Papers by Wayne Hellstrom
Introduction. The Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., text revision (... more Introduction. The Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., text revision (DSM-IV-TR) criteria for premature ejaculation (PE) have been criticized on multiple grounds including that the criteria lack precision, that the requirement of marked distress is inappropriate, and that the specification of etiological subtypes should be deleted. Since these criteria were originally adopted, there has been a tremendous gain in knowledge concerning PE. Aim. The goal of this manuscript is to review evidence relevant to diagnostic criteria for PE published since 1990. Method. Medline searches from 1990 forward were conducted using the terms PE, rapid ejaculation, ejaculatory disorder, and intravaginal ejaculatory latency. Early drafts of proposed alterations in diagnostic criteria were submitted to advisors. Main Outcome Measure. Expert opinion was based on review of evidence-based medical literature. Results. The literature search indicated possible alterations in diagnostic criteria for PE. Conclusions. It is recommended that the Diagnostic and Statistical Manual committee adopt criteria similar to those adopted by the International Society of Sexual Medicine. It is proposed that lifelong PE in heterosexual men be defined as ejaculation occurring within approximately 1 minute of vaginal penetration on 75% of occasions for at least 6 months. Field trials will be necessary to determine if these criteria can be applied to acquired PE and whether analogous criteria can be applied to ejaculatory latencies in other sexual activities. Serious consideration should be given to changing the name from PE to rapid ejaculation. The subtypes indicating etiology should be eliminated. Segraves RT. Considerations for an evidence-based definition of premature ejaculation in the DSM-V. J Sex Med 2010;7:672-689.
Amer J Physiol Heart Circ Phy, 2006
Mesenchymal stem cells (MSCs) can be used in adult stem cell-based gene therapy for vascular dise... more Mesenchymal stem cells (MSCs) can be used in adult stem cell-based gene therapy for vascular diseases. To test the hypothesis that MSCs alone or endothelial nitric oxide synthase (eNOS)-modified MSCs can be used for treatment of erectile dysfunction (ED), syngeneic rat MSCs (rMSCs) were isolated, ex vivo expanded, transduced with adenovirus containing eNOS, and injected into the penis of aged rats. Histological analysis demonstrated that rMSCs survived for at least 21 days in corporal tissue after intracavernous injection, and an inflammatory response was not induced. Intracavernous administration of eNOS-modified rMSCs improved the erectile response in aged rats at 7 and 21 days after injection. The increase in erectile function was associated with increased eNOS protein, NOS activity, and cGMP levels. rMSCs alone increased erectile function of aged rats at day 21, but not at day 7, with the transplanted cells exhibiting positive immunostaining for several endothelial and smooth muscle cell markers. This change in rMSC phenotype was accompanied by upregulation of penile eNOS protein expression/activity and elevated cGMP levels. These findings demonstrate that an adenovirus can be used to transduce ex vivo expanded rMSCs to express eNOS and that eNOS-modified rMSCs improve erectile function in the aged rat. Intracavernous injection of unmodified wildtype rMSCs improved erectile function 21 days after injection through mechanisms involving improved endothelium-derived NO/cGMP signaling and rMSC differentiation into penile cells expressing endothelial and smooth muscle markers. These data highlight the potential clinical use of adult stem cell-based therapy for the treatment of ED.
Journal of andrology
The etiologies of erectile dysfunction (ED) after nerve-sparing radical prostatectomy have not be... more The etiologies of erectile dysfunction (ED) after nerve-sparing radical prostatectomy have not been clearly elucidated. The aim of this study was to evaluate the effects of cavernous nerve injury on cavernous fibrosis, and to consider measures to prevent irreversible damage to the cavernous tissues. Twenty male Sprague-Dawley rats constituted the study population. The animals were divided into 2 groups; group 1 consisted of sham-operated rats (n = 10), and group 2 consisted of rats that underwent incision of both cavernous nerves (n = 10). Three months later, all rats underwent intracavernous papaverine injection (300 and 600 mg), and intracorporal pressures were recorded. Transforming growth factor-beta(1) (TGF-beta(1)) messenger RNA (mRNA) expression from rat penile tissue was measured using reverse transcriptase-polymerase chain reaction. Hypoxia-inducible factor-1alpha (HIF-1alpha), TGF-beta(1), and collagen I and III protein expressions were determined by Western blot analysis ...
