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Deger MD, Gül M, Serefoglu EC. Surgical treatment of premature ejaculation: a narrative review. Int J Impot Res 2023:10.1038/s41443-023-00771-9. [PMID: 37798540 DOI: 10.1038/s41443-023-00771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
Recurrence after drug cessation is the biggest drawback of medical premature ejaculation (PE) treatments. Although these treatments are demonstrated to be safe and effective, most of the PE patients are interested in a more permanent solution. Despite the fact that currently available guidelines do not recommend surgical treatment for PE, some surgical interventions have been commonly performed for many years, especially in the Asian countries. The main purpose of these surgical treatments is to decrease the sensitivity of the glans penis. However, they are associated with irreversible complications such as penile deformity, sensory loss and erectile dysfunction. The aim of this narrative review is to summarize the advantages and disadvantages of various surgical interventions introduced for the treatment of PE. PubMed, Scopus and Web of Science have been utilized to search articles about glans penis augmentation and penile dorsal nerve interventions. A total of 11 articles were included, three articles excluded because they were in non-English languages. Glans penis augmentation offered a less invasive treatment that avoids severe side effects but requires retreatment in time. Selective dorsal neurectomy provided a more invasive but curative treatment alternative. However, more clinical data are necessary before surgical treatment options can be recommended to patients with PE.
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Affiliation(s)
| | - Murat Gül
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
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2
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Leisegang K, Opuwari CS, Moichela F, Finelli R. Traditional, Complementary and Alternative Medicines in the Treatment of Ejaculatory Disorders: A Systematic Review. Medicina (Kaunas) 2023; 59:1607. [PMID: 37763726 PMCID: PMC10535559 DOI: 10.3390/medicina59091607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Ejaculatory dysfunction (EjD) is a common male sexual disorder that includes premature ejaculation, delayed ejaculation, retrograde ejaculation, and anejaculation. Although psychological and pharmacological treatments are available, traditional, complementary, and alternative medicine (TCAM) is reportedly used. However, the clinical evidence for TCAM in EjD remains unclear. Therefore, this study aims to systematically review human clinical trials investigating the use of TCAM to treat EjD. Materials and Methods: A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted by searching Scopus and PubMed databases. Controlled clinical trials investigating a cohort of male patients diagnosed primarily with EjD and undergoing any TCAM intervention compared to any comparison group were included. Quality of the studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials. Results: Following article screening, 22 articles were included. Of these, 21 investigated TCAM in premature ejaculation, and only 1 investigated TCAM in retrograde ejaculation. Different TCAM categories included studies that investigated lifestyle, exercise and/or physical activities (n = 7); herbal medicine supplements (n = 5); topical herbal applications (n = 4); acupuncture or electroacupuncture (n = 3); vitamin, mineral and/or nutraceutical supplements (n = 1); hyaluronic acid penile injection (n = 1); and music therapy (n = 1). Only 31.8% (n = 7) of the included studies were found to have a low risk of bias. The available studies were widely heterogenous in the TCAM intervention investigated and comparison groups used. However, the included studies generally showed improved outcomes intra-group and when compared to placebo. Conclusions: Different TCAM interventions may have an important role particularly in the management of PE. However, more studies using standardized interventions are needed.
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Affiliation(s)
- Kristian Leisegang
- School of Natural Medicine, University of the Western Cape, Bellville 7535, South Africa;
| | - Chinyerum Sylvia Opuwari
- Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa; (C.S.O.); (F.M.)
| | - Faith Moichela
- Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa; (C.S.O.); (F.M.)
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Chen K, Li Q, Xu T, Zhang X. Hyaluronic acid injection to coronal sulcus of the penis for the treatment of premature ejaculation: a retrospective observational study. BMC Urol 2023; 23:55. [PMID: 37005592 PMCID: PMC10067247 DOI: 10.1186/s12894-023-01214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Hyaluronic acid (HA) injection has become a burgeoning method to treat premature ejaculation (PE) due to its high biocompatibility and structural properties. PURPOSE In this study, we proposed a modified technique: injecting hyaluronic acid around coronal sulcus to treat PE, aiming to decrease the complications of hyaluronic acid injection in penis while achieving similar effects. METHOD A total of 85 patients who had HA injection from January 2018 to December 2019 were analyzed retrospectively in our study. 31 patients received injection at glans penis and 54 patients received injection around coronal sulcus. Intravaginal ejaculation latency time (IELT) was mainly measured to estimate the efficacy and the severity of complications was assessed between two groups. RESULTS The mean IELT was 123.0 ± 37.28 s of all patients, 124.7 ± 39.01 s of patients injecting at glans penis and 121.9 ± 36.58 s of patients injecting around coronal sulcus. IELT of all patients increased to 482.1 ± 121.7 s at 1 month, 331.2 ± 81.2 s at 3 month and 280 ± 80.4 s at 6 month. In the group of injecting at glans penis, the incidence of complications is 25.8% and it is 1.9% in the group of injecting around coronal sulcus. No severe complication was reported in both groups. CONCLUSION The modified technique of injecting around coronal sulcus decreases complications and it has the potential to become a new injectable technique for treating premature ejaculation.
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Affiliation(s)
- Kewei Chen
- Urology, Peking University People's Hospital, Beijing, China
| | - Qing Li
- Urology, Peking University People's Hospital, Beijing, China
| | - Tao Xu
- Urology, Peking University People's Hospital, Beijing, China
| | - Xiaowei Zhang
- Urology, Peking University People's Hospital, Beijing, China.
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Wang J, Li S, Li WJ, Zhu WL, Xia YB, He Y, Zhang YP, Zeng HQ, Cheng YB, Zhu ZH. Effect of Selective Dorsal Neurectomy on Erectile Function in Rats. Curr Med Sci 2023; 43:324-328. [PMID: 36892787 DOI: 10.1007/s11596-022-2685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/11/2022] [Indexed: 03/10/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of penile selective dorsal neurectomy (SDN) on erectile function in rats. METHODS Twelve adult male Sprague-Dawley rats (15 weeks old) were divided into three groups (n=4 per group): in control group, rats received no treatment; in sham group, rats underwent a sham operation; in SDN group, rats underwent SDN with half of the dorsal penile nerve severed. The mating test was performed, and the intracavernous pressure (ICP) assessed six weeks after the surgical treatment. RESULTS At postoperative six weeks, the mating test revealed no significant difference in mounting latency and mounting frequency among the three groups (P>0.05), while the ejaculation latency (EL) was significantly longer and ejaculation frequency (EF) lower in the SDN group than in the control and sham groups (P<0.05). There were no significant differences in preoperative and postoperative ICP and ICP/mean arterial blood pressure (MAP) among the three groups (P>0.05). CONCLUSION SDN does not adversely affect the erectile function and sexual desire of rats, and at the same time it can reduce EL and EF, providing an application basis for SDN in the clinical treatment of premature ejaculation.
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Affiliation(s)
- Jin Wang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Sen Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wen-Jia Li
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wen-Li Zhu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuan-Bin Xia
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yao He
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - You-Peng Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Han-Qing Zeng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yong-Biao Cheng
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Zhao-Hui Zhu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Sakr A, Elgalaly H, Seleem MM, Kamel M, El-Sakka AI, Ibrahim IM. Outcome of hyaluronic acid gel injection in glans penis for treatment of lifelong premature ejaculation: A pilot study. Arab J Urol 2023; 21:31-35. [PMID: 36818372 PMCID: PMC9930752 DOI: 10.1080/2090598x.2022.2100580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective To assess safety and efficacy of hyaluronic acid (HA) gel injection in glans penis for treatment of premature ejaculation (PE) using our new five puncture technique. Patients and methods This is a prospective, non-randomized clinical trial on HA gel injection in glans penis for all patients with lifelong PE; all patients were circumcised having heterosexual normal marital life and sexually active. Patients with history of ejaculatory medication use within the previous 3 months, psychiatric disorders, erectile dysfunction, lower urinary tract symptoms (LUTS) due to prostatitis and acquired PE were excluded from the study. A local anesthetic was applied to the skin of glans penis for 30 minutes before the injection of 2 ml HA in glans penis via 30-gauge needle using our new Five-puncture technique. Intra-vaginal ejaculatory latency time (IELT) was measured at 1, 3, 6 and 12 months after injection. Results Thirty patients completed our study follow up schedule. Mean age of the patients was 41.72 ± 8.50, while mean age of female partner was 37.23 ± 8.54 years. IELT was highly significantly increased (P-value < 0.001) after HA gel injection from baseline, which was in maximum 37.83 ± 11.01 sec at baseline to 323.03 ± 42.06, 281.07 ± 41.05, 241.03 ± 43.09 and 235.6 ± 41.87 sec after 1, 3, 6 and 12 months, respectively, after injection. Three patients complained from discomfort at the site of injection, two from bullae formation at the site of injection and one from ecchymosis, and all resolved spontaneously after 1 week to 10 days after injection. Conclusion HA gel injection in glans penis using our new five-puncture technique is a safe and effective method that ensures a modest long-term significant increase in IELT and improves ejaculatory control.
