目
錄
理事長序…………………………………………………………………………… 2
研討會議程………………………………………………………………………… 3
Curriculum vitae…………………………………………………………………… 4
Advances in CNS Pharmacology for Sexual Dysfunction
Dr. Kuang-Kuo Chen……………………………………………………………… 30
Chronic Pelvic Pain Syndrome and Sexual Dysfunction
Dr. Chia-Chu Liu…………………………………………………………………. 32
Radical Prostatectomy: Evidence-based Approaches for Sexual Rehabilitation
Dr. Han-Sun Chiang……………………………………………………………… 34
New Insights of Premature Ejaculation
Dr. Chris G McMahon…………………………………………………………… 36
Optimization of Erectile Dysfunction Management
Dr. Sae Chul Kim………………………………………………………………… 38
Outcome Measures for Assessing Female Sexual Functioning
Dr. Bang-Ping Jiann……………………………………………………………..… 40
The Impact of Testosterone Deficiency on Men’s Health
Dr. Allen D Seftel………………………………………………………………..… 47
Testosterone and Prostate Cancer: From Myth to Scientific Understanding
Dr. Farid Saad……………………………………………………………………… 55
TAA Consensus on Testosterone Replacement Therapy
Dr. Chii-Jye Wang ………………………………………………………………… 57
1
th
Highlights of 12 APSSM & Recent Advances in Sexual Medicine
理事長序
首先要感謝台灣男性學醫學會秘書長劉家駒醫師及學術委
員會召集人簡邦平醫師，在他們努力協調和細心策劃之下，精
心安排這一場 Pre-Congress Symposium ，內容包括兩個
Sections，分別邀請數位國內男性學資深醫師和國外知名學者擔
任 Speakers。其次要感謝台灣男性學醫學會的五家團體會員（即
友華生技醫藥股份有限公司、台灣拜耳股份有限公司、台灣禮
來股份有限公司、台灣嬌生公司楊森大藥廠、輝瑞大藥廠股份
有限公司）的鼎力相助，才促使此次會議能夠順利進行。
Symposium 的內容包括 Section I：Highlights of 12th APSSM (Asia-Pacific
Society for Sexual Medicine) ，和 Section II ： Recent Advances in Sexual
Medicine。
Highlights of 12th APSSM 的部分有三個題目分別為：
1.陳光國教授的 Advances in CNS Pharmacology for Sexual Dysfunction，
2.劉家駒醫師的 Chronic Pelvic Pain Syndrome and Sexual Dysfunction，
3.江漢聲教授的 Radical Prostatectomy：Evidence-based Approaches for Sexual
Rehabilitation。
而 Recent Advances in Sexual Medicine 的部分則有六個題目分別為：
1.Dr. Chris G McMahon 的 New Insights of Premature Ejaculation，
2.Dr. Sae Chul Kim 的 Optimization of Erectile Dysfunction Management，
3.簡邦平醫師的 Outcome Measures for Assessing Female Sexual Functioning，
4.Dr. Allen D Seftel 的 The Impact of Testosterone Deficiency on Men’s Health，
5.Dr. Farid Saad 的 Testosterone and Prostate Cancer：From Myth to Scientific
Understanding，
6.王起杰理事長的 TAA Consensus on Testosterone Replacement Therapy。
內容相當豐富且精彩，請大家千萬不要錯過。
最後特別要感謝本次會議的大會會長吳錫金主任及其幕僚們的協助，他們
精心策劃各項會前工作、規劃場地課程、協調行程、整合硬體設備及人力調派，
使大家能在一個舒適的環境下來進行學術討論會，讓我們大家一起感謝他們辛
苦的付出。
總之希望透過這次的學術討論會，經由各個不同角度來切入，深入淺出的
一起來探討性功能障礙，進而達到良好的性健康管理，共同為性健康而努力，
謹祝學術討論會順利，成功！
王起杰謹識
2010.03.05
於高雄醫學大學附設醫院
2
th
Highlights of 12 APSSM & Recent Advances in Sexual Medicine
研討會議程
Contents
Time:
Speaker
13:30-13:50 Registration
大會會長：吳錫金醫師
台灣男性學醫學會理事長
王起杰醫師
13:50-14:00 Opening Remarks
Highlights of 12th APSSM
Moderator：江漢聲醫師
14:00-14:20
Advances in CNS Pharmacology for Sexual
Dysfunction
陳光國醫師
14:20-14:40
Chronic Pelvic Pain Syndrome and Sexual
Dysfunction
劉家駒醫師
14:40-15:00
Radical Prostatectomy: Evidence-based
Approaches for Sexual Rehabilitation
江漢聲醫師
15:00-15:10 Break
Recent Advances in Sexual Medicine
Section Ⅰ
Moderator：謝汝敦醫師
15:10-15:35 New Insights of Premature Ejaculation
Optimization of Erectile Dysfunction
15:35-16:00
Management
16:00-16:25
Outcome Measures for Assessing Female
Sexual Functioning
Dr. Chris G McMahon
Dr. Sae Chul Kim
簡邦平醫師
16:25-16:40 Discussion
16:40-16:55 Break
Section Ⅱ
Moderator：黃一勝醫師
16:55-17:20
The Impact of Testosterone Deficiency on
Men’s Health
17:20-17:45
Testosterone and Prostate Cancer: From
Myth to Scientific Understanding
Dr. Farid Saad
17:45-18:10
TAA Consensus on Testosterone Replacement
Therapy
王起杰醫師
18:10-18:25 Discussion
18:25-18:30 Closing Remarks
大會會長：吳錫金醫師
18:30-19:00 Welcome Party
19:00~
Dr. Allen D Seftel
B1 禮來攤位前
清新溫泉飯店
6 樓景觀餐廳
Congress Banquet
3
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
CURRICULUM VITAE
Kuang-Kuo Chen, M.D., Ph.D.
Sex:
Date of Birth:
Medical Education:
Male
July 19, 1951
1) National Defense Medical Center,
Taipei, Taiwan, Republic of China
(August 1969 – August 1975)
2) National Yang-Ming University, Institute of Clinical
Medicine, Taipei, Taiwan, Republic of China
(September 1989 – June 1992)
Degree :
M.D., Ph.D.
Internship :
Rotating Internship at Taipei Veterans General Hospital,
Taiwan, Republic of China (July 1, 1974 – June 30, 1975)
Postgraduate Training:
July 1979–June 1981 Rotating Residency – Department of Surgery Taipei
Veterans General Hospital, Taiwan, R.O.C.
July 1981–June 1983 Fixed Residency – Division of Urology, Department of
Surgery, Taipei Veterans General Hospital, Taiwan,
R.O.C.
July 1983–June 1984 Chief Residency – Division of Urology, Department of
Surgery, Taipei Veterans General Hospital, Taiwan,
R.O.C.
July 1986–June 1987 Fellowship–Department of Urology, Medical School,
University of Minnesota, Minneapolis, Minnesota,
U.S.A.
Hospital Appointment:
July 1984–Aug. 1993 Attending Surgeon, Division of Urology, Department of
Surgery, Taipei Veterans General Hospital, Taiwan,
R.O.C.
Sept. 1993–July 2009 Chief, Division of Urology, Department of Surgery,
Taipei Veterans General Hospital, Taiwan, R.O.C.
July 2009–present
Chairman, Department of Surgery, Taipei Veterans
General Hospital, Taiwan, R.O.C.
