Perth, Western Australia 26-30 November, 2000
This was the second time that the biennial meeting of the International Society for Impotence Research (ISIR) has been held in the Asia Pacific region since 1980.The ISIR is a multidisciplinary organization of researchers, therapists and clinicians with a major research or clinical interest in sexual function and dysfunction. The local conference chair, Bronwyn Stuckey and her committee, as well as Jeremy Heaton, the scientific committee chairman of the ISIR, are to be congratulated for arranging an excellent program. It was at this meeting that the ISIR made major changes to their operating by-laws to reflect the expanded scope of the organization. One of those changes was the name of the organization to the International Society for Sexual and Impotence Research, ISSIR, to reflect the expansion of interests of the organization to all of sexual medicine, not just erectile dysfunction. The remainder of the name was retained to tie the present organization to its twenty-two year history, of importance to the roots of the organization. The scientific program, which will be summarized below, reflected the expanded focus of the organization. The new by-laws also strengthened the international nature of the organization by expansion of the executive committee to include a wider window for participation by the members from the five regional affiliated organizations which represent North America, Europe, Latin and Central America, Africa, and the Asia Pacific regions. The new president assuming leadership of the ISSIR at this meeting, replacing Ronald Lewis from the United States, is Sidney Glina of Brazil. The previous secretary-treasurer elected to the office of president-elect is Jacques Buvat from France. The new secretary of the organization is Ira Sharlip of the United States and the treasurer, which is now a separate office, is Eric Meuleman from the Netherlands.
The scientific meeting opened with a debate on the topic “the world cannot afford to treat erectile dysfunction”. Three affirmative and three negative speakers debated various aspects of the topic for over one hour with no clear cut winner in the debate. Erectile dysfunction, in fact, is being treated in many countries and from an epidemiologic standpoint the disorder does have many more ramifications to relationships and general health of the sufferer of the disorder than simply poor erectile function. We can not, however, forget that this is not a life threatening disorder and that total health care resources available are variable. There are important cultural differences in the role of sexual health in the framework of total health care for any given population.
A highlight of the meeting was the six state of the art lectures presented as pairs each morning after the first. An elegant description by Yoshiaki Banya (Japan) of the three dimensional micro-architecture of the human penis, based upon scanning electron microscopy, demonstrated two separate arterial systems in the corpora, a division into a capillary system and a division of drainage directly into sinus spaces. The changes that occur in the various layers of the tunica albuginea from the flaccid to the erect state and the effect of these changes on the emissary veins were shown with convincing technical data. Karl-Erik Andersson (Sweden) presented a comprehensive analysis of the new directions in molecular research on normal erection and the pathophysiology of ED. On the third day of the meeting Christian Stief (Germany) and Hans Hedlund (Norway) teamed up to present two of the most superb lectures I have ever heard presented at our meeting on “Neural Processes of the Erectile Response” and “Receptors Involved in Penile Erection.”
Finally on the last day of the meeting the quality continued with an analysis of “Future Directions in Pharmacotherapy” by Hartmut Porst (Germany) and “Imaging the Corpora Cavernosa” by Francesco Montorsi (Italy). A summary of the highlights of each of these presentations will be available in the supplementary issue of the Journal of Impotence Research, which will be forthcoming.
There were four symposia during the meeting in which experts presented state-of-art presentations in the areas selected. The first two of these occurred on the opening day and were entitled respectively, “Neural Aspects of Sexual Function” and “Surgery for Male Sexual Function.” Francois Giuliano (France) and Kwangsung Park (Korea) introduced the former symposia with description of the key issues in central nervous system regulation of erectile dysfunction and the brain centers involved in sexual function. This area has involved much experimental work and has progressed markedly over the last two years, particularly in rodent animal models. The previous rather simplistic division of the autonomic nervous system into two opposing systems, sympathetic for flaccidity and the parasympathetic for erection, has been more completely elicited to reflect the nature of the spinal network interaction with the end organ along with supraspinal center integration processes. Key areas in the brain include the medial preoptic area and the paraventricular nucleus of the hypothalamus and the nucleus paragigantocellularis in the pons. Dr. Park described work using functional magnetic resonance imaging of the brain associated with sexual arousal to visual sexual stimulation to delineate areas of the brain involved with sexual activity. A clearer understanding of neurochemical mediators such as dopamine, oxytocin, serotonin, noradrenaline, and nitric oxide in these central processes has allowed development of new central mediated therapy for sexual dysfunction which was discussed by Ronald Lewis (USA), particularly two, apomorphine, a dopamine agonist, and a melanocyte stimulating hormone analog. Giles Plant (Australia) presented some early experimental work with neural regeneration techniques as possible new breakthrough treatment for nerve trauma. Francesco Montorsi (Italy) ended this symposium with a discussion of managing neural causes of sexual function for particular disease entities.