Journal of andrology
Peyronie's disease is an idiopathic, localized connective tissue disorder of the penis, invol... more Peyronie's disease is an idiopathic, localized connective tissue disorder of the penis, involving the tunica albuginea of the corpus cavernosum and adjacent areolar space. Current proposals as to the origin of Peyronie's disease suggest that fibrosis and collagen changes of the tunica are the result of an inflammatory process following vascular trauma. Our laboratory and other investigators have recently proposed an animal model for the study of Peyronie's disease. When transforming growth factor-beta1 (TGF-beta1) was injected into the rat tunica albuginea, tissue fibrosis was observed at 6 weeks. Therefore, our aim was to assess arginase II, endothelial and inducible nitric oxide synthase isoforms, and nitrotyrosine levels--all factors involved in inflammatory reactions--in the cavernosal tissue of saline-injected and TGF-beta1-injected rats after 6 weeks in order to evaluate the roles these enzymes may play in the induction of a Peyronie's-like condition in the rat...
Urology, 1996
Previous studies have indicated that the urethra may provide an effective route for administering... more Previous studies have indicated that the urethra may provide an effective route for administering vasoactive medication for the treatment of erectile dysfunction. We evaluated the safety and efficacy of alprostadil administered intraurethrally at home for the treatment of this disorder. This prospective, multicenter, double-blind, placebo-controlled study evaluated the erectile response to randomly assigned doses of transurethral alprostadil at home in 68 men with long-standing (mean 41 months) erectile dysfunction of primarily organic etiology. Patients completing the study each administered a random sequence of four different doses (125, 250, 500, and 1000 micrograms) and placebo over a 2 to 4-week period. Assessments included the couples' ability to have intercourse, patient ratings of erectile response by both categorical and visual analogue scales, penile volume measurements, and overall assessments of comfort and ease of administration. Overall, 75.4% (49 of 65) of study p...
The Journal of trauma, 1995
Fifty consecutive cases of gunshot wounds to the male external genitalia were treated by the Tula... more Fifty consecutive cases of gunshot wounds to the male external genitalia were treated by the Tulane University Urology Service at the Medical Center of Louisiana in New Orleans. Fifty percent of the patients had significant associated injuries. Eight anterior urethral injuries were identified, all by retrograde urethrography. Five of 17 testicular injuries were salvaged with conservative operative technique. Review of this series suggests that good functional integrity of the male genitalia after gunshot injury can be maintained by following a strict diagnostic and therapeutic regimen.
Journal of andrology
The ability of pentoxifylline to stimulate the motion characteristics of antegrade and retrograde... more The ability of pentoxifylline to stimulate the motion characteristics of antegrade and retrograde sperm collected at the time of electroejaculation with a rectal probe was assessed in six neurologically impaired men. Before electroejaculation, the bladder was rinsed and instilled with 20 to 30 ml Ham's F-10 medium. Washed sperm were incubated with various doses (0, 0.1, 1, and 3 mmol/L) of pentoxifylline. Video sequences were recorded at intervals from 0 to 4.5 hours and analyzed for sperm motion parameters using manual and computer-assisted semen analysis. The results were compared with equimolar concentrations of caffeine. Both pentoxifylline and caffeine demonstrated a dose-dependent stimulation of percent motility and other motion parameters. A maximal stimulation of two-fold to three-fold for both percent motility and curvilinear velocity, and 30% to 60% for straight line velocity was observed after incubation under these conditions. A significant increase in mean linearity...
European Urology Supplements, 2002
Urologia Internationalis, 1986
To elucidate the hemodynamic changes during erection, we measured corporeal blood gases in 6 monk... more To elucidate the hemodynamic changes during erection, we measured corporeal blood gases in 6 monkeys before, during, and after erection induced by either papaverine or phentolamine or a combination of the two. Papaverine alone caused a strong erection (maximal tumescence and rigidity) by means of a rapid, large increase in pO2 and pCO2 with a pH drop to the acidic range. Phentolamine alone caused 'delayed' tumescence with less rigidity; the intracorporeal pO2 level increased, but pCO2 and pH values did not change significantly. The combination of both drugs offered no advantage over papaverine alone. We conclude that papaverine is a potent erection-inducing drug that acts in a bimodal manner, namely, it increases the arterial inflow and, at the same time, decreases the venous outflow. Phentolamine affects the arterial component of erectile function only.
