Ponholzer A., Plas E., Schatzl G., Struhal G., Brossner C., Mock K., Rauchenwald M., Madersbacher S.:
“Relationship between testosterone serum levels and lifestyle in aging men“
Aging Male, 8 (3-4), 190-193, 2005
OBJECTIVE: The aim of this study was to evaluate the association between serum levels of testosterone and free testosterone to lifestyle in aging males. METHODS: Men between 45 and 85 years were assessed regarding body mass index (BMI), nicotine and alcohol consumption, stress level, physical and social activity, and sleeping quality by a self-administered questionnaire. In parallel, serum levels of testosterone (T), free testosterone (fT), LH, FSH, DHEA-S, E2 and SHBG were obtained. RESULTS: In total, 375 men with a mean age of 59.9 years (9.2 +/- SD) entered this study; 25.4% and 27.4% had hypogonadal testosterone or free testosterone serum levels, respectively. Nicotine consumption (smokers had higher levels of T and fT; p < 0.01), BMI (negative correlation to T; p < 0.01) and age (negative correlation to fT; p < 0.001) correlated with serum levels of testosterone or free testosterone. Physical and social activity, nicotine and alcohol consumption, stress level and sleep quality did not show a significant association with serum androgen levels. CONCLUSION: This prospective study of 375 men aged 45 to 85 years confirms the correlation between age, BMI and smoking with serum levels of testosterone and free testosterone, whereas the investigated variety of lifestyle factors did not show a significant association to serum androgen levels.

Buse S., Lynch TH., Martinez-Pineiro L., Plas E., Serafetinides E., Turkeri L., Santucci RA., Sauerland S., Hohenfellner M., German Society for Trauma Surgery:
”Urinary tract injuries in polytraumatized patients”
Unfallchirurg, 108(10), 821-828, 2005
BACKGROUND: Within the S3 Guideline Project of the European Association of Urology (EAU) an expert committee was set up to develop guidelines for the appropriate management of genitourinary trauma. These European guidelines were accepted in principle as national guidelines by the German Urological Society. Therefore, they also became the basis of the contribution of the German Urological Society to the S3 Guideline Project "Polytrauma" of the German Society for Trauma Surgery. METHOD: For the guideline "management of genitourinary trauma" all the requirements for classification as S3 guidelines were full-filled. The guideline itself was developed in accordance with the principles of "evidence-based medicine". A systematic analysis of literature published between 1966 and 2004 was carried out. The articles retrieved were assessed in respect of study design and clinical relevance and classified following the scheme of the Centre for Evidence-Based Medicine in Oxford. CONCLUSION: In suspected renal injuries the hemodynamic situation of the patient is the benchmark for the diagnostic and therapeutic algorithm. The diagnostic gold standard for the assessment of haemodynamically stable patients is CT scanning. Uncontrolled haemodynamic instability is an indication for immediate explorative laparotomy. Partial ureteral tears are managed by stenting; complete tears by immediate surgical repair. Pelvic fractures are often associated with bladder ruptures. Extraperitoneal bladder ruptures, identified by retrograde cystography, are in most cases safely managed by simple catheter drainage. Intraperitoneal ruptures require surgical intervention. Blood at the meatus may suggest a urethral lesion-blind urethral catheterization should not be attempted. Suprapubic cystostomy and delayed urethroplasty are recommended.

