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- Editorial -
Men's health is evolving
The Asian Journal of Andrology (AJA) is growing at a fast pace and becoming one of the leading journals in the
field of andrology thanks to the leadership of Prof. Yi-Fei Wang, Editor-in-Chief of AJA, and the hard work of the AJA
editorial staff. It was the spring of 2006 in Chicago when Ms. Dan-Qing Ren, Scientific Editor of the AJA, first
approached us at the 31st American Society of Andrology (ASA) Annual Meeting regarding publishing a special issue
on men's health. We were honored by the invitation to be guest editors for this special issue. We discussed potential
topics with many of the contributors while Ms. Qin-Zhu Zheng, Editorial Director of the AJA worked out the details
and met with us at the 32nd ASA Annual Meeting in Tampa, Florida. We are very pleased to present this issue of
superior articles with contributions by internationally recognized authorities.
Andrology is an exciting and vibrant field involving multidisciplinary specialties. Men's health is a relatively new
area of interest under the scope of andrology that deals with male reproductive health including male sexual
function/dysfunction, fertility/infertility, male reproductive endocrinology and general well being. In the past two decades our
understanding of the physiology of sex has experienced exponential growth. Our knowledge of the pathophysiology
of erectile dysfunction (ED) is greater now than at any time before. Each discovery provides new targets for potential
therapies and raises new questions. For example, in this issue, researchers from Johns Hopkins describe a novel
pathway involving reactive oxygen species (ROS) causing ED through activation of
nicotinamide adenine dinucleotide phosphate (NADPH)
oxidase . Gene and stem cell-based therapies targeted at the penile endothelium have gained
momentum in preclinical studies. Researchers from Johns Hopkins and Duke University highlight our current
understanding of endothelial-specific gene and stem cell-based therapies performed in a number of experimental animal
models, including changes of growth factors in hypercholesterolemic ED and the employment of various growth
factors for ED therapy in animal studies [2, 3].
It is estimated that 322 million men worldwide will suffer from ED by 2025 . Accumulated data from basic
science and clinical studies have determined a link between the occurrence of ED and a number of lifestyle factors,
such as smoking, obesity, alcohol consumption, and lack of physical activity. Hypogonadism is a common entity in
aging males and presents with decreased sexual interest, diminished erectile capacity, delayed or absent orgasms and
reduced sexual pleasure. Clinicians from Turkey review the potential benefits of modifying these factors to improve
ED with respect to evidence-based medicine [5, 6]. In the aging male, the associations between lower urinary tract
symptoms (LUTS) and ED have recently been elucidated. There is emerging interest in identifying the common
approaches to managing these two conditions simultaneously and many remain to be investigated .
Prostate cancer is the leading solid-organ cancer among adult men in the U.S. and radical prostatectomy (RP) is
the most common treatment option for clinically localized prostate cancers with excellent long term results. Despite
being a first-rate therapy for prostate cancer, RP is associated with several quality of life issues; mainly urinary
incontinence (UI) and ED . ED following RP is hypothesized to be secondary to the cavernous nerve injury which
is termed as neuropraxia. Researchers from the University of Ottawa and the University of California review the
recent advances in the neurobiology of growth factors, neural development, and prevention of cell death that have
resulted in a heightened clinical interest in the development of protective and regenerative neuromodulatory strategies
for the cavernous nerves . Recent advances in the understanding of post-prostatectomy ED have also led to
promising, yet controversial new strategies, namely penile rehabilitation in the management of this serious issue. The
article from New York University reviews in detail the epidemiology, experimental pathophysiological models,
rationale for penile rehabilitation, and currently published rehabilitation strategies . For patients suffering from both
ED and UI after RP that require surgical treatment, they can be best served with combination therapy of penile
prosthesis implantation and male sling or artificial urinary sphincter as reviewed by physicians from the University of
Texas Medical School at Houston . One of the concerns regarding penile implantation is the loss of penile length.
A simple technique of ventral phalloplasty reported in this issue may help with patient satisfaction, cosmetic results
and improve perception of penile length .