4
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
Faculty Appointment:
Aug. 1984–July 1989 Instructor, Department of Surgery, National Yang-Ming
Medical college
Aug. 1989–July 1992 Associate Professor, Department of Surgery, National
Yang-Ming Medical college
Aug. 1992–July 1996 Professor, Department of Surgery, National Yang-Ming
University
Aug. 1996–present Professor and Chairman, Department of Urology,
National Yang-Ming University
Membership in Medical Society:
Taiwan Urological Association (former President)
Taiwanese Association of Andrology (former President)
Surgical Association of Republic of China
Chinese Medical Association
Taiwan Cooperative Oncology Group (TCOG)–Prostate Cancer Committee
American Urological Association
International Society for Sexual Medicine
Asia-Pacific Society for Sexual Medicine
Publication: 210 Urological articles
Address:
Department of Surgery, Taipei Veterans General Hospital
No. 201, section 2, Shih-Pai Road, Taipei, Taiwan, 112
Republic of China
Telephone No.: 886-2-28757533, 886-2-28757100
Fax No.: 886-2-28757534
E-mail: [email protected]
5
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
CURRICULUM VITAE
Dr. Chia-Chu Liu
Sex: Male
Date of Birth: Feb. 4, 1975
Address: Department of Urology,
Kaohsiung Medical University Hospital
No.100, TzYou 1st Road, Kaohsiung 807, Taiwan
Tel:
(O) +886-7-3121101 ext 7929 or 6694
Fax:
+886-7-3211033
E-mail: [email protected]
Education:
Field
From
The Graduate Institute of Medicine,
Kaohsiung Medical University
The Graduate Institute of Medicine,
Kaohsiung Medical University
College of Medicine, Kaohsiung
Medical University
To
Place
2003
2006
1993
2000
Kaohsiung,
Taiwan
Kaohsiung,
Taiwan
Kaohsiung,
Taiwan
2008
Academic
Degree
PhD
Master
MD
Current Position:
1. Director (2010-Present)
Department of Urology, Pingtung Hospital, Pingtung, Taiwan
2. Attending Urologist (2004- Present)
Department of Urology, Kaohisung Medical University Hospital, Kaohsiung,
Taiwan
3. Secretary General (2008- Present)
The Taiwanese Association of Andrology, Taiwan
Recent Publications:
1. Chia-Chu Liu, Hsu-Cheng Juan, Yung-Chin Lee, Wen-Jeng Wu, Chii-Jye Wang,
Hung-Lung Ke, Wei-Ming Li, Hsin-Chih Yeh, Ching-Chia Li, Yii-Her Chou,
Chun-Hsiung Huang, Shu-Pin Huang. The impact of physical health and
socioeconomic factors on sexual activity in middle-aged and elderly
Taiwanese men. Aging Male. 2010 (Accepted)
2. Chia-Chun Tsai, Chia-Chu Liu, Shu-Pin Huang, Wei-Ming Li, Wen-Jeng Wu,
6
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
Chun-Hsiung Huang, Yung-Chin Lee, Shu-Yen Huang, Shu-Ching Pan.
The impact of irritative lower urinary tract symptoms on erectile dysfunction
in aging Taiwanese males. Aging Male. 2009 (Accepted)
3. Chia-Fang Wu1, Chia-Chu Liu1, Bai-Hsiun Chen, Shu-Pin Huang, Hei-Hwa Lee,
Yii-Her Chou, Wen-Jeng Wu, Ming-Tsang Wu*. Urinary melamine and adult
urolithiasis in Taiwan. Clin Chim Acta. 2009 (in press)
4. Shu-Pin Huang, Chao-Yuan Huang, Chia-Chu Liu, Chia-Cheng Yu,
Yeong-Shiau Pu, Shih-Chieh Chueh, Hong-Jeng Yu, Tony T. Wu, Ching-Chia Li,
Chun-Hsiung Huang, Wen-Jeng Wu. Clinical outcome of Taiwanese men
with clinically localized prostate cancer post-radical prostatectomy: a
comparison with other ethnic groups. Aging Male. 2009 (in press)
5. Yung-Chin Lee, Wen-Jeng Wu, Chia-Chu Liu, Chii-Jye Wang, Wei-Ming Li,
Chun-Hsiung Huang, Hsin-Chih Yeh, Hung-Lung Ke, and Shu-Pin Huang*.
The Associations Among eNOS G894T Gene Polymorphism, Erectile
Dysfunction, and Benign Prostate Hyperplasia-Related Lower Urinary Tract
Symptoms. J Sex Med. 2009 (in press)
6. Chia-Chu Liu, Shu-Pin Huang, Wen-Jeng Wu, Yii-Her Chou, Suh-Hang Hank Juo,
Li-Yu Tsai, Chun-Hsiung Huang, and Ming-Tsang Wu*. The impact of
cigarette smoking, alcohol drinking and betel quid chewing on the risk of
calcium urolithiasis. Ann Epidemiol 2009;19:539-45
7. Chia-Chu Liu, Wen-Jeng Wu, Yung-Chin Lee, Chii-Jye Wang, Hung-Lung Ke,
Wei-Ming Li, Hsi-Lin Hsiao, Hsin-Chih Yeh, Ching-Chia Li, Yii-Her Chou,
Chun-Hsiung Huang, and Shu-Pin Huang. The prevalence of and risk
factors for androgen deficiency in aging Taiwanese men. J Sex Med. 2009;
6:936-946
8. Yung-Chin Lee, Hui-Hui Lin, Chii-Jye Wang, Chia-Chu Liu, Wen-Jeng Wu,
Chun-Hsiung Huang, Lin-Li Chang. The associations among GNB3 C825T
polymorphism, erectile dysfunction, and related risk factors. J Sex Med.
2008; 5(9):2061-8.
9. Chia-Chu Liu, Shu-Pin Huang, Wei-Ming Li, Chii-Jye Wang, Yii-Her Chou,
Ching-Chia Li, Chun-Hsiung Huang, and Wen-Jeng Wu. Relationships
between serum testosterone and measures of benign prostatic hyperplasia in
aging males. Urology 2007; 70: 677-680
7
Highlights of 12th APSSM & Recent Advances in Sexual Medicine
10. Yuan-Chin Lee, Chun-Hsiung Huang, Chii-Jye Wang, Chia-Chu,Liu,
Wen-Jeng Wu, Lin-Li Chang, Hui-Hui Lin. The associations among eNOS
G894T gene polymorphism, erectile dysfunction and related risk factors.
BJU Int. 2007; 100(5):1116-20.
11. Chia-Chu Liu, Chun-Hsiung Huang, Wen-Jeng Wu, Shu-Pin Huang, Yii-Her Chou,
Ching-Chia Li, Chee-Yin Chai, and Ming-Tsang Wu. Association of vitamin
D receptor FokI polymorphism with clinical presentation of calcium
urolithiasis. BJU Int 2007, 99:1534-38.
12. Chia-Chu Liu, Shu-Pin Huang, Wei-Ming Li, Chii-Jye Wang, Wen-Jeng Wu,
Yii-Her Chou, Chun-Hsiung Huang. Are lower urinary tract symptoms
associated with erectile dysfunction in aging male of Taiwan? Uro Int
2006,77(3):251-254
8
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
CURRICULUM VITAE
Han-Sun Chiang MD, PhD
Han-Sun Chiang is Professor and Vice-President at the Fu Jen
Catholic University, Taipei, Taiwan, R.O.C. Prof Chiang is
also Professor at the Department of Urology, National Taiwan
University, and Taipei Medical University.
He graduated from the National Taiwan University in 1975, where he
undertook his residency at the Department of Urology before receiving further
training at the Urological Clinic Rechts der Isar, Munich, Germany. He was
appointed as Professor and chairmen at the Department of Urology of Taipei
Medical University Hospital from 1983 to 2002. He held the appointment of
Dean, College of Medicine at the Fu-Jen Catholic University from 2002 to 2008.
Prof Chiang was also the President of the Taiwan Andrological Association
(2000-2003), Taiwan Urological Association (2006-2008), and now is the
President of Asian Pacific Society for Sexual Medicine (APSSM) (2007-2009).
Professor Chiang is widely respected figure in the field of surgical andrology and
is primarily interested in the study of the aging male in Taiwan and Asia-Pacific
region. Prof Chiang’s research focus also includes male infertility and sexual
dysfunction, medical history, ethics and education. He has published more than
150 academic papers on clinical and basic medical research in peer-reviewed
journals and is frequently invited to present special lectures internationally.
9
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
CURRICULUM VITAE
Assoc. Professor Chris G McMahon MB,BS (Monash)
FAChSHM
BRIEF BIOGRAPHY
Chris G McMahon is a Consultant Sexual Health Physician
and Fellow of the Royal Australian College of Physician’s
Chapter of Sexual Medicine. He is an Associate Professor
in the Faculty of Health Sciences, University of Sydney and the Director of the
Australian Centre for Sexual Health in Sydney, Australia. Dr McMahon is a
committee chairman for the WHO Second and Third International Consultation
on Erectile and Sexual Dysfunction and a chairman of the International Society
of Sexual Medicine (ISSM) medical and research standards committee. He is an
Associate Editor of the Journal of Sexual Medicine, and a member of the
editorial board of the International Journal of Sexual Health, Current Sexual
Health Reports and an associate section editor of the British Journal of Urology.