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Affiliation(s)
- Ahmed Sakr
- Faculty of Medicine, Urology Department, Zagazig University, Zagazig, Egypt,CONTACT Ahmed Sakr Faculty of Medicine, Urology Department, Zagazig University, Zagazig, Egypt
| | - Hazem Elgalaly
- Faculty of Medicine, Urology Department, Zagazig University, Zagazig, Egypt
| | - Mohamed M. Seleem
- Faculty of Medicine, Urology Department, Zagazig University, Zagazig, Egypt
| | - Mostafa Kamel
- Faculty of Medicine, Urology Department, Zagazig University, Zagazig, Egypt
| | - Ahmed I. El-Sakka
- Faculty of Medicine, Urology Department, Suez Canal University, Ismailia, Egypt
| | - Ibrahim M. Ibrahim
- Faculty of Medicine, Urology Department, Zagazig University, Zagazig, Egypt
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Abstract
Premature ejaculation (PE) is a prevalent male sexual dysfunction. Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine and other selective serotonin reuptake inhibitors (SSRIs). Most of the pharmacotherapeutic options target neurotransmitters (such as serotonin and oxytocin) that have a role in the ejaculation mechanism. However, these treatments are mildly effective and only provide a temporary delay in the ejaculation latency time, and PE recurs when the treatment is stopped. Thus, a treatment for PE is urgently needed and research is ongoing to find the ideal PE therapy. The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials. Both preclinical and clinical studies on new-generation SSRIs are ongoing. Moreover, promising results came from clinical trials in which the efficacy of on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, was assessed. Surgical intervention and neuromodulation have been proposed as potential treatment options for PE; however, current PE guidelines do not recommend these treatments owing to safety concerns.
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Affiliation(s)
- Murat Gul
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | - Kadir Bocu
- Department of Urology, Silopi State Hospital, Sirnak, Turkey
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.
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Perri A, Lofaro D, Iuliano S, Bossio S, Rago V, Damiano R, Di Luigi L, La Vignera S, Mondaini N, Aversa A. Effects of One-Shot Hyaluronic Acid Injection in Lifelong Premature Ejaculation: A Pilot Study. Endocrines 2022; 3:538-544. [DOI: 10.3390/endocrines3030044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The therapeutic management of premature lifelong ejaculation (PE) ranges from behavioral therapy to pharmacological and surgical treatments. Hyaluronic Acid (HA) injection into the glans penis is a non-surgical procedure, intended to reduce glans hypersensitivity, improving the intravaginal ejaculation latency time (IELT). HA injection can be performed through different techniques that, although safe and effective, rarely can cause local complications. In this pilot uncontrolled study, we tested the effectiveness of a new technique based on a single HA injection into the frenulum of the glans, to improve IELT in a sample of patients affected by PE. We observed a significant increase of the IELT after one (median 73.3, IQR 66.2–79.9 s) and two months (66.2, 63.1–73.9) that gradually decreased at three months, remaining still significantly higher than at baseline (34.8, 30.9–37.4). PEDT and IIEF questionnaires significantly improved compared to baseline in the first two months of follow-up (p < 0.001). In conclusion, the preliminary results emerging from this pilot uncontrolled study, highlight the effectiveness of this one-shot HA injection approach, although a larger sample and longer follow-up time are needed to standardize the procedure.
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Zhang C, Quan Y, Song Y, Bai W, Li Q, Xu T, Zhang X. Efficacy and safety assessment of glandular augmentation with hyaluronic acid for premature ejaculation. Andrologia 2022; 54:e14435. [PMID: 35523761 DOI: 10.1111/and.14435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/21/2022] [Accepted: 03/30/2022] [Indexed: 12/13/2022] Open
Abstract
Glandular augmentation (GA) with hyaluronic acid (HA) is a newly developed, minimally invasive therapy for patients with premature ejaculation (PE); however, evidence supporting its efficacy is scarce. To provide a comprehensive profile of GA with HA gel in managing PE, 184 patients with PE who received GA with HA gel therapy from October 2017 to November 2019 were included and followed up for 1 year. The Fan technique was applied. Intravaginal Ejaculation Latency Time (IELT), Chinese Index of Premature Ejaculation-5(CIPE-5) and Visualised Satisfaction Index (VSI) of sexual experience were assessed at initial and 1-, 3-, 6- and 12-month post injection. A total of 71 patients with primary PE (pPE, 38.6%) and 113 patients with acquired PE (aPE, 61.4%) were enrolled. The mean IELT increased to 100.7 ± 43.2 s(p < .05) for pPE patients and 359.2 ± 87.1 s (p < .05) for aPE patients 1-month post injection and remained significantly higher at the end point with acceptable attenuation. The mean CIPE-5 score increased to 17.6 ± 6.4 (p < .05) in the 1st month and remained steady. The VSI scores increased to 6.6 ± 1.0 (p < .05) for patients with pPE and 7.7 ± 1.2 (p < .01) for patients with aPE. Increments in VSI in patients with aPE were significantly higher than those in patients with pPE (p < .01). No severe complications were noted. GA with HA may be an effective and safe method to treat PE. Patients with acquired PE were also more satisfied post treatment.
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Affiliation(s)
- Chunlong Zhang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yuan Quan
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yuxuan Song
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Wenjun Bai
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Qing Li
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Xiaowei Zhang
- Department of Urology, Peking University People's Hospital, Beijing, China
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Mitsogiannis I, Dellis A, Papatsoris A, Moussa M. An up-to-date overview of the pharmacotherapeutic options for premature ejaculation. Expert Opin Pharmacother 2022; 23:1043-1050. [PMID: 35108136 DOI: 10.1080/14656566.2022.2035361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Premature ejaculation (PE) is a sexual dysfunction of unknown etiology affecting a substantial number of males and deteriorating sexual health and quality of life of the patient and his partner. Treatment still remains challenging; however, pharmacotherapy is considered the mainstay of therapy with behavioral and psychosexual interventions being particularly important as adjudicate procedures, within the context of a holistic approach. AREAS COVERED The authors review the literature on the available medications for PE, both officially registered and non-registered. Currently, only dapoxetine and an anesthetic spray containing lidocaine and prilocaine (Fortacin™) are officially approved, with the rest being used off-label. Herein, updated data regarding the efficacy and safety of the pharmaceutical agents are presented. EXPERT OPINION On-demand dapoxetine is reportedly efficacious and safe in treating lifelong PE and is the first medication to be approved for this purpose. Fortacin has also shown considerable efficacy and may be reliably used on-demand. Phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be effective in the treatment of PE and are therefore recommended either as monotherapy or combined with other therapies (i.e. dapoxetine). Adverse events of any therapy should be taken under consideration. Physicians should encourage patients to discuss their needs and expectations and grade any improvement of their condition with treatment.
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Affiliation(s)
- Iraklis Mitsogiannis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamd Moussa
- Department of Urology, Al-Zahraa University Medical Center, Beirut, Lebanon
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Abstract
To analyse the current therapeutic options for patients with premature ejaculation (PE) and highlight their mechanism(s) of action, effectiveness, advantages and limitations. A literature search was conducted using the PubMed database searching for articles exploring different PE treatment modalities. A Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) approach was used to report the results of the literature search. A total of 149 articles were included in this review. The currently available treatment methods for PE include behavioural therapy, local anaesthetics, tricyclic antidepressants, selective serotonin reuptake inhibitors, and selective phosphodiesterase inhibitors. Most PE treatments are either experimental or used off-label. New treatments are certainly warranted to overcome this exasperating sexual dysfunction.