Pernkopf D., Plas E., Lang T., Daha K., Kubin K., Treu T., Pflueger H.:
“Uroflow nomogram for male adolescents“
J.Urol., 174(4), 1436-1439, 2005
PURPOSE: Uroflowmetry is well established for investigating lower urinary tract symptoms. Current nomograms are based on sample sizes limited to 8 men of the same age. We generated percentile curves for the maximum urinary flow rate (Qmax) in relation to voided volume in male adolescents in a large homogenous healthy group. MATERIALS AND METHODS: A total of 348 males who were 18 years old were investigated, excluding probands with a urological history. Only samples with a voided volume of 150 cc or more were included. One micturition was obtained per proband to determine Qmax, the average urinary flow rate, time to Qmax and volume. Resulting curves were compared with nomograms for children and adults. RESULTS: Average voided volume +/- SD was 262 +/- 91.9 cc (range 151 to 664). Qmax was 28.4 +/- 9.7 cc per second (range 11.4 to 76) with an average urinary flow rate of 18.6 +/- 5.5 cc per second (range 4 to 44), a micturition time of 16.9 +/- 6.8 seconds (range 7 to 48) and a mean time to Qmax of 7.8 +/- 4.1 seconds (range 1 to 25). A total of 341 probands had a Qmax of more than 15 cc per second, while only 7 showed a Qmax of less than 15 cc per second. At up to 350 cc Qmax increased with volume, followed by a plateau phase at 350 to 550 cc and a Qmax decrease at higher volumes. CONCLUSIONS: Voiding volumes in a large homogenous adolescent group demonstrated optimal Qmax at voiding volumes between 350 and 550 cc with a decrease at higher volumes. Therefore, uroflow studies in adolescent males should be interpreted with caution at volumes less than 350 and more than 550 cc.

Untergasser G., Plas E., Pfister G., Heinrich E., Berger P.:
“Interferon-gamma induces neuroendocrine-like differentiation of human prostate basal-epithelial cells“
Prostate, 64(4), 419-429, 2005
BACKGROUND: Prostatic neuroendocrine (NE) cells are intraglandular hybrid epithelial-neural-endocrine cells that express and secrete numerous hormones and neuropeptides, which presumably regulate growth, differentiation, and secretory activity of the prostatic epithelium. This specialized cell type appears to differentiate from a common basal/precursor/stem cell that also gives rise to the secretory epithelium. In order to elucidate mechanisms of NE-differentiation the effects of type 1 (alpha, beta) and type 2 (gamma) interferons (IFNs) on human prostate basal cells (PrECs) were evaluated. METHODS AND RESULTS: Application of alpha/beta IFN increased the expression of the cell-cycle inhibitor p21(CIP1) and inhibited DNA synthesis, while only IFN-gamma led to increased apoptosis, cell-cycle inhibitor p27(KIP1) upregulation, and differentiation of PrECs into NE-like cells. In vitro differentiated NE-like cells expressed the glycolytic enzyme neuron-specific enolase (NSE) and chromogranin A (CgA), known markers of NE-cells in vivo in the prostate. These NE-like cells also changed cytokeratin (CK) expression patterns by upregulating CK 8/18, predominantly found in terminally-differentiated secretory luminal/NE epithelial cells. CONCLUSIONS: IFN-gamma produced locally in the prostate by basal cells and, under proinflammatory conditions, by infiltrating lymphocytes could support NE cell differentiation and play a role in NE differentiation processes of tumor cells in hormone-refractory prostate cancer. Copyright 2005 Wiley-Liss, Inc.