He is a referee for multiple international peer-reviewed medical journals
including the Journal of Sexual Medicine, the Journal of Urology, Urology,
European Journal of Urology, the British Journal of Urology, the International
Journal of Impotence Research, the Medical Journal of Australia and Expert
Opinion on Investigational Drugs. He is a member of several local, regional and
international medical associations and a committee member of the
International Society of Sexual Medicine (ISSM). He has been invited to lecture
on sexual medicine worldwide and has published extensively on sexual health.
He has published over 50 original research and invited review articles in peer
reviewed international medical journals, and 12 book chapters. His recent
research has focused on drug treatment for patients with refractory erectile
dysfunction (ED) and drug treatment of premature ejaculation.
NAME: Dr Christopher Gordon McMahon
DATE OF BIRTH: July 3 1951
ADDRESS: Australian Centre for Sexual Health
Suite 2-4, 1A Berry Rd St Leonards NSW 2065
TEL:
IDD+ 61 2 9437 3906
FAX:
IDD+ 61 2 9906 5900
EMAIL:
[email protected]
10
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
EDUCATION
Pre-Medical
1963-1968
Christian Brothers College St Kilda, Melbourne Australia
Undergraduate
1969-1975
MB., BS Monash University, Melbourne, Australia
Residency
1976-1977
1977- 1978
1978-1981
Internship Alfred Hospital Melbourne
Junior Surgical Resident Alfred Hospital Melbourne
Surgical Registrar Mont Park Hospital Melbourne
Fellowships
1996
2005
Fellow of the Australian College of Sexual Health Medicine
Foundation Fellow of the Royal Australian College of
Physician’s Chapter of Sexual Medicine
MEDICAL REGISTRATION
1997-1982
Victoria Australia
1980 – current
New South Wales Australia
POSITIONS
Associate Professor
Faculty of Health Sciences, University of
Sydney
Director
Australian Centre for Sexual Health
(1991-current)
Founding and Past President
Australian Society of Impotence Medicine
(ASIM)
Committee Chairman
World Health Organisation (WHO) 3rd
International Consultation on Sexual
Dysfunction (2009)
World Health Organisation (WHO) 2nd
International Consultation on Sexual
Dysfunction (2004)
International Society of Sexual Medicine
(ISSM) Standards Committee (2005-current)
11
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
World Health Organisation (WHO) 1st
International Consultation on Erectile
Dysfunction (1998)
Committee Member
Chairman of Scientific Committee 19th Congress of World Association of Sexual
Health (WAS) Sydney 2007
Associate Editor
Journal of Sexual Medicine
Editorial Board Member
Journal of Sexual Medicine
Journal of Men’s Health
Current Sexual Health Reports
The Journal of Medical Case Reports
Associate Section Editor
British Journal of Urology
Committee Member
International Society of Sexual Medicine
(ISSM)
Scientific Publication Referee
Journal of Urology
Urology
European Journal of Urology
British Journal of Urology
Journal of Sexual Medicine
International Journal of Impotence Research
Asian Journal of Andrology
Medical Journal of Australia
Expert Opinion on Investigational Drugs
Current Sexual Health Reports
Journal of Men’s Health
Future Medicine
The Journal of Medical Case Reports
Consultant/Member
NSW Ministerial Committee of Enquiry into
Impotence Treatment Services in NSW - 1998
Medical Referee
NSW Health Care Complaints Commission
(HCCC)
Medical Advisor
Competition and Consumer Commission
(ACCC)
Therapeutics Goods Administration Australia
(TGA)
Australian Government Solicitors Department
NSW Department of Public Prosecutions (DPP)
12
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
RECENT PUBLICATIONS
1. Priapism associated with concurrent use of phosphodiesterase inhibitor
drugs and intracavernous injection therapy. Int J Impot Res. 2003
Oct;15(5):383-4.
2. Efficacy and Safety of Daily Tadalafil in Men with Erectile Dysfunction
Previously Unresponsive to On-demand Tadalafil. J Sex Med 2004; 1:
292–300
3. Disorder of Orgasm and Ejaculation in Men. J Sex Med 2004 1(1): 58-65
4. Comparison of efficacy and safety of on-demand tadalafil and daily dosed
tadalafil for the treatment of erectile dysfunction. J Sex Med 2005,
3:415-427
5. A 6-month Study of the Efficacy and Safety of Oral Tadalafil in the Treatment
of Erectile Dysfunction: A Randomised, Double-Blind, Parallel-Group,
Placebo-Controlled Study. Int J Clin Pract. Vol 59, Issue 2, Page 143-149,
February 2005
6. Efficacy of sildenafil citrate in men with premature ejaculation. J Sex Med,
2005. 2(3): 368.
7. Premature Ejaculation: Past Present and Future Perspectives. J Sex Med
2005 2 (suppl.2) 94-96
8. Efficacy, safety and tolerability of daily tadalafil in men with diabetes mellitus
and erectile dysfunction previously unresponsive to on-demand tadalafil.
Submitted to European Urology
9. AUA Guidelines for the Management of Premature Ejaculation. American
Urological Association 2006
10. The Etiology and Management of Premature Ejaculation. Nature Clin Prac
Urol 2005. 2 (9):426-433
11. New Agents in the Treatment of Premature Ejaculation (PE). Neuropsych Dis
Treatment 2006:2(4) 489-503
12. Tolerance to the Therapeutic Effect of Tadalafil Does Not Occur During 6
13
Highlights of 12th APSSM & Recent Advances in Sexual Medicine
Months of Treatment: A Randomized, Double-Blind, Placebo-Controlled
Study in Men with Erectile Dysfunction – J Sex Med. 2006 May;
3(3):504-11
13. Efficacy of type-5 phosphodiesterase inhibitors in the drug treatment of
premature ejaculation: a systematic review - BJU Int. 2006 Aug; 98(2):259-72
14. Treatment of erectile dysfunction with chronic dosing of tadalafil. Eur Urol.
2006 Aug;50(2):215-7
15. Vardenafil improved erectile function in a ‘real-life’ broad population study
of men with moderate to severe erectile dysfunction in Australia and New
Zealand – J Sex Med. 2006 Sep;3(5):892-900
16. Treatment of erectile dysfunction with chronic dosing of tadalafil. Eur Urol.
2006 Aug;50(2):215-7
17. Premature Ejaculation. Indian Journal of Urology, 2007;23(2):97-109
18. Correlates to the Clinical Diagnosis of Premature Ejaculation: Results From a
Large Observational Study of Men and Their Partners. J.Urol.
2006;177(3):1059-1064
19. Ejaculatory Latency vs. Patient-Reported Outcomes (PROs) as Study End
Points in Premature Ejaculation Clinical Trials. Eur Urol. 2007
Aug;52(2):321-3
20. Sexual Dysfunction in Men Receiving Methadone and Buprenorphine
Maintenance Treatment. J Sex Med. 2008 Mar;5(3):684-92. Epub 2007 Dec
18
21. Hypogonadism in Men Receiving Methadone and Buprenorphine
Maintenance Treatment. Int J Androl. 2007 Oct 30. [Epub ahead of print]
22. An Evidence-Based Definition of Lifelong Premature Ejaculation: Report of
the International Society for Sexual Medicine (ISSM) Ad Hoc Committee for
the Definition of Premature Ejaculation. J Sex Med. 2008 May 6. [Epub
ahead of print]
14
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
BOOK CHAPTERS
1. Local Pharmacological Treatment Modalities. In Erectile Dysfunction. Ed.
Jardin A, Wagner G, Khoury S, Giuliano F, Padma Nathan H, Rosen R.