On Tuesday, 28 November, the two simultaneous symposia were on the two topics of “Androgens” and “Basic Science.” John Morley (USA) presented his thoughts on the diagnosis of hypogonadism in the older male and the use of the androgen deficiency in aging male questionnaire (ADAM) developed at Saint Louis University for such diagnosis. David Handelsman (Australia) introduced the symposia with a discussion of biochemical measurements of testosterone necessary for the diagnosis of hypogonadism in the male. As usual there was a rich discussion of what method and type of testosterone measurement is necessary.
Alvaro Morales (Canada) ended this symposium with his usual well-articulated presentation on andropause, facts and fiction, a practical approach. The basic science symposium covered four major areas: designing experiments by David Lindsay (Australia), application of molecular biology to impotence research by Ching-Shwun Lin (USA), monitoring nitric oxide levels in the corpus cavernosum in the in-vivo setting by Manuel Mas (Spain), and how a chemical compound moves from basic research to effective therapy by Erwin Bischoff (Germany).
The following day included two simultaneous symposia entitled “Cardiovascular” and “Ejaculatory Disorders.” Topics included in the former were epidemiology of ED and cardiovascular disease by Dale Glasser (USA), endothelial dysfunction as the crux of vascular dysregulation in ED by Michael Adams (Canada), assessment of cardiovascular risk before treatment of ED by Peter Thompson (Australia), and cardiovascular profile and risks of ED therapies by Harin Padma-Nathan (USA). The latter symposia consisted of an in depth look at premature ejaculation from pathophysiology of the disorder presented by Chris McMahon (Australia), to psychosexual and pharmaceutical treatment by Koos Slob (Netherlands) and Jae-Seung Paick (Korea); this symposium ended with a presentation of the role of dorsal neurotomy in men with refractory premature ejaculation by Bayard Santos (Brazil).
On the last day of the meeting Irwin Goldstein (USA) chaired an extensive symposium on “Female Sexual Dysfunction”. It included topics such as physiology of female sexual response by Kwangsung Park (Korea), diagnosis of organic female sexual dysfunction by genital sensory testing by Y Vardi (Israel), psychometric measures of female sexual response by Frances Quirk (UK), sexuality and the menopausal transition by Lorraine Dennerstein (Australia), psychosexual counseling and FSD by Rosie McInnes (Australia), and management of FSD by Irwin Goldstein (USA). The scientific meeting closed with two final simultaneous symposia on “Taxonomy” and “Psychosocial and Sexological Aspects of ED.”
Approximately 90 podium presentations were given at the meeting on various aspects of basic science, clinical diagnosis and treatment of sexual dysfunction. One of the unique features of the meeting was the six papers presented in podium form on Female Sexual Dysfunction, the first time for our meeting. In fact, one of these papers shared the Ginestie prize essay award. It was presented by Dr. Annemaria Giraldi (Denmark) and was entitled “Effects of Diabetes Mellitus on Neurotransmission in Rat Vaginal Smooth Muscle.” It was co-authored by V Werkstrom, G. Wagner, and K-E Andersson. The co-winner of the Ginestie award for the best submitted manuscript was by Kanhan Chitaley (USA) entitled “Antagonism of Rho Kinase Stimulates Rat Erection via a Nitric Oxide Independent Pathway.” It was co-authored by Chris J. Wingard, R.Clinton Webb, H. S. Branam, V.S. Stoppen. Ronald W. Lewis, and Thomas M. Mills. The Tanagho prize paper went to Yosikauzu Sato (Japan) for his paper “Significant Physiological Roles of Ancillary Penile Nerves in the Intracavernous Pressure Response in Rats: Experiments using Electrical Stimulation of the MPOA.” The ISSIR Poster Prize was awarded to M.A. Khan (UK). The Perth Prize given by the local scientific meeting organizers was presented to H Mizusawa (Sweden) for his work entitled “ Morphological and Functional In Vitro and In Vivo Characterization of the Mouse Corpus Cavernosum.”
Ronald Lewis, USA