Untergasser G., Gander R., Lilg C., Lepperdinger G., Plas E., Berger P.:
“Profiling molecular targets of TGF-beta 1 in prostate fibroblast-to-myofibroblast transdifferentiation“
Mech.Ageing Dev., 126(1), 59-69, 2005
The development of age-related proliferative disorders of the prostate gland is supported by transdifferentiation and cellular senescence processes in the stroma. Both processes are involved in remodeling of stromal tissue, as observed in benign prostatic hyperplasia (BPH), and in "reactive stroma" adjacent to prostate cancer (PCa). It has been assumed that TGF-beta1 plays a key role in the aging prostate by inducing premature senescence and favoring myofibroblast differentiation. Therefore, we evaluated the stromal cell phenotypes of human primary adult prostatic fibroblasts (n=3) and the molecular and cellular mechanisms of growth arrest after treatment with TGF-beta1 and of in vitro cellular senescence. Microarray analysis, quantitative PCR, immunofluorescence and western blot revealed that cellular senescence and transdifferentiation of fibroblasts have distinct underlying mechanisms, pathways and gene and protein expression profiles in human PrSCs. In clear contrast to senescent cells, TGF-beta1-treated cells morphologically transdifferentiated into myofibroblasts with dense cytoskeletal fibers and increased expression of smooth muscle cell alpha-actin, calponin and tenascin. TGF-beta1 induced neither expression of senescence-associated markers nor genes involved in terminal growth arrest, such as senescence-associated beta-galactosidase and cyclin-dependent kinase (cdk) inhibitors p16(Ink4A) and p21(Cip1) but increased p15(Ink4B) protein expression. Differentiation inhibitor (Id-1) protein level down-regulation was observed under both conditions. Genes specifically up-regulated by transdifferentiation but not by cellular senescence of PrSCs were metalloproteinase 1 tissue inhibitor (Timp1), transgelin (Tagln), gamma 2 actin (Actg2), plasminogen activator inhibitor 1 (Serpinel), insulin-like growth factor binding protein 3 (Igfbp3), parathyroid hormone-like hormone (Pthlp), Tgfb-1, four and a half LIM domains 2 (Fhl-2), hydrogen peroxide-inducible clone 5 (Hic5) and cartilage oligomeric matrix protein (Comp). Other genes, such as Cdc28 protein kinase 1 (Cks1b), v-myb myeloblastosis viral oncogene homolog (MybL2), pyruvate kinase, muscle 2 (Pkm2) and Forkhead box M1 (FoxM1), were down-regulated only upon TGF-beta1 treatment but not by cellular senescence. Pyruvate dehydrogenase kinase 3 (Pdk3) and connective tissue growth factor (Ctgf) were up-regulated and hyaluronan synthase 3 (Has3) down-regulated under both conditions. Moreover, GageC1, a prostate/testis-specific protein overexpressed in symptomatic BPH and PCa was induced in transdifferentiated stromal cells. Genes such as GageC1 could be promising targets for therapeutic inhibitors of stromal tissue remodeling and progression of BPH and PCa.

Lynch TH., Martinez-Pineiro L., Plas E., Serafetinides E., Turkeiri L., Santucci RA., Hohenfellner M., European Association of Urology:
”EAU guidelines on urological trauma”
Eur.Urol., 47(1), 1-15, 2005
PURPOSE: To determine the optimal evaluation and management of genitourinary (renal, ureteral, bladder, urethral and genital) injuries by review of the world's literature on the subject. METHODS: A consensus committee convened by the Health Care Office of the European Association of Urology (EAU) to summarize the literature concerning the diagnosis and treatment of genitourinary trauma. RESULTS: Findings of 350 citations are reviewed. CONCLUSIONS: The genitourinary trauma literature still relies heavily on expert opinion and single-institution retrospective series. Future prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates practitioner behavior.

Daha L., Pflüger H.:
“Pelvic Pain“
Universum Mann, 2, 26-27, 2005

Daniltchenko D.I., Riedl C.R., Sachs M.D., Koenig F., Daha K., Schnorr D., Pflueger H., Loening S.A.:
”Long-term benefit of 5-amino-levulinic-acid-fluorscence-assisted transurethral resection of superficial bladder cancer: five-year results of a prospective randomised study”
J.Urol., 174, 2129-2133, 2005

Riedl C.R., Sternig P., Galle G., Langmann F., Vcelar B., Vorauer K., Wagner A., Katinger H., Pflueger H.:
“Liposomal recombinant human superoxid-dismutase for the treatment of Peyronie´s Disease: A randomised, placebo-controlled double-blind prospective clinical study”
Eur.Urol., 48, 656-661, 2005