Abbreviations: AIPE: Arabic Index of Premature Ejaculation; CNS: central nervous system; CYP: cytochrome P450; ED: erectile dysfunction; FDA: United States Food and Drug Administration; H1: histamine receptors; 5-HT: 5-hydroxytryptamine; IELT: The intravaginal ejaculation latency time; IPE: Index of Premature Ejaculation; M1: muscarinic receptors; OCD: obsessive–compulsive disorder; PDE5: phosphodiesterase type 5; PE: premature ejaculation; PEP: Premature Ejaculation Profile; PRO: patient-reported outcome; RCT: randomised controlled trial; SS: Severance Secret (cream); SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic antidepressants
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Affiliation(s)
- Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmad Majzoub
- Urology Department, Hamad Medical corporation, Doha, Qatar.,Urology Department, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Mohammed Abu El-Hamd
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
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Califano G, Arcaniolo D, Ruvolo CC, Manfredi C, Smarrazzo F, Cilio S, Verze P. Glans penis augmentation: when, how, and why? Int J Impot Res 2021; 34:343-346. [PMID: 34400809 DOI: 10.1038/s41443-021-00464-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
The growing demand for glans penis augmentation (GPA) makes it a hot topic in the field of andrological surgery, albeit still widely debated. The lack of high supporting evidence and its technically challenging aspects are the main concerns. The aim of this study was to review the current literature about GPA in order to provide an easy and comprehensive overview of the topic. GPA is suitable for managing both cosmetic and functional issues. Counseling should be the cornerstone of the decision-making process. A thorough understanding of the glans anatomy and treatment strategies remain essential to safely and effectively address the patient's needs. GPA can be performed using injectable fillers or surgical grafting. Glans-shaft penis asymmetries, small glans size, and loss of glans tumescence can be managed by both injectable fillers and surgery. On the other hand, patients with lifelong premature ejaculation can mainly benefit from using injectable fillers. Currently, available studies show promising results but are limited by small sample's size and non-randomized design. Furthermore, treatment-related complications are poorly reported. The long-term efficacy and safety profiles of GPA techniques should be further investigated.
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Affiliation(s)
- Gianluigi Califano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Davide Arcaniolo
- Urology Unit, Department of Medicine and Surgery, University of Naples Luigi Vanvitelli, Naples, Italy
| | - Claudia Collà Ruvolo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Celeste Manfredi
- Urology Unit, Department of Medicine and Surgery, University of Naples Luigi Vanvitelli, Naples, Italy
| | - Francesco Smarrazzo
- Urology Unit, Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana"-University of Salerno, Baronissi, Italy
| | - Simone Cilio
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Verze
- Urology Unit, Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana"-University of Salerno, Baronissi, Italy.
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Zucchi A, Scroppo FI, Capogrosso P, Salonia A, Duante J, Bini V, Liguori G, Bartoletti R. Clinical use of hyaluronic acid in andrology: A review. Andrology 2021; 10:42-50. [PMID: 34297894 PMCID: PMC9135118 DOI: 10.1111/andr.13083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Abstract
Background Hyaluronic acid is a glycosaminoglycan widely used in the fields of orthopedics, ophthalmology, and aesthetic medicine due to its significant ability to reduce the synthesis of pro‐inflammatory proteins and its activity against oxidative stress, a feature of many degenerative illnesses. Objectives The objective of the present review is to provide a comprehensive narrative review of the most recent literature on the use of hyaluronic acid in andrology in order to facilitate the use of this therapeutic device in the common clinical practice of many physicians. Specific conditions covered in the review are Peyronie's disease, premature ejaculation, and penile enlargement. Materials and methods A broad and comprehensive literature search included Medline, EMBASE, and the Cochrane Libraries, with no time restriction up to December 2020 and restricted to English language publications. Unpublished studies were not included. The study was registered as “The role of hyaluronic acid in andrology: A systematic review and meta‐analysis” in PROSPERO with the ID CRD42021223416. Discussion and conclusion Hyaluronic acid is a valid choice for the treatment of Peyronie's disease in terms of the resolution of the acute phase of the disease and of contributing to stabilizing the disease as a bridge to potential surgery. Data, furthermore, suggest that hyaluronic acid is frequently associated with an overall clinical improvement, allowing the patient to resume normal sexual activity. With regard to premature ejaculation, data suggests hyaluronic acid‐based treatments were effective in prolonging intra‐vaginal ejaculation time. Furthermore, hyaluronic acid was found to be safe and well‐tolerated, with main adverse events limited to local discomfort, ecchymosis, papule formation, and glans numbness, all of which were reported to resolve spontaneously. Last, with regard to penile enlargement, the overall perception of experts is that hyaluronic acid may be an extremely well‐tolerated compound with potential for application in specific areas of male sexual health that are often neglected as compared to more common, and relatively simpler to treat, conditions.
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Affiliation(s)
- Alessandro Zucchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Andrea Salonia
- Urology dept., University Vita-Salute San Raffaele, Milan, Italy
| | - Jacopo Duante
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Vittorio Bini
- Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Pisa, Italy
| | - Giovanni Liguori
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Ahn ST, Shim JS, Bae WJ, Kim SW, Kim JJ, Moon DG. Efficacy and Safety of Penile Girth Enhancement Using Hyaluronic Acid Filler and the Clinical Impact on Ejaculation: A Multi-Center, Patient/Evaluator-Blinded, Randomized Active-Controlled Trial. World J Mens Health 2021; 40:299-307. [PMID: 33988002 PMCID: PMC8987147 DOI: 10.5534/wjmh.210007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose We aimed to evaluate the efficacy and safety of penile girth enhancement (PGE) using hyaluronic acid (HA) filler with different physical properties from previous studies. Additionally, we evaluated the clinical impact on ejaculation after PGE. Materials and Methods This was a prospective, patient/evaluator-blinded, randomized, active-controlled, multicenter trial. Patients recruited between December 2017 and March 2018 were randomly assigned to the HA filler or control group (polylactic acid [PLA] filler). Penile girth, satisfaction level, Premature Ejaculation Profile (PEP), and self-estimated intravaginal ejaculation latency time (IELT) were assessed at baseline and at 24 weeks post-injection. Results Sixty-four subjects (32 in each group) completed the trial. The mean increase in girth was 22.74±12.60 mm and 20.23±8.73 mm in the HA and control groups, respectively. Satisfaction level regarding penile appearance and sexual life significantly increased in both groups. There was no statistically significant difference between the groups in terms of increase in penile girth or change in satisfaction level. Both groups showed significant improvements in PEP index scores. Self-estimated IELT also significantly increased in the HA group (from 5.36±3.51 to 7.86±4.73 minutes, p=0.0001) and control group (from 5.23±3.55 to 6.43±4.22 minutes, p=0.021). No serious adverse events (AEs) were reported. Conclusions PGE with HA and PLA fillers resulted in significant enhancement of girth without serious AEs with no significant differences. Furthermore, PGE using filler improved clinical symptoms related to ejaculation.
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Affiliation(s)
- Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Shebl SE, Ali S, Shokr M. Hyaluronic acid injection in the glans penis for the treatment of refractory premature ejaculation: A prospective, controlled study. Andrologia 2021; 53:e14084. [PMID: 33930204 DOI: 10.1111/and.14084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022] Open
Abstract
We aimed to demonstrate the safety and efficacy of hyaluronic acid (HA) injection in the glans penis for the treatment of persistent premature ejaculation (PE). Eighty patients with persistent PE were divided equally into two groups. In group A, patients underwent HA injection by four-inlet injection technique, while in group B, patients were subjected to saline injection in glans penis by the same method as a control group. Patients were followed up for six months. At the end of follow-up, the IELT significantly improved in the HA injection group, as compared to the baseline values and control group. The maximal glandular circumference significantly increased at the 1st, 3rd and 6th month of follow-up. The rate of patient satisfaction with sexual intercourse was 64.9%, 70.3% and 78.4% at the 1st, 3rd and 6th month of follow-up, respectively. Besides, the partner satisfaction with sexual intercourse was 54.1%, 48.6% and 59.5% at the 1st, 3rd and 6th month of follow-up, respectively. In conclusion, HA injection may represent a promising treatment modality for persistent PE.
