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Bolat MS, Bolat IA, Dündar C, Asci R. Which is better to predict erectile dysfunction and male sexual function in the context of metabolic syndrome: triglyceride-glucose index or visceral adiposity index?: a retrospective cross-sectional study. Int Urol Nephrol 2024:10.1007/s11255-024-04057-x. [PMID: 38687440 DOI: 10.1007/s11255-024-04057-x] [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: 02/16/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Many factors influence male sexual function, including metabolic disorders such as metabolic syndrome (MetS). We aimed to investigate the effects of two metabolic indices, the triglyceride-glucose (TyG) index and the visceral adiposity index (VAI), on male sexual function. METHODS A total of 400 men having sexual dysfunction were included. Anthropological data, comorbidities were recorded. Serum total testosterone, prolactin, and estradiol levels were recorded. Sex-specific VAI was calculated using the [(WC/39.68) + (1.88xMI)] × (TG/1.03) × (1.31/HDL) formula and using Ln (fasting triglycerides) × (fasting glucose)/2] formula, TyG index was calculated. Turkish-validated 15-item long-form of the International Index of Erectile Dysfunction (IIEF) questionnaire and male sexual health questionnaire (MSHQ) were used for erectile function and ejaculatory function, respectively. The ROC analysis was used to evaluate the predictive abilities of TyG and VAI cut-off values for ED risk. RESULTS A higher TyG index and VAI were associated with an increased risk of ED. The presence of MetS further worsened sexual function, with lower scores in sexual satisfaction, orgasm, desire, and general satisfaction. The TyG index and VAI showed similar predictive abilities for ED. Patients with MetS had worse ejaculation quality compared to those without MetS. CONCLUSIONS These findings highlight the potential of the TyG index and VAI as convenient tools for predicting and assessing sexual dysfunction in men, particularly in the context of metabolic disorders. Early detection and intervention for metabolic syndrome and insulin resistance may help to mitigate their negative impact on male sexual function.
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Affiliation(s)
- Mustafa Suat Bolat
- Medicana International Hospital, Urology Clinic, Canik/Samsun Türkiye. Atilim University, Yenimahalle, Şht. Mesut Birinci Cd. No:85, 55080, Ankara, Türkiye.
- Atılım University, Faculty of Medicine, Ankara, Türkiye.
| | - Ipek Akalin Bolat
- Clinic of Obstetrics and Gynaecology, Samsun Training and Research Hospital, Health Sciences University, Samsun, Türkiye
| | - Cihad Dündar
- Department of Public Health, Ondokuz Mayis University, Samsun, Türkiye
| | - Ramazan Asci
- Department of Urology, Ondokuz Mayis University, Samsun, Türkiye
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Alipour-Kivi A, Eissazade N, Shariat SV, Salehian R, Soraya S, Askari S, Shalbafan M. The effect of drug holidays on sexual dysfunction in men treated with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine: an 8-week open-label randomized clinical trial. BMC Psychiatry 2024; 24:67. [PMID: 38263040 PMCID: PMC10807197 DOI: 10.1186/s12888-024-05507-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) are widely used for the treatment of various mental disorders. Sexual dysfunction is one of the most common side effects of SSRIs, and often leads to poor adherence and treatment discontinuation. While several strategies have been employed to manage SSRI-induced sexual dysfunction, drug holidays has not been extensively studied for this purpose. This clinical trial aims to assess the effect of drug holidays on sexual dysfunction in married men under treatment with SSRIs other than fluoxetine (as its long half-life makes drug holidays ineffective). METHODS This 8-week double-center, randomized, open-label, controlled trial was conducted in the outpatient clinics of Iran Psychiatric Hospital and Tehran Institute of Psychiatry, from January 2022 to March 2023. We included married men aged between18 and 50 years who had experienced sexual dysfunction during treatment with SSRIs, other than fluoxetine. The Male Sexual Health Questionnaire (MSHQ) and the 28-Question General Health Questionnaire (GHQ-28) were used for the assessment of sexual function and mental health status. The drug holidays group was instructed not to take their medications on the weekends. The control group was asked to continue their regular medication regimen without any changes. Both groups were assessed at baseline, and weeks 4 and 8. RESULTS Sixty-three patients were included and randomly assigned to the drug holidays group (N = 32) or the control group (N = 31). Fifty patients (25 in each group) completed the trial. Drug holidays significantly improved erection, ejaculation, satisfaction, and the overall sexual health of the participants (P < 0.001). No significant change was observed in their mental health status. No major side effects were recorded. CONCLUSIONS Drug holidays significantly improved the MSHQ scores in 'erection', 'ejaculation', 'satisfaction' and 'total' in married men with sexual dysfunction induced by SSRIs, other than fluoxetine, without causing any significant changes in their mental health status. Further research is needed to reach a certain conclusion. TRIAL REGISTRATION The trial was registered at the Iranian Registry of Clinical Trials on 2021.10.25 ( www.irct.ir ; IRCT ID: IRCT20170123032145N6) before the trial.
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Affiliation(s)
- Arman Alipour-Kivi
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Negin Eissazade
- Brain and Cognition Clinic, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Salehian
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Soraya
- Research Center for Addiction and Risky Behaviors (ReCARB), Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Askari
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Besong EE, Akhigbe TM, Ashonibare PJ, Oladipo AA, Obimma JN, Hamed MA, Adeyemi DH, Akhigbe RE. Zinc improves sexual performance and erectile function by preventing penile oxidative injury and upregulating circulating testosterone in lead-exposed rats. Redox Rep 2023; 28:2225675. [PMID: 37345699 DOI: 10.1080/13510002.2023.2225675] [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] [Indexed: 06/23/2023] Open
Abstract
AIM The present study evaluated the effect of lead exposure with and without zinc therapy on male sexual and erectile function. METHODS Twenty male Wistar rats were randomly assigned into four groups; the control, zinc-treated, lead-exposed, lead + zinc-treated groups. Administrations were per os daily for 28 days. RESULTS Zinc co-administration significantly improved absolute and relative penile weights and the latencies and frequencies of mount, intromission, and ejaculation in lead-exposed rats. Also, zinc ameliorated lead-induced reductions in motivation to mate and penile reflex/erection. These findings were accompanied by attenuation of lead-induced suppression of circulating nitric oxide (NO), penile cyclic guanosine monophosphate (cGMP), dopamine, serum luteinizing hormone, follicle-stimulating hormone, and testosterone. In addition, zinc alleviated lead-induced upregulation of penile activities of acetylcholinesterase and xanthine oxidase (XO), and uric acid (UA) and malondialdehyde (MDA) levels. Furthermore, zinc ameliorated the lead-induced decline in penile nuclear factor erythroid 2-related factor 2 (Nrf2) and reduced glutathione (GSH) levels, and catalase, superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione-S-transferase (GST) activities. CONCLUSION This study revealed that co-administration of zinc improves lead-induced sexual and erectile dysfunction by suppressing XO/UA-driven oxidative stress and upregulating testosterone via Nrf2-mediated signaling.
