Ajay Nehra

PURPOSE: The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction. MATERIALS AND METHODS: A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1965 to 7/29/17) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of erectile dysfunction. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions. RESULTS: The American Urological Association has developed an evidence-based guideline on the management of erectile dysfunction. This document is designed to be used in conjunction with the associated treatment algorithm. CONCLUSIONS: Using the shared decision-making process as a cornerstone for care, all patients should be informed of all treatment modalities that are not contraindicated, regardless of invasiveness or irreversibility, as potential first-line treatments. For each treatment, the clinician should ensure that the man and his partner have a full understanding of the benefits and risk/burdens associated with that choice.

No AccessJournal of UrologyCLINICAL UROLOGY: Special Communications1 Oct 2003American Urological Association Guideline On The Management of Priapism DROGO K. MONTAGUE, JONATHAN JAROW, GREGORY A. BRODERICK, ROGER R. DMOCHOWSKI, JEREMY P.W. HEATON, TOM F. LUE, AJAY NEHRA, IRA D. SHARLIP, and MEMBERS OF THE ERECTILE DYSFUNCTION GUIDELINE UPDATE PANEL‡‡ DROGO K. MONTAGUEDROGO K. MONTAGUE Financial interests/and or relationship with American Medical Systems, Bayer, Lilly-ICOS and Pfizer. More articles by this author , JONATHAN JAROWJONATHAN JAROW Financial interest and/or other relationship with Pfizer and Bayer. More articles by this author , GREGORY A. BRODERICKGREGORY A. BRODERICK Financial interest and/or other relationship with Bayer, Eli Lilly/ICOS, Mentor Corp. Abbott/Tap and Pfizer. More articles by this author , ROGER R. DMOCHOWSKIROGER R. DMOCHOWSKI Financial interest and/or other relationship with Ortho-McNeil Pharmaceuticals, Watson and Indevus. More articles by this author , JEREMY P.W. HEATONJEREMY P.W. HEATON Financial interests/and or relationship with AGGSH International, Cellegy and TAP. More articles by this author , TOM F. LUETOM F. LUE Financial interest and/or other relationship with Pfizer, Lilly/ICOS, Bayer-GlaxoSmithKline and Tap. More articles by this author , AJAY NEHRAAJAY NEHRA Financial interest and/or other relationship with Bayer and Pfizer. More articles by this author , IRA D. SHARLIPIRA D. SHARLIP Financial interest and/or other relationship with Pfizer, Lilly/ICOS, Bayer, Tap and NexMed. More articles by this author , and MEMBERS OF THE ERECTILE DYSFUNCTION GUIDELINE UPDATE PANEL‡‡ Consultants: Hanan S. Bell, Patrick M. Florer and Charles B. Hathaway. More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000087608.07371.caAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Low-flow priapism: risk factors for erectile dysfunction. BJU Int2002; 89: 285. Google Scholar 2 : The ultrastructure of erectile tissue in priapism. J Urol1986; 135: 142. Link, Google Scholar 3 : Pharmacologic erection: time-dependent changes in the corporal environment. Int J Impot Res1994; 6: 9. Google Scholar 4 : Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. Edited by . New York: McGraw-Hill Professional Publishing, chapt. 102001: 215. Google Scholar 5 : Priapism. In: Glenn's Urologic Surgery. Edited by . Philadelphia: Lippincott Williams & Wilkins1998. Google Scholar 6 : Atlas of Urologic Surgery. Philadelphia: W. B. Saunders Co.1998: 177. sect. 6. Google Scholar 7 : Permanent open shunt as a reason for impotence or reduced potency after surgical treatment of priapism in 26 patients. Int J Impot Res1995; 7: 175. Google Scholar 8 : Priapism. Our experience. Arch Esp Urol1998; 51: 269. Google Scholar 9 : Pulmonary embolism: a complication of corpus-saphenous shunt for priapism. J Urol1968; 99: 196. Link, Google Scholar 10 : Placebo-controlled study of oral terbutaline and pseudoephedrine in management of prostaglandin E1-induced prolonged erections. Urology1993; 42: 51. Google Scholar 11 : High flow priapism complicating veno-occlusive priapism: pathophysiology of recurrent idiopathic