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Affiliation(s)
- Salah E Shebl
- Urology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Saadelddin Ali
- Dermatology and Andrology Department, Al-Azhar University, Cairo, Egypt
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Abo-Hedibah SA, Badawi AN, Aly SA, Ismail SRM, Elmokadem AH. Penile girth augmentation by injectable fillers: a comprehensive review of imaging features and inflammatory complications. Abdom Radiol (NY) 2021; 46:1703-17. [PMID: 33040174 DOI: 10.1007/s00261-020-02788-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
Despite the extensive controversy and debate of penile girth augmentation, high demands for such procedures are increasing. Penile inflammation is not common sequel after penile filler augmentation, but when it occurs, it has serious complications that sometimes necessitate emergency surgical intervention. Imaging with a variety of modalities, including ultrasonography, magnetic resonance imaging, and ascending urethrogrphy plays a paramount role in the detection and assessment of these conditions. Inflammatory conditions after penile girth augmentation using injectable fillers are ranging from local granuloma to penile abscess formation or diffuse cellulitis that may extend to the scrotum, perineum or deep pelvic organs. Rapid diagnosis and evaluation of extensions are important to avoid associated morbidity and permanent deformity. Our purpose is to provide a practical review of relevant penile anatomy, imaging appearance and injection technique of different types of subcutaneous fillers used in penile girth augmentation, and inflammatory complications that may occur after these procedures. Brief descriptions of patient clinical information and imaging features of inflammatory complications will be included and correlated in actual cases.
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16
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Quan Y, Gao ZR, Dai X, Kuang L, Zhang M, Li Q, Xu T, Zhang XW. Complications and management of penile augmentation with hyaluronic acid injection. Asian J Androl 2021; 23:392-395. [PMID: 33533738 PMCID: PMC8269832 DOI: 10.4103/aja.aja_78_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hyaluronic acid injection is becoming a popular way for penile augmentation. However, only few studies and follow-ups have investigated the various complications of hyaluronic acid injection and their corresponding management. In this study, a total of 230 patients who had penile augmentation with hyaluronic acid injection from January 2018 to December 2019 were examined on follow-up for penile girth, complications, and their corresponding management. At 1-month, 3-month, and 6-month postoperative follow-ups, the penile circumference had increased by 2.66 ± 1.24 cm, 2.28 ± 1.02 cm, and 1.80 ± 0.83 cm, respectively. During the entire 6-month follow-up, 4.3% had complications such as subcutaneous bleeding, subcutaneous nodules, and infection. There were no systemic or local allergic reactions among all the patients. All complications were treated accordingly, and no further deterioration or severe sequelae were observed. Although complications of hyaluronic acid injections are mild and rare, these may affect the patient's satisfaction postoperatively. Preoperative redundant prepuce may increase the incidence of penile edema or postoperative gel migration. Standardization of the surgery protocol and elucidation of the effects of other injection parameters are still lacking. Nevertheless, it still highlights the importance of preoperative preparation and surgical technique.
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Affiliation(s)
- Yuan Quan
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Zi-Rui Gao
- Department of Dermatology and Venereology, Peking University People's Hospital, Beijing 100044, China
| | - Xiang Dai
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Ling Kuang
- Department of Nephrology Division, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu 610072, China
| | - Min Zhang
- Department of Urology, Chengdu Kowloon Hospital, Chengdu 614000, China
| | - Qing Li
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Xiao-Wei Zhang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
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17
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Kosseifi F, Chebbi A, Raad N, Ndayra A, El Samad R, Achkar K, Durand X, Noujeim A. Glans penis augmentation using hyaluronic acid for the treatment of premature ejaculation: a narrative review. Transl Androl Urol 2020; 9:2814-2820. [PMID: 33457252 PMCID: PMC7807328 DOI: 10.21037/tau-20-1026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Premature ejaculation (PE) is the most common self-reported male sexual disorder estimated to occur in approximately 5% of men in the general community. Penile hypersensitivity is thought to be an etiologic factor of lifelong PE. The role of glans penis augmentation using injectable hyaluronic acid (HA) for the treatment of PE is debatable and remains to be confirmed. The creation of a barrier at the level of the glans, by the bulking agent blocking accessibility and inhibiting the tactile stimuli to reach the dorsal nerve of the penis (branch of the pudendal nerve) receptors, is the theory behind the effectiveness of HA in the field of PE. We reviewed the literature using PubMed and searched for the following keywords: premature ejaculation, glans penis and HA, over the last 20 years. Five studies were found. These studies showed that HA injection could significantly increase IELT (2.43- to 4.46-fold), and this increase could persist for long term (up to 5 years). No serious adverse reactions were reported besides transient discoloration and swelling of the glans that recovered to normal within 2 weeks. Many techniques were discussed, their effectiveness remains to be proved. However, proper patient selection and mastering the esthetics of the technique, by adequate surgical training, is necessary in order to achieve the optimal results.
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Affiliation(s)
- Fares Kosseifi
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.,Department of Urology, Saint-Joseph Hospital, Paris, France
| | - Ala Chebbi
- Department of Urology, Saint-Joseph Hospital, Paris, France
| | - Nehme Raad
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Antoinette Ndayra
- Department of Psychology, Faculty of Arts and Sciences, University of Balamand, Beirut, Lebanon
| | - Raed El Samad
- Department of Urology, GHPSO Hospital, Creil, France
| | - Kamal Achkar
- Department of Urology, GHPSO Hospital, Creil, France
| | - Xavier Durand
- Department of Urology, Saint-Joseph Hospital, Paris, France
| | - Antoine Noujeim
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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18
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Gul M. Comment on "Hyaluronic acid injection in glans penis for treatment of premature ejaculation: a randomized controlled cross-over study". Int J Impot Res 2019; 32:364-365. [PMID: 31543515 DOI: 10.1038/s41443-019-0200-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/02/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Murat Gul
- Department of Urology, Aksaray University School of Medicine, Aksaray, Turkey. .,Laboratory of Reproductive Biology, University of Copenhagen, Copenhagen, Denmark.
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19
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Yang DY, Ko K, Lee SH, Moon DG, Kim JW, Lee WK. Efficacy and safety of newly developed cross-linked dextran gel injection for glans penis augmentation with a novel technique. Asian J Androl 2019; 20:80-84. [PMID: 28303807 PMCID: PMC5753559 DOI: 10.4103/aja.aja_1_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There is no safe and effective standard method for glans penis augmentation. Furthermore, there has been scant research on glans penis augmentation due to a poor understanding of glans anatomy, technical difficulty, and a lack of suitable substances for augmentation. Cross-linked dextran gel is a newly developed filler for soft-tissue augmentation. We evaluated the efficacy and safety of using a novel technique to inject cross-linked dextran gel for glans penis augmentation during a 24-week follow-up study. This prospective, single-arm, multicenter study enrolled twenty healthy adult men who underwent glans penis augmentation between June and August 2013. Cross-linked dextran gel was injected into the glans penis using a simple and easy technique. The sizes of the glans penis and individual satisfaction were assessed. Any adverse event was also reported. A total of 18 individuals were analyzed; two of them were lost to follow-up. The mean procedure time and injected volume were about 30 min and 6.6 ± 0.9 ml, respectively. The mean surface areas of the glans at baseline and 24 weeks were 20.0 ± 3.5 cm2 and 33.6 ± 5.4 cm2, respectively, representing a mean increase of 68.7% ± 14.0% (P < 0.001). Sixteen individuals (88.9%) were satisfied with the outcomes, and none were dissatisfied. There were no serious adverse events during the study. Cross-linked dextran gel injection for glans penis augmentation was easy and showed a significant augmentative effect on the glans penis, good durability, and was well tolerated without serious adverse events. Therefore, cross-linked dextran gel injection may be an effective, new technique for glans penis augmentation.
