International journal of impotence research
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Int. J. Impot. Res. · Mar 2009
Comparative StudyPenetrating trauma to the external genitalia in Operation Iraqi Freedom.
This report details the incidence and description of trauma to the external genitalia experienced during Operation Iraqi Freedom at a United States Army Combat Support Hospital, and demonstrates that acceptable rates of testicular salvage are possible in the combat setting. The operating room logs and the Joint Theater Trauma Registry were used to conduct a retrospective review of the patients who sustained genitourinary (GU) injuries at an US Army Combat Support Hospital (CSH) in Iraq from 27 February 2007 to 14 August 2007. Of the 3595 battle trauma injuries seen at the CSH during the time period, 168 (4.7%) had one or more GU injuries for a total of 172 GU injuries. ⋯ Injuries to the external genitalia continue to account for the vast majority of GU trauma in a combat setting. Of patients who presented with penetrating testicular trauma, there was a 74.4% salvage rate, which is higher than previous reports of combat external genitalia injuries. Treatment of penetrating trauma to the external genitalia in a combat setting requires attention to tissue preservation while coordinating associated surgical procedures.
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Int. J. Impot. Res. · Nov 2008
Correlation between simultaneous PSA and serum testosterone concentrations among eugonadal, untreated hypogonadal and hypogonadal men receiving testosterone replacement therapy.
The primary objective of this study was to correlate simultaneous measures of prostate-specific antigen (PSA) and serum testosterone among large samples of eugonadal, untreated hypogonadal and hypogonadal men treated with testosterone replacement therapy (TRT). From 2001 to 2007, laboratory records were reviewed to identify men who underwent simultaneous measurement of PSA and serum testosterone levels. The data were stratified based on three groups of men: group 1 consisted of eugonadal men (T>300 ng per 100 ml) evaluated for BPH, reproductive failure or sexual dysfunction; group 2 consisted of untreated hypogonadal men (T<300 ng per 100 ml); and group 3 comprised symptomatic hypogonadal men receiving TRT. ⋯ Mean total serum testosterone levels were increased significantly (P<0.001) following treatment. Mean PSA levels did not increase in a statistically or clinically significant manner following TRT (mean PSA increase from baseline 0.05 ng ml(-1), P=0.6). In conclusion, TRT does not appear to significantly influence serum PSA expression and no significant correlation was identified between PSA and serum testosterone among eugonadal, untreated hypogonadal and hypogonadal men receiving TRT.
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Int. J. Impot. Res. · Mar 2008
Review'Off-label' drug use: an FDA regulatory term, not a negative implication of its medical use.
As physicians continue to prescribe more and more drugs, plaintiff's attorneys in the wake of tort reform are attempting to carve out or create informed consent cases based on the Food and Drug Administration's (FDA) labeling requirements and the doctors' communications with their patients as it relates to those requirements. The theory of tort litigation revolves around whether the doctor disclosed to his patient the fact that he prescribed a drug in an 'off-label' manner, or for a purpose not approved by the FDA's testing process. This article argues that the doctor's decision to inform the patient of the 'off-label' status of the prescription is not relevant to the physician's standard of care for an informed consent case. ⋯ In fact, prescribing medication in an 'off-label' manner can constitute the standard of care in many cases. Third, a doctor's duty is to practice medicine and treat his patient, not inform the patient of the FDA's non-medically related labeling. Therefore, doctors should not be branded with the additional duty of disclosing non-pertinent information, such as the FDA's medically irrelevant distinction, to their patients.
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Int. J. Impot. Res. · Mar 2008
Comparative Study Clinical TrialEfficacy of changing testosterone gel preparations (Androgel or Testim) among suboptimally responsive hypogonadal men.
The study objective was to evaluate the efficacy of changing testosterone gel preparations among suboptimally responsive hypogonadal men. The records of all hypogonadal men on gel (Testim or Androgel) testosterone replacement therapy (TRT) were reviewed to identify men who underwent a brand substitution in gel TRT due to initial suboptimal response. Total and free serum testosterone levels and the presence of hypogonadal symptoms (ADAM) were compared pre- and post-gel substitution. ⋯ A change in testosterone gel preparation among initially unresponsive hypogonadal men is justified prior to abandoning or considering more invasive TRT. Changing from Androgel to Testim offers hypogonadal men the potential for improved clinical and biochemical responsiveness. Changing from Testim to Androgel is indicated to eliminate or minimize unwanted side effects.
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Int. J. Impot. Res. · Jan 2008
Case ReportsManagement of penile fractures complicated by urethral rupture.
The combination of lesions of the penile urethra and the corpus cavernosum is rare and likely to go unremarked. It worsens the immediate and long-term prognosis and poses a problem of management. Among 312 cases of penile fracture, we performed a retrospective study of a series of 10-case of traumatic corpora cavernosa rupture complicated with urethral rupture, treated in the department of Urology at 'Charles Nicolle' Hospital in Tunis. ⋯ No urethral stricture or erectile complaints were noted within a 36-month mean follow-up. Urethral rupture must be suspected in any case of penile fracture presenting with bloody urethral discharge. Standard treatment is immediate surgical repair.