Objective  To determine whether the treatment of patients with testicular cancer, using cisplatin combined with etoposide and bleomycin (BEP) after orchidectomy in those with disseminated disease, causes changes in sex hormones and penile vascularization, possibly related to sexual dysfunction. Patients and methods  Ten patients treated with BEP were compared with 11 undergoing orchidectomy alone followed by surveillance. Sex hormone levels were analysed and cavernosal artery duplex ultrasonography performed before orchidectomy and at 6 and 12 months afterward. Patients were questioned about their sexual function. After 1 year, a visual erotic stimulation (VES) test was performed to assess penile rigidity. Results  In contrast to the surveillance group, BEP‐treated patients had higher follicle‐stimulating hormone (4.6 vs 26.5 U/L) and luteinizing hormone (1.4 vs 8.2 U/L) levels, and lower testosterone levels (21.1 vs 14.7 nmol/L) at 6 months than at baseline. At 1 year, most patients had compensated hypergonadotrophic eugonadism, but Leydig cell function had recovered. Changes in cavernosal artery peak flow velocities induced by local injection with papaverine/phentolamine showed no difference between the groups before and 6 months after orchidectomy. Loss of libido and erectile dysfunction were reported more frequently by BEP‐treated patients. However, 1 year after treatment, most reported a satisfying sex life and VES resulted in a rigid erection in nearly all patients. The reported erectile dysfunction could not be explained by changes in plasma testosterone levels or diminished blood flow velocities. Conclusions  After being diagnosed with testicular cancer, sexual morbidity is considerable, but within 1 year some improvement may be expected. BEP induces transient testicular dysfunction but this recovers. Although BEP is related to symptoms of angiopathy, cavernosal blood flow seems to be unaffected. These findings and the normal VES‐evoked penile rigidity suggest that sexual dysfunction is more psychological than organically induced by BEP.

A low number in green building development cause the building construction will have an immense direct and indirect impact on future generations. This paper identified the optimum incentive model driving the building efficiency achievement in green building operation and maintenance. Critical factors that influence building consultant and contractor decision in green building design and construction toward the operation and maintenance achievement planned were analysed using partial least square structural equation modelling (PLS-SEM) methods. Precisely, the study modelled the regional policy affecting building efficiency achievement in the developing country. This research already identified the way of green building stakeholders’ operations and maintenance in the capital city of Indonesia. Quantitative method using case study analysis already validated for the questionnaire data. The PLS-SEM indicated that sustainable in green building implementation and sustainability has significant causal effects on the regional policy of building the life cycle. Among these factors, tax exemption, expedited permit, and floor to area ratio were significant. The regional policy indicators in green building implementation have the most significant effect on building efficiency achievement.

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