Current Urology Reports, 2010
Premature ejaculation is the most common male sexual dysfunction. The International Society of Se... more Premature ejaculation is the most common male sexual dysfunction. The International Society of Sexual Medicine recently defined premature ejaculation as ejaculation less than about 1 min after penetration, inability to control ejaculation, and resulting negative personal consequences. Evolving treatments target the modulation of the neurobiological causes of the disorder. Current pharmaceuticals focus on aerosolized topical agents, selective serotonin reuptake inhibitors, 5-hydroxytryptamine receptor modulators, and opioid agonists. These emerging medications and the ability to tailor treatments based on genetic information likely will change the paradigm of this disorder and how it will be treated by clinicians.
Urology, 2003
The durability of key efficacy response parameters and safety of vardenafil was evaluated in a pi... more The durability of key efficacy response parameters and safety of vardenafil was evaluated in a pivotal trial conducted in a broad population of men with erectile dysfunction (ED) in North America. In this randomized, double-blind, placebo-controlled, multicenter, fixed-dose, parallel-group, 6-month comparison study, men Ͼ18 years of age with ED for Ͼ6 months received 5-mg, 10-mg, and 20-mg doses of vardenafil as needed for up to 26 weeks. The primary efficacy variables were the International Index of Erectile Function (IIEF)-Erectile Function (EF) domain scores, and the Sexual Encounter Profile (SEP) mean per-patient success rates for penetration (SEP question 2) and maintenance of erections (SEP question 3). Safety data were also collected over time. Improvement in all primary efficacy variables was observed in all vardenafil groups versus placebo. These improvements occurred early and were either sustained or increased through week 26. Vardenafil in 10-mg and 20-mg doses was significantly superior to placebo at all time points for all efficacy variables (P Ͻ0.01), and all doses were superior to placebo at endpoint (P Ͻ0.001). Most treatment-emergent adverse events (headache, flushing, dyspepsia, and rhinitis) were mild or moderate in intensity, and incidence generally decreased over time. All 3 doses of vardenafil were superior to placebo across all primary efficacy variables and all study time points in a broad range of patients with ED, regardless of etiology or severity. Vardenafil was well tolerated. These results demonstrate that vardenafil provides sustained efficacy with reduced incidence of nuisance side effects over time. UROLOGY 61 (Suppl 4A): 8-14, 2003.
Urology, 1997
Calciphylaxis is a condition of cutaneous necrosis secondary to small-and medium-sized
Urology, 1987
Although chronic nonbacterial prostatitis is common, the condition remains poorly understood and ... more Although chronic nonbacterial prostatitis is common, the condition remains poorly understood and refractory to treatment. Another approach, i.e., a urodynamic explanation, seems warranted. The underlying cause of the symptoms may be an inappropriate spasm of of the distal urethra/external sphincteric unit, leading to increased pressure in the prostatic urethra with a resultant reflux of urine into the prostatic ducts. The presence of urine (sterile or infected) could induce ductal and periductal inflammation, which could further aggravate spasm of the involved pelvic musculature, exacerbating the voiding dysfunction. We present 3 patients in whom this sequence of events was documented radiographically and urodynamically. Consequently, treatment involved modulation of the dysfunction of the distal urethra/external sphincteric unit: (1) reeducation by reassurance and biofeedback was the initial line of therapy; (2) pharmacologic manipulation using alpha-blockers (to affect smooth and striated muscle irritability) and striated muscle relaxants was next tried; (3) finally, in unremitting symptoms, we used selective sacral-root electro-stimulation, successfully fatiguing the involved muscles and relieving the voiding dysfunction.
Trends in Pharmacological Sciences, 2000
Male erectile dysfunction (ED) is a condition defined by the inability to attain or maintain peni... more Male erectile dysfunction (ED) is a condition defined by the inability to attain or maintain penile erection sufficient for satisfactory sexual intercourse. Data from the Massachusetts Male Aging Study have indicated that the prevalence of ED is 39% in 40-year-old men and 67% in those aged 70 years 1,2 . In the past, ED was believed to be primarily a result of nonspecific psychological causes; more recently, an organic etiology can be identified in the majority of men with ED. Although patients can have several medical conditions, organic ED is usually associated with vascular risk factors, such as atherosclerosis, hypertension, diabetes mellitus, Peyronie's disease and cigarette smoking 3-5 . Pelvic trauma and pelvic surgery (radical prostatectomy or radical cystectomy) resulting in either vascular or nervous injury can cause ED. In addition, specific pharmacological medications, such as antihypertensive agents (-blockers), diuretics, cardiac medications, hormones and antidepressants can induce ED (Ref. 4).
