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AED, antiepileptic drug; CON, control; E2, estradiol; FSH, follicle?stimulating hormone; LEV, levetiracetam; LH, luteinizing hormone; LTG, lamotrigine; OXC, oxcarbazepine; PRL, prolactin; T, testosterone.

It has been reported that the incidence of sexual dysfunction in male patients with epilepsy is 5 times higher than that in healthy people, and the incidence of sexual hyperactivity is about 2.9%.

10 A number of studies have shown that epilepsy and AEDs (especially older AEDs)

have

4, 5 In this study, the marriage rate and birth rate of the male adult patients with epilepsy were significantly lower than those of the healthy group, which may be related to the patients’ anxiety caused by seizures and different degrees of social discrimination. That the fertility rate of the adult male epilepsy patients was lower than that of the healthy controls may be related to the low occurrence of marriage and the impact of seizures on reproductive function.

In this study, we only recruited those patients with generalized and secondary generalized tonic–clonic seizures; patients with focal seizures (except for secondary generalized tonic–clonic seizures) were excluded, because they rarely seek medical care and show poor medical compliance. It has been reported in both animal and clinical studies that an epileptic seizure itself can affect the secretion of sex hormones.

In animal experiments, a partial or generalized seizure can lead to abnormal sex hormone levels; repeated seizure attacks can cause gonadal size changes and decreased sexual function.

10 Clinical studies have

also

10 It is known that AEDs can cause endocrine disorders in male patients with epilepsy, which is particularly common in older AEDs such as the enzyme inducer classes (CBZ, PHT, PB,

etc

This class of drugs induces hepatic cytochrome P450 to increase the synthesis of sex hormone–binding globulin, decreases the level of free androgens, or promotes the conversion of testosterone to estradiol by aromatase.

This affects the function of the hypothalamic?pituitary?gonadal axis and causes sex hormone disorders. 11 Enzyme inhibitory AEDs can affect the output of cheap viagra pills gonadotrophin?releasing hormone neurons by affecting serotonin and ??aminobutyric acid (GABA) neurons, thereby increasing the concentration of dehydroepiandrosterone sulfate, causing negative feedback regulation and a reduction of LH and FSH. The study on the impact of AEDs on the level of sex hormones in male patients with epilepsy has yielded differing results. Malatkova et al 13 reported that sex hormone disorders in 12 patients returned to normal after CBZ was replaced by OXC.

Verrotti et al 14 showed that OXC can have a dose?dependent effect on reproductive endocrine function, and serum testosterone, sex hormone–binding protein, and gonadotropin levels all increased when OXC doses were >900 mg/d. Harden et al 15 reported that a marked increase in testosterone levels was observed after 1 month of LEV treatment in 8 male adult patients with epilepsy. However, Spencer showed that in 26 adult male patients with epilepsy, no statistically significant changes were found in sex hormone levels measured before taking LEV and after taking it for 13.7 weeks. 16 Herzog et al 17, 18 and Gil?Nagel et al 18 observed no change in sex hormone levels in men with epilepsy after LTG administration. In our study, monotherapy of OXC, LEV, or LTG alone did not cause obvious changes of sex hormones in male adult patients

with

Semen quality decline is also one of the important factors that causes impaired fertility disorders of male patients with epilepsy. In the maturation of sperm, sex hormone regulation plays a very important role; LH stimulates testicular stromal cells to synthesize testosterone, and FSH acts on supporting cells in the seminiferous tubules, leading to synthesis of androgen?binding globulin (ABP). Then, ABP and testosterone are combined and carried in spermatogonia and spermatocytes, so that germ cells obtain stable, high concentrations of androgen, and effectively differentiate into mature sperm.