Health Publications Ltd 2000
2. Androgens in Male Physiology. In Male and Female Sexual Dysfunction. Ed.
Seftel A, Padma Nathan H, McMahon CG, Giuliano F, Althof SE. Mosby
2004
3. Physiology of the Ejaculatory Response. In Male and Female Sexual
Dysfunction. Ed. Seftel A, Padma Nathan H, McMahon CG, Giuliano F,
Althof SE. Mosby 2004
4. Treatment of Ejaculatory Dysfunction. In Male and Female Sexual
Dysfunction. Ed. Seftel A, Padma Nathan H, McMahon CG, Giuliano F,
Althof SE. Mosby 2004
5. Disorders of Orgasm and Ejaculation in Men. In Sexual Medicine: Sexual
Dysfunctions in Men and Women. Ed. Lue T, Wagner G, Khoury S, Giuliano F,
Padma Nathan H, Rosen R. Health Publications Ltd 2004
6. Pharmacological Strategies in the Management of Premature Ejaculation. In
Current Clinical Urology: Oral Drug Therapy of Sexual Dysfunction: A Guide
to Clinical Management. Ed. Broderick GA. The Humana Press 2004
7. Evaluation and Therapy for Ejaculatory Disorders. In Atlas of Male Sexual
Dysfunction. Ed. Lue TF. Current Medicine 2004
8. Clinical Manual of Sexual Medicine: Sexual Dysfunction in Men. Ed. Lue T,
Khoury S, Giuliano F, Rosen R. Health Publications Ltd 2004
9. Ejaculatory Dysfunction. In. Male Sexual Function. A Guide to Clinical
Management. Ed. J.J. Mulcahy; Pub. Humana Press Inc., Totowa, New Jersey,
2005 in press
10. Ejaculatory Dysfunction. In. Sexual Medicine. Standards in Clinical Practice.
Ed. H. Porst, J Buvat. Blackwell, 2006
11. Premature Ejaculation. In. Handbook of Psychiatry. Ed. Rowland D, Incrocci,
L. In Press 2006
15
Highlights of 12th APSSM & Recent Advances in Sexual Medicine
12. Medical Treatment of Ejaculatory Dysfunction. In. Textbook of Erectile
Dysfunction. Ed Carson C, Goldstein I, Kirby R. In Press 2006
13. Erectile Dysfunction-Fast Facts – Health Press UK 2008
16
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Highlights of 12 APSSM & Recent Advances in Sexual Medicine
CURRICULUM VITAE
Dr. Sae Chul Kim
I. Professional Background :
1971; Graduated from Kyungpook National University,
School of Medicine, Daegu, Korea
1971 - 1975; Urology training in Kyungpook National
University Hospital, Daegu, Korea
1980; Ph.D. Kyungpook National University, Daegu, Korea
1982; Research fellow, Brookdale Medical Center, N.Y.,
USA
1980 - 1990; Assistant professor, Associate Professor, Department of Urology,
Chung-Ang University College of Medicine, Seoul, Korea
1984 - 1996; Chairman, Department of Urology, Chung-Ang University College
of Medicine
1996 - 1997; Superintendent General, Chung-Ang University Yongsan Hospital
1994 - 1997; President, Korean Andrological Society
1999 - 2000; President, Korean Society of Fertility and Sterility
2002 - 2003; President, Korean Society for Smooth Muscle Research
1989 - 1991; Secretary General, Asia-Pacific Society of Impotence Research
1996; Secretary General, 3rd Asian Congress of Urology
1996 - 2000; Program Organizing Committee member, International Society of
Andrology
Professor, Department of Urology, Chung-Ang University College of Medicine
President, Korean Society for the Study of Female Sexual Health
President elect, Korean Urological Association
President elect, Korean Society of Sexology
President, Asian-Pacific Society of Sexual and Impotence Research
Local Organizing Committee Chairman, 2005 Congress of International Society
of Andrology
Organizing Committee member, Korea-Japan Urological Congress
Executive Committee member, Asian Society of Andrology
Council member, Asian Urological Association
Associate Editor, Journal of Korean Medical Science
Consultant, Journal of Urology
Scientific Advisory Board, “Andrologia”
Editor, Asian Journal of Andrology
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II. Awards;
1) Academic Award from Korean Urological Association (1975, 1991, 1993,
1999, 2001, 2002)
2) Academic Award from Seoul Society of Korean Medical Association (1986)
3) Academic Award from the Asia-Pacific Society of Impotence Research (1989)
III. Academic Achievements:
255 scientific papers have been published in the domestic or international
journals
Recent scientific papers published in the SCI idexed-international journals
1. Kim SC, Seo KK, Myung SC, Lee MY. Relaxation of rabbit cavernous smooth
muscle to 17β-estradiol: a non-genomic, NO-independent mechanism.
Asian J Androl 2004;6(2):127-131
2. Choi HK, Ahn TY, Kim JJ, Kim SC, Paick JS, Suh JK, et al. A double-blind,
randomized-placebo controlled, parallel group, multicenter, flexible-dose
escalation study to assess the efficacy and safety of sildenafil administered as
required to male outpatients with erectile dysfunction. Int J Impotence Res
2003;15(2):80-86
3. Kim SC, Chang IH, Jeon HJ. Preference for oral sildenafil or intracavernosal
injection in patients with erectile dysfunction already using intracavernosal
injection for > 1 year. BJU International 2003;92(3):277-280
4. Kim HW, Kim SC, Seo KK, Lee MY. Effects of estrogen on the relaxation
response of rabbit clitoral cavernous smooth muscles. Urol Res
2002;30:26-30
5. Seo KK, Kim SC, Lee MY. Comparison of peripheral inhibitory effects of
clomipramine with selective serotonin re-uptake inhibitors on contraction of
vas deferens: in vitro and in vivo studies. J Urol 165: 2110-2114, 2001
6. Seo KK, Kim SC, Jun IO, Oh MM, Lee MY. Synergistic effects of sildenafil on
relaxation of rabbit and rat cavernosal smooth muscles when combined with
various vasoactive agents. BJU International 87: 596-601, 2001
7. Heaton JPW, Lording D, Liu S-N, Litonjua A D, Guangwei L, Kim SC, Kim JJ,
Zhi-zhou S, Israr D, Niazi D, Rajatanavin R, Suyono S, Benard F, Casey R,
Brock G, Belanger A. Intracavernosal alprostadil is effectve for the treatment
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Highlights of 12th APSSM & Recent Advances in Sexual Medicine
of erectile dysfunction in diabetic men. Int J Impt Res 2001;13(6):317-21
8. Kim SC, Seo KK, Han JH, Lee MY. Inhibitory effect of serotonergic drugs on
contractile response of rat vas deferens to electrical nerve stimulation: In vivo
study. J Urol 163: 1988-1991, 2000
9. Kim SC, Seo KK, Kim HW, Lee MY. The effects of isolated lipoproteins and
triglyceride, combined oxidized low density lipoprotein (LDL) plus
triglyceride, and combined oxidized LDL plus high density lipoprotein on the
contractile and relaxation response of rabbit cavernous smooth muscle. Int J
Androl 23(suppl 2): 26-29, 2000
10. Kim SC, Seo KK, Park BD, Lee SW. Risk factors for an early increase in dose
of vasoactive agents for intracavernous pharmacotherapy. Urol Int 65:
204-207, 2000
11. Kim SC, Ahn TY, Choi HK, et al. Multicenter study of the treatment of
erectile dysfunction with transurethral alprostadil (MUSE) in Korea. Int J
Impotence Res 12: 97-101, 2000
12. Kim SC. Hyperlipidemia and erectile dysfunction. Asian J Androl 2:
161-166, 2000
13. Kim SC, Seo KK, Kim IK, et al. Effects of bacterial endotoxin of the
contraction and relaxation responses of the rabbit cavernous smooth
muscles. J Urol 161: 964-969, 1999
14. Seo KK, Yun HY, Kim H, Kim SC. Involvement of endothelial nitric oxide
synthase in the impaired endothelium-dependent relaxation of cavernous
smooth muscle in hypercholesterolemic rabbit. J Androl 20: 298-306, 1999
15. Kim, SC, Seo KK, Yoon SH. Fracture at the input tube-cylinder junction of
AMS 700 inflatable penile prosthesis as a complication of a modified implantation
technique in a series of 99 patients. Urology 54: 148-151, 1999
16. Kim, SC. Mechanical reliability of AMS hydraulic penile prosthesis; from
Asian point of view. Asian J Surg 22:263-267, 1999
17. Kim, SC. Recent advancement in diagnosis of vasculogenic impotence.
Asian J Androl 1: 37-43, 1999
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Highlights of 12th APSSM & Recent Advances in Sexual Medicine
18. Kim SC, Lee MY, Seo KK. Comparison of relaxation responses of cavernous
and trigonal smooth muscles from rabbits by α1-adrenoceptor antagonists;
prazosin, terazosin, doxazosin, and tamsulosin. J Kor Med Sci 14: 69-74,
1999
19. Kim SC, Seo KK. Efficacy and safety of fluoxetine, sertraline and clomipramine
in patients with premature ejaculation: a double-blind, placebo controlled
study. J Urol 159: 425-427, 1998
20. Kim SC, Bang JH, Hyun JS, Seo KK. Changes in erectile response to repeated
audiovisual sexual stimulation. Eur Urol 33: 290-292, 1998.
