PubMed · 16528083
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Jonathan Rees, Biral Patel. 2006-03-11. Erectile dysfunction.. https://doi.org/10.1136/bmj.332.7541.593
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Since the origin, the man tried by all possible means to restor his erectile capacity. The obscurantism prevailed for a long time. We had to wait up to the turn of the 19th Century with Freud to get that things evolve a little bit. In the Fifties, the first penile prostheses were developed by Goodwin and Scott. In the Sixties, the behavioral therapies by Masters and Johnson. The Eighties represent the pharmacological revolution with the discovery of the effects of papaverin by Virag, then the E1 prostaglandin by Ishii, as well as the inhibitors of the 5 phospho di esterase (sildenafil, vardenafil, tadalafil) following studies on nitric oxide by Ignarro, Nobel Prize of medicine in 1998.
OBJECTIVE: To evaluate the variability in the volume of radical retropubic prostatectomy (RP) performed by urologists in the USA, and the physician characteristics that predict RP volume, as previous studies showed that individual surgeon volume for RP is associated with clinical outcomes. METHODS: In a nationwide, representative survey of 2000 urologists who treat prostate carcinoma in the USA, we asked respondents to indicate a numerical range of RPs they perform each year (none, 1-10, 11-30, and >30, the last which we defined as 'high volume'). We then identified characteristics of the provider and practice associated with a high volume of RPs. Supplementing survey results with other national data, we estimated the proportion of all RPs in the USA performed by 'high-volume' urologists. RESULTS: The survey response rate was 66.1% (1313 urologists) with no differences between the respondents and non-respondents for the measured demographic variables. Among urologists who performed RPs (89.1% of the sample), 37.3% did < or = 10, 46.9% 11-30 and 15.8% >30 RPs/year. Academic and urological oncology fellowship-trained urologists were, respectively, 41% and 27% more likely than private-practice and non-fellowship-trained urologists to have a high volume of RPs. Of all RPs performed yearly in the USA, only an estimated 46.1% were by high-volume urologists. CONCLUSION: A significant proportion of urologists report a RP volume that might be associated with higher rates of cardiac, respiratory, vascular, wound-healing, and genitourinary complications. Further study is needed to characterize the possible relationships between RP volume and tumour recurrence, survival, and long-term erectile dysfunction and incontinence.