==inizio objective==

Among different approaches proposed through time, peno-scrotal and infrapubic ones are the most common performed for penile prosthesis implantation. Those are generally shorter in dimension than that of the past and allows to implant the prosthesis with a single incision of few centimeter. In scientific literature works comparing both approaches are lacking. Aim of this study is to compare advantages and disadvantages of each peno-scrotal and infrapubic approach in order to assess whether there is one to prefer on the other.

==fine objective==

==inizio methodsresults==

This was a retrospective analysis on 69 consecutive patients who all have been implanted between 2010 and 2013. Among these 10 received and implantation via infrapubic incision and other 59 via peno-scrotal one. Quality of Life(QoL) was determined using the validated questionnaire QoLSPP. Data were analyzed using SPSS software for statistical analysis.

==fine methodsresults==

==inizio results==

Samples were homogeneous according to age ((60.3 A vs 67.1 B; p= 0.12).In Group A (peno-scrotal) 9 patients of 59 had concomitant IPP vs none in Group B (infrapubic). Mean of total implant length showed no difference, with differences in lenght of the extensor which is higher in group A. Operation time is 8 minutes shorter in group B (77.5 minutes A vs 85.2 minutes B; p<0,05). Penis length after surgery showed not significant difference (13.48 cm A vs 13.6 cm B; p=0,9). Few complications was observed all belonging to Dindo 1 with no significant difference between the groups. As well, QoLSPP scores showed no difference in the 4 domains: functional (3.9 A vs 4.0 B; p=0,32), relational (4,2 A vs 4,1 B; p=0.8), social (3.7 A vs 4,1 B; p=0.47) and personal (4.0 A vs 4.3 B; p=0.18). ==fine results== ==inizio discussions== The peno-scrotal approach was largely more frequently performed (6:1).Operation time was barely shorter with the infrapubic approach, although its effectiveness in reducing infections has been questioned (1). The peno-scrotal approach allows a better exposition of the corpora cavernosa and it should be preferred in complex cases (like concomitant IPP). Using one approach or another did not affect patients QoL after the implantation(2). ==fine discussions== ==inizio conclusion== Both approaches are safe, effective and should be considered minimally invasive if any ancillary procedure has been performed; the decision on which is to choice actually depends on surgeon or patient preference, evaluating every single case. In our centre, peno-scrotal approach is more frequently used as it is, in general, in Italy. (3) ==fine conclusion== ==inizio reference== (1) Garber , Markus. Urology 1998 Aug 52(2):291-3. (2) Caraceni, Utizi et al. J Sex Med 2014; 11:1005-1012 (3) INSIST-ED. Archivio italiano Urologia Andrologia 2016; 88-2 ==fine reference==

==inizio objective==

Communication in sexology is always a hard matter because the terapist must listen to and inform the patient and in the same time take care of him : so that the concept of “communication” have to change in “communi-care “. Uroandrological departments and ambulatory outpatients represent a challenge both in case of anamnesis collection , explanation of side effects and complications of drugs, surgery and in case of physical exam or nursing .

==fine objective==

==inizio methodsresults==

During a professional training course about “communi-care “ held on october 2016 a simple 8 items questionnaire was submitted to all participants :
1)Do you think that sex is important in your life?
2) Do you feel to have “sexological problems” in this moment ?
3) Are there sexological questions to which do you like to have answers?
4) Do you consult a specialist to deepen any curiosity or sexual problem?
5) Have you any trouble talking about sex ?
6) Have you any trouble talking about sex with your partner?
7) Do your personal sexological problems affect your professional activities ?
8) Do your personal sexological problems affect your dialogue with patients?
AIM of the questionnaire is the evaluation of the sexual status and feeling about sex of the participants and the relevance of sexual matters and personal problems in approaching patients
76 participants of professional training course: 14 males , 52 females ,10 not decleared sex;
13 medical doctors, 41 nurses, 4 psychologists , 5 other professional workers 13 not decleared profession, aged 23 -64 years

==fine methodsresults==

==inizio results==

item 1 :yes 72/76 (94.7 %)
item 2 : no 60/76 (78,9 %)
item 3: yes 53/76 (69.7 %)
item 4 : no 42/76 (55,2 %)
item 5 : no 63/76 (82,8 %)
item 6 : no 68/76 (89,4 %)
item 7 : no 73/76 (96 %)
item 8 : no 75/76 (98,6 %)

==fine results==

==inizio discussions==

78,9 % of the participants decleared NO “sexological problems”, BUT 69.7% YES : had to ask some sexological questions
Females seem to have more sexological problems (25 % versus 14.3% of the male) and have more questions to be answered (77 % versus 57.1 % of the male )
Furthermore females decleared a bit more trouble talking about sex (18.8 % versus 7.2% of the male)
100 % of the male decleared NO trouble in talking about sex either with the partner or with patients
Only 1 male and 1 female decleared that personal sexological problems affected professional activity and the dialogue with the patient respectively : the others showed very clear and strong positions thinking and feeling about communication in sex. Perhaps this strong unanimuos response may hide any psychological resistances or underlying problems?