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Affiliation(s)
- Elizabeth Enohnyket Besong
- Department of Physiology, Faculty of Basic Medical Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Tunmise Maryanne Akhigbe
- Breeding and Plant Genetics Unit, Department of Agronomy, Osun State University, Osogbo, Osun State, Nigeria
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
| | - Precious Jesutofunmi Ashonibare
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Abimbola Ayoola Oladipo
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Jacinta Nkechi Obimma
- Department of Physiology, Faculty of Basic Medical Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Moses Agbomhere Hamed
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
- Department of Medical Laboratory Science, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
- The Brainwill Laboratory, Osogbo, Osun State, Nigeria
| | - Damilare Hakeem Adeyemi
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Osun State, Nigeria
| | - Roland Eghoghosoa Akhigbe
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
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Hadidi AT, Fawzy M, Sennert M, Wirmer J. The Natural (non-invasive) Erection Test: Is it a reliable alternative to the artificial erection test? J Pediatr Urol 2023; 19:702-707. [PMID: 37652827 DOI: 10.1016/j.jpurol.2023.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
AIM OF THE STUDY To test the accuracy and reliability of the natural erection test (NET) as compared to the artificial erection test in assessing penile curvature in hypospadias. MATERIALS AND METHODS 50 children underwent both natural and artificial erection tests intraoperatively between January 2020 and October 2021. These included 5 glandular, 26 distal, 9 proximal, and 10 perineal hypospadias patients with curvature. The mean follow up period was 20 months (range 16-37). Under anesthesia, the curvature was assessed before degloving, then after degloving using both the natural and the artificial erection test. The NET test was repeated after curvature correction (3 times per patient). The measurements were analyzed using paired t-test. TECHNIQUE OF NATURAL ERECTION TEST Two fingers of the left hand press just below the symphysis pubis to stop blood drainage from the penis and two fingers of the right hand massage the blood from the perineum distally into the penis until it becomes hard without tourniquet. The standard artificial erection test was performed using saline injected through a butterfly needle into the corporeal bodies without tourniquet. Photos were taken of both tests using the exact angle and angle of curvature was measured using Angle Meter App. RESULTS There was no statistically significant difference between both erection tests with a P value of 0.705. The Bland-Altman plot also showed that all studied children have a difference in their natural and artificial erection tests within the limits of agreements. DISCUSSION Erection is commonly induced using the artificial saline injected erection test first described by Gittes and less commonly using pharmaceutical erection test first described by Perovic. The severity of chordee apparent during artificial erection test varies with the amount of pressure used during injection. Also, it is difficult to place the tourniquet proximal enough to detect chordee at the base of the penis. It may be associated with hematoma formation, oedema, postoperative pain and the need for multiple punctures to assess the curvature before and after repair. Disadvantages of the pharmacological-induced erections in hypospadias include increased blood loss during erection, additional cost, and the need for a reversal agent. The natural erection test mimic the normal erection mechanism and may avoid all these potential disadvantages. CONCLUSION The study showed that the natural erection test is easy to perform, non-invasive, non-traumatic and can be repeated several times intraoperatively without the need of repeated puncturing of the corpora cavernosa and avoids the potential risks and complications of the artificial erection test.
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Affiliation(s)
- Ahmed T Hadidi
- Hypospadias Center, Pediatric Surgery Department, Sana Klinikum Offenbach, Frankfurt, Germany.
| | - Mohamed Fawzy
- Hypospadias Center, Pediatric Surgery Department, Sana Klinikum Offenbach, Frankfurt, Germany
| | - Michael Sennert
- Hypospadias Center, Pediatric Surgery Department, Sana Klinikum Offenbach, Frankfurt, Germany
| | - Johannes Wirmer
- Hypospadias Center, Pediatric Surgery Department, Sana Klinikum Offenbach, Frankfurt, Germany
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Akhigbe RE, Hamed MA, Odetayo AF, Akhigbe TM, Oyedokun PA. Zinc improves sexual and erectile function in HAART-treated rats via the upregulation of erectogenic enzymes and maintenance of redox balance. Aging Male 2023; 26:2205517. [PMID: 37144473 DOI: 10.1080/13685538.2023.2205517] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE HAART has been shown to impair sexual function and penile erection via perturbation of penile redox balance, while zinc has been established to exert antioxidant activity. Therefore, this study focused on the role and associated molecular mechanism of zinc in HAART-induced sexual and erectile dysfunction. MATERIALS AND METHODS Twenty male Wistar rats were randomly grouped into four (n = 5 rats per group); the control, zinc-treated, HAART-treated, and HAART + zinc-treated groups. Treatments were per os daily for eight weeks. RESULTS Zinc co-administration significantly improved HAART-induced increase in the latencies of mount, intromission, and ejaculations. Zinc also attenuated HAART-induced reduction in the motivation to mate, penile reflex/erection, and frequencies of mount, intromission, and ejaculations. In addition, zinc co-treatment improved HAART-induced decline in penile NO and cGMP, dopamine, and serum testosterone. More so, zinc prevented HAART-induced rise in penile activities of monoamine oxidase, acetylcholinesterase, phosphodiesterase-5, and arginase. Furthermore, concomitant treatment with zinc ameliorated HAART-induced penile oxidative stress and inflammation. CONCLUSION In conclusion, our present findings show that zinc improves sexual and erectile function in HAART-treated rats by upregulating erectogenic enzymes via the maintenance of penile redox balance.
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Affiliation(s)
- R E Akhigbe
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
| | - M A Hamed
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
- Department of Medical Laboratory Science, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
- The Brainwill Laboratories and Biomedical Services, Osogbo, Osun State, Nigeria
| | - A F Odetayo
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
- Department of Physiology, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - T M Akhigbe
- Reproductive Biology and Toxicology Research Laboratory, Oasis of Grace Hospital, Osogbo, Osun State, Nigeria
- Department of Agronomy, Osun State University (Ejigbo Campus), Osogbo, Nigeria
| | - P A Oyedokun
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
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Chaker K, Ouanes Y, Chedly WB, Bibi M, Mosbahi B, Fakhfakh H, Abed WE, Hriz A, Rahoui M, Dali KM, Ammous A, Nouira Y. [Outcomes of early endoscopic realignment of post-traumatic posterior urethral ruptures]. Prog Urol 2023; 33:469-473. [PMID: 37634959 DOI: 10.1016/j.purol.2023.08.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/16/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury. PATIENTS AND METHODS We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up. RESULTS Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25). CONCLUSION Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Kays Chaker
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie.
| | - Yassine Ouanes
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Wassim Ben Chedly
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Mokhtar Bibi
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Boutheina Mosbahi
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Hend Fakhfakh
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Wiem El Abed
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Aziz Hriz
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Moez Rahoui
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | | | - Adel Ammous
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Yassine Nouira
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
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Wen YX, Fan LY, Yang AY, Zhang YC, Xu C, Wang ZH, Xie WJ, Lu Y, Zhang XY, Zhu JN, Sun A, Li L, Zhang QP. Oxytocinergic neurons, but not oxytocin, are crucial for male penile erection. Neuropharmacology 2023; 235:109576. [PMID: 37164226 DOI: 10.1016/j.neuropharm.2023.109576] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/12/2023]
Abstract
The cumulative evidence suggests that oxytocin is involved in the male sexual behaviors. However, no significant sexual impairments were observed in oxytocin gene knock-out (KO) mice, suggesting that oxytocin is not necessary for sexual behavior in male mice. To better understand the role of oxytocin in male erection, two types of oxytocin gene KO mice were created. In the first type, the oxytocin gene was deleted in the zygote, while in the second type, the oxytocin gene was mutated in adulthood by injecting the CRISPR/Cas9 AAVs. The results showed that disrupting the oxytocin gene at either the embryonic or adult stage did not affect erection, indicating that oxytocin is not necessary for penile erection. Pharmacologically, injecting oxytocin receptor agonist Carbetocin into the VTA of the oxytocin gene KO mice still evoked penile erection. By employing the Oxt-Ires-Cre mice, we found that specifically activating oxytocinergic neurons through chemogenetics strongly induced penile erection, while inhibiting these neurons blocked the erection responses. Furthermore, ablating PVN oxytocinergic neurons abolished the male erection response. In conclusion, although the neuropeptide oxytocin is not essential for male erection, the activity of oxytocinergic neurons is required. Our results might reflect the redundancy in the central nerve system in the sense that many signals contribute to the activation of oxytocinergic neurons to evoke penile erection during sexual behaviors.
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Affiliation(s)
- Yu-Xiang Wen
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Lin-Yao Fan
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - An-Yong Yang
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Yan-Chufei Zhang
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Chang Xu
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Zi-Hui Wang
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Wen-Jiong Xie
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Yang Lu
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Xiao-Yang Zhang
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Jing-Ning Zhu
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Anyang Sun
- Laboratory of Neurodegenerative Diseases & Molecular Imaging, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China.
| | - Liang Li
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China.
| | - Qi-Peng Zhang
- Nanjing Drum Tower Hospital Center of Molecular Diagnostic and Therapy, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, NJU Advanced Institute of Life Sciences (NAILS), NJU Institute of AI Biomedicine and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China.
