Report from the 7th ESSM Congress
Mr Duncan J Summerton, Consultant Urologist, Leicester, UK
Mr David Ralph, Consultant Urologist, London, UK
The 7th Congress of the European Society for Sexual Medicine (ESSM) was held in London just before Christmas. From December 5-8, over 1700 delegates gathered from Europe and from further afield to present and discuss a variety of subjects relevant to the modern practice of sexual medicine and surgery.
The topics covered an eclectic and enjoyable mix - from the basic science of erectile function in laboratory animals, through new insights in pharmacotherapy for erectile dysfunction, new techniques and surgical reports in genitoreconstructive surgery, to psychological, cultural and counselling issues in male and female sexual function and dysfunction.
A variety of formats disseminated this information. In addition to the podium sessions, three master lectures were given - a superb and clear discourse on neurological disease and sexual function by Clare Fowler, an enthusiastic and thought-provoking presentation by the outgoing President of the ESSM, Dimitrious Hatzchristou, and a very eloquent and thorough overview of PDE Isoenzymes in human male and female urogenital tissue given by Stefan Uckert as the ESSM award of excellence lecture.
The point-counterpoint sessions were well-attended , and a popular way to air both sides of a particular, usually contentious, subject. The session which sought to answer whether penile augmentation was appropriate in men with a normal penis stimulated heated debate between the panel and a particular member of the audience. When put to the vote - by a show of hands - 30% agreed with Aivar Bracka's view 'for', with only slightly more 'against' as outlined by Yoram Vardi.
In a round table discussion we learnt from Karl Andersson that when men with both BPH and ED are treated with sildenfil alone, a 20% reduction in the IPSS score is seen.
Interactive sessions, with electronic keypads for audience participation and instant feedback were also popular. John Pryor steered a panel of experts, and the large audience, through a number of difficult andrological cases. There were evident differences in opinion, highlighting the fact that medicine is not always an exact science, with room for different approaches to the same problem. However, a majority concensus was usually reached, after education and re-voting!
Several instructional courses were held, mainly in the treatment, management and role of nurses in aspects of both male and female sexual dysfunction.
24 posters were given in moderated sessions, and included excellent, concise presentations on surgery for penile dysmorphophobia, conservative surgery in penile cancer, a large series of feminising genitoplasties, and numerous refinements of penile implant surgery.
Several videos were presented formally in the first session on the Sunday afternoon, as a video surgery course - all were well produced and informative. Amongst them, Antonio Casarico showed how an autologous tunica albuginea graft was successfully excised from the greater curve and placed on the opposite 'inside' area in a case of marked Peyronie's curvature. Francesco Montorsi's eloquently presented the peno-scrotal approach to placement of the three-piece inflatable penile implant, as popularised by Wilson in the USA. Ignacio Moncada introduced a very attractive technique in laparoscopic harvesting of the epigastric artery for microsurgical penile revascularisation. Other videos were constantly available to be viewed throughout the meeting, in a section next to the trade fair. The trade fair was provided by over 15 companies, and some of the larger organisations provided sponsorship of the 5 satellite symposia - all of which were reported to be informative and a useful adjunct to the educational aims of the meeting.
169 posters were also displayed in a single large hall. These were posted for the majority of the meeting and provided a chance of some education whilst standing!
The standard was uniformly high, and a lot of new and interesting work was outlined.
Paradiso et. al. showed that latent thyroid dysfunction is seen in up to 11.5% of men with ED of unknown origin. Virag described, with a penile NO release test based on the increase in cavernous artery diameter on cuff occlusion, that there is a huge decrease in penile NO production after radical prostatectomy which may explain the poor response to PDE5 inhibitors. Sommer and Engelmann, on behalf of the German Men's Health Study Group, showed in a prospective, randomised, controlled trial that daily dosing with sildenafil, as opposed to on-demand dosing, is able to regress ED and that, even after cessation of sildenafil, 80% of this group had improved erectile function 12 months later. This daily-dosing idea was also discussed in many other fora. Agrawal et.al. , in a retrospective analysis of 24 years of penile implantation in Peyronie's disease concluded that 82% of patients were satisfied with the results of their surgery, and reported a 4% infection rate.
The lifetime achievement award was presented to Giles Brindley and Ronald Virag for their discovery of intracavernosal therapy.
As well as the educational side, the hotel was a good venue and the flight on the London Eye which preceded the excellent Gala Evening at the London Aquarium was a fitting celebration and a time to forge new friendships. David Ralph, his organising committee and the ESSM secretariat are all to be congratulated for co-ordinating such a successful meeting. Next year, the 8th ESSM Congress will be in Copenhagen and anybody with an andrological interest should consider attending.