==fine discussions==

==inizio conclusion==

Discrepancy revealed by an accurate analysis of the answers underlines the importance of treating sexual matters in uroandrological environment and in the same time a kind of personal psychological involvement by health care staff: so sexological informations is needed togheter with a basical sexological training

==fine conclusion==

==inizio reference==

Biopsychosocial aspects of Prostate cancer . EJS Kunkel JR Bakker RE Myers, O Oyesanmi, LG Gomella Psychosomatics 2000; 41:85-94
Longitudinal effects of social support and adaptive coping on the emotional well-being of survivors of Localized Prostate Cancer RES Zhou, FJ Penedo et al J Support Oncol 2010; 8 (5):196-201
Perceptions and opinions of men and women on a man’s sexual confidence and its relationship to ED: results of the European Sexual Confidence Survey.
San Martín C1, Simonelli C, Sønksen J, Schnetzler G, Patel S.
Int J Impot Res. 2012 Nov-Dec;24(6):234-41. doi: 10.1038/ijir.2012.23. Epub 2012 Jun 21.

==fine reference==

==inizio objective==

Erectile dysfunction (ED) is the main complaint in male sexual medicine and it can affect patients (pts) physically and psychologically [1]. The primary goal in the management of ED would be to cure it when possible, and not just to treat the symptom alone [2]. One of the new promising treatments is Low intensity shock waves (LISW). In this study, we combine LISW [3]and a vacuum Device[4] for the treatment of ED.
T

==fine objective==

==inizio methodsresults==

This is a single-blind, two-arm randomized study. Sixty-five pts with mild to severe ED were enrolled. Group A (30 pts) underwent four weekly treatment sessions of LISW. During each session, 3600 shocks at 0.09 mJ/mm2 were given, 900 shocks at each anatomical area in right and left corpus cavernous, and right and left crus. Group B (30pts) underwent LISW plus vacuum device rehabilitation for 6 months.
he principle of Vaccum erection device therapy is so mechanically create negative pressure surrounding the penis to engorge it with blood and then restrain blood egress from the organ to maintain the erection like effect.
It is placed directly over the flaccid penis and operated, and after the penis is erected an elastic constriction ring or band is positioned at the base of the penis; then the vacuum is released and the device is removed.
They were investigated using the International Index of Erectile Function (IIEF-5) and the Sexual Encounter Profile (SEP) diaries (SEP- Questions 2 and 3).

==fine methodsresults==

==inizio results==

At 6 months’ follow-up, in Group A was reported a mean improvement of IIEF-5 scores from 11.05 ± 5.35 at baseline to 20.06 ± 5.28, SEP-Q2 from 48% to 72%, SEP-Q3 from 28% to 55%. In Group B was reported a mean improvement of IIEF-5 scores improved from 10.54 ± 6.87 at baseline to 22.06 ± 5.28, SEP-Q2 from 52% to 85%, SEP-Q3 from 30% to 62%.

==fine results==

==inizio discussions==

The finding of this study demonstrate that LISW plus Vacuum device therapy gives better results than LISW alone in the treatment of ED. LISW induces neovascularization and it can improve cavernously arterial flow which can result in an improvement of erectile function by releasing tissue factors (NO, VEGF). The vacuum device using the negative pressure generated by the apparatus, enables a greater influx of arterial blood within the cavernous bodies with an increase in oxygen saturation at microvascular level[5].

==fine discussions==

==inizio conclusion==

This combination therapy is proved to be effective and without side effects.
It can be a safe and valid tool in the management of erectile dysfunction or in men that can not undergo treatment with PDE5-i.

==fine conclusion==

==inizio reference==

1. 1. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Wespes E; European Association of Urology.
Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010
2. Lewis RW, Fugl-Meyer KS, Corona G, et. Al. Defnitions/Epidemiology/risk factor for sexual dysfuntion. J Sex Med 2010; 7:1598-607.
3. Ruffo A, Capece M, Prezioso D, Romeo G, Illiano E, Romis L, Di Lauro G, Iacono F. Safety and efficacy of low intensity shockwave (LISW) treatment in patients with erectile dysfunction. Int Braz. Urology 2015

==fine reference==