Many studies have shown that epilepsy and a variety of AEDs can adversely affect the quality of semen, particularly older AEDs, most of which can affect the sex hormones and in turn have an impact on the

occurrence

19, 20 The epileptic abnormal discharge of brain neurons can also affect the function of the hypothalamic?pituitary?gonadal axis, indirectly affecting the quality of sperm. The effect of the AEDs on cheap viagra pills semen quality has only been reported by a few authors. Calabro et al 21 reported the case of a male patient with epilepsy who was diagnosed as infertile and had a marked reduction in semen quality. After 3 months of LTG treatment, the sperm count increased 2.7?fold and sperm motility increased 68%, and a pregnancy resulted after 5 months. Cansu et al 22 found in an animal study that OXC can reduce the number of spermatocytes at all developmental stages, although the difference was not statistically significant. Kose?Ozlece et al 23 observed a significant decrease in sperm count and viability as the dose of VPA was increased, cheap viagra pills but the semen quality was restored after the VPA dose was tempered by combination with LTG.

Baysal et al 24 found that when male rats received oral LEV for 70 days, histological examination of the

rat

In our study, the semen quality of the patients with epilepsy was significantly decreased compared with the healthy control group, suggesting that the reduction of semen quality may be mainly because of the seizures themselves. There was a trend toward improvement in all sperm parameters before and after treatment with the 3 different novel AEDs compared with those before treatment, but there was only a statistically significant difference in the OXC treatment group. In the LEV and LTG treatment groups, although comparison between before and after treatment showed a substantial improvement, no significant difference was observed.

We believe that these 3 AEDs

have

have

correlated

especially

sexual

27 Newer AEDs (OXC, LEV, or LTG) might affect sexual function less than older AEDs.

4, 5, 28 They can cause sexual dysfunction by affecting the secretion of sex hormones 11 or by increasing the inhibition of GABA, inhibiting nerve conduction and reducing the transmission of sexual stimuli.

29 The effect of these AEDs on sexual function has been less reported, with contrasting results. Different studies have pointed out that OXC can both improve sexual function in patients with epilepsy and can also cause sexual dysfunction. Luef et al 6 reported that among 228 adult male epilepsy patients with partial seizures and sexual dysfunction, 181 (79.4%) of them improved their sexual function after being treated with OXC monotherapy or by replacing other AEDs with OXC monotherapy for 12 weeks of treatment; moreover, 23 (10.1%) patients did not get worse, and the improvement in sexual function was more obvious in patients who had previously used enzyme?inducing AEDs. Calabro et al 7 reported that treatment with OXC at 1800 mg/d caused retrograde ejaculation in a 35?year?old man with traumatic epilepsy, and the retrograde ejaculation disappeared after switching to other AEDs.

However, Calabro et al 30 also reported that 2 young men with epilepsy had loss of libido and a lack of sex appeal after taking LEV, and recovered sexual function after switching to other AEDs.

In case studies or sample studies, LTG has not been found to have any adverse effects on sexual function, and it has been shown to have a positive effect on sexual function.

18, 31 A clinical study by Gil?Nagel et al 18 followed 141 patients with

epilepsy

The authors thought that this was probably a multivariate result of an improvement in seizures, the elimination of adverse effects of other AEDs, and the stabilizing effect of LTG.

In this study, the patients with epilepsy had a lower erectile function score than the healthy control group.

In patients with epilepsy, premature ejaculation levels have a lower trend, but it was not statistically significant.

These results, to some extent, suggest that epilepsy itself can adversely affect the erectile function score.

The scores of erectile function and premature ejaculation were increased in the

OXC

In

conclusion

He is one of a handful of surgeons in the United States who is fellowship trained in both sexual medicine and penile prosthetic surgery (at Memorial Sloan-Kettering Cancer Center) and male infertility and microsurgery (at Weill-Cornell Medical College).

Stember has developed several novel medical products and holds a patent for the design of a device to assist with improved outcomes for penile prosthesis surgery. He is Chair of the Membership Committee of the Sexual Medicine Society of North America.

Stember reviews and selects articles for publication in medical journals including the Journal of Sexual Medicine, European Urology, The Journal of Urology, Andrology, Sexual Medicine, and the Asian Journal of Andrology.

He is a member of multiple organizations including the Sexual Medicine Society of North America (SMSNA), the International Society for Sexual Medicine (ISSM), the American Urological Association (AUA), and the New York Section of the American Urological Association (NYAUA). Stember is the recipient of the prestigious Scholars in Sexuality Research Grant Award from the Society for Sexual Medicine in 2010.

