Prof. Run Wang (Figure 1) is a Professor of Surgery (Urology) and the Cecil M. Crigler, MD Chair in Urology at the University of Texas Medical School at Houston, Texas, USA. He is also a Professor of Urology and the Director of Sexual Medicine in the Department of Urology at the University of Texas MD Anderson Cancer Center. He served as a panelist for the International Consultation for Sexual Medicine in 2009 and 2015. Prof. Wang has authored 138 articles and chapters in peer-reviewed journals and books. He served as a co-editor, guest editor, associate editor, editorial member and reviewer for many medical and research journals. Prof. Wang is the President-elect for the Sexual Medicine Society of North America.
Prof. Wang was invited to give a lecture on “ED after radical prostatectomy: mile stones in development of rehabilitation strategy” during the 15th biennial meeting of the Asia-Pacific Society for Sexual Medicine and The Genitourinary Medical Symposium (APSSM2015 and GUMS2015) in Beijing. We were honored to invite Prof. Wang for an interview to give his brilliant perspectives on erectile dysfunction.
TAU: Could you briefly introduce the current status of erectile dysfunction in USA?
Prof. Wang: Erectile dysfunction has changed a lot in the last 20-30 years. Particularly in 1998 when Viagra was put on the market, the same year that the Nobel Prize was awarded to three scientists who discovered that nitric oxide could be used to mediate the function of the cardiovascular system including penile erection. Before the Viagra era, many people believed erectile dysfunction was a psychological problem. Since the discovery of nitric oxide and introduction of Viagra into the market, many people have changed their perceptions completely. Even though we can not one hundred percent rule out the psychological factor contributing to erectile dysfunction, we now know that the majority of erectile dysfunction is caused by organic etiology such as diabetes and hypertension.
TAU: What are the current treatments for erectile dysfunction? When treating erectile dysfunction, how is the therapy method selected? Is there any basic principle?
Prof. Wang: Erectile dysfunction management was completely changed by Prof. Tom F. Lue’s proposal. Previously, whenever we had patients with erectile dysfunction, we tried everything to identify the possible etiology and then to treat it. This kind of treatment really wastes a lot of resources, because many studies don’t really change the management. So Prof. Lue proposed the concept of goal-oriented therapy to simply treat the erectile dysfunction. Basically, disregard what has happened and disregard the etiology of erectile dysfunction. Almost everyone is offered the medication first as the first therapy since the introduction of Viagra into the market. So many patients come to our clinic, we don’t have to waste time or money on expensive testing. Generally the basics of history and physical examination are enough. We can offer the patient oral medications as the first line therapy. Once the therapy fails, then we can go to the second line therapy such as penis injection, vacuum erectile device and placement of the medication inside the urethra. And finally we have the top gun treatment of penile implant. Almost everyone with erectile dysfunction can be be treated with one of these methods.
TAU: What is the biggest challenge in the treatment?
Prof. Wang: Every patient wants to be cured. But for erectile dysfunction, we don’t really say a cure. We can improve the erectile function to various degrees so our patients can enjoy their sex life. But erectile dysfunction is not a disease that can be cured at present time. In other words, erectile dysfunction is managed by giving medication, injection or by surgery. They still have erectile dysfunction per se, but we can provide methods that allow the patients to enjoy their sex life. So the “cure” is the biggest challenge. At this point, we don’t have a cure for erectile dysfunction. Recent studies by scientists including Prof. Tom F. Lue from San Francisco, Prof. Xin from Beijing University Andrology Hospital involve a new technology called low intensity shockwave therapy which may provide new potential for the cure of erectile dysfunction.
TAU: You are doing well in this field. Do you have any suggestions for the young doctors who want to focus on this field? Why do you choose to contribute in this field?
Prof. Wang: Sexual medicine is one of the most exciting subspecialties in the world. For the young physician, you need to look at the long-term perspectives. This is an aging world and people will get older. If you specialize in sexual medicine and andrology, you will never be out of work. This is the number one reason to be a sexual medicine doctor and andrologist. Number two is that many new studies from sexual medicine are really the leading discoveries among many medical specialties. This is a very exciting field. If you really want to become a physician scientist, this probably is one of the best fields to get into. The quality of life for this subspecialty is very good; it has very few emergencies, like penis fracture. But it is not very common. Therefore you have a very good quality of life. In the US, many urologists are subspecialists in sexual medicine or andrology. Urologists in the US have a very good lifestyle. Personally, I believe this is one of the best specialties for somebody who wants to do science, contribute to the world, be a surgeon, and at the same time wants to live a quality life.
On behalf of the editorial office of Translational Andrology and Urology, we would like to extend our gratitude to Prof. Run Wang for sharing his perspectives with us.
Conflict of Interest: The authors have no conflicts of interest to declare.
(Science Editors: Lucine M. Gao, Helen X. Seliman, TAU, email@example.com)