Penile venous surgery for treating erectile dysfunction: Past, present, and future perspectives with regard to new insights in venous anatomy

Investigating in-vitro functionality and in-vivo taste assessment of eco-friendly Tadalafil Pastilles

Tadalafil (TDL) has poor bioavailability due to the less aqueous solubility and bitter taste. Oral solid dosage forms, especially tablets, have a broad market worldwide. Constraints of tablets are a long process, pollution, high processing cost, and requiring more excipient. The research was performed to optimize an eco-friendly immediate-acting pastille of TDL to put forward an alternate formulation to a tablet using advanced data mining tools. Another objective is to assess the taste masking of TDL using the Brief Access Taste Aversion (BATA) model. The amount of PEG-4000, Polyox N-10, and Kyron T-314 were chosen as critical material attributes from failure mode effect analysis. Box-Behnken design (BBD) was utilized to optimize the pastilles and ascertained the significant impact of chosen variables on disintegration time and % CDR at 10 min. The control strategy and optimal region were located using an overlay plot. The pastilles were able to release the drug within 15 min due to faster disintegration. The formulated pastilles were of uniform size, shape, and mechanical strength. The bitter taste of TDL was masked and confirmed by the BATA model. The newer formulation may be helpful in the industry due to its eco-friendly, single-step, and economical process. It unlocks a new direction in the field of oral solid dosage form as an alternative to tablets.

MRI-Cavernosography: A New Diagnostic Tool for Erectile Dysfunction Due to Venous Leakage: A Diagnostic Chance

Erectile dysfunction caused by venous leakage is a vascular disease in which blood fails to accumulate in the corpora cavernosa due to the abrupt drainage of blood from the penis secondary to an abnormal venous network that affects 1 to 2% of men under 25 years old and about 10 to 20% over 60 years old, who do not raise a sufficient erection for penetrative sex. The study of the venous leak and its characterization in young patients with erectile dysfunction represent a diagnostic challenge, and imaging remains the best way to diagnose this condition. In the article, it is described the methods of execution and the diagnostic role of the cavernous MRI in the study of vasogenic erectile dysfunction from the venous leak, proposing it as a good alternative to the cavernous CT, considering the satisfactory results in terms of diagnostic interpretation, the absence of ionizing radiation, the higher soft tissue resolution of the imaging method and the lower administration of contrast agent.

[Quality of life in patients who suffered erectile dysfunction and underwent penile implant surgery in terms of sexual satisfaction of the patient and partner]

BACKGROUND

Erectile dysfunction is a condition that shows a continuously growing prevalence in the male population. The penis prosthesis implant (PPI) qualifies as an effective form of therapy.

OBJECTIVES

The aim of this study was to analyze the sexual satisfaction rate and quality of life in patients who had suffered from erectile dysfunction and who were treated with a penile prosthesis. The patient's partners were also surveyed.

METHODS

We collected data from patients who underwent surgery in the Center of Excellence for Penile Implants, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. Questionnaires with validated scores (EDITS, EDITS Partner) were sent to all patients and their partners via mail.

RESULTS

The satisfaction rate in this study was high which shows that the patients and partners are pleased, and the high sexual satisfaction rate led to a higher quality of life.

CONCLUSION

The penile prosthesis implantation as a last option of therapy for erectile dysfunction is useful and brings more than adequate results.

Emerging nonsurgical and surgical techniques to treat erectile dysfunction: A systematic review of treatment options and published outcomes

Erectile dysfunction (ED) is one of the most common causes of morbidity in male patients, with a prevalence of 50-60% in men aged 40-70 years. EDs may be caused by physical or psychological trauma, the former of which may be treatable through surgical intervention. Physical trauma may be further categorized as vasculogenic, neurogenic, or idiopathic in nature. Although many patients do not respond well to nonsurgical treatment options, few opt for surgical intervention. This is likely due to the difficulty of the procedures, as well as relatively low historical success rates. As such, a systematic review of the literature was performed to identify novel surgical interventions for ED. A total of 19 manuscripts were included in this review, representing data of three minimally invasive approaches to ED treatment and seven novel surgical techniques. The data revealed compelling evidence in support of microsurgical treatments for ED - namely, microvascular arterial bypass penile revascularization surgery (MABS) and cavernous nerve graft reconstruction. Nerve grafts varied, with the use of end-to-side ilioinguinal, genitofemoral, and sural grafts, all demonstrating high rates of success. Furthermore, minimally invasive botulinum toxin (BoNT-A) treatment and adipose-derived stem cell (ADSC) therapy have shown extreme promise in rat models; with BoNT-A treatment entering phase II human clinical trials this year. Many of the surgical methods investigated in this review are microsurgical interventions that demonstrate high rates of success in patients with neurogenic or vasculogenic ED. As such, microsurgeons are uniquely trained and positioned to be of value to ED treatment.

Abnormal deep dorsal vein resulting in veno-occlusive erectile dysfunction

A 59-year-old man with a 6-year history of erectile dysfunction presented to the andrology outpatient clinic. Multimodality assessment with ultrasound, MRI venography and fluoroscopic venography demonstrated an aberrant emissary vein arising from the corporal bodies causing venogenic erectile dysfunction. Selective coil embolisation of the collateral vein resulted in an almost immediate and sustained improvement in his erections.