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demonstrate that this was technically feasible, and that it increased the chances of functional recovery of erections, although formal hemodynamic assessment of erectile response to cavernous nerve injury was not used then, as is currently standard Following cavernous nerve resection, an assessment can be made of the ipsilateral or contralateral genito femoral nerve (GNG) for caliber matching If the caliber is acceptable then the GNG can be harvested and sutured with ne non-absorbable sutures between the two stumps of the cavernous nerve If not, then the sural nerve can be harvested as described by Kim et al [52] The rst report was by Kim et al from Baylor discussing their experience with nine men, with excellent preoperative erectile function, who underwent non-nerve-sparing RP for locally extensive, highgrade prostate carcinoma [52] All underwent bilateral sural nerve interposition grafting (SNG) Postoperative erectile function was assessed using patient interview, a questionnaire and RigiscanTM analysis Of the nine patients, one had spontaneously functioning erections at 14 months postoperatively This experience demonstrated feasibility and encouraged these investigators to continue to accrue patients for SNG The following year, they reported on their experience in 12 men in whom SNG and genito femoral nerve interposition grafting (GNG) was performed [53] The data from this analysis indicated that erections unassisted by medication and suf cient for sexual intercourse occurred in one third of patients; partial erections occurred in 42%, while the remainder had no return of erections The mean IIEF erectile function domain scores for the three groups were 16 10, 9 10, and 7 1, respectively Erections with sildena l use were achieved in 50% at 12 months after RP Twelve potent men who had non-nerve-sparing surgery and had no grafting, acted as controls In this latter group none had return of functional erections with or without sildena l A follow-up study from the same group included 28 men who underwent bilateral cavernous nerve resection and SNG/GNG, 23 of whom had at least 12-month follow-up [54] The data demonstrated that 26% of patients had spontaneous medicallyunassisted erections suf cient for intercourse, 26% had partial erections, while 48% had no erectile activity whatsoever In these three groups, the mean.

The relationship between hypoxia and cavernosal brosis has been documented in at least two in vitro studies [9,57] It is thought that hypoxia induces TGF- 1 expression that in turn accelerates collage-

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both ratchet GDP up a notch Some types of consumption are necessary and bene cial, but even then, there is a tipping point where you can have too much of a good thing Every time you dip into your savings or use your credit card to buy a bigger at-screen television, for example, you may damage your ability to later purchase a home, nance a higher education, start a business, or ensure a comfortable retirement In the United States, personal savings has declined dramatically over the last three decades, from 185 percent in 1982 to negative 1 percent in 2006, only to turn moderately positive in 2007/200826 This sentiment also applies to government spending Just as we can distinguish between useful and wasteful personal consumption, there is a difference between using government funds to build infrastructure projects that may eventually be productive assets and using government funds to give consumers a small tax rebate to nance a shopping spree at the mall The problem of too little savings will only get worse as workingage populations in most major industrialized countries shrink and the developed world continues to age Aging populations are a problem because, as Franco Modigliani and Richard Brumberg s widely accepted life cycle theory of savings suggests, saving rates rise throughout a worker s active career and then decline in retirement As baby boomers start to retire, pension systems the world over are straining But instead of readjusting scal prerogatives in preparation for these changes, the United States and many of its G7 peers are running large de cits creating debt-funded illusory GDP growth The United States was not always like this The whole idea of a consumption-driven economy is only about a hundred years old, according to University of Michigan s Thomas Princen: For much of US history, until roughly the end of the nineteenth century, underproduction was the big problem Then we suddenly had plenty of production capacity To become an industrial power, the problem then became, how do we stimulate purchase of all the output If people were thrifty and frugal, as they had been for generations, there wouldn t be enough demand to drive the production that would make the country great27 This new emphasis was reinforced by the 1930s advent of national accounting, which de ned progress in terms of consumption As mentioned earlier, the focus on GDP and consumption came about during.

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