Laparoscopic retroperitoneal lymph node dissection.

OBJECTIVES: Primary objective of the present article is to evaluate the surgical efficiency of the laparoscopic retroperitoneal lymph node dissection in clinical stage I and II testis tumor. Secundary, objective is the description of the technique used by the author. METHODS: A description of the author's experience and review of the literature in terms of feasibility, oncological results and quality of life. RESULTS: Once the learning curve has been overcome, the operative time is in the range of that open surgery with lower morbidity and complications. Ejaculation can be preserved in virtually all patients by means of a template dissection. With a mean follow-up of almost four years oncologic long-term outcome is not compromised by the laparoscopic approach. CONCLUSIONS: In clinical stage I testis tumor laparoscopic retroperitoneal lymph node dissection can be used as a diagnostic measure with the same long term results as the open procedure. In stage II disease removal of residual tumor can also be achieved by laparoscopy.

Female sexual dysfunction: state of the art.

Female sexual dysfunction, a common, multifactorial, and often undertreated medical condition, attracted the attention of the medical community with the successful introduction of medical therapy for male erectile dysfunction. This review discusses the updated classification systems and definitions, epidemiologic aspects, and new pathophysiologic and therapeutic implications of this sexual disorder.

New achievements and pharmacotherapeutic approaches to impotence in the elderly.

Erectile dysfunction (ED) has a negative impact on the quality of life of elderly men, but impotence is not an absolute concomitant of aging. Aging changes influencing sexual function in men consist of a decreased capacity to reach arousal by imagination or view, fragility of erection, and an increase in the refractory period. These events may be part of the andropause syndrome, which includes a decrease in intellectual activity, fatigue, depression, decreases in body hair, lean body mass and bone mineral density, accompanied by an increase in weight. As a consequence, the overlap of aging processes, concurrent diseases and social situations to which elderly men are subject, results in the great variability reported in epidemiological studies. In the same way, the complex physiology of erection depends on the social, environmental, or physical context in which it occurs. New achievements in research on intracellular mechanisms of erection and on the neuroendocrinology of aging contribute to better understanding the pathophysiology of ED in the elderly. For example, testosterone declines with age with great interindividual variability, since other hormonal changes are also involved. What currently can be easily identified is the alteration of LH-testosterone feedback alterations, although hormone levels fall in the normal range. Nevertheless, the extent to which age-dependent decline in hormones leads to health problems that may affect the quality of life remains to be clarified. Several concepts on aging-related processes have been challenged, and conditions that were once accepted as physiologically age-related are now thought to lead to medical problems, but until now erectile dysfunction remains underreported, underdiagnosed, and undertreated, especially in the elderly. Nowadays, we are witnessing a rapid growth in available pharmacotherapies, from intracavernous injections of vasoactive drugs, to powerful new oral agents, with differing pharmacological dynamic and kinetic properties. New options for treatment are therefore possible, taking into account both the possibility of changing ineffective drugs and augmenting efficacy by means of synergistic associations. This rich generation of progress is certainly contributing to a better medical approach to sexuality in aging people.

Erectile dysfunction: evaluation and new treatment options.

OBJECTIVE: Erectile dysfunction (ED) is a common condition of aging men. Indeed as many as 50% of men over age 40 will suffer some degree of ED. This erectile dysfunction has substantial impact on interaction with their partners, families, and employment. ED may be a harbinger of more serious vascular events and is commonly associated with depression. METHODS: Evaluation of ED begins with a careful history, asking the patient about his sexual function during clinical visits. Once identified, ED must be carefully considered with full history, careful physical examination, and laboratory studies to include markers of vascular risk factors, diabetes, and hypogonadism. RESULTS: The treatment of ED was revolutionized by the introduction of phosphodiesterase type 5 (PDE5) inhibitors in 1998. Currently, 3 PDE5 inhibitors are available internationally with excellent expected results and somewhat unique profiles. Although these agents are safe in all patients who do not have severe cardiac disease or who are taking nitrate medications, they require some patient instruction and counseling to optimize results. In that small group of patients who do not respond to these oral medications, additional alternatives are available for patients motivated to pursue treatment of their ED.CONCLUSION: Currently available safe and effective alternatives for the treatment of ED can improve the lives of patients and partners and increase their quality of life.