21. Kim SC, Kim HW. Effects of nitrogenous components of urine on sperm
motility - an in vitro study. Int J Androl 21: 29-33, 1998
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CURRICULUM VITAE
Bang-Ping Jiann MD
Kaohsuing Veterans General Hospital and Shu-Te University,
Taiwan
Ban-Ping Jiann is Associate Professor in the Human Sexology
Research Centre and Graduate Department at Shu-Te
University in Kaohsuing, Taiwan. He is also Visiting Staff in urology for the
Department of Surgery in Kaohsiung Veterans General Hospital.
A/Prof Jiann graduated from Taipei Medical College in Taipei, Taiwan, and
completed his residency at Taipei Veterans General Hospital. He was Chief
Resident at Taipei Veterans General Hospital before becoming a Research
Fellow at Case Western Reserve University Hospital in Ohio, US, between July
1992 and June 1993. A/Prof Jiann is a member of various professional societies
including the Taiwan Urological Society, European Society for Sexual Medicine
and the International Society for Sexual and Impotence Research. He is also
Chairman of the Local Organizing Committee for the 13th Asia-Pacific Society
for Sexual Medicine to be held in 2011.
A/Prof Jiann has published in various international peer-reviewed journals, and
is on the editorial review board for the International Journal of Impotence
Research, Journal of Sexual Medicine and European Urology.
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CURRICULUM VITAE
Allen D Seftel, M.D.
Departmental Title:
Head, Division of Urology
Director, Urology Residency Training Program
Specialty:
Urology
Board Certification:
Board Certified in Urology
National Board of Medical Examiners
Medical Group:
Cooper University Physician
Medical School:
SUNY Health Science Center at Brooklyn
Internship:
North Shore University Hospital
Residency:
SUNY Downstate Medical Center
Case Western Reserve University School of Medicine
Fellowship:
Boston University Medical Center
Awards and Honors:
America’s Top Doctors-2001-present
Editorial Positions:
Editor-in-Chief: International Journal of Impotence Research, The Journal of
Sexual Medicine, Editor, Journal of Urology-Urologic Survey, Male and Female
Sexual Function, Editorial Board, Journal of Andrology, Current Surgery, Post
-Graduate Medicine, Net Wellness, Editor: Male Sexual Dysfunction, Post
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Graduate Medicine, Editorial Board Member, Current Surgery, Editorial Board
Member.
Bibilography:
Dr. Seftel is well published in his field.
Memberships:
American Medical Association, American Urological Association, American
Fertility Society, American Andrology Society, American Association of Clinical
Urologists, American Geriatric Society, American Diabetes Association,
American Paraplegia Society, Society for Basic Urologic Research, Society of
University Urologists, International Society of Sexual Medicine, Society for
Study of Sexual Medicine, Society for Study of Male Reproduction, The
Society of Laparoendoscopic Surgeons, The American Physiological Society,
Society for Prosthetic Urology, International Society for Sexual Medicine.
NPI [National Provider Identification]:
1538187653
Special Interests:
Specialty: Male Sexual Medicine Male Sexual Function Male Infertility Benign
Prostatic Hyperplasia Testosterone Deficiency in Men
Office Locations:
Three Cooper Plaza
Suite 403
Camden, NJ 08103
Phone: (856) 342-3113 (856) 342-3113
Fax: (856) 968-8457
127 Church Road
Suite 400
Marlton, NJ 08053
Phone: (856) 342-3113 (856) 342-3113
Fax: (856) 817-3023
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CURRICULUM VITAE
Prof. h.c.* Dr. med. vet. Farid Saad
Prinzenallee 28, 13359 Berlin, Germany
Email: [email protected]
Dec. 23rd, 1953 born in Alexandria, Egypt.
1972 – 1973
3 semesters studies of human medicine at the University of
Hamburg.
1973 – 1976
studies of veterinary medicine and preclinical exams at the
Free University of Berlin
1976 – 1980
studies of veterinary medicine, state exams, graduation and
PhD at the Veterinary University of Hannover - during this
time several working periods with equine practitioners in the
U.S.A.
1980 – 1987
veterinary surgeon, employed by Dr. G. Kubitza in Hamburg,
specialisation in race horses and equine reproduction.
1988 – 1990
sales representative and member of the sales force of Hoechst
AG.
1990 – 1998
product manager, then marketing director and international
marketing and sales director, Ferring GmbH in Kiel; specialist
for reproductive endocrinology, pediatric endocrinology, and
Andrology.
1998
team leader reproductive medicine, Organon GmbH,
Oberschleissheim.
1998 – 2001
leader of clinical development andrology, Jenapharm, Jena;
specialist in endocrinology of aging, male aging, male
hormonal fertility control.
since May 2001 corporate strategic marketing Schering AG, Berlin; leader of
product group ”Male Health Care“
2005-12-28
Honorary professorship in clinical research and endocrinology
at Gulf Medical College, Ajman, United Arab Emirates.
2006-08-10
Honorary professorship at Men’s Health Reproduction Study
Center, Hang Tuah University, Surabaya, Indonesia
Citizenship: German
*Gulf Medical University School of Medicine, Ajman, UAE
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Recent Publications
1. Farid Saad, Kamischke A, Yassin A, Zitzmann M, Schubert M, Jockenhövel F,
Behre HM, Gooren L, Nieschlag E. More than eight years’ hands-on
experience with the novel long-acting parenteral testosterone undecanoate.
Asian J Androl 9(3): 291-297 (2007)
2. Farid Saad, Anca S. Grahl, Antonio Aversa, Aksam A. Yassin, Ates Kadioglu,
Ignacio Moncada and Ian Eardley. Effects of testosterone on erectile
function: implications for the therapy of erectile dysfunction. BJU Int 99(5):
988-992 (2007)
3. Heufelder A, Saad F, Gooren L. Additional therapeutic action of testosterone
to the favourable effects of exercise and diet in diabetes type 2. J Urol
177(4): 228 (2007)
4. Yassin AA and Saad F. Erectile dysfunction, metabolic syndrome, hypogonadism
are intertwined. J Urol 177(4): 288 (2007)
5. LJ Gooren, HM Behre, F Saad, A Frank, S Schwerdt. Diagnosing and
treating testosterone deficiency in different parts of the world. Results from
global market research. Aging Male 10(4): 173-181 (2007)
6. F Saad, LJ Gooren, A Haider, A Yassin. An exploratory study of the effects of
12 months administration of the novel long-acting testosterone undecanoate
on measures of sexual function and the metabolic syndrome. Arch Androl
53(6): 353-357 (2007)
7. LJ Gooren, F Saad, A Haider, A Yassin, S Sakhri. A decline of plasma
5α-dihydrotestosterone (DHT) levels upon testosterone administration to
elderly men with subnormal plasma testosterone and high DHT levels.
Andrologia (2008)
8. F Saad, LJ Gooren, A Haider, A Yassin. A dose response study of
testosterone on sexual dysfunction and on features of the metabolic
syndrome using testosterone gel and parenteral testosterone undecanoate. J
Androl 29(1): 102-105 (2008)
9. F Saad, LJ Gooren, A Haider, A Yassin. Effects of testosterone gel followed
by parenteral testosterone undecanoate on sexual dysfunction and on
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Highlights of 12th APSSM & Recent Advances in Sexual Medicine
features of the metabolic syndrome. Andrologia 40(1): 102-105 (2008)
10. A Yassin and F Saad. Plasma levels of dihydrotestosterone remain in the
normal range in men treated with long-acting parenteral testosterone
undecanoate. Andrologia 39(4): 181-184 (2007)
11. A Haider, A Yassin, F Saad, R Shabsigh. Effects of androgen deprivation on
glycemic control and on cardiovascular biochemical risk factors in men with
advanced prostate cancer with diabetes. Aging Male 10(4): 189-196
(2007)
12. F Saad, L Gooren, A Haider, A Yassin. Significance of plasma levels for
effects of testosterone on the metabolic syndrome. Aging Male 11(1): 39
(2008)
13. F Saad, A Heufelder, L Gooren. Testosterone administration in addition to
exercise and diet enhance therapeutic effects in men with type 2 diabetes
with subnormal testosterone. Aging Male 11(1): 11 (2008)
14. YA Tishova, GZ Mskhalaya, F Saad, SY Kalinchenko. Effect of testosterone
treatment on cardiovascular risk factors and variables of the metabolic
syndrome (MS) in hypogonadal men. Aging Male 11(1): 19-20 (2008)
15. A Yassin, A Haider, A Shamsodini, F Saad. The testicular volume alters
under testosterone therapy. Aging Male 11(1): 18 (2008)
16. A Shamsodini, F Saad, A Yassin, R Alzubaidi, A Al Ansari. RigiScan
monitoring of nocturnal tumescence in patients with low testosterone level
treated with testosterone undecanoate. Aging Male 11(1): 40-41 (2008)
17. A Yassin and F Saad. The link between erectile dysfunction, metabolic
syndrome and testosterone deficiency: outcome of data analysis of 771 ED
patients. Aging Male 11(1): 29 (2008)
18. SY Kalinchenko, EL Vishnevskiy, AN Koval, GJ Mskhalaya, F Saad. Beneficial
effects of testosterone administration on symptoms of the lower urinary
tract in men with late onset hypogonadism: a pilot study. Aging Male
accepted (2008)
