Andrea Salonia1, Carlo Bettocchi2, Luca Boeri3, Paolo Capogrosso4, Joana Carvalho5, Nusret Can Cilesiz6, Andrea Cocci7, Giovanni Corona8, Kostantinos Dimitropoulos9, Murat Gül10, Georgios Hatzichristodoulou11, T Hugh Jones12, Ates Kadioglu13, Juan Ignatio Martínez Salamanca14, Uros Milenkovic15, Vaibhav Modgil16, Giorgio Ivan Russo17, Ege Can Serefoglu18, Tharu Tharakan19, Paolo Verze20, Suks Minhas21. 1. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy. Electronic address: salonia.andrea@hsr.it. 2. Department of Urology, University of Foggia, Foggia, Italy. 3. Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 4. Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy. 5. CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal. 6. Department of Urology, Taksim Training & Research Hospital, Istanbul, Turkey. 7. Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy. 8. Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy. 9. Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK. 10. School of Medicine, Department of Urology, Selcuk University, Konya, Turkey. 11. Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany. 12. Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK. 13. Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey. 14. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain. 15. Department of Urology, University Hospitals Leuven, Leuven, Belgium. 16. Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK. 17. Urology Section, Department of Surgery, University of Catania, Catania, Italy. 18. Department of Urology, Biruni University School of Medicine, Istanbul, Turkey. 19. Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK; Section of Investigative Medicine, Department of Medicine, Imperial College London, London, UK. 20. Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, Fisciano, Campania, Italy. 21. Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK.
Abstract
CONTEXT: The present summary of the European Association of Urology (EAU) guidelines is based on the latest guidelines on male sexual health published in March 2021, with a last comprehensive update in January 2021. OBJECTIVE: To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health. EVIDENCE ACQUISITION: A literature review was performed up to January 2021. The guidelines were updated, and a strength rating for each recommendation was included based on either a systematic review of the evidence or a consensus opinion from the expert panel. EVIDENCE SYNTHESIS: Late-onset hypogonadism is a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. A comprehensive diagnostic and therapeutic work-up, along with screening recommendations and contraindications, is provided. Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Along with a detailed basic and advanced diagnostic approach, a novel decision-making algorithm for treating ED in order to better tailor therapy to individual patients is provided. The EAU guidelines have adopted the definition of premature ejaculation (PE), which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, patient's expectations should be discussed thoroughly and pharmacotherapy must be considered as the first-line treatment for patients with lifelong PE, whereas treating the underlying cause must be the initial goal for patients with acquired PE. Haemospermia is defined as the appearance of blood in the ejaculate. Several reasons of haemospermia have been acknowledged; the primary goal over the management work-up is to exclude malignant conditions and treat any other underlying cause. CONCLUSIONS: The 2021 guidelines on sexual and reproductive health summarise the most recent findings, and advise in terms of diagnosis and treatment of male hypogonadism and sexual dysfunction for their use in clinical practice. These guidelines reflect the multidisciplinary nature of their management. PATIENT SUMMARY: Updated European Association of Urology guidelines on sexual and reproductive health are presented, addressing the diagnosis and treatment of the most prevalent conditions in men. Patients must be fully informed of all relevant diagnostic and therapeutic options and, together with their treating physicians, decide on optimal personalised management strategies.
CONTEXT: The present summary of the European Association of Urology (EAU) guidelines is based on the latest guidelines on male sexual health published in March 2021, with a last comprehensive update in January 2021. OBJECTIVE: To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health. EVIDENCE ACQUISITION: A literature review was performed up to January 2021. The guidelines were updated, and a strength rating for each recommendation was included based on either a systematic review of the evidence or a consensus opinion from the expert panel. EVIDENCE SYNTHESIS: Late-onset hypogonadism is a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. A comprehensive diagnostic and therapeutic work-up, along with screening recommendations and contraindications, is provided. Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Along with a detailed basic and advanced diagnostic approach, a novel decision-making algorithm for treating ED in order to better tailor therapy to individual patients is provided. The EAU guidelines have adopted the definition of premature ejaculation (PE), which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, patient's expectations should be discussed thoroughly and pharmacotherapy must be considered as the first-line treatment for patients with lifelong PE, whereas treating the underlying cause must be the initial goal for patients with acquired PE. Haemospermia is defined as the appearance of blood in the ejaculate. Several reasons of haemospermia have been acknowledged; the primary goal over the management work-up is to exclude malignant conditions and treat any other underlying cause. CONCLUSIONS: The 2021 guidelines on sexual and reproductive health summarise the most recent findings, and advise in terms of diagnosis and treatment of male hypogonadism and sexual dysfunction for their use in clinical practice. These guidelines reflect the multidisciplinary nature of their management. PATIENT SUMMARY: Updated European Association of Urology guidelines on sexual and reproductive health are presented, addressing the diagnosis and treatment of the most prevalent conditions in men. Patients must be fully informed of all relevant diagnostic and therapeutic options and, together with their treating physicians, decide on optimal personalised management strategies.
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