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Affiliation(s)
- Dae Yul Yang
- Department of Urology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Kyungtae Ko
- Department of Urology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Seong Ho Lee
- Department of Urology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Du Geon Moon
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Jong Wook Kim
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Won Ki Lee
- Department of Urology, College of Medicine, Hallym University, Chuncheon, Korea
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20
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Liu Q, Li S, Zhang Y, Cheng Y, Fan J, Jiang L, Li S, Tang Y, Zeng H, Wang J, Zhu Z. Anatomic Basis and Clinical Effect of Selective Dorsal Neurectomy for Patients with Lifelong Premature Ejaculation: A Randomized Controlled Trial. J Sex Med 2019; 16:522-530. [DOI: 10.1016/j.jsxm.2019.01.319] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/05/2023]
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21
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Whelan P, Levine LA. Additional procedures performed at time of penile prosthesis implantation: a review of current literature. Int J Impot Res 2020; 32:89-98. [PMID: 30705435 DOI: 10.1038/s41443-019-0118-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/31/2018] [Accepted: 01/07/2019] [Indexed: 11/08/2022]
Abstract
Penile prosthesis implantation for treatment of medical refractory erectile dysfunction remains the gold standard. However, some men have additional pathology present such as Peyronie's Disease, penile shortening, penoscrotal webbing, buried penis or other penoscrotal anatomical abnormalities that may be addressed at the time of prosthesis implantation. Although several techniques are described, there remains a lack of data regarding the outcomes. We sought to identify the results of available literature regarding the additional procedures performed at the time of penile prosthesis implantation that provide defined surgical outcomes rather than merely describe surgical techniques. Surgical outcomes to procedures provide more realistic clinical outcome for readers than simply the description of novel techniques or expert opinions. We performed a review of the MEDLINE database to identify additional procedures performed in conjunction with penile prosthesis placement. Many procedures are described in review articles, however, with limited data regarding their outcomes. The included articles must describe additional procedures performed in conjunction with penile prosthesis placement. Perioperative office techniques and management were included if it changed the surgical technique. All abstracts obtained through search criteria were reviewed. Only articles written in English, on human subjects with documented surgical results and relevant articles were included in this study. After a thorough literature search, a total of 24 articles were identified. Penile lengthening procedures at the time of penile prosthesis comprise most of the literature on this subject. Lengthening procedures are as simple as Peyronie's plaque excision and grafting to complex sliding and lengthening procedures requiring complete neurovascular bundle and partial urethral mobilization. Additionally, aggressive cylinder sizing and prolonged postoperative cycling at home are also described. Glanulopexy may be necessary when malpositioning of the glans is present. Other options such as scrotoplasty are also available options for those patients with scrotal webs. Notably there is a paucity of published literature regarding girth enhancement, buried penis repair, hernia repair, and vasectomy at time of penile prosthesis placement. There are numerous procedures that can be performed in the same operative setting as penile prosthesis. Although the procedures do have a common goal to provide optimal postoperative natural appearance, length, straightness, girth and function, the techniques employed must be tailored to each patient as there is not a one-procedure fits all in this patient population.
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Alahwany A, Ragab MW, Zaghloul A, Abdallah H, Mostafa T. Hyaluronic acid injection in glans penis for treatment of premature ejaculation: a randomized controlled cross-over study. Int J Impot Res 2019; 31:348-55. [PMID: 30610210 DOI: 10.1038/s41443-018-0104-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/04/2018] [Accepted: 11/26/2018] [Indexed: 02/08/2023]
Abstract
This randomized controlled cross-over study aimed to assess the efficacy and safety of glans penis injection with hyaluronic acid (HA) in treating premature ejaculation (PE). A total of 30 patients with PE were randomly allocated into two groups: group 1 (n = 15) which was subjected to glans penis HA injection and group 2 (n = 15) which was injected with saline as a control then both groups were subjected to follow-up at 1 week and 1 month after injection. These subjects were evaluated by intra-vaginal ejaculation latency time (IELT) and the Arabic validated index of premature ejaculation (AIPE). After a wash-out period, cross-over and re-evaluation of both groups were carried. Additionally, patients with reported improvement after 1 month of HA injection (n = 20) were subjected to extended evaluation by IELT at 3, 6, and 9 months intervals. Two-way repeated measures ANOVA indicated significant improvement after HA in comparison with saline across the follow-up periods (F(1.66: 91.37) = 24.85, p = 0.001). Post-hoc Bonferroni test indicated no significant difference after 1 week period in comparison with baseline IELT, but a significant difference after 1 month of injection in comparison with baseline IELT (p < 0.001) and after 1 week (p < 0.001). After 1 month of HA, IELT increased by a median of 2.6 folds while 1.1 folds increase was observed after 1 month of saline injection. Total AIPE scores improved significantly after HA injection compared with baseline (p = 0.003) and saline scores (p = 0.002). Reported adverse effects were minimal and self-limited. It could be concluded that glans penis injection with HA for treatment of PE is a safe method that ensures a modest but significant increase in IELT and improves couple sexual satisfaction.
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Ahn ST, Il Kwak T, Park KS, Kim JJ, Moon DG. Complications of glans penis augmentation. Int J Impot Res 2019; 31:245-55. [PMID: 30478264 DOI: 10.1038/s41443-018-0097-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/15/2018] [Accepted: 10/29/2018] [Indexed: 01/25/2023]
Abstract
Despite the controversy regarding penile augmentation (PA), glans penis augmentation (GPA) is used in penile reconstructive surgery in selected patients with small glans penis. Since 2003, injectable hyaluronic acid (HA) gel has been used for GPA. The attractiveness of HA gel fillers and interest in this technique have led to the use of other fillers for GPA, particularly irreversible fillers that improve the longevity of HA gels. Conversely, indirect glans augmentation via implantation of dermofat grafts or scaffolds between the corpus spongiosum and the distal tip of the corpus cavernosum is used to overcome poor longevity of the gel and glans surface undulation, which are the primary limitations of GPA using HA gel. Unfortunately, these implants form hard painful lumps over time in most patients and are difficult to remove. Blunt dissection is an invasive procedure that may cause vascular compromise and consequent glans necrosis in a few patients. We present our review regarding the current status of GPA for a more comprehensive understanding of this subject. Additionally, we have discussed a few complicated cases that were referred to us.
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Abstract
BACKGROUND To investigate the efficacy of acellular dermal matrix in penis augmentation (ADMPA) for premature ejaculation (PE). METHODS A total of 39 patients treated with ADM in penis augmentation from June 2014 to December 2017 were evaluated. Detailed evaluations on PE were conducted before operation and at the 6-month and 2-year follow-up visits after operation. Self-estimated intravaginal ejaculatory latency time (IELT) and 5-item version of the International Index of Erectile Function (IIEF-5) were used to measure the ejaculation and the erectile function for all subjects. RESULTS Compared to the baseline data, the IELT and IIEF-5 scores were increased, and PE was relieved at 6 months and 2 years after operation. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. The psychosexual impact of the operation was beneficial in the majority of cases. CONCLUSION Our survey systematically evaluated the effects of ADMPA for PE. ADMPA might be an optional surgical method in patients with PE, especially for those who seek penile augmentation. However, given the small amount of cases involved in this study, further studies on the effect of ADMPA for PE were still needed.