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Beirnaert J, Benarroche D, Tabourin T, Weis S, Faix A, Beley S, Huyghe E, Guillot-Tantay C, Droupy S, Akakpo W, Pinar U, Rouprêt M. [French language validation of the SSIPI questionnaire assessing the satisfaction of patients with penile implant]. Prog Urol 2023; 33:21-26. [PMID: 36153223 DOI: 10.1016/j.purol.2022.09.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The objective of this study was to propose a French version of the satisfaction survey for inflatable penile implant (SSIPI) questionnaire. MATERIAL Questionnaire validation was performed in three steps: translation into French by two urologists, its validation by the committee of andrologist and sexual medicine (CAMS) and an independent translation in English by another urologist to exclude any distortion with the original version. Furthermore, the questionnaire was tested in few patients having penile implant. RESULTS The andrology committee approved the French version of the questionnaire. The final version of the questionnaire was successfully tested on all patients. Every patient (n=10) confirmed the good comprehension and pertinence of the questions, and the easy response selection. CONCLUSION This French version of the SSIPI questionnaire will allow French-speaking urologists to assess the satisfaction of their patients with a penile implant on a large scale. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jeanne Beirnaert
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; Université Libre de Bruxelles, hôpital Erasme, service d'urologie, 1080 Bruxelles, Belgique
| | - Davy Benarroche
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Thomas Tabourin
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Sylvia Weis
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Antoine Faix
- Polyclinique Saint-Roch, service d'urologie, 34070 Montpellier, France
| | - Sébastien Beley
- Hôpital américain de Paris, service d'urologie, 92200 Neuilly-sur-Seine, France
| | - Eric Huyghe
- CHU de Toulouse, hôpital Rangueil, service d'urologie, 31059 Toulouse, France
| | | | | | - William Akakpo
- Clinique Ambroise Paré, service d'urologie, 92200 Neuilly-sur-Seine, France
| | - Ugo Pinar
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Morgan Rouprêt
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France.
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Chen BH, Chen CF, Lee CC, Chiu AW. Prolonged penile erection: A case report of ischemic priapism. Asian J Surg 2022; 45:3021-3022. [PMID: 35842387 DOI: 10.1016/j.asjsur.2022.06.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Bo-Han Chen
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chi-Fang Chen
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Chiao Lee
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan; School of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| | - Allen W Chiu
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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10
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Manfredi C, García-Gómez B, Arcaniolo D, García-Rojo E, Crocerossa F, Autorino R, Gratzke C, De Sio M, Romero-Otero J. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 2022; 8:1711-1732. [PMID: 35803852 DOI: 10.1016/j.euf.2022.06.007] [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: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO). OBJECTIVE To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907). EVIDENCE SYNTHESIS A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006). CONCLUSIONS Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk. PATIENT SUMMARY Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
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Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
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11
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Rohrer GE, Premo H, Lentz AC. Current Techniques for the Objective Measures of Erectile Hardness. Sex Med Rev 2022; 10:648-659. [PMID: 37051971 DOI: 10.1016/j.sxmr.2022.05.001] [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: 10/29/2021] [Revised: 03/12/2022] [Accepted: 05/10/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION One of the most discussed topics in the urology provider's office is that of the male penile erection. Moreover, this is also a frequent basis for consultation by primary care practitioners. As such, it is essential that urologists are familiar with the various means by which the male erection may be evaluated. OBJECTIVES This article describes several techniques presently available that may serve to objectively quantify the rigidity and hardness of the male erection. These techniques are meant to bolster information gathered from the patient interview and physical examination to better guide patient management. METHODS An extensive literature review was performed examining publications in PubMed on this subject, including corresponding contextual literature. RESULTS While validated patient questionnaires have been routinely employed, the urologist has many additional means available to uncover the extent of the patient's pathology. Many of these tools are noninvasive techniques that involve virtually no risk to the patient and take advantage of pre-existing physiologic properties of the phallus and its blood supply to estimate corresponding tissue stiffness. Specifically, Virtual Touch Tissue Quantification which precisely quantifies axial and radial rigidity, can provide continuous data on how these forces change over time, thus providing a promising comprehensive assessment. CONCLUSION Quantification of the erection allows for the patient and provider to assess response to therapy, aids the surgeon in choice of appropriate procedure, and guides effective patient counseling regarding expectation management. Rohrer GE, Premo H, Lentz AC. Current Techniques for the Objective Measures of Erectile Hardness. Sex Med Rev 2022;XX:XXX-XXX.
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Affiliation(s)
- Gabrielle E Rohrer
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Hayley Premo
- Duke University School of Medicine, Durham, NC, USA
| | - Aaron C Lentz
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
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12
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Dekalo S, Stern N, Broderick GA, Brock G. Priapism or Prolonged Erection: Is 4 - 6 Hours of Cavernous Ischemia the Time Point of Irreversible Tissue Injury? Sex Med Rev 2022; 10:660-668. [PMID: 37051958 DOI: 10.1016/j.sxmr.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/06/2022] [Revised: 06/02/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ischemic priapism remains a significant cause of morbidity among men. To date, the precise time when penile ischemia results in permanent, non-reversible cavernosal smooth muscle injury, compromising subsequent erectile integrity, remains ill-defined. OBJECTIVES To review the medical literature pertaining to ischemic priapism, focusing on factors that predict the exact timeline of irreversible cavernous tissue injury. METHODS A comprehensive literature search was performed. Our search included both publications on animal models and retrospective clinical series through January 2022. Articles were eligible for inclusion if they contained original data regarding nonreversible tissue injury on histology and/or provided a timeline of erectile function loss or preservation and had full text available in English. RESULTS Innovative studies in the 1990s using invitro models with strips of rabbit, rat, canine and monkey corpus cavernosal tissue demonstrated that anoxia eliminated spontaneous contractile activity and reduced tissue responsiveness to electrical field stimulation or pharmacological agents. The same models demonstrated that the inhibitory effects of field stimulated relaxation, were mediated by nitric oxide. Subsequent studies using similar models demonstrated that exposure of corpus cavernosum smooth muscle to an acidotic environment impairs its ability to contract. A pH of 6.9 was chosen for these experiments based on a case series of men with priapism, in whom a mean pH of 6.9 was measured in corporal blood after 4-6 hours of priapism. Invivo animal studies demonstrated that after erection periods of 6-8 hours, microscopy shows sporadic endothelial defects but otherwise normal cavernous smooth muscle. In these studies, greater durations of ischemic priapism were shown to result in more pronounced ultrastructural changes and presumably irreversibility. In studies involving human corporal tissues, samples were obtained from men who had experienced priapism for at least 12 hours. Overall, erectile function outcome data is deficient in priapism reporting, especially within treatment windows less than 6 hours. Some reports on ischemic priapism have documented good erectile function outcomes with reversal by 12 hours. CONCLUSION Based on our extensive review of animal models and clinical reports, we found that many clinical papers rely on the same small set of animal studies to suggest the time point of irreversible ischemic damage at 4-6 hours. Our review suggests an equal number of retrospective clinical studies demonstrate that ischemic priapism reversed within 6-12 hours may preserve erectile function in many patients. Dekalo S, Stern N, Broderick GA, et al. Priapism or Prolonged Erection: Is 4 - 6 Hours of Cavernous Ischemia the Time Point of Irreversible Tissue Injury? Sex Med Rev 2022;XX:XXX-XXX.
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Affiliation(s)
- Snir Dekalo
- Division of Urology, Western University, Department of Surgery, London, ON, Canada.
| | - Noah Stern
- Division of Urology, Western University, Department of Surgery, London, ON, Canada
| | | | - Gerald Brock
- Division of Urology, Western University, Department of Surgery, London, ON, Canada; Omega Fertility and Andrology Clinic, London, ON, Canada
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13
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Peradejordi Font MR, Mercader Barrull C, López Martínez JM, Corral Molina JM, García Cruz E, Alcaraz Asensio A, Peri Cusi L. Consequences of penile fracture: Complications and long-term functional outcomes. Actas Urol Esp 2022; 46:178-183. [PMID: 35277377 DOI: 10.1016/j.acuroe.2021.12.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Penile fracture (PF) is a urological emergency with low incidence, and evidence of its long-term outcomes is scarce. This study focuses on postoperative complications and long-term functional outcomes in patients with PF and surgical repair at our center. MATERIALS AND METHOD Clinical records of patients undergoing urgent surgery for PF at a third level hospital between 2006 and 2020 were retrospectively reviewed. Functional outcomes were assessed with voluntary telephone interviews from June 2020 to February 2021. Lower urinary tract symptoms were screened by IPSS questionnaire, sexual function by EHS and IIEF-5 and morphological alterations by direct questions to patients. RESULTS A total of 41 patients underwent surgery for PF. Eleven of them also had urethral injury (higher incidence if there was bilateral corpora cavernosa injury, 19.4% vs. 80%, p < 0.05). Only 1 patient presented a Clavien-Dindo type 3a complication due to wound dehiscence, 4 (13%) type 2 and 9 (29%) type 1. Twenty-four patients underwent long-term follow-up, of whom 20 (83.3%) presented normal sexual function. Twelve patients (50%) had a palpable nodule at the fracture site, 8 (33.3%) had new onset penile curvature and 1 patient with previous urethral injury presented urethral stricture. CONCLUSION In cases of penile fracture, there is a higher incidence of urethral injury if both corpora cavernosa are affected. Long-term functional sequelae after surgical repair of a PF are rare.
