For many years, the role of testosterone has been perceived to play a role in the development of prostate cancer and certain cardiovascular diseases (Jones et al., 2013); with its general therapeutic roles being much overlooked. Much of this unprecedented assumption was based upon clinical observations showing the benefit of androgen deprivation in prostate cancer patients, and the perceived reports of higher cardiovascular death amongst people abusing steroid therapies (Jones et al., 2013; Basaria et al., 2010). However, there has been compelling evidence that suggests that testosterone administration within physiological ranges does not contribute to prostate cancer or the pathogenesis of cardiovascular disease (Morgentaler et al., 2009; Jones et al., 2013; Traish et al., 2009). Recent evidence actually suggests the protective role of androgens in the management of metabolic conditions, such as: obesity, metabolic syndrome, and type-2 diabetes mellitus, all of which are known to increase the risk of cardiovascular disease (Traish et al., 2009; Morgentaler et al., 2009; Wang et al., 2000). Erectile dysfunction, which is a type of endothelial dysfunction disorder, is defined as the persistent inability to achieve or maintain an erection for satisfactory sexual performance, and it affects an estimated 30 million American men between the ages of 40 to 70 years old, and this prevalence increases with age (Nehra A, 2007; Barkin J, 2011; Guay A, 2007). The male human erection involves a multifactorial interplay between various mechanisms within the body; encompassing psychological, vascular, neural and endocrine factors (Dean et al., 2005; Castela et al, 2011). The human erection involves the increased inflow of blood into the penile arteries, and the subsequent veno-occlusion, all of which occurs at a perfectly orchestrated hormonal environment (Bivalacqua et al, 1998; Castela et al., 2011). Nitric oxide is released from the endothelium, which dilates penile arteries and relaxes the penile smooth muscles, causing the corpora cavernosa of the penis to fill with blood; the ischiocavernosus and bulbospongiosus muscles then compress the veins, which restricts the egress of blood (Bivalacqua et al, 1998; Castela et al., 2011). Nitric oxide increases cGMP, which decreases intracellular calcium uptake, and increases K+ efflux; these all cause a smooth muscle cell relaxation. The decreased venous outflow from the penis helps maintain erection. In addition to nitric oxide, several other mechanisms are involved in the erectile response. The endothelium, which regulates vascular tone and blood flow, is responsible for the cholinergic smooth muscle relaxation observed by the addition of acetylcholine (Furchgott et al., 1983). Chamness et al. (1995) have shown that androgen differentially affects nitric oxide synthase activity in the male reproductive tract endothelium. Thus, the role of androgens, namely testosterone, is of importance in maintaining erectile function. In addition to affecting nitric oxide synthase activity, testosterone is also shown to affect erectile physiology in many more ways, including its role in activating K+ channels to increase the efflux or inhibit calcium channels via hyperpolarization (Yildiz et al., 2009), and even increasing arterial blood flow to the penis (Aversa et al., 2000). Interestingly, testosterone also modulates endothelial function. Endothelial progenitor cells are responsible for the regeneration of the endothelium. The area of study of these progenitor cells is relatively new, thus, it is important to evaluate how they affect endothelial function. Since erectile dysfunction is a form of endothelial dysfunction, it has been found that patients with erectile dysfunction had significantly lower levels of circulating progenitor cells than patients with a normal erectile function (Baumhäkel et al., 2006). Endothelial cells in the penile arteries play a critical role in regulating the physiological function of the erectile response in humans. Modulation of the endothelium in the penis by androgens, thus, is a critical area of research that must be further addressed.

