Erectile dysfunction (ED) is a common complaint in hypertensive men and can represent a systemic vascular disease, an adverse effect of antihypertensive medication or a frequent concern that may impair drug compliance. ED has been considered an early marker of cardiovascular disease. The connection between both conditions seems to be located in the endothelium, which may become unable to generate the necessary dilatation in penile vascular bed in response to sexual excitement, producing persistent impairment in erection. On the other hand, the real influence of antihypertensive drugs in erectile function still deserves discussion. Therefore, regardless of ED mechanism in hypertension, early diagnosis and correct approach of sexual life represent an important step of cardiovascular evaluation which certainly contributes for a better choice of hypertension treatment, preventing some complications and restoring the quality of life.

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In fetuses without congenital malformations or epididymal alterations, such as tail disjunction or elongated epididymis, the proximal portion of the gubernaculum was attached to the testis and epididymis in all cases. In undescended testes there was an increased incidence of paratesticular structure malformations accompanied by gubernacular attachment anomalies compared to the testes in normal fetuses.

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After the 2013 FDA approval of collagenase clostridium histolyticum (CCH) what was its impact on the use of surgical management of Peyronie Disease (PD) in United State? Dr. Sukumar and cols. from Columbia University hypothesized that with the introduction of CCH, surgery as a primary treatment modality for PD would be used less often. The authors reviewed 547 men with PD registered in Statewide Planning and Research Cooperative System (SPARCS) that provides data on patients in the outpatient, inpatient, ambulatory, and emergency department setting in New York. All patients >18 years old with a diagnosis with PD who received surgical therapy (ST), defined as plaque excision/incision and grafting or plication, or injection therapy (IT) as a primary treatment between 2003 and 2016 were included. Over the study period, surgical management was used less often as the primary procedure with a concurrent increase in use of IT (P < .001). On multivariable modeling, patients more likely to receive IT as treatment for penile curvature were younger, of higher socioeconomic status and presented to a surgeon with a high volume practice. That trend should worry other countries were CCH could be approved? IMPRESS I and II data revealed that men treated with CCH showed a mean 34% improvement in penile curvature, representing a mean-9.3 ± 13.6 degree change per subject (p <0.0001) (1) after eight injections.

ARTICLE INFO _________________________________________________________ ___________________Objective: To perform a cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia (BPH) under Brazilian public health system perspective (Unified Health System -"Sistema Único de Saúde (SUS)"). Material and Methods:A revision of the literature of the medical treatment of BPH using alpha-blockers, 5-alpha-reductase inhibitors and combinations was carried out. A panel of specialists defined the use of public health resources during episodes of acute urinary retention (AUR), the treatment and the evolution of these patients in public hospitals. A model of economic analysis(Markov) predicted the number of episodes of AUR and surgeries (open prostatectomy and transurethral resection of the prostate) related to BPH according to stages of evolution of the disease. Brazilian currency was converted to American dollars according to the theory of Purchasing Power Parity (PPP 2010: US$ 1 = R$ 1.70). Results: The use of finasteride reduced 59.6% of AUR episodes and 57.9% the need of surgery compared to placebo, in a period of six years and taking into account a treatment discontinuity rate of 34%. The mean cost of treatment was R$ 764.11 (US$449.78) and R$ 579.57 (US$ 340.92) per patient in the finasteride and placebo groups, respectively. The incremental cost-effectiveness ratio (ICERs) was R$ 4.130 (US$ 2.429) per episode of AUR avoided and R$ 2.735 (US$ 1.609) per episode of surgery avoided. The comparison of finasteride + doxazosine to placebo showed a reduction of 75.7% of AUR episodes and 66.8% of surgeries in a 4 year time horizon, with a ICERs of R$ 21.191 (US$ 12.918) per AUR episodes avoided and R$ 11.980 (US$ 7.047) per surgery avoided. In the sensitivity analysis the adhesion rate to treatment and the cost of finasteride were the main variables that influenced the results. Conclusions: These findings suggest that the treatment of BPH with finasteride is costeffective compared to placebo in the Brazilian public health system perspective.

and Research Cooperative) database for men who underwent inflatable penile prosthesis and/or artificial urinary sphincter insertion between 2000 and 2014. Compared with men who received a penile prosthesis alone those with a penile prosthesis and an artificial urinary sphincter (not necessarily done at the same surgery) had a higher likelihood of undergoing inflatable penile prosthesis reoperation at 1 year (OR 2.08, 95% CI 1.32-3.27, p <0.01) and 3 years (OR 2.60, 95% CI 1.69-3.99, p <0.01). The authors concluded that combined inflatable penile prosthesis and artificial urinary sphincter insertion portends a higher likelihood of inflatable penile prosthesis reoperation at 1 and 3 years. However, artificial urinary sphincter outcomes remain comparable. These data are in opposition to 2013 publication on Journal of Urology by Dr. Segal and cols. (1) retrospectively reviewed the records of 55 combined procedures that were performed from 2000 to 2011 and concluded that dual implantation (DI) was feasible without an increased risk of adverse outcomes compared to implantation of a single prosthesis. And also contradict a 2019 publication in Urology by Dr. Boysen and cols. (2) where, with the biggest number of cases (all over 65 years old), dual implantation does not adversely affect perioperative complications or device survival relative to placement of either device alone.