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122 Kochakarn W, Leenanupunth C, Muangman V, Ratana-Olarn K, Viseshsindh V Ejaculatory duct obstruction in the infertile male: experience of 7 cases at Ramathibodi Hospital J Med Assoc Thai 2001;84(8): 1148 1152 123 Nickel JC, Elhilali M, Vallancien G Benign prostatic hyperplasia (BPH) and prostatitis: prevalence of painful ejaculation in men with clinical BPH BJU Int 2005;95(4):571 574 124 Corriere JN, Jr Painful ejaculation due to seminal vesicle calculi J Urol 1997;157(2):626 125 Weintraub MP, De Mouy E, Hellstrom WJ Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction J Urol 1993;150(4):1150 1154 126 van Moorselaar RJ, Hartung R, Emberton M, et al Alfuzosin 10 mg once daily improves sexual function in men with lower urinary tract symptoms and concomitant sexual dysfunction BJU Int 2005;95(4):603 608 127 Aizenberg D, Zemishlany Z, Hermesh H, Karp L, Weizman A Painful ejaculation associated with antidepressants in four patients J Clin Psychiatry 1991; 52(11):461 463 128 Hsu JH, Shen WW Male sexual side effects associated with antidepressants: a descriptive clinical study of 32 patients Int J Psychiatry Med 1995;25(2):191 201 129 Michael A Venlafaxine-induced painful ejaculation Br J Psychiatry 2000;177:282 130 Hermabessiere J, Guy L, Boiteux JP Human ejaculation: physiology, surgical conservation of ejaculation Prog Urol 1999;9(2):305 309 131 Hedlund H, Ek A Ejaculation and sexual function after endoscopic bladder neck incision Br J Urol 1985; 57(2):164 167

While erectile dysfunction is the most wellappreciated radical pelvic surgery-associated sexual dysfunction, there are a number of others that deserve attention, namely penile length changes, Peyronie s disease and orgasm alterations

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Link-state updates are transmitted through the network via a message that is called a topology control (TC) message TC messages are ooded throughout the network and every node can then recalculate its own routing table using this information The ooding process is accomplished through the MPRs, as shown in Figure 417 In the case of OLSR it is not required for each node to advertise all its neighbors It is adequate to advertise only the nodes that a node has selected as its MPRs OLSR also includes two additional message types: the host and network association (HNA) messages that are used by nodes for advertising connectivity to external networks, that is, networks that are not participating in the OLSR routing protocol, and the multiple interface declaration (MID) messages that are used only by nodes that have multiple interfaces that are participating in the OLSR routing protocol so that other nodes can associate the different interfaces with the same node OLSR has no support for message authentication and is therefore vulnerable to a variety of attacks 451 Secure Extension to OLSR

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There are a total of three analyses on this issue in the literature Fraiman et al studied 100 men less than six months after radical prostatectomy, and took preoperative and postoperative accid and erect measurements and demonstrated an overall mean reduction in erect penile length of 9% but a mean reduction in volume of 22 [1] Munding et al studied 31 men and measured penile length in the stretched accid state (accepted as equivalent to erect length) and showed that 71% had a decrease in penile length compared to preoperatively, with 48% of men demonstrating greater than a 1 cm loss and a range of loss of 05 4 cm [2] Finally, Savoie et al studied 63 patients with preoperative measurements followed by repeat measurement, at three months postoperatively, and demonstrated that 68% of patients had some degree of length loss The authors also showed that in this population there was no difference between patients with erectile dysfunction (ED) and those without, postoperatively [3] One of the commonest explanations given by urologists to patients is that the removal of the prostate results in shortening of the urethra, which leads to loss of penile length However, the urethra is xed at the urogenital diaphragm and cannot easily be retracted inwards and the bladder is in fact brought down to the urethra at this level for the fashioning of the vesico urethral anastomosis The

reasons for penile volume changes may be related to three factors: (1) cavernous nerve injury associated structural alterations in the penis; (2) cavernosal hypoxia-induced structural changes in the penis; and (3) sympathetic hyper-innervation (competitive sprouting) It is recognized that even in the hands of an experienced surgeon performing nerve sparing surgery, neuropraxia is likely to occur to the cavernous nerves Some have suggested that the tunica albuginea may also undergo structural changes after radical prostatectomy; however, other than a small amount of data on post-radical prostatectomy (RP) Peyronie s disease, at this time there is no data to support tunical structural alterations [4] It is recognized that neural injury leads to end-organ structural alterations Carrier et al in 1995 demonstrated that in a rat model of bilateral cavernous nerve transaction there was a signi cant reduction in nitric oxide synthase (NOS) staining of nerves as early as three weeks post-injury, and that these reductions were sustained at the six-month time point [5] Shortly after, Klein et al demonstrated that following cavernous nerve injury, the corporal smooth muscle demonstrated apoptotic changes [6]; these ndings were con rmed by User et al [7] This latter group demonstrated that penile wet weight and DNA content were reduced in both unilateral and bilateral cavernous nerve injury models, the latter demonstrating greater changes Of note, the apoptosis was mostly observed in the subtunical zone of the smooth muscle Leungwattanaki et al further demonstrated that cavernous neurotomy leads to upregulation of brogenic cytokines and collagenization of the corporal smooth muscle [8] It has also been postulated that the chronic ab-

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