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Affiliation(s)
- Xiaowei Zhang
- Department of Urology, Peking University People's Hospital
| | - Yuanyi Wu
- Department of Urology, First Affiliated Hospital of PLA General Hospital
| | - Min Zhang
- Department of Urology, Chengdu Kowloon Hospital, Southwest Institute of Sexual and Health Medicine, Chengdu, China
| | - Huaqi Yin
- Department of Urology, Peking University People's Hospital
| | - Qing Li
- Department of Urology, Peking University People's Hospital
| | - Wenjun Bai
- Department of Urology, Peking University People's Hospital
| | - Tao Xu
- Department of Urology, Peking University People's Hospital
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Jeong HG, Ahn ST, Kim JW, Seo KK, Lee DS, Uh HS, Kim JJ, Moon DG. Practice Patterns Among Korean Urologists for Glans Penis Augmentation Using Hyaluronic Acid Filler in the Management of Premature Ejaculation. Sex Med 2018; 6:297-301. [PMID: 30078733 PMCID: PMC6302150 DOI: 10.1016/j.esxm.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/22/2018] [Accepted: 06/27/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction Glans penis augmentation (GPA) using hyaluronic acid (HA) gel has been developed for treating premature ejaculation (PE) with penile hypersensitivity. The injected HA filler creates a barrier that reduces the tactile stimuli to the hypersensitive dorsal nerve. Although the HA filler is biodegradable and is believed to not cause permanent loss of sexual function, the current International Society for Sexual Medicine guideline for PE does not recommend this procedure owing to concerns regarding sexual dysfunction. Aim To investigate the practice patterns for GPA using HA filler among Korean urologists, and to identify whether urologist experienced patient reports of sexual dysfunction post-treatment. Methods Between March 2016 and July 2016, a specially designed questionnaire was mailed to 86 selected Korean urologists who had used injectable materials to treat PE. Main Outcome Measures The prevalence and awareness of sexual dysfunction after GPA using HA filler were evaluated. Results Overall, 56 urologists completed the survey (response rate: 69.2%), of which 36 (64.3%) had performed GPA using HA filler. They reported having performed a combined total of 4,344 such GPA procedures. Most urologists (72.7%) performed GPA using HA filler in patients who benefit from topical anesthetics. Patients with a history of failed pharmacotherapy (59.1%) and selective dorsal nerve neurotomy (45.5%) were selected for GPA using HA filler. The respondents (44.4%) encountered overall 206 (4.7%) cases of patients reports of recurrence of PE. Interestingly, only 36 (0.8%) cases of glans pain or paresthesia and no cases of erectile dysfunction post-treatment were reported. Conclusion Korean urologists performed GPA using HA filler when pharmacotherapy failed or if there was a response to topical treatment. Paresthesia and hypoesthesia after GPA using HA filler are rare, and no cases of erectile dysfunction were encountered by Korean urologists. Jeong HG, Ahn ST, Kim JW, et al. Practice Patterns Among Korean Urologists for Glans Penis Augmentation Using Hyaluronic Acid Filler in the Management of Premature Ejaculation. Sex Med 2018;6:297–301.
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Affiliation(s)
- Hyeong Guk Jeong
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sun Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jong Wook Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | | | | | - Hong Sun Uh
- Association of Korean Urologists, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea.
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Yang DY, Ko K, Lee SH, Moon DG, Kim JW, Lee WK. Efficacy and safety of a newly developed polylactic acid microsphere as an injectable bulking agent for penile augmentation: 18-months follow-up. Int J Impot Res 2017; 29:136-141. [DOI: 10.1038/ijir.2017.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 02/18/2017] [Accepted: 03/20/2017] [Indexed: 11/09/2022]
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Tran H, Goldfarb R, Ackerman A, Valenzuela RJ. Penile Lengthening, Girth, and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017; 5:403-412. [PMID: 28238678 DOI: 10.1016/j.sxmr.2016.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/30/2016] [Accepted: 11/27/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Penile prosthetic devices are the gold standard treatment of medication-refractory erectile dysfunction. Inflatable penile prosthetic (IPP) devices have been available and used for more than four decades. Oftentimes, medical conditions causing erectile dysfunction also cause penile shortening, causing decreased patient quality of life. AIM To identify and review all available penile lengthening procedures that can be performed at time of IPP insertion. METHODS An extensive, systematic literature review was performed using PubMed searching for key terms penile lengthening, inflatable penile prosthesis, penile girth, corporoplasty, glans augmentation, and penile enhancement; all articles with subjective and/or objective penile length outcomes were reviewed. MAIN OUTCOME MEASURES A review of various techniques for penile length and girth preservation and enhancement during penile prosthesis insertion. RESULTS Several advanced and novel techniques were found for penile length preservation and enhancement at time of IPP insertion, including the sub-coronal IPP insertion technique, and adjuvant maneuvers during insertion, such as the sliding technique, modified sliding technique, multiple slice technique, and circumferential incision and grafting. Other adjuvant techniques that can enhance perception of increased length include ventral phalloplasty, suprapubic lipectomy, and suspensory ligament release. Further enhancement can be obtained using augmentation corporoplasty and glans augmentation with hyaluronic acid and other fillers. The different techniques vary in complexity and could require specialized training and experience. Maximum length gain appears to be limited by the length of the neurovascular bundles. CONCLUSION Overall, surgical penile lengthening procedures at time of IPP insertion appear safe and effective for treatment of patients with penile shortening and severe erectile dysfunction. These therapies can significantly improve patient self-esteem and quality of life in properly selected patients. Tran H, Goldfarb R, Ackerman A, Valenxuela RJ. Penile Lengthening, Girth and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017;5:403-412.
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Affiliation(s)
- Henry Tran
- Department of Urology, Columbia University Medical Center, New York, NY, USA.
| | - Robert Goldfarb
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Anika Ackerman
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Robert J Valenzuela
- Department of Urology, Columbia University Medical Center, New York, NY, USA
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Seo DH, Jeh SU, Choi SM, Kam SC, Kim SW, Yang DY, Moon DG, Yang SK, Moon KH, Hyun JS. Diagnosis and Treatment of Premature Ejaculation by Urologists in South Korea. World J Mens Health 2016; 34:217-223. [PMID: 28053952 PMCID: PMC5209563 DOI: 10.5534/wjmh.2016.34.3.217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/31/2016] [Accepted: 09/18/2016] [Indexed: 01/23/2023] Open
Abstract
Purpose This study discusses the treatment of premature ejaculation (PE) using various approaches with the goal of evaluating the methods of diagnosis and treatment of PE in clinical practice in 2014 in South Korea. Materials and Methods We surveyed 200 urologists and andrologists who treated patients with PE from July 1, 2014 to July 29, 2014 using an online questionnaire. The questionnaire was composed of 4 parts: disease, comorbidities, diagnosis, and treatment. Using the answers to this survey, current trends in the diagnosis and treatment of PE were investigated using weighted averages. Results The median number per month of patients who were diagnosed with PE was 14 patients (interquartile range, 7~24). The time to ejaculation necessary for a diagnosis of PE was considered to be <1 minute by 12% of respondents, <2 minutes by 27%, <3 minutes by 28%, <5 minutes by 13%, and 20% stated that diagnosis was based on a patient's subjective complaint. The treatment methods preferred by PE patients were reported to be pharmacological treatment (87%), surgical treatment (9.5%), and behavioral management (3.5%). The treatment methods used by respondents were pharmacological treatment (77%), surgical treatment (15%), and behavioral management (14%). The most commonly used pharmacological treatment was the oral administration of dapoxetine (97%). Conclusions In 2014 in South Korea, various methods were used to diagnose and treat PE. The most commonly used treatment for PE was the oral administration of dapoxetine. It was also found that surgical treatment was applied in some cases.
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Affiliation(s)
- Deok Ha Seo
- Department of Urology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University Hospital, Jinju, Korea
| | - See Min Choi
- Department of Urology, Gyeongsang National University Hospital, Jinju, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Yul Yang
- Department of Urology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sang Kuk Yang
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea
| | - Ki Ha Moon
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University Hospital, Jinju, Korea
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Martin C, Nolen H, Podolnick J, Wang R. Current and emerging therapies in premature ejaculation: Where we are coming from, where we are going. Int J Urol 2016; 24:40-50. [DOI: 10.1111/iju.13202] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/09/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Christopher Martin
- Department of Urology; McGovern Medical School; The University of Texas Health Science Center at Houston; Houston Texas USA
| | - Hunter Nolen
- Department of Urology; McGovern Medical School; The University of Texas Health Science Center at Houston; Houston Texas USA
| | - Jason Podolnick
- Department of Urology; McGovern Medical School; The University of Texas Health Science Center at Houston; Houston Texas USA
| | - Run Wang
- Department of Urology; McGovern Medical School; The University of Texas Health Science Center at Houston; Houston Texas USA
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Abstract
Management of premature ejaculation (PE) has evolved tremandoulsy over the last 20 years. Selective serotonin reuptake inhibitor (SSRI) antidepressants and local anesthetics are the most and best studied treatments. This evidence has led to the establishment of an evidence-based definition of PE and the International Society for Sexual Medicine (ISSM) guidelines for the diagnosis and treatment of PE. The current treatment of choice for PE according to the ISSM guidelines is a centrally acting SSRI or peripherally acting topical anesthetics. Despite the progress in threating PE, the drawbacks of these medical treatments are controversial. Before the ISSM guidelines were established, selective dorsal neurectomy (SDN) and glans penis augmentation (GPA) using a hyaluronic acid (HA) gel were developed to decrease sensitivity of the glans penis but later ISSM guidelines do not recommend surgical treatment because of possible permanent loss of sexual function and insufficient reliable data. Despite the drawbacks of medical treatments and debates about the ISSM guideline, surgical treatment for PE has increased continuously in Asian countries for non-responders to medical treatment. In contrast to the concerns outlined in the ISSM guidelines, SDN has been reported as effective and safe with rare sensory loss. Percutaneous computed tomography-guided cryoablation of the dorsal penile nerve and neuromodulation of the dorsal penile nerve by pulsed radiofrequency are reported as effective and safe for PE. It is time to re-evaluate rather than ignore surgical treatments for PE because doctors and patients need surgical alternatives for patients with PE who are not satisfied with medical treatment. SDN has a definite role in the efficacy but needs more safety data to be used as standard surgical treatment for PE. SDN must be performed carefully and more well-designed studies are needed. GPA with a HA gel does not induce serious sensory loss in patients with ED erectile dysfunction and the recommendation should be re-evaluated by the ISSM after additional reliable studies are performed.