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Affiliation(s)
| | - C Mercader Barrull
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - J M López Martínez
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J M Corral Molina
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - E García Cruz
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Alcaraz Asensio
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - L Peri Cusi
- Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, Spain
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14
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Nakamura S, Watanabe Y, Goto T, Ikegami K, Inoue N, Uenoyama Y, Tsukamura H. Kisspeptin neurons as a key player bridging the endocrine system and sexual behavior in mammals. Front Neuroendocrinol 2022; 64:100952. [PMID: 34755641 DOI: 10.1016/j.yfrne.2021.100952] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/20/2021] [Accepted: 10/19/2021] [Indexed: 02/08/2023]
Abstract
Reproductive behaviors are sexually differentiated: for example, male rodents show mounting behavior, while females in estrus show lordosis behavior as sex-specific sexual behaviors. Kisspeptin neurons govern reproductive function via direct stimulation of gonadotropin-releasing hormone (GnRH) and subsequent gonadotropin release for gonadal steroidogenesis in mammals. First, we discuss the role of hypothalamic kisspeptin neurons as an indispensable regulator of sexual behavior by stimulating the synthesis of gonadal steroids, which exert "activational effects" on the behavior in adulthood. Second, we discuss the central role of kisspeptin neurons that are directly involved in neural circuits controlling sexual behavior in adulthood. We then focused on the role of perinatal hypothalamic kisspeptin neurons in the induction of perinatal testosterone secretion for its "organizational effects" on masculinization/defeminization of the male brain in rodents during a critical period. We subsequently concluded that kisspeptin neurons are key players in bridging the endocrine system and sexual behavior in mammals.
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Affiliation(s)
- Sho Nakamura
- Faculty of Veterinary Medicine, Okayama University of Science, Imabari, Ehime 794-8555, Japan
| | - Youki Watanabe
- Graduate School of Applied Life Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan
| | - Teppei Goto
- RIKEN Center for Biosystems Dynamics Research, Hyogo 650-0047, Japan
| | - Kana Ikegami
- Graduate School of Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - Naoko Inoue
- Graduate School of Bioagricultural Science, Nagoya University, Nagoya 464-8601, Japan
| | - Yoshihisa Uenoyama
- Graduate School of Bioagricultural Science, Nagoya University, Nagoya 464-8601, Japan
| | - Hiroko Tsukamura
- Graduate School of Bioagricultural Science, Nagoya University, Nagoya 464-8601, Japan.
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15
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Pescatori ES, Drei B, Rabito S. Circumferential Acquired Macropenis: Definition, Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty. Sex Med 2021; 10:100460. [PMID: 34818603 PMCID: PMC8847819 DOI: 10.1016/j.esxm.2021.100460] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Over the years, scattered cases of acquired penile girth increase have been published with different terms, the common clinical feature being a mechanically hampered penetration. Aim To search for all published cases of acquired penile girth increase, and to propose a geometrically-based reduction corporoplasty. Methods A case of acquired penile bilateral albuginea herniation prompted us to a PubMed, EMBASE and Google Scholar literature review from 1970 to 2021, in search for similar conditions. Main Outcome Measure We identified 7 cases of acquired penile girth increase; the geometric approach used to surgically correct bilateral corporal herniation proved successful in our case. Results In 5 of the 7 cases of acquired penile girth increase, priapistic episodes were deemed the causal factor; in the remaining 2 and in ours, a clear etiology could not be identified. Conclusion “Circumferential acquired macropenis” describes the unusual syndrome of acquired penile girth increase, that encompasses 2 distinct etiologies: post-priapistic cases, characterized by penile girth increase both in flaccidity and erection, and idiopathic cases, characterized by girth increase in erection only, and at surgery by a thinned albuginea in the affected area. Pescatori ES, Drei B, Rabito S Circumferential Acquired Macropenis: Definition, Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty. Sex Med 2022;10:100460.
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Affiliation(s)
| | - Barbara Drei
- Servizio di Andrologia, Hesperia Hospital, Modena, Italy
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16
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Abstract
The science of penile erection, including recent advances in its molecular physiology and neuroanatomic pathways, is described. The pathophysiology of erectile dysfunction is presented, acknowledging associated disease states, and accordingly follows a practical classification scheme: vasculogenic, neurogenic, endocrine, and psychogenic.
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Affiliation(s)
- Susan M MacDonald
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Mail Code H055, 500 University Drive, Hershey, PA 17033, USA.
| | - Arthur L Burnett
- James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, 600 North Wolfe Street, Marburg 407, Baltimore, MD 21287, USA
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17
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Teymourian H, Saeedi N, Salimi H. Comparison of Epidural Dexmedetomidine Versus Ropivacaine Infusion Effectiveness in Preventing Erection Following Reconstructive Urethral Surgery: A Randomized Clinical Trial. Anesth Pain Med 2021; 11:e114259. [PMID: 34540636 PMCID: PMC8438744 DOI: 10.5812/aapm.114259] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/16/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background One of the most common devastating problems that occur after urethroplasty is erection, which causes surgical complications (fistula, wound dehiscence, and surgical graft failure) and the need for repairing the complications. We attempted to compare the effect of continuous epidural infusion of dexmedetomidine and ropivacaine as a post-surgical erection prevention strategy. Objectives In this study, we aimed to compare the effect of dexmedetomidine and ropivacaine epidural infusion on the incidence of erection after reconstructive urethral surgery. Methods An RCT was conducted on 45 patients who were scheduled for reconstructive urethral surgery. They were randomly divided into three groups: (1) control (n = 15), (2) epidural dexmedetomidine (n = 15), (3) and epidural ropivacaine (n = 15). The control group received oral medication after surgery according to the conventional method (cyproterone compound tablets 50 mg BD and diazepam tablets 2 mg TDS for a week) to prevent erection. The DEX group received dexmedetomidine as continuous epidural infusion, and the ROP group received ropivacaine in addition to the conventional method. The occurrence of erection during day and night was recorded separately until the seventh day after surgery. Due to the long-time interval between case selection, participants from different groups were not matched with each other. Results The incidence of erection in the dexmedetomidine group was lower than that in the ropivacaine group per person (0.87) and significantly lower than in the control group (2.8 per person). Also, there was significantly less erection in the ropivacaine group (1.2 per person) than in the control group. Our study showed that erection after surgery significantly decreased with the continuous epidural infusion of dexmedetomidine and ropivacaine. Conclusions Dexmedetomidine seems to have a significant preventive effect on erection after reconstructive urethral surgery.