He has authored more than 100 articles, book chapters, and cheap viagra pills abstracts in the field of reproductive and sexual medicine.

His research and discoveries have been presented at national and international conferences and published in leading journals including The Journal of Urology, Annual Review in

Medicine

Stember frequently lectures and presents his clinical research at national and international medical conferences. He has given clinical talks throughout the United States, as well as Canada and South Korea.

He teaches and mentors medical students, residents, and fellows, and received the Beth Israel Urology Faculty Teaching Award in 2013.

He has also been a faculty member for surgical skills workshops where he has taught other practicing urologists his technique of penile prosthesis surgery. Bladder Cancer Congenital Kidney Disease Cystoscopy Frequent Urination Hypogonadism Impotence Infertility Neurogenic Bladder Penile Prosthesis Insertion Peyronie's Disease Prostate Cancer Prostate Cancer Screening Vasectomy.

Internship, General Surgery Mount Sinai School of Medicine. Fellowship, Microsurgery and Male Fertility Weill Cornell Medical College. Fellowship, Sexual Medicine Memorial Sloan-Kettering Cancer Center.

2014 Super Doctors - NY Rising

Star

2014 Center of Excellence - Penile Prosthesis Surgery Coloplast.

2010 Scholars in Sexuality Research Grant Award Sexual Medicine Society of North America. Pseudo-malfunction of the Coloplast Titan Inflatable Penile Prosthesis One-Touch Release Pump. Is there a rationale for penile rehabilitation following radical prostatectomy?. Katz BF, Gaunay GS, Barazani Y, Nelson CJ, Moreira DM, Dinlenc CZ, Nagler HM, Stember DS. Use of a preoperative checklist reduces risk of penile prosthesis infection. Reproductive sequelae of diabetes in male patients. Endocrinology and metabolism clinics of North America 2013 Dec; 42(4). Lifestyle, environment, and male reproductive health. The Urologic clinics of North America 2014 Feb; 41(1).

Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius.

Concordance between patient and physician assessment of the magnitude of Peyronie's disease curvature.

Tal R, Stember DS, Logmanieh N, Narus J, Mulhall JP. Erectile dysfunction in men treated for testicular cancer.

Preoperative erectile function is an independent predictor for decision to spare cavernous nerves during radical prostatectomy.

Sullivan JF, Stember DS,

Deveci

Ejaculation profiles of men following radiation therapy for prostate cancer.

Defining the aetiology of erectile dysfunction in men with chronic pelvic pain syndrome.

Microsurgical epididymal sperm aspiration: indications, techniques and outcomes.

Management of ejaculatory disorders in infertile men. Perioperative prevention of penile prosthesis infection: practice patterns among surgeons of SMSNA and ISSM. The concept of erectile function preservation (penile rehabilitation) in the patient after brachytherapy for prostate cancer. Options for fertility preservation in men and boys with cancer.

Advances in experimental medicine and biology 2012; 732. A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement.

International journal of impotence research 2017 Sep; 29(5). Margolin EJ, Mlynarczyk CM, Mulhall JP, Stember DS, Stahl PJ. Three-Dimensional Photography for Quantitative Assessment of Penile Volume-Loss Deformities in Peyronie's Disease. Gross MS, Phillips EA, Carrasquillo RJ, Thornton A, Greenfield JM, cheap viagra pills Levine LA, Alukal JP, Conners WP, Glina S, Tanrikut C, Honig SC, Becher EF, Bennett NE, Wang R, Perito PE, Stahl PJ, Rossello Gaya M, Rossello Barbara M, Cedeno JD, Gheiler EL, Kalejaiye O, Ralph DJ, Kohler TS, Stember DS, Carrion RE, Maria PP, Brant WO, Bickell MW, Garber BB, Pineda M, Burnett AL, Eid JF, Henry GD, Munarriz RM.

Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. Gaffney CD, Pagano MJ, Kuker AP, Stember DS, Stahl PJ. Osteoporosis and Low Bone Mineral Density in Men with Testosterone Deficiency Syndrome. Onyeji IC, Sui W, Pagano MJ, Weinberg AC, James MB, Theofanides MC, Stember DS, Anderson CB, Stahl PJ. Impact of Surgeon Case Volume on Reoperation Rates after Inflatable Penile Prosthesis Surgery.