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Affiliation(s)
- Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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Abstract
Premature ejaculation (PE) is considered the most common male sexual disorder, affecting up to 75% of men at some point in their lives. While medical management is the mainstay of therapy, surgical options such as dorsal nerve neurectomy (DNN), hyaluronic acid (HA) gel glans penis augmentation, and circumcision have been studied as alternative forms of treatment. Preliminary studies have suggested that DNN and HA gel glans penis augmentation are relatively safe and effective, but due to a lack of large, multicenter, randomized-control trials with long-term follow-up, the International Society of Sexual Medicine (ISSM) has been unable to endorse DNN or HA gel glans penis augmentation as options in the treatment of PE. Conflicting data regarding the efficacy and safety of circumcision has similarly led to its exclusion from ISSM recommendations for the treatment of PE. Ethical concerns, particularly the fundamental concept of non-maleficence, are also barriers to the implementation of surgery for PE.
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Affiliation(s)
- James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Abstract
INTRODUCTION Over the past 20-30 years, the premature ejaculation (PE) treatment paradigm, previously limited to behavioral psychotherapy, has expanded to include drug treatment. Pharmacotherapy for PE predominantly targets the multiple neurotransmitters and receptors involved in the control of ejaculation, which include serotonin, dopamine, oxytocin, norepinephrine, gamma amino-butyric acid (GABA) and nitric oxide (NO). AIM The objective of this article is to review current and emerging PE interventions. METHODS Contemporary data on the treatment of PE were reviewed and critiqued using the principles of evidence-based medicine. MAIN OUTCOME MEASURE Integrated pharmacotherapy and cognitive behavioral therapy (CBT) may achieve superior treatment outcomes in some patients. Phosphodiesterase type 5 inhibitors alone or in combination with selective serotonin reuptake inhibitors (SSRIs) should be limited to men with acquired PE secondary to comorbid erectile dysfunction (ED). New on-demand rapid-acting SSRIs, oxytocin receptor antagonists, or single agents that target multiple receptors may form the foundation of more effective future on-demand medication. RESULTS Multiple well-controlled evidence-based studies have demonstrated the efficacy and safety of SSRIs in delaying ejaculation, confirming their role as first-line agents for the medical treatment of lifelong and acquired PE. Daily dosing of SSRIs is likely to be associated with superior fold increases in intravaginal ejaculation latency time compared with on-demand SSRIs. On-demand SSRIs are less effective but may fulfill the treatment goals of many patients. CONCLUSIONS Current evidence suggests that psychosexual CBT has a limited role in the contemporary management of PE and confirms the efficacy and safety of dapoxetine, off-label SSRI drugs, and topical anesthetics drugs. Treatment with tramadol, α1-adrenoceptor antagonists cannot be recommended until the results of large, well-designed randomized controlled trials are published in major international peer-reviewed medical journals. As our understanding of the neurochemical control of ejaculation improves, new therapeutic targets and candidate molecules will be identified, which may increase our pharmacotherepeutic armamentarium. McMahon CG. Current and emerging treatments for premature ejaculation. Sex Med Rev 2015;3:183-202.
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Affiliation(s)
- Chris G McMahon
- Australian Centre for Sexual Health, Sydney, NSW, Australia.
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Moon DG, Kwak TI, Kim JJ. Glans Penis Augmentation Using Hyaluronic Acid Gel as an Injectable Filler. World J Mens Health 2015; 33:50-61. [PMID: 26331121 PMCID: PMC4550597 DOI: 10.5534/wjmh.2015.33.2.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/17/2015] [Accepted: 05/31/2015] [Indexed: 11/15/2022] Open
Abstract
Glans penis augmentation (GPA) has received little attention from experts despite the existence of a subset of patients who may be dissatisfied with a small glans or poor tumescence of the glans during erection. Recently, GPA using an injectable filler or implantation of a graft or filler has been developed. Despite a demanding injection technique and inevitable uneven undulation of the glandular surface, GPA using injectable hyaluronic acid (HA) gel is a novel and useful therapy and an effective and safe procedure for soft tissue enhancement. For long-term presence of implants, timed supplementation can be used similar to that for fascial plasty. In complications such as mucosal necrosis of the glans penis, most cases occur from the use of non-HA gel or an unpurified form and misunderstanding of the management protocol for immediate side effects. Currently, GPA using injectable HA gel is not recommended in the International Society for Sexual Medicine guideline due to possible sensory loss. In a 5-year long-term follow-up of GPA by subcutaneous injection of HA gel, the residual volume of implants decreased by 15% of the maximal glandular circumference, but was still effective for alleviating the hypersensitivity of the glans penis in premature ejaculation patients. For efficacy in premature ejaculation, selection of appropriate candidates is the most important factor for success. GPA does not harm erectile function and is less invasive and irreversible compared to dorsal neurectomy. To refine the procedure, more interest and well-designed studies are required for the establishment of the procedure.
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Affiliation(s)
- Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Tae Il Kwak
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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Littara A, Palmieri B, Rottigni V, Iannitti T. A clinical study to assess the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. Int J Impot Res 2013; 25:117-20. [PMID: 23552577 DOI: 10.1038/ijir.2013.13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Premature ejaculation is a sexual debilitating condition affecting a large number of men worldwide and leading to important dysfunctions influencing the patients' affective and emotional life. Hyaluronic acid is a natural and safe compound that has been widely used not only in the aesthetic medicine clinic, but also for treatment of osteoarthritis. The present study shows the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. A hundred and ten male patients were treated with hyaluronic acid injections in the deep dermis of their glans penis to increase the volume and the circumference of their penis to prevent male premature ejaculation and improve the patients' and their partners' sexual satisfaction. The intravaginal ejaculation latency time increased significantly from a baseline value of 88.34±3.14 s to 293.14±8.16 s after 6 months from the procedure. Maximal glandular circumference increased from 98.51±0.71 mm to 114.35±0.66 mm after 6 months from the procedure. At 6-month follow-up, patients' self-rated satisfaction was 5.3±0.07 (range: 4–6). At the follow-up, partners' self-rated satisfaction was 5.1±0.09 (range: 3–6). The present clinical study showed that hyaluronic acid injection is a promising treatment for premature ejaculation. The effect of the procedure in the long-term follow-up needs to be clarified.
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Abstract
BACKGROUND Penis enlargement is increasingly in demand. Methods for penis enlargement can be classified into surgical, nonsurgical (filling), and mechanical. Each method has shown only relatively successful results. A new formulation of injectable, stabilized, hyaluronic acid (HA)-based, nonanimal gel is available that may have applications for this use. OBJECTIVES The authors propose a new technique for emicircumferential-injection filling of the penis and assess the safety and efficacy of this procedure compared with lipofilling. METHODS The authors retrospectively reviewed the charts of 83 patients who underwent penis enlargement with either their HA-injection technique or lipofilling between December 2007 and July 2011. Safety, efficacy, and patient satisfaction were assessed. RESULTS The circumferential enlargement obtained from both techniques ranged from 3.2 to 4.5 cm, with a decrement during erection. In all patients, the increase in penis length ranged from 1.8 to 3.6 cm. No complications were seen in patients treated with HA, whereas 8 patients treated with lipofilling developed granuloma, and another experienced fat necrosis. The vast majority (n = 72) of patients reported being "very satisfied" with the results. CONCLUSIONS The ideal technique for penis enlargement should be nonsurgical, with a satisfactory and predictable result, a low rate of complications, and long-term stability. Emicircumferential enlargement with HA filler meets these requirements. However, results have been durable but not definitive, and repeated treatment (with associated costs) is necessary.