Daha K., Riedl C.R., Lazar D., Hohlbrugger G., Pflueger H.:
”Do Cystometric Findings Predict the Results of Intravesical Hyaluronic Acid in Women with Interstitial Cystitis”
Eur.Urol., 47, 393-397, 2005
INTRODUCTION AND OBJECTIVES: According to National Institute of Health (NIH) criteria, a bladder capacity of less than 350 cc is an automatic exclusion for a diagnosis of Interstitial Cystitis (IC). In the present study, patients, showing symptoms of IC and with bladder capacities of <350 and >/=350 cc were tested as to their response to a intravesical hyaluronic acid therapy. METHODS: The study included 48 patients with clinical symptoms of IC and a positive 0.4 M potassium sensitivity test. Maximum bladder capacity (C(max)) was assessed for the 0.9% NaCl solution first and then for the 0.2 M KCl solution. After the NaCl cystometry, patients were separated into two groups: Group I with a C(max) of <350 cc and Group II with a C(max) of >/=350 cc. Both groups were again separated in two further groups as to the respective percentage reduction of C(max) with the 0.2 M KCl solution: Group Ia/IIa (>/=30%) and Group Ib/IIb (<30%). Patients were treated with weekly instillations of 40 mg hyaluronic acid for 10 consecutive weeks. Pre- and post-treatment bladder symptoms were evaluated through their visual analog scale (VAS) scores. RESULTS: With the saline solution, 32 patients had a C(max) of <350 cc (Group I), while 16 patients had a C(max) of >/=350 cc (Group II). Evaluation of VAS scores confirmed a positive response, i.e. symptom relief, to hyaluronic acid therapy, irrespective of bladder capacity. The improvement was particularly evident in patients with a C(max) reduction of >/=30% versus those with a reduction of <30% with the 0.2 M KCl solution (p=0.003). CONCLUSION: The present study demonstrates that patients with typical IC symptoms and a cystometric bladder capacity of >/=350 cc, may have increased potassium sensitivity as a sign of IC and show symptom improvement after hyaluronic acid instillation therapy.

Riedl C., Sternig P., Galle G., Langmann F., Vcelar B., Vorauer K., Wagner A., Katinger A., Pflueger H.:
“Liposomal recombinant human superoxide dismutase for the treatment of Peyronie´s Disease: A randomized, placebo-controlled double-blind prospective clinical study”
Eur.Urol., 48, 656-661, 2005

Daniltchenko D., Riedl C., Sachs M., König F., Daha K., Pflueger H., Loenig S., Schnorr D:
“Long-term benefit of 5-aminolevulinic acid fluorescence assisted transurethral resection of superficial bladder cancer: 5-year results of a prospective randomised study”
J. Urol., 174, 2129-2133, 2005
PURPOSE: As shown in various studies 5-aminolevulinic acid (ALA) induces fluorescence of malignant and dysplastic bladder tissue and increases tumor detection rates by about 20%. However, data on the long-term benefits are sparse. Thus, the 5-year outcome data of a prospective randomized trial comparing patients who initially underwent bladder tumor resection (TUR) under standard white light or with ALA induced fluorescence were evaluated. MATERIALS AND METHODS: A total of 115 patients with suspected superficial bladder cancer were randomized to undergo standard or ALA assisted TUR. After the second look TUR at 6 weeks patients were followed for a median of 39 (standard) and 42 (ALA) months. RESULTS: Median time to first recurrence was 5 months in the standard and 12 months in the ALA group. Recurrence-free survival was 25% in the standard and 41% in the ALA group. The recurrence rate at 2, 12, 36 and 60 months after initial TUR was 41%, 61%, 73% and 75%, and 16%, 43%, 59% and 59% in the white light and ALA groups, respectively. The total number of recurrences was 82 in the standard and 61 in the ALA group. Tumor progression occurred in 9 patients in the standard and 4 in the ALA group. Cost analysis suggests a considerable economical advantage of ALA fluorescence assisted TUR compared to the standard procedure. CONCLUSIONS: The initial advantage of improved tumor detection and decreased recurrence rates by ALA fluorescence assisted TUR is maintained for years, and effectively reduces morbidity and costs in patients with superficial bladder tumors.