The Patient Experience Star Rating reflects our patients’ perception of how well their Mount Sinai physician communicated with them during an office visit. The Star Rating is based on patient responses to three questions on the Clinician & Group CAHPS (CG-CAHPS) Survey, a standardized questionnaire developed by Medicare. Responses are measured on a scale of 1 to 5, with 5 being the best score. Don’t want a penile implant or lifetime of dependence upon PGE penile injections? Morganstern’s ExoSurge® Technology utilizes a patented tandem of mostly FDA-approved devices that represent the first

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We’re now able to completely heal men in our Atlanta erectile dysfunction clinic who suffer from chronic and severe ED issues – supplanting the need for penile prosthetic surgery or penile injections – in almost 90% of cases. Morganstern, a board-certified urologist was recognized as one of the Best Urologists in Georgia by 3-Best Rated. Chronic erectile dysfunction is best defined as a condition in which the patient isn’t improving from traditional urologic treatment ED paradigms including Phosphodiesterase-type 5 inhibitors (Viagra, Cialis, Levitra, etc.), shockwave therapy, hormone therapy, penile injections or vacuum pumps.

Until now, a penile prosthetic was the only other option for such patients.

Erectile Dysfunction Solutions

Born

The underlying causes of male erection issues vary; sometimes it’s hormonal, other times its blood flow related or due to ineffective function with inner tissue.

It’s a combination of more than one of these typical root causes.

A key component of our success is rooted in the fact “we don’t guess” when it comes to what’s wrong or attempt to stamp a “one size fits all” solution upon your case.

A big part of why we excel is the degree of testing and evaluation we perform during your

initial

the

We examine every detail and come up with a pathway that will enhance your life. During your firs t visit we’ll gather and review all your health history indicators, collect information on any prior treatments you might have explored, perform a physical exam related to your complaints and order tests that will help us narrow in on exactly why things aren’t operating up to par. Your next visit usually involves detailed testing that will help us discover the root

cause

At your third visit we are able to provide a complete diagnosis regarding the origins of your troubles: what’s not working and why – along with treatment options to repair the problems. We look forward to serving you and getting you performing at levels you need and deserve.

Blood Work Analyzes blood components looking at the presence of various Macronutrients and in what quantity they present themselves in your body. Sometimes our bodies have the bare minimum macronutrients to function from.

This test allows us to check these numbers and supplement what is needed to get the body into optimal operational and healing range prior to treatment.

Vascular Study Looks at the blood

flow

Checks for any plaque or calcification build up in the penis.

*This may

reveal

blood

(RejuvaHeart™) If flow is not retained in the penis then a treatment pertaining to increasing blood retention will be required.

(Neosonic™) If there is plaque of calcification in the penis then the treatment for breaking down this plaque and calcification is required.

(EndoStim™) Endograph *if blood flow from

the

This gives a better indication of whether the low/sporadic blood flow in the penis is an isolated situation or across the entire body.

If it is not isolated then a treatment pertaining to increasing blood flow is required.

(RejuvaHeart™) Most Comprehensive Blood Testing for ED. Every doctor takes blood; it provides the clearest immediate roadmap about what ails you beyond what you can verbalize.

Our blood draws are twice as intensive as seen at typical urology practices and five-times more detailed than at a family physician or men’s health center.

Simple: Remember this is not an “ending” diagnosis – but a symptom of another problem. Tracking down that underlying cause starts with blood work. Our urologists provide a unique and detailed Doppler ultrasound of the penis to unlock the keys to healing plus we perform an endothelial test to evaluate healthy blood flow throughout the rest of your body. Most issues are sourced from problems within the penis.

However, 40% are rooted from challenges outside the groin area.

What happens without this tandem of detailed analysis? Doctors are just guessing – throwing out treatment ideas on what might be wrong. This uncertainty leaves the patient facing less than ideal treatment paths, a lifetime of dependency on treatments like injections or pills – or even worse: overlooking a life-threatening health issue.