19. AM Traish, A Guay, R Feeley, F Saad.
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Highlights of 12th APSSM & Recent Advances in Sexual Medicine
deficiency: I. Metabolic syndrome and erectile dysfunction.
submitted (2008)
J Androl
20. A Yassin and F Saad. The link between erectile dysfunction, metabolic
syndrome and testosterone deficiency: outcome of data analysis of 771 ED
patients. European Urology Supplements 7(3): 296 (2008)
21. F Saad, A Heufelder, L Gooren. Normalization of testosterone levels
enhances the favourable effects of exercise and diet in men with diabetes
type 2 with subnormal testosterone. J Androl (Suppl.): 54 (2008)
23. F Saad, A Haider, A Yassin, L Gooren. With regard to testosterone
(patho)physiology men are not created equal. J Androl (Suppl.): 54 (2008)
24. M Zitzmann, E Vorona, M Wenk, F Saad, E Nieschlag. Testosterone
administration decreases carotid intima media thickness as indicator of
vascular damage in middle-aged overweight men. J Androl (Suppl.):
54-55 (2008)
25. MC Meriggiola, F Armilotta, A Costantino, P Altieri, AM Perrone, F Saad, T
Ghi, C Pelusi, G Pelusi. Effects of testosterone undecanoate (TU)
administered alone or in combination with letrozole or dutasteride in
female-to-male (FtM) transsexuals. J Sex Med (2008)
26. A Traish, A Guay, F Saad. The dark side of testosterone deficiency: II. Type
2 diabetes and insulin resistance. J Androl (submitted)
27. A Yassin, A El-Sakka, F Saad. Testosterone and erectile dysfunction. In:
Jones H, Testosterone Deficiency in Men, Oxford University Press, Oxford,
UK 2008: 97-105
28. F Saad. The role of testosterone in the metabolic syndrome. Journal of Steroid
Biochemistry & Molecular Biology (accepted)
29. F Saad. C-reactive protein levels and aging male symptoms in hypogonadal
men treated with testosterone supplementation. Journal of Steroid
Biochemistry & Molecular Biology (accepted)
30. F Saad. Age and baseline testosterone value do not predict the beneficial
effect of normalization of testosterone on the metabolic syndrome.
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Highlights of 12th APSSM & Recent Advances in Sexual Medicine
Journal of Steroid Biochemistry & Molecular Biology (accepted)
31. F Saad. Comparison of long-acting testosterone undecanoate formulation
versus testosterone enanthate on sexual function and mood in hypogonadal
men. Journal of Steroid Biochemistry & Molecular Biology (accepted)
32. A Haider, L Gooren, P Padungtod, F Saad. Safety aspects of administration
of parenteral testosterone undecanoate to elderly men. Asian J Androl
(submitted)
33. EJ Giltay, A Haider, F Saad, L Gooren. C-reactive protein levels and aging
male symptoms (AMS) in hypogonadal men treated with testosterone
supplementation. Andrologia (submitted)
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簡
歷
表
【姓名】
王起杰醫師
【現任】
台灣男性學醫學會理事長
台灣男性學醫學會常務理事
高雄醫學大學泌尿科副教授
高雄醫學大學泌尿科主治醫師
台灣勃起功能障礙諮詢暨訓練委員會委員
【學經歷】
高雄醫學大學醫學系畢業
高雄醫學大學醫學博士
高雄醫學大學泌尿科副教授
高雄市立小港醫院泌尿科主任
美國舊金山加州大學 (UCSF)泌尿科研究員
丹麥哥本哈根大學泌尿科研究員
瑞典 UPPSALA 大學泌尿科研究員
97 年 3 月~迄今
97 年 3 月~迄今
85 年 8 月~迄今
74 年 8 月~迄今
89 年 10 月~迄今
68 年 6 月
82 年 6 月
85 年 8 月
91 年 8 月~96 年 7 月
77 年 1 月~12 月
74 年 6 月~7 月
74 年 8 月~9 月
【會員】
台灣泌尿科醫學會會員 (TUA)
台灣男性學醫學會會員 (TAA)
美國泌尿科醫學會會員 (AUA)
亞太性醫學會會員 (APSSM)
國際性醫學會會員 (ISSM)
【通訊方式】
高雄醫學大學附設醫院泌尿科
地址：高雄市 80756 三民區自由一路 100 號
電話：07-3208212
傳真：07-3211033
E-mail：[email protected]
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Advances in CNS Pharmacology for Sexual Dysfunction
Dr. Kuang-Kuo Chen
Chairman, Department of Surgery,
Taipei Veterans General Hospital, Taiwan, R.O.C.
Currently, the neural mechanisms for penile erection through central nervous
system (CNS) including many neural transmitters, modulators and pathway
systems are still not clearly known. Some of the brain loci regarding to sexual
function are reported to include the medial preoptic area (MPOA),
paraventricular nucleus of hypothalamus (PVN), hippocampus, medial
amygdala, periaqueductal gray (PAG), and ventral tegmentum. The MPOA
integrates the sensory stimuli from higher brain areas. The PVN also integrates
the sensory inputs from the higher brain centers and MPOA, and projects to
spinal autonomic preganglionic neurons. The neural impulses may also transmit
from PVN to the PAG, nucleus paragigantocelluaris (nPGi) and raphe nuclei.
The neurons in nPGi send inputs to the spinal cord to inhibit penile erection.
Stimulatory pathways for penile erection may transmit to spinal cord through
PAG or disinhibition of nPGi neurons. Pharmacological stimulation of MPOA
and PVN with dopaminergic receptor agonist (apomorphine) may elicit penile
erection and ejaculation in the rat. Apomorphine induces penile erection by
releasing oxytocin in the CNS through activation of D1/D2 receptors and
oxytocinergic neurons in the PVN.
The agents of this pharmacologically mediated penile erection through the CNS
at present include dopaminergic receptor agonist (apomorphine), melanocortin
receptor agonist (melanotan II, PT-141), serotoninergic agonist acting at
receptors
(m-chlorophenylpeperazine,
5-hydroxytryptamine
(5-HT)2C
p-chloroamphetamine), serotonin reuptake inhibitor (trazodone), selective
α2-adrenoceptor antagonist (delequamine, yohimbine), opioid receptor
antagonist (naltrexone), oxytocinergic receptor agonist, hexarelin receptor
analogue (EP 50885, EP 60761), nitric oxide system (L-arginine) and excitatory
amino acid (L-glutamate, N-methyl-D-aspatate). Among the present
pharmacotherapeutic agents for male erectile dysfunction (ED), some induce
penile erection through CNS which include trazodone, apomorphine,
melanotan II, PT-141, yohimbine, naltrexone, delequamine and L-arginine.
The current therapy for ED may be improved by understanding the CNS
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pharmacology. New agent may be developed targeting the melanocortin
receptors (MC3-5) agonist, to provide a better therapeutic efficacy. Oxytocinergic
and nitrergic receptors or pathways being always involved in the mechanism of
most of current central acting drugs for ED are another interesting targets to
design new agents. Selective dopamine receptor activation to enhance the
efficacy and prevent side effect may be also a direction to search for new drugs
acting through CNS for the management of male ED.