Riedl C., Sternig P., Galle G., Langmann F., Vcelar B., Vorauer K., Wagner A., Katinger A., Pflueger H.:
“Liposomal recombinant human superoxide dismutase for the treatment of Peyronie´s Disease: A randomized, placebo-controlled double-blind prospective clinical study”
J.Urol., 173 (4) Supp. 253 (937A), 2005
Eur.Urol., S4No.3: 219 (865A), 2005
OBJECTIVE: To demonstrate the efficacy and safety of a topical gel containing liposomally encapsulated recombinant human Superoxide Dismutase (lrhSOD) in the treatment of painful Peyronie's Disease. The theoretical background is that lrhSOD, by scavenging of free oxygen radicals, might interrupt inflammatory cascades and thereby limit further disease progression. METHODS: In a placebo-controlled randomized clinical trial, 39 patients with Peyronie's Disease and significant pain symptoms were treated with lrhSOD or placebo for a 4 week period. At this time, statistical evaluation of pain resolution was performed as primary study endpoint. Patients then were continued in a cross-over study design to ensure a total of 8 weeks of lrhSOD therapy for all study participants. Pain, plaque and curvature assessment was performed at study entry and every 4 weeks until week 12. RESULTS: LrhSOD treatment resulted in a statistically significant reduction of pain (p=0.017) compared to placebo already after 4 weeks. At week 12 pain was significantly reduced in 89% of patients who all had received 8 weeks of lrhSOD therapy at that time. Response to other disease parameters was assessed at week 12: plaque size was reduced in 47% of patients, as was plaque consistence in 38%. Penile curvature was improved at 5-30 degrees in 23% of patients. The expected spontaneous disease progression rate of up to 40%, as reported by several investigators, was significantly reduced to <10% under lrhSOD therapy, and patients satisfaction was high, also consequent to the lack of therapy-related side effects observed in the present study. CONCLUSION: LrhSOD is an easily administrable, safe and effective local therapeutic for the painful phase of Peyronie's Disease.

Daniltchenko D., Riedl C., König F., Sachs M., Daha K., Schnorr D., Loenig S.:
“Reducing the Risk of Cancer Recurrence and Progression in Patients with Superficial Bladder Tumor with 5-Aminolevulinic Acid-Induced Fluorescence Diagnosis. Results of a Prospective Randomized 5-Year Study”
J.Urol., 173 (4) Supp: 246 (912A), 2005
INTRODUCTION & OBJECTIVES: 5-Aminolevulinic acid (ALA) induces macroscopic fluorescence of tumour tissue in the bladder. Since its introduction more than 10 years ago it has been shown to increase the detection rate of small papillary or satellite tumours and more importantly flat lesions such as carcinoma in situ and significantly decrease the rate of residual tumour at the second look TUR. Here we present our 5 year results of a prospective randomized trial comparing recurrence rate and tumour progression after transurethral resection with standard white light (WL) or ALA-induced fluorescence.

MATERIAL & METHODS: 115 Patients with suspected superficial bladder cancer were randomized to undergo resection either under standard white light conditions or under violet-blue light after introduction of 50 ml of a 3% ALA solution (MEDAC GmbH, Germany). A second look-TUR was performed at 6-8 weeks and patients were followed for 23-61 months (median 39 and 42, respectively) with regular cystoscopy and urine cytology. Primary end-points were recurrence rate at 12, 36 and 60 months follow-up analyzed by Kaplan-Meier statistics, time to recurrence and rate of tumour progression.

