | - Omar Massarwa
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Yoram Vardi
- Urology Department, Sheba Medical Center, Tel-Hashomer, Israel
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Gruenwald I, Kitrey ND, Appel B, Vardi Y. Low-Intensity Extracorporeal Shock Wave Therapy in Vascular Disease and Erectile Dysfunction: Theory and Outcomes. Sex Med Rev 2015; 1:83-90. [PMID: 27784587 DOI: 10.1002/smrj.9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Low-intensity extracorporeal shock wave therapy (LI-ESWT) to the penis has recently emerged as a new and promising modality in the treatment of erectile dysfunction (ED). AIM To review the published literature on the mechanism of action of LI-ESWT; and to report our clinical data on its efficacy in men with vasculogenic ED. METHODS A Medline search using the relevant keywords on this topic has been done. RESULTS From the results of numerous preclinical and animal studies that have been done to date, sufficient evidence shows that the underlying mechanism of action of LI-ESWT is probably neovascularization. Therefore, local application of LI-ESWT to the corpora cavernosa may potentially act in the same mechanism and increase corporal blood flow. We found that the application of LI-ESWT to patients who responded to oral therapy (PDE5i) eliminated their dependence on PDE5i and they were able to successfully achieve erections and vaginal penetration (60-75%). Furthermore, PDE5i non-responders became responders and capable of vaginal penetration (72%). Additionally, LI-ESWT resulted in long-term improvement of the erectile mechanism. CONCLUSIONS LI-ESWT has the potential to improve and permanently restore erectile function by reinstating the penile blood flow. Although these results on LI-ESWT are promising, further multi- centered studies with longer follow-up are needed to confirm these findings. Gruenwald I, Kitrey ND, Appel B, and Vardi Y. Stem low-intensity extracorporeal shock wave therapy in vascular disease and erectile dysfunction: Theory and outcomes. Sex Med Rev 2013;1:83-90.
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Affiliation(s)
- Ilan Gruenwald
- Neuro-Urology Unit, Rambam Healthcare Campus, Haifa, Israel; Department of Urology, Sheba Medical Center, Ramat-gan, Israel
| | - Noam D Kitrey
- Neuro-Urology Unit, Rambam Healthcare Campus, Haifa, Israel; Department of Urology, Sheba Medical Center, Ramat-gan, Israel
| | - Boaz Appel
- Neuro-Urology Unit, Rambam Healthcare Campus, Haifa, Israel; Department of Urology, Sheba Medical Center, Ramat-gan, Israel
| | - Yoram Vardi
- Neuro-Urology Unit, Rambam Healthcare Campus, Haifa, Israel; Department of Urology, Sheba Medical Center, Ramat-gan, Israel.
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Greenstein A, Ferman Z, Stav K, Gruenwald I, Matzkin H, Ramon J. [Position statement for the diagnosis and treatment of men with benign prostate enlargement and lower urinary tract symptoms]. Harefuah 2014; 153:546-557. [PMID: 25417493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Benign prostate enlargement causing lower urinary symptoms is a common progressive phenomenon in adult men. Lower urinary tract symptoms may emerge during the storage, voiding, and post micturition phases, harm quality of life and may be caused by a variety of factors. The purpose of evaluation is to identify benign prostate enlargement and factors other than enlarged prostate as the cause of symptoms, and recognize the risk factors for progression of the condition. The goal of treatment is to alleviate symptoms and improve quality of life, and to prevent deterioration of symptoms and development of complications. Medical therapy is the basic approach, whereas surgery and minimally invasive procedures are reserved for patients not interested in medical therapy or for those in whom symptoms were not alleviated by means of medical therapy. In the present position statement, we present the approach to the evaluation and treatment of lower urinary tract symptoms in men with benign prostate enlargement.
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Abu-Ghanem Y, Kitrey ND, Gruenwald I, Appel B, Vardi Y. Penile low-intensity shock wave therapy: a promising novel modality for erectile dysfunction. Korean J Urol 2014; 55:295-9. [PMID: 24868332 PMCID: PMC4026654 DOI: 10.4111/kju.2014.55.5.295] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Penile extracorporeal low-intensity shock wave therapy (LIST) to the penis has recently emerged as a novel and promising modality in the treatment of erectile dysfunction (ED). LIST has angiogenic properties and stimulates neovascularization. If applied to the corpora cavernosa, LIST can improve penile blood flow and endothelial function. In a series of clinical trials, including randomized double-blind sham-controlled studies, LIST has been shown to have a substantial effect on penile hemodynamics and erectile function in patients with vasculogenic ED. LIST is effective in patients who are responsive to phosphodiesterase 5 inhibitors (PDE5i) and can also convert PDE5i nonresponders to responders. The response to LIST wanes gradually over time, and after 2 years, about half of the patients maintain their function. Extensive research is needed to understand the effect of LIST on erectile tissue, to modify the treatment protocol to maximize its outcomes, and to identify the patients who will benefit the most from this treatment.