Urethral injury is a very common condition seen in general urologic practice. Surgical reconstruction for urethral
stricture disease has now become a mainstay for treatment in refractory cases and the success rate is now well
documented throughout the urological community. Surprisingly, despite the magnitude of genital dissection required
for many complex urethroplasty procedures, little has been reported regarding the effect of urethral reconstruction
surgery on erectile function. Authorities from the University of Texas Southwestern Medical Center discuss the
effects of various urethral reconstructive techniques, broadly categorized into two categories_anterior and
posterior_on erectile function .
Peyronie's disease (PD) is the formation of a plaque of fibrous tissue within the tunica albuginea of the penis that
causes penile deformity and disability. Men with PD can be both physically and psychologically devastated. Yet,
treating this condition has been a challenge and a frustration for many urologists and andrologists due to the lack of
effective medical or minimally invasive surgical treatment. In this issue of the AJA, experts from the U. S. and Brazil
report on the currently available non-surgical therapies and the optimal surgical approaches to improve patients'
satisfaction [14, 15].
Male erectile function is a precisely controlled event at the molecular level. Erection beyond or unrelated to sexual
desire manifests as priapism. Management of priapism is another challenge since little is known regarding the signal
transduction process and the molecules causing and maintaining priapic events. A review from the University of
Texas Medical School at Houston enthusiastically reviews the recently published research in this area and claims that
the advances in understanding the pathophysiology of priapism will lead to new management strategies .
The most common male sexual dysfunction is premature ejaculation (PE). Unfortunately, there is not a
universally accepted definition of PE. Physicians are also facing tremendous difficulties in the management of PE because
no medication has been approved by the Food and Drug Administration (FDA) to treat PE. However, recent advances
in the study of PE have taken us one step closer to the effective treatment of this disorder. The review from Tulane
University discusses the current and emerging treatment options and medications for PE and provides the advantages
and limitations of each treatment option in the light of current published peer-reviewed literature .
When we discuss sexual function and sexual disorders, one should never forget sexually transmitted diseases
(STDs). STDs are within the first ten most bothersome of diseases in young adult males and females in developing
countries. The review from Brazil discusses the global epidemiology of STDs, emphasizing that prevention is the key
to control STDs .
Soon after phosphodiesterase-5 (PDE-5) inhibitors became popular as effective oral medications in the
management of ED, concerns regarding the effects of PDE-5 inhibitors on sperm function were raised.
In vivo and in vitro studies have been carried out to examine whether PDE-5 inhibitors positively or negatively affect sperm parameters
and sperm fertilizing capacity. Unfortunately, the results of these studies are still controversial. The existing
hypothesis is that some PDE-5 inhibitors may enhance the secretory function of the prostate and subsequently increase the
qualitative and quantitative motility of spermatozoa. Researchers from Ioannina University in Greece and Tottori
University in Japan predict that the effects of PDE-5 inhibitors on sperm parameters may lead to improvement of the
outcome of assisted reproductive technology programs and PDE-5 inhibitors might serve as adjunctive agents for the
alleviation of male infertility .
Human fertility and sexual behaviors can be associated with the environment. There are many agents, called
endocrine disruptors, that have estrogen-like and/or anti-androgenic actions. Endocrine disruptors can exert
potentially hazardous effects on the male reproductive axis resulting in infertility. They may also disrupt other hormonal
dependent reproductive functions causing ED. In addition to reducing fertility, causing ED, and abnormal sexual
development, an authoritative review from Tulane University in this issue warns us that these endocrine disruptors
may contribute to testicular and prostate cancers, alter pituitary and thyroid gland functions, damage immune systems,
and cause unpredictable neurobehavioral effects .
Andrology, like other medical specialties, has progressed quickly by keeping pace with the evolution of modern
technology. One of the examples is seen in this AJA special issue in the report from the physicians of Vanguard
Urological Institute and the University of Texas Medical School at Houston regarding the use of robot-assisted
varicocelectomy . One anticipates further news and developments in the field of andrology and men's health in the
coming years. It is hoped that this special issue of the AJA will stimulate a whole generation of researchers in this
rapidly progressing area of medicine.