RESULTS: Results are summarized in table 1. The rate of tumour recurrence was significantly decreased in the ALA-group. This advantage could be shown even after a long follow-up of 5 years. Time to first recurrence was significantly increased and tumour progression was decreased after ALA-TUR. Cost analysis shows a strong economical advantage of ALA-TUR by reducing the number of necessary TURs from 1.3 to 0.94 per patient per year.

Table 1. Summary of results.

CONCLUSIONS: Our results show, that fluorescence detection not only decreases the number of residual tumours at a short interval but also significantly decreases the risk of recurrence at a long term follow-up. It reduces tumour progression and is cost-effective.

Lazar D., Daha K., Plas E., Pflüger H. :
“Interstitielle Cystitis und sexuelle Funktionsstörungen bei Frauen“
Journal für Urologie und Urogynäkologie, Sonderheft 2, 15, 2005

Lazar D., Daha K., Plas E., Pflüger H.:
“Interstitial Cystitis and Sexual Dysfunction“
Abstract, 17^th  World Congress of Sexuality, Montreal, Canada, July 2005

Plas E.:
Der alternde Mann: Hormonersatztherapie?”
Arzt&Praxis, 902, 162-167, 2005

Pflueger H.:
“Benigne Prostatahypertrophie“ – Überblick und Update“
Clinicum, 5, 7-9, 2005

Plas E.:
“Erektile Dysfunktion – Überblick und Update“
Clinicum, 5, 9-10, 2005

Lunglmayr G., Pflueger H. et al.:
“Stellenwert von Bicalutamid 150mg in der Behandlung des Prostatakarzinoms“
Update, 26, 2005

Daha K., Riedl C., Lazar D., Hohlbrugger G., Pflueger H.:
“Einfluss von Ernährung auf den Symptomenkomplex der interstitiellen Cystitis“
Journal für Urologie und Urogynäkologie, Sonderheft 2, P22, 30-31, 2005

Untergasser G., Pernkopf D., Plas E., Pflueger H., Berger P.:
“In vitro-Wirkung von PDE-5-Inhibitoren auf Prostatazellkulturen“
Journal für Urologie und Urogynäkologie, Sonderheft 2, P40, 38, 2005
Ziele: PDE-5-Inhibitoren sind in der Therapieder erektilen Dysfunktion weit verbreitet.Neben dem Corpus cavernosum ist diePDE 5 auch stark in der Prostata exprimiert.Haben dann PDE-5-Hemmer einenEinfluß auf Wachstum oder Differenzierunggut- wie bösartiger Prostatazellen?
Material & Methode: Kulturen von Prostataepithelzellen(PrEC), Fibroblasten(PrSC), BPH-1-Zellen, LnCAP und PC3wurden 72 Stunden mit verschiedenenKonzentrationen der PDE-5-HemmerSildenafil, Tadalafil und Vardenafil inkubiert.Dann wurde mit WST-1 gefärbtund die Umwandlung in Formazanphotometrisch gemessen und so dieMitoserate bestimmt. Weiters wurdendie einzelnen Kulturen lichtmikroskopischauf morphologische Veränderungenuntersucht und wir versuchten,die PDE-5 mit Westernblot in den verschiedenenZellen nachzuweisen.
Ergebnisse: Keine untersuchte Substanzerhöhte in vitro die Mitoserate. Tadalafilhemmt das Wachstum von PrEC undzeigte bei diesen eine neuroendokrineDedifferenzierung. Sildenafil flockte inhohen Konzentrationen aus und hemmtePrSC, PrEC und LnCAP. Tadalafil hemmtePrFC. Im Westernblot war PDE-5 in PrECund PRFC, nicht aber in BPH 1, LnCAPund PC3 nachweisbar.
Schlußfolgerung: Sildenafil, Tadalafilund Vardenafil führen in vitro zu keinerWachstumsinduktion bei den untersuchtenZellinien. Da die PDE-5 in BPH-1,LnCAP und PC3 nicht nachweisbar war,ist eine Beeinflussung dieser Zellendurch PDE-5-Hemmer unwahrscheinlich.Diese Tests müssen noch mit denReinsubstanzen wiederholt werden,ebenso sollen noch frische Prostatakarzinomzellenuntersucht werden.