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Affiliation(s)
| | - Noam D Kitrey
- Department of Urology, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Boaz Appel
- Neuro-urology Unit, Rambam Health Campus, Haifa, Israel
| | - Yoram Vardi
- Department of Urology, Sheba Medical Center, Ramat-Gan, Israel
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Vardi Y, Appel B, Kitrey N, Massarwa O, Gruenwald I. 603 Low-intensity shockwave treatment for ED – long term follow up of 2 years. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/s1569-9056(14)60593-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization. As a result of these characteristics we initiated a series of experiments evaluating the effect of LI-ESWT on the cavernosal tissue of patients with vasculogenic ED. The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects. Although further extensive research is needed, LI-ESWT may create a new standard of care for men with vasculogenic ED.
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Affiliation(s)
- Ilan Gruenwald
- Neuro-Urology Unit, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa 34679, Israel
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Gruenwald I, Appel B, Massarwi O, Vardi Y. 1511 MID-TERM FOLLOW-UP ON THE EFFECT OF LOW INTENSITY SHOCK WAVES FOR THE TREATMENT OF ERECTILE DYSFUNCTION. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gruenwald I, Appel B, Vardi Y. Low-intensity extracorporeal shock wave therapy--a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy. J Sex Med 2011; 9:259-64. [PMID: 22008059 DOI: 10.1111/j.1743-6109.2011.02498.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Low-intensity shock wave therapy (LI-ESWT) has been reported as an effective treatment in men with mild and moderate erectile dysfunction (ED). AIM The aim of this study is to determine the efficacy of LI-ESWT in severe ED patients who were poor responders to phosphodiesterase type 5 inhibitor (PDE5i) therapy. METHODS This was an open-label single-arm prospective study on ED patients with an erection hardness score (EHS) ≤ 2 at baseline. The protocol comprised two treatment sessions per week for 3 weeks, which were repeated after a 3-week no-treatment interval. Patients were followed at 1 month (FU1), and only then an active PDE5i medication was provided for an additional month until final follow-up visit (FU2). At each treatment session, LI-ESWT was applied on the penile shaft and crus at five different anatomical sites (300 shocks, 0.09 mJ/mm(2) intensity at 120 shocks/min). Each subject underwent a full baseline assessment of erectile function using validated questionnaires and objective penile hemodynamic testing before and after LI-ESWT. MAIN OUTCOME MEASURES Outcome measures used are changes in the International Index of Erectile Function-erectile function domain (IIEF-ED) scores, the EHS measurement, and the three parameters of penile hemodynamics and endothelial function. RESULTS Twenty-nine men (mean age of 61.3) completed the study. Their mean IIEF-ED scores increased from 8.8 ± 1 (baseline) to 12.3 ± 1 at FU1 (P = 0.035). At FU2 (on active PDE5i treatment), their IIEF-ED further increased to 18.8 ± 1 (P < 0.0001), and 72.4% (P < 0.0001) reached an EHS of ≥ 3 (allowing full sexual intercourse). A significant improvement (P = 0.0001) in penile hemodynamics was detected after treatment and this improvement significantly correlated with increases in the IIEF-ED (P < 0.05). No noteworthy adverse events were reported. CONCLUSIONS Penile LI-ESWT is a new modality that has the potential to treat a subgroup of severe ED patients. These preliminary data need to be reconfirmed by multicenter sham control studies in a larger group of ED patients.
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Affiliation(s)
- Ilan Gruenwald
- Neuro-urology Unit, Rambam Healthcare Campus, Haifa, Israel.
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Lowenstein L, Gruenwald I, Itskovitz-Eldor J, Gartman I, Vardi Y. Is there an association between female urinary incontinence and decreased genital sensation? Neurourol Urodyn 2011; 30:1291-4. [PMID: 21404320 DOI: 10.1002/nau.20988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 07/05/2010] [Indexed: 11/11/2022]
Abstract
AIM To explore the relationship between urinary incontinence and genital sensory functioning in females with sexual dysfunction disorders. METHODS A retrospective consecutive chart review was conducted for all women who were referred to our tertiary female urology clinic with a primary complaint of sexual dysfunction between October 1999 and January 2009. Our study sample included 177 women, all of whom underwent a thorough clinical evaluation. Urinary incontinence was diagnosed based on clinical history and physical examination by a urogynecologist. The Genital Thermal and Vibratory Sensory Analyzer (GSA) was used for sensory testing in the genital area. Independent t-test and multivariate linear regression were used for statistical analysis. RESULTS Of the 177 study patients (median age 34, range 18-68), 63 (36%) had urinary incontinence. Women with urinary incontinence were found to be less sensitive to warm, cold, and vibratory thresholds at both the anterior and the posterior vaginal wall and the clitoral area (P < 0.05). CONCLUSIONS Women with urinary incontinence and sexual dysfunction are less sensitive to all sensory testing in the genital region than women with sexual dysfunction alone. This relationship may be attributable to afferent nerve damage and the critical role it may play in the etiology of urinary incontinence.