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Chronic Pelvic Pain Syndrome and Sexual Dysfunction
Dr. Chia-Chu Liu
Department of Urology, Kaohisung Medical University Hospital, Kaohsiung, Taiwan
Prostatitis is defined as painful inflammation of the prostate that is often
associated with lower urinary tract symptoms (LUTS), as well as with sexual
dysfunction or discomfort. It is the most common urologic diagnosis in men
younger than 50 years and the third most common urologic diagnosis in men
older than 50 years next to benign prostatitic hyperplasia and prostate cancer.
Population-based estimates of the prevalence of prostatitis in the general male
population range from 2 to 10%. According to National Institutes of Health
(NIH) classification system for prostatitis, it was classified into four categories,
including acute bacterial prostatitis (categoryⅠ), chronic bacterial prostatitis
(category Ⅱ), chronic pelvic pain syndrome (CPPS)(category Ⅲ), and
asymptomatic inflammatory prostatitis (category Ⅳ). CPPS is both the most
common form and the most challenging to evaluate and treat.
The etiology of CPPS remains unclear. It is thought to cause by an interrelated
cascade of inflammatory, immunologic, neuroendocrine, and neuropathic
mechanisms that begin with an initiator (such as infection, immunogen, toxin,
trauma, stress) in a genetically or anatomically susceptible men. The
predominant symptoms of CPPS include chronic pain located in the part
between the scrotum and testicules (i.e.,perineum), and below the waist areas,
as well as pain at ejaculation and urination. As with other chronic pain
conditions, many patients with CPPS report reduced quality of life and
increased depression.
CPPS is also known for its negative impact on sexual function. Men with CPPS
tend to report ejaculatory pain, premature ejaculation, erectile dysfunction,
decreased sexual desire, and decreased frequency of sexual activities than those
without pelvic pain. Intimacy and couple relationships may also be affected
by CPPS. Until now, the pathogenesis of CPPS-associated sexual dysfunction
remains unclear. Physiologic factors and psychological factors may all play
important roles in the link between these two entities.
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Due to the complex relationship exists between CPPS and sexual function, a
comprehensive approach to managing CPPS is needed. In addition to
traditional pain management strategies, interventions to evaluate and improve
sexual dysfunction should be integrated, which may help ameliorate CPPS
symptoms and vice versa. Further CPPS treatment studies may suggested to
include sexual function as a outcome measure to elucidate the their complex
relationship.
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Radical Prostatectomy – Evidence – based Approaches for Sexual Rehabilitation
Han-Sun Chiang
President, Asian Pacific Society of Sexual Medicine
Recent literature evidence suggests early postoperative penile rehabilitation
after radical prostatectomy can prevent cavernosal hypoxia fibrosis and penile
atrophy. Serial reviews also show the penile rehabilitation can definitely
decrease the incidence of permanent erectile dysfunction. According to the
evidence appeared on the previous studies, we start our protocol of penile
rehabilitation for patients after radical prostatectomy since this year. Based on
our experience, we found the following thoughts might be more beneficial for
the couples to have penile rehabilitation:
1.Preoperative counseling should be more comprehensive: including
psychosocial concerns of their sexuality; questionnaire for the quality of life;
the detail of sex therapy thereafter etc.
2.The regimen of penile rehabilitation should be more flexible. We provide
different program of regular intracavernosal injection or/and oral intake of
phosphodiesterase type 5 (PDE-5) inhibitors for the couples. The programs
could also be switched during the treatment. It became more acceptable for
the couples.
3.The penile rehabilitation should be taught and followed up by a special
personnel. It would be even better performed by a clinical psychologist in
combination with sex therapy. Our preliminary result showed that early
penile rehabilitation with sex therapy can remain the couple’s sexually active
and easily achieve sexual satisfaction for them.
It is a new goal of early penile rehabilitation for restoring a more complete
sexual function. The concept of a “new sex therapy” may be promoted in
other medical fields such as for any other major surgeries, for critical medical
diseases and even for the aging couples whom lose of sexual function for a long
period.
Based on our preliminary result, almost all of the couples can accept the
concept of penile rehabilitation to preserve the penile length and erectile
function, even though they may not so active in sexual life. They can start the
program as early as no more symptom of urinary incontinence. Compare with
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the group of the patients without penile rehabilitation after radical prostatectomy
the sexual function, sexual intimacy, quality of life is very much improved. We
conclude that sexual rehabilitation should be a gold standard for the patients
after radical prostatectomy.
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New Insights of Premature Ejaculation
Dr. Chris G McMahon
Australian Centre for Sexual Health,
Sydney Australia
Ejaculatory/orgasmic disorders are common male sexual dysfunctions and
include premature ejaculation, inhibited ejaculation, anejaculation, retrograde
ejaculation and anorgasmia. Premature ejaculation (PE) is a common male
sexual dysfunction with a prevalence that is relatively consistent across age
groups and across countries. PE is associated with a substantial psychological
and relationship burden for sufferers and their partners. Although recent
epidemiological and observational research has provided new insights into
premature ejaculation (PE) and the associated negative psychosocial effects of
this dysfunction, the true prevalence of PE remains unclear. Community IELT
stopwatch observational studies of unselected subjects demonstrate a positively
skewed distribution of a broad range of lIELTs with a median IELT of 5.4 minutes.
80-90% of men seeking treatment for lifelong PE ejaculate within 60 seconds.
The first contemporary multivariate evidence-based definition of lifelong PE was
developed in 2008 by a panel of international experts, and characterises
lifelong PE as “…ejaculation which always or nearly always occurs prior to or
within about one minute of vaginal penetration, the inability to delay ejaculation
on all or nearly all vaginal penetrations, and the presence of negative personal
consequences, such as distress, bother, frustration and/or the avoidance of sexual
intimacy.” This definition is limited to heterosexual men engaging in vaginal
intercourse. There is insufficient published evidence to propose an
evidenced-based definition of acquired PE.
Animal and human sexual psychopharmacological studies have demonstrated
that serotonin and 5-HT receptors are involved in ejaculation and confirm a
role for selective serotonin re-uptake inhibitors (SSRIs) in the treatment of PE.
There is accumulating evidence to suggest that the intravaginal ejaculatory
latency time (IELT) is a genetically influenced biological variable, suggesting that
PE is a neurobiological disorder and that some men may be genetically prone to
ejaculate with a brief latency. The evidence to support this includes animal
studies showing a subgroup of persistent rapidly ejaculating Wistar rats, an
increased familial occurrence of lifelong PE and the recently genetic
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polymorphism of the 5-HT transporter protein gene which appears to
determine the regulation of the IELT. Acquired PE is associated with sexual
performance anxiety, ED, genitourinary infection, thyroid dysfunction or may be
idiopathic.
The off-label use of some SSRIs and clomipramine, along with the development
and recent regulatory approval of dapoxetine for the treatment of PE, has drawn
new attention to this common and often ignored sexual problem. However,
until the neurobiological, physiological and psychological mechanisms
responsible for PE are better understood, ideal treatment outcomes may remain
elusive.
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Optimization of Erectile Dysfunction Management
Dr. Sae Chul Kim
Department of Urology Chung-Ang University Hospital, Seoul, Korea
For the optimal ED management, the first to consider is that healthcare
professional has to redirect men into healthcare system. Healthcare professional
should educate men to have a correct understanding about ED; ED is a medical
issue, possibly associated with serious cardiovascular diseases and should be
treated with genuine medicine. For the successful ED treatment, 1) the effective
assessment of ED (predisposing, precipitating, and maintaining factors) by
bio-psycho-social approach and impact on the couple, 2) accurate diagnosis, 3)
identification of contributory factors to ED such as androgen deficiency and
concomitant medications are mandatory. 4) Physicians have to know what is the
goals for the man and his partner. The goal should be realistic and holistic. 5)
physicians have to decide which treatments are most likely to allow them to
achieve these goals.
Optimal erection hardness is important to treat ED successfully because
satisfaction with erection hardness is associated with greater levels of satisfaction
with intercourse. According to European Sexual Confidence Survey conducted
in 12 countries (2009), 95% of adults agree that it is important for a man to be
sexually confident in order to have good sex, and 90% of men and women
believe that a lack of sexual confidence, as a result of insufficiently hard
erections, can have a negative impact on a man’s life outside of sex. Men with
ED treated with sildenafil regained confidence levels similar to men without ED.