Southern Medical Journal, 1996
Extensive urethral defects in the presence of insufficient local skin can challenge the reconstru... more Extensive urethral defects in the presence of insufficient local skin can challenge the reconstructive urologist. We report a case of complete anterior urethral loss due to Fournier's gangrene that was successfully reconstructed using autologous buccal mucosa. A 17.5 x 2.5 cm tube graft was harvested, extending from the left to right buccal regions along the lower labial fold. At long-term follow-up, the patient had an acceptable cosmetic result with maintenance of potency and the ability to urinate. Buccal mucosal grafts are a viable alternative for cases of near-total urethral reconstruction.
Seminars in Reproductive Medicine, 2009
Infertility is a major stressor in life and can cause disturbances in both sexual and marital rel... more Infertility is a major stressor in life and can cause disturbances in both sexual and marital relationships. The following review focuses on sexual function in men who are diagnosed with infertility. The impact of the diagnosis of infertility on male sexuality, including related diagnostic procedures and specific infertility treatments, is scrutinized in light of current scientific literature.
New England Journal of Medicine, 1997
Erectile dysfunction in men is common. We evaluated a system by which alprostadil (prostaglandin ... more Erectile dysfunction in men is common. We evaluated a system by which alprostadil (prostaglandin E1) is delivered transurethrally to treat this disorder. Alprostadil was delivered transurethrally in a double-blind, placebo-controlled study of 1511 men, 27 to 88 years of age, who had chronic erectile dysfunction from various organic causes. The men were first tested in the clinic with up to four doses of the drug (125, 250, 500, and 1000 microg); those who had sufficient responses were randomly assigned to treatment with either the effective dose of alprostadil or placebo for three months at home. During in-clinic testing, 996 men (65.9 percent) had erections sufficient for intercourse. Of these men, 961 reported the results of at least one home treatment; 299 of the 461 treated with alprostadil (64.9 percent) had intercourse successfully at least once, as compared with 93 of the 500 who received placebo (18.6 percent, P<0.001). On average, 7 of 10 alprostadil administrations were followed by intercourse in men responsive to treatment. The efficacy of alprostadil was similar regardless of age or the cause of erectile dysfunction, including vascular disease, diabetes, surgery, and trauma (P<0.001 for all comparisons with placebo). The most common side effect was mild penile pain, which occurred after 10.8 percent of alprostadil treatments, but the pain rarely resulted in refusal to continue in the study. Hypotension occurred in the clinic in 3.3 percent of men receiving alprostadil. Hypotension-related symptoms were uncommon at home. No men had priapism or penile fibrosis. In men with erectile dysfunction, transurethral alprostadil therapy resulted in erections in the clinic and in intercourse at home.
The Journal of Urology, 2004
Purpose: In this study we defined the prevalence of Peyronie's disease in a cohort of men being s... more Purpose: In this study we defined the prevalence of Peyronie's disease in a cohort of men being screened for prostate cancer in the United States. The association between Peyronie's disease, and medical comorbidities and patient self-reported erectile dysfunction was also defined.
The Journal of Urology, 2003
We assessed the effects on spermatogenesis of placebo vs 10 or 20 mg tadalafil administered daily... more We assessed the effects on spermatogenesis of placebo vs 10 or 20 mg tadalafil administered daily for 6 months to healthy men and men with mild erectile dysfunction. In 2 studies 421 healthy men or men with mild erectile dysfunction who were 45 years or older and met semen criteria derived from WHO reference values were randomized to 6 months of treatment with placebo (101) or 10 mg tadalafil (103), or to placebo (106) or 20 mg tadalafil (111). Semen samples and serum for reproductive hormones (testosterone, luteinizing hormone and follicle-stimulating hormone) were collected at baseline, after 3 months and at the end of treatment. Tadalafil had no adverse effects on spermatogenesis, as assessed by sperm concentration, sperm count per ejaculate, percent sperm motility, normal morphology or serum reproductive hormones. Tadalafil was well tolerated. Common adverse events were headache, dyspepsia and back pain. Chronic daily administration of tadalafil at doses of 10 and 20 mg for 6 months had no adverse effects on spermatogenesis or on reproductive hormones in men older than 45 years.
The Journal of Urology, 2007
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Papers by Wayne Hellstrom