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Affiliation(s)
- Houman Teymourian
- Department of Anesthesiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Saeedi
- Department of Anesthesiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hojat Salimi
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bakr AM, El-Sakka AI. Extracorporeal Shockwave Therapy in Peyronie's Disease: Systematic Review and Meta-Analysis. J Sex Med 2021; 18:1705-14. [PMID: 34511369 DOI: 10.1016/j.jsxm.2021.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is associated with penile pain, deviation, and sexual dysfunction. Up till now, there is no conservative standard treatment for PD. However, the role of Extracorporeal Shock Wave Therapy (ESWT) is gaining increasing interest. AIM To evaluate the effect of ESWT on penile deviation, plaque size, erectile function, pain scale, and the rate of complications in PD patients. METHODS PubMed database was searched for articles published from January 2000 to November 2020, using related keywords and including randomized controlled trials (RCTs) only. Meta-analysis and forest plots were carried out using RevMan, and outcomes were reviewed by 2 authors independently. PRISMA guidelines were used in this article to achieve the quantitative and qualitative synthesis of data. OUTCOMES Changes in penile deviation, plaque size, erectile function, pain scale, and the rate of ESWT related complications. RESULTS The search yielded 73 articles. Three RCTs, including 117 patients in the ESWT group and 121 patients in the placebo group, were reviewed. ESWT is associated with reduction in plaque size (OR = 2.59, 95% CI (1.15-5.85), P= .02). No significant difference in reduction of penile deviation angle or rate of bruises were detected in post ESWT group when compared to placebo. No evidence was found to show an effect of ESWT on erectile function or pain scale. CLINICAL IMPLICATIONS Based on the available RCTs, ESWT fails to improve penile curvature or pain in men with PD. Although ESWT may reduce plaque size, this remains of questionable clinical significance. STRENGTHS & LIMITATIONS RCTs used different metrics to report the same outcome. Missed data were imputed to match the requirements of meta-analysis. However, there is still much data that cannot be estimated. CONCLUSION The current data suggest that ESWT fails to improve penile curvature or pain in men with PD. Although ESWT may reduce plaque size, this remains of questionable clinical significance, and further studies are required to confirm findings. Bakr AM, El-Sakka A. Extracorporeal Shockwave Therapy in Peyronie's Disease: Systematic Review and Meta-Analysis. J Sex Med 2021;18:1705-1714.
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Rod X, Akakpo W, Roupret M. [Efficacy and safety of local injections treatments for Peyronie's disease: Review of the literature]. Prog Urol 2021; 31:1072-1079. [PMID: 34148769 DOI: 10.1016/j.purol.2021.04.009] [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: 08/04/2020] [Revised: 02/07/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
AIM To assess the efficacy and safety of local injection used to reduce penile curvature in Peyronie's disease. METHODS A review of the literature was carried out according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) on the Medline database in April 2020, with the research: "collagenase"[All Fields] OR "Interferon"[All Fields] OR "verapamil"[All Fields] OR "betamethasone"[All Fields] OR "hyaluronic acid"[All Fields] OR "Platelet-Rich Plasma"[All Fields] OR "Stem Cells"[All Fields] AND "peyronie's"[All Fields] AND Controlled Clinical Trial[ptyp]. Only controlled studies with placebo group were included in this review. RESULTS Of the 35 articles identified, 6 placebo-controlled studies were finally included. Intra-plaque injections of verapamil did not show improvement in penile curvature. Injections of interferon α 2b and clostridium histolyticum collagenase allowed a statistically significant improvement in terms of curvature reduction: 13.5 versus 4.5 degrees P<0.01) and 17 versus 9.3 degrees P<0.0001 respectively. However, interferon α 2b is not available in France for Peyronie's disease and clostridium histolyticum collagenase is no longer authorized since March 1, 2020. No controlled studies are available on corticosteroids, hyaluronic acid, platelet-rich plasma or stem cells injections. CONCLUSION To correct the deformity in Peyronie's disease in the chronic phase, there is no effective solution currently available in France based on controlled studies. Surgery retains its place for the correction of a curvature of at least 30° associated with a sexual handicap in the stable phase, however at the cost of potential adverse effects. Stem cell or Platelet-Rich Plasma injection might be an injectable therapeutic alternative but need controlled studies.
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Affiliation(s)
- X Rod
- GRC 5 Predictive ONCO-URO, urologie, Sorbonne Université, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - W Akakpo
- GRC 5 Predictive ONCO-URO, urologie, Sorbonne Université, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Roupret
- GRC 5 Predictive ONCO-URO, urologie, Sorbonne Université, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Cripps SM, Mattiske DM, Pask AJ. Erectile Dysfunction in Men on the Rise: Is There a Link with Endocrine Disrupting Chemicals? Sex Dev 2021; 15:187-212. [PMID: 34134123 DOI: 10.1159/000516600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/02/2020] [Accepted: 04/18/2021] [Indexed: 11/19/2022] Open
Abstract
Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of erectile tissues in the penis and/or disruptions in adulthood that impact sexual stimuli, neural pathways, molecular changes, and endocrine signalling that are required to drive erection. Sexual stimulation activates the parasympathetic system which causes nerve terminals in the penis to release nitric oxide (NO). As a result, the penile blood vessels dilate, allowing the penis to engorge with blood. This expansion subsequently compresses the veins surrounding the erectile tissue, restricting venous outflow. As a result, the blood pressure localised in the penis increases dramatically to produce a rigid erection, a process known as tumescence. The sympathetic pathway releases noradrenaline (NA) which causes detumescence: the reversion of the penis to the flaccid state. Androgen signalling is critical for erectile function through its role in penis development and in regulating the physiological processes driving erection in the adult. Interestingly, estrogen signalling is also implicated in penis development and potentially in processes which regulate erectile function during adulthood. Given that endocrine signalling has a prominent role in erectile function, it is likely that exposure to endocrine disrupting chemicals (EDCs) is a risk factor for ED, although this is an under-researched field. Thus, our review provides a detailed description of the underlying biology of erectile function with a focus on the role of endocrine signalling, exploring the potential link between EDCs and ED based on animal and human studies.
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Affiliation(s)
- Samuel M Cripps
- School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deidre M Mattiske
- School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew J Pask
- School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia
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Schönhofen J, Räber L, Knöchel J, Keo HH, Regli C, Kostal F, Schumacher MC, Sammarchi L, Bechir M, Diehm N. Endovascular Therapy for Arteriogenic Erectile Dysfunction With a Novel Sirolimus-Eluting Stent. J Sex Med 2021; 18:315-326. [PMID: 33454205 DOI: 10.1016/j.jsxm.2020.10.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/10/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Arteriogenic erectile dysfunction is a common disease oftentimes not satisfactory treatable with medical therapy. AIM To assess the safety and clinical success rate of endovascular revascularization of erection-related arteries with the angiolite BTK stent in patients with arteriogenic erectile dysfunction. METHODS A total of 100 consecutive men (61.8 ± 10 years) with atherosclerotic lesions in erection-related arteries agreed to participate and were included into a single-center all-comers registry. Endovascular therapy with angiolite BTK drug-eluting stents was performed on a total of 211 lesions. Patients received a baseline International Index of Erectile Function (IIEF)-15 questionnaire at first presentation and 3 and 12 months after stenting. An improvement by 4 points in the erectile function domain consisting of 6 questions (IIEF-6) was defined as minimal clinically important difference. A total of 24 patients with 52 stented arterial lesions underwent angiographic follow-up of the initially treated arterial side during secondary revascularization of the contralateral side (angiographic sub-study). OUTCOME Clinical improvement of erections in 100 patients undergoing endovascular revascularization of erection-related arteries. RESULTS No major adverse events occurred during endovascular revascularization or within 30 days thereafter. Technical success was achieved in all lesions and procedural success in all patients. At 1 year, 55 of 97 patients (56.7%) improved by at least 4 points in IIEF-6 score and thus achieved a clinically relevant improvement of erectile function.In the angiographic sub-study, arterial patency and binary restenosis were observed in 46 of 52 (88.5%) and in 8 of 52 (15.4%), respectively, after a mean follow-up of 9.6 ± 5.8 months. CLINICAL IMPLICATIONS In patients with arteriogenic erectile dysfunction, endovascular therapy with a novel thin-strut sirolimus eluting stent is a safe and feasible treatment option. STRENGTHS & LIMITATIONS This real-world arterial revascularization registry included patients with a multitude of risk factors for ED, thereby representing the heterogeneity in patients in the clinical practice, which is one of its strengths but also one of its weaknesses. Another strength was the focus being laid on analyzing outcomes of patients with arteriogenic ED using only a single endovascular device. Further studies are warranted to better define subgroups of patients with impaired clinical outcomes. CONCLUSION Within the present all-comers registry, endovascular therapy of erectile dysfunction with the angiolite BTK stent was shown to be a safe and feasible treatment option resulting in clinical improvement rates comparable to earlier clinical trials although also showing that further research is warranted to define patient subgroups with particular benefits of endovascular therapy. Schönhofen J, Räber L, Knöchel J, et al. Endovascular Therapy for Arteriogenic Erectile Dysfunction With a Novel Sirolimus-Eluting Stent. J Sex Med 2021;18:315-326.