priapism?. J Urol1998; 159: 1300. Link, Google Scholar 12 : Pathophysiology of “low flow” priapism: intermediate phase-evidence of “high flow” defined with duplex ultrasound. Int J Impot Res1999; 11: S27. Google Scholar 13 : Arterial priapism: diagnosis, treatment and long-term followup. J Urol1994; 151: 1231. Link, Google Scholar 14 : Use of methylene blue and selective embolization of the pudendal artery for high flow priapism refractory to medical and surgical treatments. J Urol1991; 146: 1361. Link, Google Scholar 15 : Short period of administration of diethylstilbestrol in stuttering priapism in sickle cell anemia. Am J Hematol2002; 69: 297. Google Scholar 16 : Preventive treatment of priapism in sickle cell disease with oral and self-administered intracavernous injection of etilefrine. Urology1996; 47: 777. Google Scholar 17 : Antiandrogens in the treatment of priapism. Urology2002; 59: 138. Google Scholar 18 : Gonadotropin-releasing hormone analogues in the treatment of sickle cell anemia-associated priapism. J Urol1993; 150: 475. Link, Google Scholar 19 : Stilboestrol and stuttering priapism in homozygous sickle-cell disease. Lancet1985; 2: 1274. Google Scholar 20 : Management of recurrent priapism with epinephrine self-injection and gonadotropin-releasing hormone analogue. J Urol1995; 153: 152. Link, Google Scholar 21 : Treatment of recurrent idiopathic priapism. J Urol2002; 168: 2552. Link, Google Scholar 22 : A possible mechanism for alteration of human erectile function by digoxin: inhibition of corpus cavernosum sodium/potassium adenosine triphosphatase activity. J Urol1998; 159: 1529. Link, Google Scholar 23 : Treatment of intermittent idiopathic priapism with oral terbutaline. Br J Urol1997; 80: 341. Google Scholar 24 : Management of sickle cell priapism with etilefrine. Arch Dis Child2001; 85: 52. Google Scholar 25 : Intracorporeal self-injection with epinephrine as treatment for idiopathic recurrent priapism. Eur Urol1990; 17: 95. Google Scholar © 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBivalacqua T, Allen B, Brock G, Broderick G, Chou R, Kohler T, Mulhall J, Oristaglio J, Rahimi L, Rogers Z, Terlecki R, Trost L, Yafi F and Bennett N (2022) The Diagnosis and Management of Recurrent Ischemic Priapism, Priapism in Sickle Cell Patients, and Non-Ischemic Priapism: An AUA/SMSNA GuidelineJournal of Urology, VOL. 208, NO. 1, (43-52), Online publication date: 1-Jul-2022.Hou L and Burnett A (2020) Regimented Phosphodiesterase Type 5 Inhibitor Use Reduces Emergency Department Visits for Recurrent Ischemic PriapismJournal of Urology, VOL. 205, NO. 2, (545-553), Online publication date: 1-Feb-2021.Masterson T, Parmar M, Tradewell M, Nackeeran S, Rainer Q, Blachman-Braun R, Heller N, Greer A, Hauser N, Kava B and Ramasamy R (2020) Using Artificial Intelligence to Predict Surgical Shunts in Men with Ischemic PriapismJournal of Urology, VOL. 204, NO. 5, (1033-1038), Online publication date: 1-Nov-2020.Zacharakis E, Raheem A, Freeman A, Skolarikos A, Garaffa G, Christopher A, Muneer A and Ralph D (2013) The Efficacy of the T-Shunt Procedure and Intracavernous Tunneling (Snake Maneuver) for Refractory Ischemic PriapismJournal of Urology, VOL. 191, NO. 1, (164-168), Online publication date: 1-Jan-2014.Roghmann F, Becker A, Sammon J, Ouerghi M, Sun M, Sukumar S, Djahangirian O, Zorn K, Ghani K, Gandaglia G, Menon M, Karakiewicz P, Noldus J and Trinh Q (2013) Incidence of Priapism in Emergency Departments in the United StatesJournal of Urology, VOL. 190, NO. 4, (1275-1280), Online publication date: 1-Oct-2013.Qureshi J, Wood H and Feldman M (2013) High Flow Priapism on Color Doppler UltrasoundJournal of Urology, VOL. 189, NO. 6, (2312-2313), Online publication date: 1-Jun-2013.Segal R, Readal N, Pierorazio P, Burnett A and Bivalacqua T (2012) Corporal Burnett “Snake” Surgical Maneuver for the Treatment of Ischemic Priapism: Long-Term FollowupJournal of Urology, VOL. 189, NO. 3, (1025-1029), Online publication date: 1-Mar-2013.Salem E and El Aasser O (2010) Management of Ischemic Priapism by Penile Prosthesis Insertion: Prevention