Run Wang, MD, FACS, Departments of Urology, University of Texas Medical School at Houston and
University of Texas MD Anderson Cancer Center, Houston, USA
Wayne J. G. Hellstrom, MD, FACS, Section of Andrology, Department of Urology, Tulane University
Health Sciences Center, New Orleans, USA (E-mail:
We would like to thank Annie Bleecker, Joanna Federico and Dorothy Stradinger for their diligent editorial
assistance with this special issue of AJA.
1 Jin L, Burnett AL. NADPH oxidase: recent evidence for its role in erectile dysfunction. Asian J Androl 2008; 10: 6_13.
2 Strong TD, Gebska MA, Burnett AL, Champion HC, Bivalacqua TJ. Endothelium-specific gene and stem cell-based therapy for
erectile dysfunction. Asian J Androl 2008; 10: 14_22.
3 Xie D, Annex BH, Donatucci CF. Growth factors for therapeutic angiogenesis in hypercholesterolemic erectile dysfunction. Asian J Androl 2008; 10: 23_7.
4 Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999; 84: 50_6.
5 Horasanli K, Boylu U, Kendirci M, Miroglu C. Do lifestyle changes work for improving erectile dysfunction? Asian J Androl 2008; 10: 28_35.
6 Gurbuz N, Mammadov E, Usta MF. Hypogonadism and erectile dysfunction: an overview. Asian J Androl 2008; 10: 36_43.
7 Taylor JM, DeSouza R, Wang R. Common approach to managing lower urinary tract symptoms and erectile dysfunction. Asian J
Androl 2008; 10: 45_53.
8 Wang R. Penile rehabilitation after radical prostatectomy: where do we stand and where are we going? J Sex Med 2007; 4: 1085_97.
9 Bella AJ, Lin G, Cagiannos I, Lue TF. Emerging neuromodulatory molecules for the treatment of neurogenic erectile dysfunction
caused by cavernous nerve injury. Asian J Androl 2008; 10: 54_9.
10 McCullough AR. Rehabilitation of erectile function following radical prostatectomy. Asian J Androl 2008; 10: 61_74.
11 Zafirakis H, Wang R, Westney OL. Combination therapy for male erectile dysfunction and urinary incontinence. Asian J Androl 2008;
12 Caso J, Keating M, Miranda-Sousa A, Carrion R. Ventral phalloplasty. Asian J Androl 2008; 10: 155_7.
13 Carlton J, Patel M, Morey AF. Erectile function after urethral reconstruction. Asian J Androl 2008; 10: 75_8.
14 Taylor FL, Levine LA. Non-surgical therapy of Peyronie's disease. Asian J Androl 2008; 10: 79_87.
15 Egydio PH. Surgical treatment of Peyronie's disease: choosing the best approach to improve patient satisfaction. Asian J Androl 2008;
16 Yuan J, DeSouza R, Westney OL, Wang R. Insights of priapism mechanism and rationale treatment for recurrent priapism. Asian J
Androl 2008; 10: 88_101.
17 Gurkan L, Oommen M, Hellstrom WJ. Premature ejaculation: current and future treatments. Asian J Androl 2008; 10: 102_9.
18 Da Ros CT, Schmitt CD. Global epidemiology of sexually transmitted diseases. Asian J Androl 2008; 10: 110_4.
19 Dimitriadis F, Giannakis D, Pardalidis N, Zikopoulos K, Paraskevaidis E, Giotitsas N,
et al. Effects of phosphodiesterase-5 inhibitors
on sperm parameters and fertilizing capacity. Asian J Androl 2008; 10: 115_33.
20 Sikka SC, Wang R. Endocrine disruptors and estrogenic effects on male reproductive axis. Asian J Androl 2008; 10: 134_45.
21 Shu T, Taghechian S, Wang R. Initial experience with robot-assisted varicocelectomy. Asian J Androl 2008; 10: 146_8.