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Affiliation(s)
- Jan Schönhofen
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Knöchel
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Hak Hong Keo
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Christian Regli
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Filip Kostal
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | | | - Lisa Sammarchi
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Markus Bechir
- Department of Internal Medicine, Hirslanden Clinic, Aarau, Switzerland
| | - Nicolas Diehm
- Department of Angiolog, Vascular Institute Central Switzerland, Aarau, Switzerland.
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22
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Prihadi JC, Kusumajaya C. Priapism secondary to tamsulosin: A case report. Int J Surg Case Rep 2020; 72:460-3. [PMID: 32698265 DOI: 10.1016/j.ijscr.2020.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tamsulosin is the most potent adrenergic alpha-1 antagonist used for treatment of benign prostatic hyperplasia (BPH). Priapism has been reported as a rare side effect through direct inhibition of the sympathetic input necessary for detumesence. PRESENTATION OF CASE We describe an otherwise healthy man with recurrent and then persistent unresolved priapism after the use of tamsulosin and concomitant use of ace inhibitor and beta blocker for hypertension. We then performed aspiration and intracavernosal irrigation of saline and vasoconstrictive agent. DISCUSSION Health-care professionals should inform all patients taking such medications about this rare but possible serious adverse effect. Tamsulosin is a useful medication for the management of Lower Urinary Tract Symptoms (LUTS) related to BPH and medical expulsion of distal ureteric calculi. However, its use may be associated on rare occasions with priapism, hence Health-care professionals should be aware in order to advice all patients taking such medications about this rare but serious adverse effect and to seek help as soon as possible. CONCLUSION With caution against the use of tamsulosin in hypertension treated patient, the possibility of the adverse effect can be more noticed and encourage practitioners to look for other alternatives that are safer and better for dealing with LUTS in the future and develop better treatment strategies.
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Sen V, Sahin MO, Irer B, Koc E, Yildiz G. The impact of hyperbaric oxygen therapy on erectile functions and serum testosterone levels in patients with erectile dysfunction. Aging Male 2020; 23:66-70. [PMID: 30907218 DOI: 10.1080/13685538.2019.1578740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To evaluate the effects of hyperbaric oxygen therapy (HBOT) on erectile functions and serum testosterone levels in patients with erectile dysfunction (ED).Methods: The patients treated by HBOT for several diseases between July 2017-May 2018 and had erectile dysfunction were included in the study. All patients filled the International Index of Erectile Function (IIEF) questionnaire form; serum total testosterone (TT) and free testosterone (FT) levels were examined before the first day and after the last day of HBOT. The effects of demographic characteristics of patients on erectile functions were evaluated. Patients were categorized according to the risk factors. The IIEF scores, TT and FT levels of patients in first day and after last day of HBOT were compared.Results: Totally 43 patients were included in the study. The mean post-HBOT IIEF-EF score was significantly higher than the mean pre-HBOT IIEF-EF score of patients (25.4 ± 5.3 vs 20.6 ± 5.1; p < .001). There was no statistical difference between the pre-HBOT and post-HBOT serum TT and FT levels of patients (4.0 ± 2.3 ng/ml vs 4.1 ± 2.0 ng/ml, p = .797; 8.6 ± 3.8 pg/ml vs 8.9 ± 3.5 pg/ml, p = .658).Conclusions: HBOT improved the erectile functions in ED patients however we cannot detect any effect on testosterone levels in our study.
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Affiliation(s)
- Volkan Sen
- Department of Urology, Manisa State Hospital, Manisa, Turkey
| | | | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Evin Koc
- Department of Underwater and Hyperbaric Medicine, Neoks Hyperbaric Oxygen Therapy Center, Izmir, Turkey
| | - Guner Yildiz
- Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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Blum C, Chesnel C, Hentzen C, Turmel N, Lacroix P, Manceau P, Amarenco G. [Ejaculation disorders in multiple sclerosis: Prospective study of 44 patients]. Prog Urol 2019; 29:385-90. [PMID: 30819632 DOI: 10.1016/j.purol.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To analyze in a descriptive way the ejaculation disorders during MS and to study the correlations between dysejaculations, other sexual, urinary and anorectal disorders. MATERIAL Prospective, monocentric, non-interventional study. Ejaculation disorders were assessed by Premature Ejaculation Profile (PEP) scores, intravaginal latency, and the Male Sexual Health Questionnaire - Ejaculation (MSHQ-Ej). The sexual disorders were evaluated by the International Index of Erectile Function (IIEF15) and the Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ). RESULTS Forty-four men of mean age 46.8 (±10.3) years, with an average EDSS of 5.0 (±1.5) were included. According to the MSHQ-Ej score, ejaculation disorders were present in 28 out of 44 patients included (64%); 26/44 (59%) had an orgasm disorder, 23/44 (52%) a delay in ejaculation, 26/44 (59%) a decrease in ejaculation flow, 24/44 (55%) decreased ejaculated volume, 18/44 (41%) decreased ejaculation frequency, 15/44 (33%) ejaculatory pain and 11 34 (25%) showed systematic non ejaculation. The PEP score showed premature ejaculation in 14 patients (32%). The intra-vaginal latency time was less than 1minute in 6 patients (13.6%). There was a statistically significant correlation between ejaculation disorders and erectile dysfunction (P<0.05, correlation coefficient at 0.53) but no statistically significant correlation between ejaculation disorders and urinary or ano-rectal disorders. CONCLUSIONS Dysejaculation was present in 64% of MS. These disorders were mainly characterized by a decrease in the volume of the ejaculation, the strength of ejaculation and the delay in ejaculation. LEVEL OF EVIDENCE 4.
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Cordes J, Zimbelmann M, Merseburger AS, Kramer M, Vonthein R, Büttner H, Recke A, Kahle BK. Transient increased tumescence of the glans penis during penile erection after endovenous ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord 2018; 7:387-391. [PMID: 30477979 DOI: 10.1016/j.jvsv.2018.06.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/21/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The primary objective of our study was to investigate the impact of endovenous ablation of the great saphenous vein (GSV) on the degree of tumescence of the glans penis during penile erection as well as on global erectile function (EF). METHODS We included patients scheduled for one of three different methods of endoluminal treatment. Our questionnaire was composed of the EF domain of the International Index of Erectile Function, an additional question that has been validated for assessment of swelling (tumescence) of the glans penis, and a question on the use of erectogenic medication. RESULTS There were 62 patients enrolled in the study. Seven patients (11%) reported a postoperative enlargement of the glans penis on penile erection compared with the subjectively assessed glans tumescence before surgery. Three patients (5%) reported an increased tumescence of the glans 1 week after surgery, and four (7.4%) different patients reported the effect 3 months after surgery. Of these seven men, three had normal EF (score ≥26) at any time. One patient had mild erectile dysfunction before the operation, with an improvement to normal EF from week 1 throughout the observation in the study (3 months). CONCLUSIONS This is the first prospective study that confirms an unexpected side effect of endoluminal treatment of the GSV occurring in approximately 10% of men. It might be of interest for insufficient responders to phosphodiesterase type 5 inhibitors with varicosis of the GSV in the future.