A prostatectomia radical (PR) é um dos procedimentos mais utilizados para o tratamento do câncer de próstata (CaP) localizado, porém apesar da maior compreensão da anatomia local e do desenvolvimento tecnológico, esta cirurgia permanece associada à elevada morbidade na esfera sexual. A redução do comprimento peniano após a PR é uma queixa freqüente na prática urológica, porém não há dados na literatura a respeito da variação deste comprimento em um longo período de acompanhamento. A determinação da história natural do comprimento peniano após PR, assim como possíveis fatores de risco ou de proteção é de fundamental importância para o aconselhamento e tratamento dos pacientes submetidos a esta cirurgia. O objetivo deste estudo é determinar a história natural do comprimento peniano após a PR em um acompanhamento de cinco anos, assim como avaliar o papel da função erétil na variação do comprimento peniano destes pacientes. Foram avaliados prospectivamente os comprimentos penianos de 105 pacientes com câncer de próstata localizado submetidos PR aberta. Participação em programas de reabilitação peniana e deformidades anatômicas do pênis foram considerados critérios de exclusão. A medição do comprimento real peniano sob máxima tração (CRTmax) foi realizada antes da PR e aos 3, 6, 12, 24, 36, 48 e 60 meses no pós-operatório. O domínio da função erétil do índice internacional de função erétil (IIEF-EF) foi utilizado para avaliar a função erétil. Houve redução média de 1 cm no CRTmax em 3 meses após a PR e essa diferença permaneceu até 24 meses (p<0,001). Após este período, a diferença reduziu gradativamente, deixando de ser estatisticamente significativa em 48 meses (-0,3 cm, p=0,080) e 60 meses (+0,4 cm, p=0,065). A função erétil foi um preditor para o retorno precoce do comprimento do pênis. Um encurtamento peniano médio de 1 cm é esperado nos primeiros 24 meses após PR. No entanto, há uma tendência para a recuperação deste comprimento após 24 meses de pós-operatório, com retorno ao comprimento original em 48 meses. A função erétil preservada após a PR é um preditor para a recuperação precoce do comprimento do pênis / Radical prostatectomy (RP) is one of the most common treatment for localized prostate cancer (PCa), but despite the advances in the local anatomy knowledge and the technological development, this surgery remains related to high morbidity in the sexual sphere. The reduction in penile length after RP is a common complaint in urologic practice, but there is no data regarding this issue in a long follow-up period. The determination of the natural history of penile length after RP and possible risk factor is necessary for the counseling and treatment of patients undergoing this surgery. The objective of this study is to determine the natural history of penile length after RP in a five years follow-up and to investigate the role of erectile function in the penile length variation. We prospectively evaluated the penile length of 105 patients with localized prostate cancer submitted to open RP. Participation in penile rehabilitation programs and anatomical deformities of the penis were considered exclusion criteria. Measurements of the real length under maximum penile traction (RSLmax) were performed before and after RP at 3, 6, 12, 24, 36, 48 and 60 months postoperatively. The erectile function domain of the International Index of Erectile Function (IIEF-EF) was used to assess erectile function. There was a mean reduction of 1 cm in RSLmax in 3 months after the PR and this difference remained up to 24 months (p <0.001). After this period, the difference decreased gradually and was not statistically significant at 48 months (-0.3 cm, p = 0.080) and 60 months (+0.4 cm, p = 0.065). Erectile function was a predictor for the early recovery of penile length. In conclusion, a mean penile shortening about 1 cm is expected in the first 24 months after RP. However, there is a tendency for the recovery of this length after 24 months postoperatively, with a return to the original length at 48 months. The normal erectile function after RP is a predictor for early recovery of penile length

A prostatectomia radical (PR) é um dos procedimentos mais utilizados para o tratamento do câncer de próstata (CaP) localizado, porém apesar da maior compreensão da anatomia local e do desenvolvimento tecnológico, esta cirurgia permanece associada à elevada morbidade na esfera sexual. A redução do comprimento peniano após a PR é uma queixa freqüente na prática urológica, porém não há dados na literatura a respeito da variação deste comprimento em um longo período de acompanhamento. A determinação da história natural do comprimento peniano após PR, assim como possíveis fatores de risco ou de proteção é de fundamental importância para o aconselhamento e tratamento dos pacientes submetidos a esta cirurgia. O objetivo deste estudo é determinar a história natural do comprimento peniano após a PR em um acompanhamento de cinco anos, assim como avaliar o papel da função erétil na variação do comprimento peniano destes pacientes. Foram avaliados prospectivamente os comprimentos penianos de 105 pacientes com câncer de próstata localizado submetidos PR aberta. Participação em programas de reabilitação peniana e deformidades anatômicas do pênis foram considerados critérios de exclusão. A medição do