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Affiliation(s)
- Giuseppe Sito
- Department of Plastic Surgery, University Federico II, Naples, Italy
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Abdallah H, Abdelnasser T, Hosny H, Selim O, Al-Ahwany A, Shamloul R. Treatment of premature ejaculation by glans penis augmentation using hyaluronic acid gel: a pilot study. Andrologia 2011; 44 Suppl 1:650-3. [PMID: 22013959 DOI: 10.1111/j.1439-0272.2011.01244.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Premature ejaculation (PE) is by far the most common male sexual complaint, with millions of men affected all over the world. It is estimated that up to 20-30% of all men may be suffering from various forms of PE. A variety of filler materials are widely used nowadays for soft tissue augmentation. The appropriate filler can restore symmetry, volume and create a smooth skin surface The aim of this pilot study was to evaluate the therapeutic effect of hyaluronic acid gel injection in patients with PE. Sixty men with self-reported PE who were referred to our outpatient andrology clinic (between January 2007 and January 2008) were included in this study. Participants were randomly assigned using random sampling numbers into two distinct groups. Group A (n = 30) received a single injection of 2 ml of hyaluronic acid gel (Hyalift 3.5% micronised hyaluronic acid) using the previously described fan technique. Group B (n = 30) received a single injection of 2 ml of hyaluronic acid gel using the multiple puncture technique. Twenty-three patients (46.9%) received injection by the fan technique, while 26 patients (53.1%) received it through the multiple-point technique. The mean intravaginal ejaculation latency time (IELT) increased significantly from 2.12 ± 1.16 to 7.71 ± 7.86 min, after 1 month of injection and then dropped to 5.32 ± 3.52 min, but still remaining significantly higher than the baseline values. Results from our present pilot study demonstrated the usefulness of the application of hyaluronic acid dermal fillers in the treatment of PE; however, further investigations in large cohorts with longer follow-up are definitely needed to obtain more consistent results.
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Affiliation(s)
- H Abdallah
- Andrology Department, Cairo University, Cairo, Egypt
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Abstract
Background and Aim: Premature ejaculation (PE) is the most prevalent sexual dysfunction in every country. There are many types of treatment, but the main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medicine. The prepuce is a specific erogenous zone that contains a rich and complex network of nerves. Circumcision radically desensitizes the penis, but incomplete circumcision may cause premature ejaculation. We evaluate the effect of removal of foreskin remnants in adults on PE. Materials and Methods: The sensitive area of penile skin and the remaining parts of foreskin in adult men were recognized in 47 selective patients. Under local anesthesia, the remnant parts of foreskin were incised and removed. They were asked to fill the investigating questionnaire about the changes of intravaginal latency ejaculatory time (IVELT), patients and their sexual partners’ satisfaction with sexual life, control over ejaculation, and penile sensitivity, before and after treatment. Results: There were no signs of inflammation and no serious adverse reactions in all cases after operation. IVELT significantly increased from 64.25 before surgery to 731.49 sec after surgery (P<0.001). The percentage of postoperative satisfaction in both the patient and his partner significantly increased (P<0.001). After surgery, 95.7% of men had better control over their ejaculation. This surgery significantly decreased sensitivity of penis (P<0.001), but it did not change glans penis insensitivity. Conclusions: These results indicate that removal of foreskin remnants in adults is an effective modality in selective patients of PE.
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Affiliation(s)
- Mohammad Reza Namavar
- Department of Anatomical Sciences, School of Medicine, Histomorphometric and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Park HJ, Park JK, Park K, Lee SW, Kim SW, Yang DY, Moon DG, Min KS, Moon KH, Yang SK, Hyun JS, Park NC. Prevalence of premature ejaculation in young and middle-aged men in Korea: a multicenter internet-based survey from the Korean Andrological Society. Asian J Androl 2010; 12:880-9. [PMID: 20676115 DOI: 10.1038/aja.2010.9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this study, we aimed to investigate the prevalence and perception of premature ejaculation (PE) in young and middle-aged Korean men. The study was conducted using an Internet-assisted questionnaire. A total of 2 037 Korean male adults, aged 20 years or older, were randomly sampled based on age and residency. The questionnaire developed by the PE Study Group of the Korean Andrological Society includes four categories (overall sexual function, symptoms, distress and treatment) with a total of 16 questions. For each question, symptoms were evaluated by a scale ranging from 0 to 10. Intravaginal ejaculation latency time was '5-10 min' in 38.6%, followed by 'longer than 10 min' in 29.9%, '2-5 min' in 23.6%, '1-2 min' in 5.4% and 'shorter than 1 min' in 2.5%. In our series, 27.5% of respondents reported having PE. Control over ejaculation within a recent 3-month period was 6.2 points on average. Respondent complaints of PE-related stress averaged 7.1 points and stress-related complaints from sexual partners averaged 7.1 points. The effect of PE on sexual life was 6.8 points. Of the respondents determined as having PE, 42.6% responded that they were inclined to receive treatment. Results from this study suggest that the prevalence of PE diagnosed by the respondent on his own was approximately 27.5% in young and middle-aged men in Korea. PE-related stress had a significant effect on the stress, sexual activity and quality of life of the respondent and his sexual partner.
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Affiliation(s)
- Hyun Jun Park
- Deparment of Urology, Pusan National University School of medicine, Busan 602739, Korea
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Abstract
Premature ejaculation (PE) is the most common sexual problem affecting men. It can affect men at all ages and has a serious impact on the quality of life for men and their partners. Currently there are no pharmaceutical agents approved for use in the UK, and so all drugs used for this condition are off label. Behavioral therapy has been used to treat PE, but the results are not durable once therapy has been concluded. Several topical therapies have been used including severance-secret (SS) cream, lignocaine spray, lidocaine-prilocaine cream and lidocaine-prilocaine spray (TEMPE). There has been recent interest in the selective serotonin reuptake inhibitors (SSRIs) for the treatment of PE, due to the fact that one of their common side effects is delayed ejaculation. Currently used SSRIs have several non-sexual side effects and long half lives, therefore there has been interest in developing a short acting, efficacious SSRI that can be used on-demand for PE. Dapoxetine has been recently evaluated for the treatment of PE by several groups, and results so far appear promising.
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Powell JA, Wyllie MG. ‘Up and coming’ treatments for premature ejaculation: progress towards an approved therapy. Int J Impot Res 2009; 21:107-15. [DOI: 10.1038/ijir.2008.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kwak TI, Jin MH, Kim JJ, Moon DG. Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation. Int J Impot Res 2008; 20:425-8. [PMID: 18548080 DOI: 10.1038/ijir.2008.26] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The authors created the glans penis augmentation by injectable hyaluronic acid gel and reported the 6-month result for premature ejaculation. In a total of 38 patients, long-term effects of 5 years were compared to those of 6 months in terms of residual volume of implants and efficacy on premature ejaculation. Maximal glandular circumference measured by tapeline significantly decreased by 15% (P<0.05) but mean patient's visual estimation (Gr 0-Gr 4) did not decrease (3.60 vs 3.56, P>0.05). Compared to 6-month follow-up, intravaginal ejaculatory latency time and vibratory threshold decreased at 5 years (P<0.05), but still well increased considering those of preaugmentation. Hence, 76% of patients and 63% of partners were still satisfied. There was no serious adverse reaction. In the 5-year long-term follow-up of glans penis augmentation by filler, the implants were well maintained and effective for glans penis hypersensitivity in premature ejaculation patients.
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Abstract
Premature ejaculation (PE) is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration (FDA). Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.
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Affiliation(s)
- Levent Gurkan
- Department of Urology, Tulane University Health Sciences Center, New Orleans, LA 70112, USA
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Bettocchi C, Verze P, Palumbo F, Arcaniolo D, Mirone V. Ejaculatory disorders: pathophysiology and management. ACTA ACUST UNITED AC 2008; 5:93-103. [DOI: 10.1038/ncpuro1016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 11/09/2007] [Indexed: 01/24/2023]
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50
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Ham WS, Kim WT, Choi HK, Choi YD. Recent Concepts of Premature Ejaculation. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.9.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Won Sik Ham
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Tae Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Ki Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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