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Affiliation(s)
- Lior Lowenstein
- Ruth and Bruce Rappaport Faculty of Medicine, Department of Obstetrics and Gynecology, Rambam Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
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Vardi Y, Appel B, Jacob G, Massarwi O, Gruenwald I. Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol 2010; 58:243-8. [PMID: 20451317 DOI: 10.1016/j.eururo.2010.04.004] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 04/07/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Low-intensity extracorporeal shockwave therapy (LI-ESWT) is currently under investigation regarding its ability to promote neovascularization in different organs. OBJECTIVE To evaluate the effect of LI-ESWT on men with erectile dysfunction (ED) who have previously responded to oral phosphodiesterase type 5 inhibitors (PDE5-I). DESIGN, SETTING, AND PARTICIPANTS We screened 20 men with vasculogenic ED who had International Index of Erectile Function ED (IIEF-ED) domain scores between 5-19 (average: 13.5) and abnormal nocturnal penile tumescence (NPT) parameters. Shockwave therapy comprised two treatment sessions per week for 3 wk, which were repeated after a 3-wk no-treatment interval. INTERVENTION LI-ESWT was applied to the penile shaft and crura at five different sites. MEASUREMENTS Assessment of erectile function was performed at screening and at 1 mo after the end of the two treatment sessions using validated sexual function questionnaires, NPT parameters, and penile and systemic endothelial function testing. The IIEF-ED questionnaire was answered at the 3- and 6-mo follow-up examinations. RESULTS AND LIMITATIONS We treated 20 middle-aged men (average age: 56.1 yr) with vasculogenic ED (mean duration: 34.7 mo). Eighteen had cardiovascular risk factors. At 1 mo follow-up, significant increases in IIEF-ED domain scores were recorded in all men (20.9 +/- 5.8 vs 13.5+/- 4.1, p<0.001); these remained unchanged at 6 mo. Moreover, significant increases in the duration of erection and penile rigidity, and significant improvement in penile endothelial function were demonstrated. Ten men did not require any PDE5-I therapy after 6-mo follow-up. No pain was reported from the treatment and no adverse events were noted during follow-up. CONCLUSIONS This is the first study that assessed the efficacy of LI-ESWT for ED. This approach was tolerable and effective, suggesting a physiologic impact on cavernosal hemodynamics. Its main advantages are the potential to improve erectile function and to contribute to penile rehabilitation without pharmacotherapy. The short-term results are promising, yet demand further evaluation with larger sham-control cohorts and longer follow-up.
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Affiliation(s)
- Yoram Vardi
- Neuro-Urology Unit, Rambam Healthcare Campus and the Technion, Haifa, Israel.
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Vardi Y, Jahshan S, Massoud M, Gruenwald I, Zaaroor M, Jacob G. 706 CEREBRAL HEMODYNAMIC RESPONSES TO SILDENAFIL IN HEALTHY MALE'S VOLUNTEERS. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim ED, Eardley I, Mc Carthy BW, Sand M, Nelson C, Miner MM, Shindel AW, Lue TF, Glina S, Wang R, Vardi Y, Gruenwald I, Bella AJ, Shamloul R, Balon R. Comments on “Considerations for Diagnostic Criteria for Erectile Dysfunction in DSM-V”. J Sex Med 2010; 7:661-71. [DOI: 10.1111/j.1743-6109.2009.01684_1.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vardi Y, Gruenwald I, Lowenstein L. Treating Stress Urinary Incontinence: Do We Need to Change a Winning Horse? Eur Urol 2009; 56:31-3. [DOI: 10.1016/j.eururo.2009.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
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Vardi Y, Sprecher E, Gruenwald I, Yarnitsky D, Gartman I, Granovsky Y. The p300 event-related potential technique for libido assessment in women with hypoactive sexual desire disorder. J Sex Med 2009; 6:1688-1695. [PMID: 19453908 DOI: 10.1111/j.1743-6109.2009.01280.