of Distal ErosionJournal of Urology, VOL. 183, NO. 6, (2300-2303), Online publication date: 1-Jun-2010.Abern M and Levine L (2009) Ketoconazole and Prednisone to Prevent Recurrent Ischemic PriapismJournal of Urology, VOL. 182, NO. 4, (1401-1406), Online publication date: 1-Oct-2009.Brant W, Garcia M, Bella A, Chi T and Lue T (2009) T-Shaped Shunt and Intracavernous Tunneling for Prolonged Ischemic PriapismJournal of Urology, VOL. 181, NO. 4, (1699-1705), Online publication date: 1-Apr-2009.Burnett A (2008) No Surgery for Stuttering PriapismJournal of Urology, VOL. 181, NO. 2, (450-451), Online publication date: 1-Feb-2009.Morey A (2007) Trauma, and Genital and Urethral ReconstructionJournal of Urology, VOL. 178, NO. 1, (174-176), Online publication date: 1-Jul-2007. Volume 170Issue 4 Part 1October 2003Page: 1318-1324 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.MetricsAuthor Information DROGO K. MONTAGUE Financial interests/and or relationship with American Medical Systems, Bayer, Lilly-ICOS and Pfizer. More articles by this author JONATHAN JAROW Financial interest and/or other relationship with Pfizer and Bayer. More articles by this author GREGORY A. BRODERICK Financial interest and/or other relationship with Bayer, Eli Lilly/ICOS, Mentor Corp. Abbott/Tap and Pfizer. More articles by this author ROGER R. DMOCHOWSKI Financial interest and/or other relationship with Ortho-McNeil Pharmaceuticals, Watson and Indevus. More articles by this author JEREMY P.W. HEATON Financial interests/and or relationship with AGGSH International, Cellegy and TAP. More articles by this author TOM F. LUE Financial interest and/or other relationship with Pfizer, Lilly/ICOS, Bayer-GlaxoSmithKline and Tap. More articles by this author AJAY NEHRA Financial interest and/or other relationship with Bayer and Pfizer. More articles by this author IRA D. SHARLIP Financial interest and/or other relationship with Pfizer, Lilly/ICOS, Bayer, Tap and NexMed. More articles by this author MEMBERS OF THE ERECTILE DYSFUNCTION GUIDELINE UPDATE PANEL‡‡ Consultants: Hanan S. Bell, Patrick M. Florer and Charles B. Hathaway. More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND: Dehydroepiandrosterone (DHEA) and testosterone are widely promoted as antiaging supplements, but the long-term benefits, as compared with potential harm, are unknown. METHODS: We performed a 2-year, placebo-controlled, randomized, double-blind study involving 87 elderly men with low levels of the sulfated form of DHEA and bioavailable testosterone and 57 elderly women with low levels of sulfated DHEA. Among the men, 29 received DHEA, 27 received testosterone, and 31 received placebo. Among the women, 27 received DHEA and 30 received placebo. Outcome measures included physical performance, body composition, bone mineral density (BMD), glucose tolerance, and quality of life. RESULTS: As compared with the change from baseline to 24 months in the placebo group, subjects who received DHEA for 2 years had an increase in plasma levels of sulfated DHEA by a median of 3.4 microg per milliliter (9.2 micromol per liter) in men and by 3.8 microg per milliliter (10.3 micromol per liter) in women. Among men who received testosterone, the level of bioavailable testosterone increased by a median of 30.4 ng per deciliter (1.1 nmol per liter), as compared with the change in the placebo group. A separate analysis of men and women showed no significant effect of DHEA on body-composition measurements. Neither hormone altered the peak volume of oxygen consumed per minute, muscle strength, or insulin sensitivity. Men who received testosterone had a slight increase in fat-free mass, and men in both treatment groups had an increase in BMD at the femoral neck. Women who received DHEA had an increase in BMD at the ultradistal radius. Neither treatment improved the quality of life or had major adverse effects. CONCLUSIONS: Neither DHEA nor low-dose testosterone replacement in elderly people has physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life. (ClinicalTrials.gov number, NCT00254371 [ClinicalTrials.gov].).