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Affiliation(s)
| | | | | | | | - Reinhard Vonthein
- Institute of Statistics, UKSH, Lübeck, Germany; ZKS Luebeck, University of Luebck, Lübeck, Germany
| | - Hartwig Büttner
- Medical Department, Lilly Deutschland GmbH, Bad Homburg, Germany
| | - Andreas Recke
- Clinic of Dermatology Luebeck Campus, University Medical Center, Schleswig-Holstein, Lübeck, Germany
| | - Birgit K Kahle
- Clinic of Dermatology Luebeck Campus, University Medical Center, Schleswig-Holstein, Lübeck, Germany
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Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended Consequences: A Review of Pharmacologically-Induced Priapism. Sex Med Rev 2018; 7:283-292. [PMID: 30503727 DOI: 10.1016/j.sxmr.2018.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 07/11/2018] [Revised: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Priapism has been linked to many commonly prescribed medications, as well as recreational drugs and toxins. Although the incidence of priapism as a result of medication is small, the increasing use of antidepressants, antipsychotics, and recreational drugs may lead to more cases of pharmacologically-induced priapism in the future. AIM To provide a comprehensive, up-to-date review of the most common causes of pharmacologically induced priapism and discuss incidence, pathophysiology, and basic management strategies. METHODS A review of the available literature from 1960 to 2018 was performed using PubMed with regards to pharmacologically induced priapism. MAIN OUTCOME MEASURE We reviewed publications that outlined incidence, pathophysiology, and management strategies for various pharmacologic causes of priapism: antidepressants, antipsychotics, antihypertensives, methylphenidate, cocaine, heparin, gonadotropin-releasing hormone, propofol, spider bites, and other miscellaneous causes. RESULTS An understanding of the pathophysiology behind common pharmacologic causes of priapism can assist in the development of better treatment strategies and prevent future episodes of priapism. By understanding the potential risks associated with the use of medications with α-blocking or sympathomimetic properties, physicians can reduce the likelihood of priapism in their patients, especially those with other medical conditions that put them at increased baseline risk. Early corporal aspiration and injection of phenylephrine reduces additional complications related to priapism. In select patients, early placement of a penile prosthesis may prevent further morbidity. CONCLUSION By developing a greater understanding of common pharmacologic causes of priapism, physicians can promptly identify and manage symptoms, leading to decreased patient morbidity. Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended Consequences: A Review of Pharmacologically-Induced Priapism. Sex Med Rev 2019;7:283-292.
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Affiliation(s)
| | - Amit G Reddy
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Tan V Le
- Department of Urology, Tulane University, New Orleans, LA, USA; Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
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Bolat MS, Celik B, Celik HK, Akdeniz E. The impact of thoracotomy on psychological and sexual function in men with lung cancer. Rev Int Androl 2018; 17:94-100. [PMID: 30237068 DOI: 10.1016/j.androl.2018.05.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/13/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to investigate the effect of major thoracic surgery on sexual functions and psychogenic aspects of men who underwent surgery for lung cancer. MATERIAL AND METHODS This study was conducted to assess depression and erectile function in patients who underwent surgical treatment for lung cancer. The data of 50 patients in the study group, and 39 participants in the control group who met the criteria were analyzed. Erectile dysfunction (ED) and symptoms of depression were assessed in patients before and three months after surgery. RESULTS The mean ages were 58.4±11.6 and 61.3±6.9 years; the mean BMIs were 25.6±4.3kg/m2 and 24.8±5.7kg/m2; the mean forced vital capacities (FVC) were 3.1±0.6L and 3.4±1.4L; the mean FEV1/FVC were 86.1±10.3 and 80.3±4.1; the mean Beck Depression Inventory scores were 9.3±6.9 and 6.0±6.2, and the mean FVC% were 82.9±14.9 and 82.0±26.2 for the study and control groups, respectively. The mean preoperative International Index of Erectile Function (IIEF-5) scores were 14.1±4.1 and 10.8±4.7 postoperative in the study group, and 17.4±8.6 in the control group. The logistic regression analysis showed that postoperative complications resulted in a 3.95-times higher risk of suffering from ED. CONCLUSION Our study supported that surgical treatment of lung cancer adversely affected psychogenic status and sexual function due to its stringent nature. The fear of death affects the quality of life and the psychogenic aspect of the patients with lung cancer. Clinicians should thoroughly inform the patients about sexual dysfunction and psychogenic disorders, and when needed providing an appropriate sexual counseling and treatment is necessary. Good communication contributes to a better quality of life.
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Affiliation(s)
- Mustafa Suat Bolat
- Health Sciences University, Samsun Training and Research Hospital, Turkey.
| | - Burcin Celik
- Ondokuz Mayis University, Medical School, Department of Thoracic Surgery, Samsun, Turkey
| | - Hale Kefeli Celik
- Health Sciences University, Samsun Training and Research Hospital, Turkey
| | - Ekrem Akdeniz
- Health Sciences University, Samsun Training and Research Hospital, Turkey
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Abstract
PURPOSE OF REVIEW Due to the proximity of the rhabdosphincter and cavernous nerves to the membranous urethra, reconstruction of membranous urethral stricture implies a risk of urinary incontinence and erectile dysfunction. To avoid these complications, endoscopic management of membranous urethral strictures is traditionally favored, and bulboprostatic anastomosis is reserved as the main classical approach for open reconstruction of recalcitrant membranous urethral stricture. The preference for the anastomotic urethroplasty among reconstructive urologists is likely influenced by the familiarity and experience with trauma-related injuries. We review the literature focusing on the anatomy of membranous urethra and on the evolution of treatments for membranous urethral strictures. RECENT FINDINGS Non-traumatic strictures affecting bulbomembranous urethra are typically sequelae of instrumentation, transurethral resection of the prostate, prostate cancer treatment, and pelvic irradiation. Being a different entity from trauma-related injuries where urethra is not in continuity, a new understanding of membranous urethral anatomy is necessary for the development of novel reconstruction techniques. Although efficacious and durable to achieve urethral patency, classical bulboprostatic anastomosis carries a risk of de-novo incontinence and impotence. Newer and relatively less invasive reconstructive alternatives include bulbar vessel-sparing intra-sphincteric bulboprostatic anastomosis and buccal mucosa graft augmented membranous urethroplasty techniques. The accumulated experience with these techniques is relatively scarce, but several published series present promising results. These approaches are especially indicated in patients with previous transurethral resection of the prostate in which sparing of rhabdosphincter and the cavernous nerves is important in attempt to preserve continence and potency. Additionally, introduction of buccal mucosa onlay grafts could be especially beneficial in radiation-induced strictures to avoid transection of the sphincter in continent patients, and to preserve the blood supply to the urethra for incontinent patients who will require artificial urinary sphincter placement. The evidence regarding erectile functional outcomes is less solid and this item should be furtherly investigated.
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Affiliation(s)
- Javier C Angulo
- Departamento Clínico, Facultad de Ciencias Biomédicas, Hospital Universitario de Getafe, Universidad Europea de Madrid, Carretera de Toledo Km 12.5, 28905, Getafe, Madrid, Spain.
| | - Reynaldo G Gómez
- Hospital del Trabajador, Universidad Andrés Bello, Vicuña Mackenna, 185, Santiago, Chile
| | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY, 13210, USA
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Gray M, Vasdev N, Gowrie-Mohan S, McNicholas T. The Management of Unplanned Erection during Endoscopic Urological Surgery. Curr Urol 2017; 10:113-117. [PMID: 28878592 DOI: 10.1159/000447163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/16/2016] [Accepted: 01/31/2016] [Indexed: 02/02/2023] Open
Abstract
Penile erection at the time of urological surgery is a rare but problematic event which can delay, complicate or even lead to the cancellation of planned surgery. Erection may occur irrespective of the type of anesthetic method employed. Several techniques for treatment of this troublesome complication have been described in the literature, all with varying levels of success and potential adverse effects. In our experience over the last 25 years, we have found that intracavernous injection of ephedrine into the penis has a 100% success rate in safely producing detumescence with minimum side effects and should therefore be considered early among the treatment options for this condition.
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Affiliation(s)
- Martin Gray
- Department of Anesthesia, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Department of Urological Surgery, Lister Hospital, Stevenage, UK
| | | | - Tom McNicholas
- Department of Urological Surgery, Lister Hospital, Stevenage, UK
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Babakhanian M, Haghdoost AA, Afshari M, Taghizadeh F, Moosazadeh M. Methadone Replacement Therapy and Sexual Disorders among Opium Dependent Iranian Men: A Meta-Analysis Study. Addict Health 2017; 9:1-10. [PMID: 29026497 PMCID: PMC5628762] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evaluation of sexual disorders among persons receiving methadone replacement therapy is of great importance, because these problems may lead to non-compliance and relapse. This study aimed to estimate the effect of methadone maintenance therapy (MMT) on sexual function among addicted Iranian men using met-analysis. METHODS Investigating the available data banks, relevant studies were identified. After exclusion of duplicates, irrelevant papers and low quality articles, eligible papers were entered into the meta-analysis. Prevalence and standardized mean difference of sexual function scores were illustrated by forest plots based on sexual desire, orgasm and erectile function. FINDINGS During the primary search, 5341 evidences were identified. After application of the inclusion/exclusion criteria and quality assessment, nine papers were detected eligible for final meta-analysis. Total prevalence [95% confidence intervals (CI)] of sexual disorders and erectile dysfunction among Iranian men under methadone therapy were estimated as 66.3% (27.1-105.5) and 77.5% (61.9-93.1), respectively. The standardized mean differences (95% CI) of Sexual desire, orgasm and erection before and after methadone therapy were estimated as 0.16 (-0.68, 0.99), -0.01 (-0.75, 0.74) and 0.11 (-0.41, 0.64), respectively. CONCLUSION This meta-analysis showed that methadone therapy did not significantly influence the sexual desire, erectile function and orgasm among opium dependent men.