Pflueger H.:
“Sexualität und urologische Perspektiven“
Medical News, 1, 43, 2005
Das Recht auf Sexualität ist ein Grundrecht desMenschen und in der Menschenrechtskommissionaltersunabhängig festgelegt worden. Darausergibt sich eindeutig, dass man das Auslebensexueller Bedürfnisse nicht als das Grundrechtjüngerer Menschen alleine ansehen darf, sonderndass es ein lebenslanges Recht für Menschenbeiderlei Geschlechts ist. Wenngleich inden letzten Jahren durch die Möglichkeiten derErektionshilfe für den Mann die Diskussion überSexualität im fortschreitenden Alter sich auf denMann bezieht, so sollte man nicht vergessen,dass es auch für die Frau im Laufe ihres Lebenseinen Wandel der sexuellen Bedürfnisse, der sexuellenAktivität und vor allem auch eine Veränderungder weiblichen und männlichen Hormonfraktionengibt.
Der Ablauf der sexuellen Erregung durch Libido,sexuelle Reize, Orgasmus bzw. Ejakulation undBefriedigung sind grundsätzlich für beide Geschlechtergleich. Analysiert man nun die sexuellenFunktionsstörungen der Frau, so steht eindeutigfest, dass während des gesamten sexuellenLebens das mangelnde Interesse an Sexualität(Libidostörung) im Vordergrund steht, gefolgtvon Orgasmusstörungen. Libido- und Orgasmusstörungenfinden sich bei jeweils 25-30%aller Frauen. Versagensängste spielen bei derFrau eine untergeordnete Rolle, stehen jedochbeim Mann ebenfalls über eine weite Streckedes Sexuallebens im Vordergrund, gefolgt vonLibidomangel und Orgasmusstörungen. EineStudie des Female Sexual Function Forums 2001hält fest, dass auf Grund mangelnder ärztlicherAnsprechpartner die Dunkelziffer der sexuellenFunktionsstörungen bei der Frau sehr hoch ist.80% der Frauen würden gerne mit ihrem Arztsprechen, jedoch nur knapp zwei Drittel habenin ihrem Hausarzt auch einen adäquaten Ansprechpartner.35% der Frauen verspürten einmangelndes Interesse des Arztes, die Problematikmit ihnen zu diskutieren. Aufklärung undWissensvermittlung sollten daher nicht nur dieBetroffenen erhalten, sondern es müssen auchAusbildungsprogramme für Ärzte angebotenwerden. Durch die Einführung der PDE5-Inhibitoren zurVerbesserung der Erektion kann zwar die mangelndeoder insuffiziente Erektion behandeltwerden, schwieriger ist jedoch die Therapie desreduzierten Interesses (Libidoverlust) des Mannes.Bei etwa 10 % aller Männer über dem50. Lebensjahr ist ein Hormonmangel ursächlichmit dem Libidoverlust verbunden und kanndurch eine Substitutionstherapie (HormonalReplacement) behandelt werden. Bei der überwiegendenMehrzahl der Patienten ist jedoch derRegelkreis zwischen reduziertem Interesse,Versagensangst und Vertrauensverlust in sichselbst so verfestigt, dass eine medikamentöseTherapie schwierig und eine psychotherapeutischeUnterstützung notwendig wäre. SexuelleStörungen sind partnerschaftliche Probleme undsollten als diese analysiert und behandelt werden.

Plas E.:
“Männlicher Kinderwunsch und Genetik – Was soll der Urologe wissen?“
Journal für Urologie und Urogynäkologie, Sonderheft 5, 9-10, 200
Quelle: http://www.kup.at/kup/pdf/5408.pdf