comprimento real peniano sob máxima tração (CRTmax) foi realizada antes da PR e aos 3, 6, 12, 24, 36, 48 e 60 meses no pós-operatório. O domínio da função erétil do índice internacional de função erétil (IIEF-EF) foi utilizado para avaliar a função erétil. Houve redução média de 1 cm no CRTmax em 3 meses após a PR e essa diferença permaneceu até 24 meses (p<0,001). Após este período, a diferença reduziu gradativamente, deixando de ser estatisticamente significativa em 48 meses (-0,3 cm, p=0,080) e 60 meses (+0,4 cm, p=0,065). A função erétil foi um preditor para o retorno precoce do comprimento do pênis. Um encurtamento peniano médio de 1 cm é esperado nos primeiros 24 meses após PR. No entanto, há uma tendência para a recuperação deste comprimento após 24 meses de pós-operatório, com retorno ao comprimento original em 48 meses. A função erétil preservada após a PR é um preditor para a recuperação precoce do comprimento do pênis / Radical prostatectomy (RP) is one of the most common treatment for localized prostate cancer (PCa), but despite the advances in the local anatomy knowledge and the technological development, this surgery remains related to high morbidity in the sexual sphere. The reduction in penile length after RP is a common complaint in urologic practice, but there is no data regarding this issue in a long follow-up period. The determination of the natural history of penile length after RP and possible risk factor is necessary for the counseling and treatment of patients undergoing this surgery. The objective of this study is to determine the natural history of penile length after RP in a five years follow-up and to investigate the role of erectile function in the penile length variation. We prospectively evaluated the penile length of 105 patients with localized prostate cancer submitted to open RP. Participation in penile rehabilitation programs and anatomical deformities of the penis were considered exclusion criteria. Measurements of the real length under maximum penile traction (RSLmax) were performed before and after RP at 3, 6, 12, 24, 36, 48 and 60 months postoperatively. The erectile function domain of the International Index of Erectile Function (IIEF-EF) was used to assess erectile function. There was a mean reduction of 1 cm in RSLmax in 3 months after the PR and this difference remained up to 24 months (p <0.001). After this period, the difference decreased gradually and was not statistically significant at 48 months (-0.3 cm, p = 0.080) and 60 months (+0.4 cm, p = 0.065). Erectile function was a predictor for the early recovery of penile length. In conclusion, a mean penile shortening about 1 cm is expected in the first 24 months after RP. However, there is a tendency for the recovery of this length after 24 months postoperatively, with a return to the original length at 48 months. The normal erectile function after RP is a predictor for early recovery of penile length

Introduction: Obesity has been suggested to be one of the risk factors for erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Bariatric surgery has been used for the treatment of obesity and has been suggested to have a significant impact on obesity-related conditions such as diabetes mellitus, ED and LUTS. Previous studies have investigated the effect of bariatric surgery on erectile and urological function in obese men; however those studies used long-term time points post-operatively (more than 1 month). Since it is now known that bariatric surgery can potentially induce glycaemic improvement within one week independent of weight loss, this study aimed to investigate the short-term effect in order to test the hypothesis as to whether improvement in urogenital function after bariatric surgery is due to weight loss or whether it is due to glycaemic improvement. Aim: To evaluate the baseline characteristics of patients with erectile dysfunction and to determine the early effects of bariatric surgery on erectile and urological function in morbidly obese men.

MUDr. Watcharaphol Alexandre Kamnerdsiri Determinants of Sexual Satisfaction in Czech Men Page 1 of 5 Determinants of Sexual Satisfaction in Czech Men Abstract Very legitimately, medicine as well as medical literature, especially in the field of sexology, focuses on the study and treatment of all disorders and dysfunctions that affect the human race and its sexuality. Through this thesis, we attempted to resist against this general trend and sought anything that would facilitate or promote a man's achievement of an accomplished and happy sexuality. These terms imply a sexuality that satisfies this man. There is indeed nothing more subjective than sexual satisfaction, despite the easy access to pornographic material that tends to introduce some elements of comparison in the mind of each man, however unrealistic. There are many tools to measure sexual satisfaction. However, it has been demonstrated that assessing sexual satisfaction with a single question is nearly as reliable as using more detailed questionnaires. As this thesis is integrated into a much larger research based on a 90-item questionnaire, it was decided to use only one question regarding sexual satisfaction. However, it has been divided into two variants, one on the overall sex life satisfaction, and the other on the recent sexual satisfaction...