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is a need for an objective technique to assess the degree of hypoactive sexual desire disorder (HSDD). Recently, we described such a methodology (event-related potential technique [ERP]) based on recording of p300 electroencephalography (EEG) waves elicited by auditory stimuli during synchronous exposure to erotic films. AIMS To compare sexual interest of sexually healthy women to females with sexual dysfunction (FSD) using ERP, and to explore whether FSD women with and without HSDD would respond differently to two different types of erotic stimuli-films containing (I) or not containing (NI) sexual intercourse scenes. METHODS Twenty-two women with FSD, of which nine had HSDD only, and 30 sexually healthy women were assessed by the Female Sexual Functioning Index. ERP methodology was performed applying erotic NI or I films. MAIN OUTCOME MEASURES Significant differences in percent of auditory p300 amplitude reduction (PR) in response to erotic stimuli within and between all three groups for each film type. RESULTS PRs to each film type were similar in sexually healthy women (60.6% +/- 40.3 (NI) and 51.7% +/- 32.3 [I]), while in women with FSD, reduction was greater when viewing the NI vs. I erotic films (71.4% +/- 41.0 vs. 37.7% +/- 45.7; P = 0.0099). This difference was mainly due to the greater PR of the subgroup with HSDD in response to NI vs. I films (77.7% +/- 46.7 vs. 17.0% +/- 50.3) than in the FSD women without HSDD group or the sexually healthy women (67.5% +/- 38.7 vs. 50.4% +/- 39.4 respectively), P = 0.0084. For comparisons, we used the mixed-model one-way analysis of variance. CONCLUSIONS Differences in neurophysiological response patterns between sexually healthy vs. sexually dysfunctional females may point to a specific inverse discrimination ability for sexually relevant information in the subgroup of women with HSDD. These findings suggest that the p300 ERP technique could be used as an objective quantitative tool for libido assessment in sexually dysfunctional women.
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Affiliation(s)
- Yoram Vardi
- Neuro-urology Unit, Rambam Medical Center, Haifa, Israel
| | - Elliot Sprecher
- Neurophysiology Laboratory, Rambam Medical Center, Haifa, Israel
| | - Ilan Gruenwald
- Neuro-urology Unit, Rambam Medical Center, Haifa, Israel;.
| | | | - Irena Gartman
- Neurophysiology Laboratory, Rambam Medical Center, Haifa, Israel
| | - Yelena Granovsky
- Neurophysiology Laboratory, Rambam Medical Center, Haifa, Israel
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Vardi Y, Dayan L, Apple B, Gruenwald I, Ofer Y, Jacob G. Penile and Systemic Endothelial Function in Men with and without Erectile Dysfunction. Eur Urol 2009; 55:979-85. [DOI: 10.1016/j.eururo.2008.07.041] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 07/17/2008] [Indexed: 01/27/2023]
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Gruenwald I, Leiba R, Vardi Y. Effect of Sildenafil on Middle-Aged Sexually Active Males with No Erectile Complaints: A Randomized Placebo-Controlled Double-Blind Study. Eur Urol 2009; 55:969-76. [DOI: 10.1016/j.eururo.2008.04.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 04/22/2008] [Indexed: 11/25/2022]
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Lowenstein L, Pham T, Abbasy S, Kenton K, Brubaker L, Mueller ER, Shott S, Vardi Y, Gruenwald I, FitzGerald MP. Observations relating to urinary sensation during detrusor overactivity. Neurourol Urodyn 2008; 28:497-500. [DOI: 10.1002/nau.20680] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lowenstein L, FitzGerald MP, Kenton K, Brubaker L, Gruenwald I, Papier I, Durazo-Arvizu RA, Elliot C, Mueller ER, Vardi Y. Validation of a real-time urodynamic measure of urinary sensation. Am J Obstet Gynecol 2008; 198:661.e1-4; discussion 661.e4-5. [PMID: 18377858 DOI: 10.1016/j.ajog.2008.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Revised: 11/20/2007] [Accepted: 02/11/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to test the feasibility and validity of a continuous measurement of urinary sensation during cystometry. STUDY DESIGN Subjects continuously recorded their level of urinary sensation during cystometry with the use of urodynamic diagnoses and responses to the Medical Epidemiologic and Social Aspects of Aging (MESA) and Urinary Distress Inventory (UDI) scales. Trends in urinary sensation recordings by increasing percentage of maximum cystometric capacity (MCC) were captured and compared with the use of growth curves. RESULTS Fifty-one women participated: 18 patients had detrusor overactivity incontinence (DOI); 15 patients had urodynamic stress incontinence; 9 patients had mixed incontinence, and 9 patients did not demonstrate incontinence. In the volume range between 35% and 75% of MCC, the mean sensation level was higher in the DOI group than the other groups (P < .04). Urge sensation at 50% of MCC correlated with UDI and MESA urge subscales (rho = 0.34, p < .03 and rho = 0.39, p < .02). CONCLUSION This study demonstrates that the Urgeometer measurement is feasible and correlates with urodynamic diagnosis and the severity and bother from urge incontinence.
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