Secondarily, physicians should educate patient and partner how to optimise
medication effect, and how to integrate medication use into their sexual activity,
and should discuss partner sexual health and function and suggest pro-erectile
lifestyle and behavioural changes. Prescribing issues include ensuring use of
genuine medication, discussing risks to health of counterfeit medication,
providing optimal dose and adequate supply, and promoting adequate usage. A
study analysing 17 commercial formulations of “herbal” or “dietary”
supplements marketed for sexual dysfunction said that 8 of the 17 contained
compounds related to synthetic PDE5-inhibitors. Pharmacological risks posed
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by counterfeit PDE5-inhibitors are incorrect or incomplete descriptions of
product composition, presence of unknown pharmaceutically active ingredients,
dosage variability, minimal or incorrect guidance about contraindications,
unsupervised use by men with ED and serious co-morbid conditions, and
addressing side effects caused by an unknown product is difficult and may be
dangerous.
Finally, adequate follow-up is stressed; 1) Enquire about and address
sub-optimal response, 2) Address adverse effects, 3) Discuss partner sexual
experience and treatment satisfaction, 4) Address any other treatment-emergent
sexual and relationship problems.
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Outcome Measures for Assessing Female Sexual Functioning
Dr. Bang-Ping Jiann
Kaohsiung Veterans General Hospital
Female sexual dysfunction (FSD) contains four major categories of desire,
arousal, orgasm, and pain problems. Defining and measuring FSD is a complex
and challenging task. Several factors have confounded the theory and
measurement of FSD including: the use of inappropriate male paradigm,
difficulty in capturing the complexity of women’s sexual response, and an
evolving but untested classification of FSD. Measurement approaches for sexual
dysfunction have proliferated in recent years, spurred in large part by the
development of new treatments. In the past, physiological measures of penile
tumescence in males and vaginal blood flow in females played an important
role in clinical and research studies. More recently, a variety of brief, self-report
measures have been developed for assessing male and female function across a
variety of sexual domains. These brief, self-report measures have been shown to
have a high degree of reliability and validity and to be sensitive to treatment
interventions and are widely employed in clinical trials as well as for clinical
screening and diagnostic purposes. Self-report measures of sexual function exist
in several forms, including self-administered questionnaires, daily diary records,
and event log measures of sexual behavior.
The Female Sexual Function Index (FSFI) is a validated (19-item) questionnaire
that has been widely used in epidemiological studies and clinical trials since the
past decade. The FSFI assesses aspects of female sexual function in six areas:
sexual desire, arousal, lubrication, orgasm, satisfaction, and pain, and yields six
domain scores and a total score. The six FSFI subscales and the FSFI total score
discriminated very well between women with and without sexual problems.
The measure was shown to have a high degree of internal consistency and
test-retest reliability and differentiated well between the two groups. Highly
significantly differences were observed in all six dimensions between the
patients and controls, indicating that the measure is very sensitive in
differentiating responses between sexually dysfunctional and nondysfunctional
women.
The Sexual Function Questionnaire (SFQ) is a 31-item, multidimensional
questionnaire recently developed for use in clinical trials of sildenafil in women
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with sexual arousal disorders. The questionnaire assesses sexual function in
seven dimensions: desire, physical arousal, lubrication, enjoyment, orgasm,
pain, and partner satisfaction. The questionnaire was validated in two,
large-scale clinical trials including 781 women with sexual dysfunction. The
SFQ has strong psychometric properties and initial validation data. The high
level of treatment responsiveness suggests that the measure is well suited for use
in clinical trials of androgen replacement therapy. Its psychometrics and
multilingual forms make it an excellent questionnaire that would benefit from
more use in clinical trials and comparison to the more widely used FSFI.
To qualify for the diagnosis of sexual dysfunction, a woman should show
evidence of significant personal distress in relation to her sexual problem.
Personal distress can be assessed by means of interview or questionnaire. The
Female Sexual Distress Scale (FSDS) is a 12-item scale that assesses subjective
distress associated with sexual dysfunction in clinical trials and has been shown
to have a high degree of test-retest reliability (0.91) and internal consistency
(0.88). The measure also discriminates well between women with and without
sexual dysfunction and has been shown to be sensitive to the effects of
treatment. The measure is highly recommended for inclusion in clinical trails of
FSD.
In conclusion, a number of self-report measures have been developed for
multidimensional assessment of female sexual functioning that have
demonstrated adequate psychometric properties, including test-retest reliability,
internal consistency, and discriminant validity. Personal distress is an important
component of FSD and can be reliably assessed by the FSDS.
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The Impact of Testosterone Deficiency on Men’s Health
Dr. Allen D Seftel, MD
Head, Division of Urology Cooper University Hospital Camden, NJ
Professor of UrologyRobert Wood Johnson SOM
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Testosterone and Prostate Cancer: From Myth to Scientific Understanding
1
F Saad1,2, A Yassin2,3, A Haider4
Scientific Affairs Men’s Healthcare, Bayer Schering Pharma, Berlin, Germany
2
Gulf Medical University School of Medicine, Ajman, UAE
3
Segeberger Kliniken, Norderstedt, Germany
4
Private Urology Practice, Bremerhaven, Germany
Background: Throughout the world, there is an increased interest in using
testosterone for the treatment of late-onset hypogonadism (LOH) or
testosterone deficiency syndrome (TDS) in aging men. However, concerns of
inducing prostate diseases – both prostate cancer and BPH/LUTS – oftentimes
outweigh the benefits of testosterone therapy resulting in a high degree of
hesitance whether to treat hypogonadism.
Evidence from epidemiological studies: From a large number of epidemiological
studies, there is no evidence that endogenous testosterone or any other
androgens are associated with prostate diseases.
Studies in hypogonadal men reveal that men with testosterone deficiency have
smaller prostates and lower levels of prostate specific antigen (PSA) than
eugonadal men.
Evidence from testosterone treatment studies: When testosterone levels in
hypogonadal men are normalised, their prostates normalise resulting in initial
moderate increases in both volume and PSA. These increases occur within the
first six months of treatment and are to be expected as the prostate is an
androgen-dependent organ which needs testosterone for normal development
and functioning. Following this initial increase, volume and PSA reach a
plateau.
Studies and meta-analyses of controlled trials show that the incidence of
prostate cancer in testosterone-treated elderly men is the same as in
placebo-treated men and comparable to large-scale prostate cancer screening
studies.
In experimental study designs, extreme doses of testosterone up to four- to
five-fold higher than what is considered physiological did not have an effect on
PSA or prostate volume.
Patients at high risk: Rhoden and Morgentaler treated men with biopsy-confirmed
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prostate intraepithelial neoplasia (PIN) with testosterone for one year with a
PIN-free group serving as control. They came to the conclusion that men with
PIN do not have a greater increase in PSA or a significantly increased risk of
cancer than men without PIN.
Between 2004 and 2009, three series were reported of men (n = 74) who
received testosterone treatment after curative radical prostatectomy. None of
the man had a biochemical recurrence of their prostate malignancy.
Intra-prostatic hormone milieu: In several studies, intra-prostatic concentrations
of testosterone and DHT were measured under testosterone therapy. While
serum levels of both androgens increased upon testosterone administration,
there were no changes in intra-prostatic hormone levels indicating that the
prostate creates its own hormonal milieu.
Morgentaler and Traish in their 2009 review have developed a saturation model
of testosterone effects on the prostate based on the evidence – among others –
that there is a limited number of androgen receptors which does not change
with testosterone treatment. Therefore, there is only a maximum response
possible which can not be further exceeded.
Several studies indicate that low testosterone may be associated with
higher-grade prostate cancer, positive surgical margin following radical
prostatectomy, and lower survival.
BPH/LUTS: In 1993, a first Swedish paper by Holmaeng mentioned an
improvement in urinary flow parameters. It took 15 years until a series of papers
confirmed these early observations and showed results of improved subjective
(by IPSS) and objective parameters of urinary function.
In summary, based on the current scientific and medical evidence, there is no
evidence that testosterone treatment increases the risk of prostate diseases in
hypogonadal men. Since there is no definitive proof, the answer is to follow the
guidelines on testosterone treatment in elderly men issued by and endorsed by
a substantial number of medical societies. Treating hypogonadism with
physiologic testosterone doses after proper diagnosis and under proper
monitoring according to the guidelines can be considered acceptably safe.
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TAA Consensus on Testosterone Replacement Therapy
王起杰醫師
高雄醫學大學泌尿科
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