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Affiliation(s)
- Masoudeh Babakhanian
- PhD Student, Student Research Committee, Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Akbar Haghdoost
- Professor, Research Center for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahdi Afshari
- Assistant Professor, Department of Community Medicine, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Fatemeh Taghizadeh
- PhD Student, Student Research Committee, Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Assistant Professor, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran,Correspondence to: Mahmood Moosazadeh PhD,
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Gresham R, Li S, Adekunbi DA, Hu M, Li XF, O'Byrne KT. Kisspeptin in the medial amygdala and sexual behavior in male rats. Neurosci Lett 2016; 627:13-7. [PMID: 27233219 PMCID: PMC4944646 DOI: 10.1016/j.neulet.2016.05.042] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/19/2016] [Accepted: 05/21/2016] [Indexed: 11/19/2022]
Abstract
The medial amygdala (MeA) is crucial for sexual behavior; kisspeptin (Kiss1) also plays a role in sexual function. Kisspeptin receptor (Kiss1r) knockout mice display no sexual behavior. Recently Kiss1 and Kiss1r have been discovered in the posterodorsal subnucleus of the medial amygdala (MePD). We hypothesised that Kiss1 in the MePD may have an influence on male sexual behavior. To test this we bilaterally cannulated the MePD and infused kisspeptin-10 in male rats. This caused the rats to have multiple erections, an effect specific to Kiss1 receptor activation, because Kiss1r antagonism blocked the erectile response. When Kiss1 was infused into the lateral cerebroventricle, there were no observed erections. We also measured the plasma levels of LH when Kiss1 is infused into the MePD or lateral cerebroventricle; Kiss1 increased plasma LH to comparable levels when infused into both sites. We conclude that Kiss1 has a role in male sexual behavior, which is specific to the MePD.
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Affiliation(s)
- Rebecca Gresham
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, SE1 1UL, UK
| | - Shengyun Li
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, SE1 1UL, UK
| | - Daniel A Adekunbi
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, SE1 1UL, UK
| | - Minghan Hu
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, SE1 1UL, UK
| | - Xiao Feng Li
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, SE1 1UL, UK
| | - Kevin T O'Byrne
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, SE1 1UL, UK.
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Hoepffner JL, Gaston R, Mugnier C, Rey D, Lopez L, Roche JB, Riviere J, Piechaud PT. [Minimally invasive radical prostatectomy: Contribution of robotic support, functional and oncological outcomes]. Bull Cancer 2016; 103:461-8. [PMID: 26995400 DOI: 10.1016/j.bulcan.2016.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Radical prostatectomy (RP) remains a standard for localized prostate cancer treatment. The objective of this study is to present this operating technique of the robot-assisted radical prostatectomy (PR-RA) and to evaluate oncological and functional results as well as on the surgical safety. METHODS A first series of 1679 patients consecutively operated in our institution with this technique from 2005 to 2010 and with a 5-year follow-up evaluated in 2014. The oncology monitoring is ensured with a PSA test every six months during the first three years and once a year the years after if the level remains undetectable. RESULTS The oncologic outcomes show 17.4% for pT2 stages and 36.9% for pT3 stages positive margins. The level of biological recurrence is 21.27% with an average delay of 88 months as the time needed for the recurrence to occur. At 12 months, urinary continence (0-1pad/day) returned at 94% of all patients and potency with successful penetration for all men is 61.1% and 88.8% for men with sexual activity before surgery. CONCLUSIONS The technique PRRA seems to be a reliable technique whose functional results studied from meta-analysis seem to be superior in terms of rapidity of recovery of the continence and erection in comparison with classical surgical or laparoscopic approach.
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Senbel AM, Saad EI, Taha SS, Mohamed HF. Different mechanisms for lead acetate, aluminum and cadmium sulfate in rat corpus cavernosum. Toxicology 2015; 340:27-33. [PMID: 26723573 DOI: 10.1016/j.tox.2015.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Some heavy metals show adverse vascular and neurological effects, however, their effect on erection is underestimated. This study aims to investigate the effect of Pb, Cd and Al on erectile function and their potential mechanism of action in rats. METHODS Measurement of intracavernosal pressure/mean arterial pressure (ICP/MAP) changes elicited by electrical stimulation of cavernous nerve in anesthetized rats treated with Pb-acetate, Al-sulfate, or Cd-sulfate acutely, and subacutely for 7 days. Serum creatinine, testosterone, TBARs, GSH levels and metal accumulation in corpus cavernosum were measured. RESULTS Pb, Al and Cd significantly reduced ICP/MAP in rats after acute (2,10-2,10 and 1,3 mg/kg respectively) and sub-acute (3, 3, and 1mg/kg/day respectively) treatments. They selectively accumulated in the corpus cavernosum reaching 25.107 ± 2.081 μg/g wet weight for Pb, 1.029 ± 0.193 for Cd, 31.343 ± 1.991 for Al, compared to 7.084 ± 1.517, 0.296 ± 0.067, and 8.86 ± 1.115 as controls respectively. Serum creatinine levels were not altered. Cd and Al significantly reduced testosterone level to 0.483 ± 0.059 and 0.419 ± 0.037 ng/ml respectively compared to 0.927 ± 0.105 ng/ml as control. Aluminum elevated TBARs significantly by 27.843%. The acute anti-erectile action of Pb was blocked by non-selective NOS and GC inhibitors and potassium channel blocker. Lead also masked the potentiatory effect of l-arginine and diazoxide on ICP/MAP. No interaction with muscarinic or nicotinic modulators was observed. CONCLUSIONS Pb, Cd and Al show anti-erectile effect independent on renal injury. They don not modulate cholinergic nor ganglionic transmission in corpus cavernosum. Pb may inhibit NO/cGMP/K+channel pathway. The effect of Cd and Al but not Pb seems to be hormonal dependent.
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Affiliation(s)
- Amira M Senbel
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
| | - Evan I Saad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Safaa S Taha
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Hosny F Mohamed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Kolenc M, Kobal J, Podnar S. Male sexual function in presymptomatic gene carriers and patients with Huntington's disease. J Neurol Sci 2015; 359:312-7. [PMID: 26671134 DOI: 10.1016/j.jns.2015.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 11/03/2015] [Accepted: 11/08/2015] [Indexed: 01/23/2023]
Abstract
AIMS To report sexual dysfunction in a systematically studied cohort of men with Huntington's disease (HD), and compare them with control men of a similar age. METHODS In men with HD and asymptomatic HD gene carriers, the male sexual dysfunction questionnaire (International Index of Erectile Function--IIEF, covering erectile and orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction), neurologic assessment using the Unified Huntington's Disease Rating Scale (UHDRS) and the Total Functional Capacity (TFC) Score were utilized. RESULTS Responses were obtained from 23 HD patients and 2 HD gene carriers. HD patients reported more problems with erection, intercourse satisfaction and overall satisfaction (p<0.05) compared to 41 controls. HD patients generally reported reduced sexual desire and performance. Sexual dysfunction progressed in parallel with patients' decline in motor (UHDRS) and TFC, but was not related to patients' age and duration of disease. CONCLUSIONS Our study demonstrated a significant impact of HD on male sexual function that progressed in parallel with motor and total patient (TFC) dysfunction. Physicians helping HD patients should also consider this largely neglected aspect of the disease.
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Reis LO. Sexual functioning in men who underwent bariatric surgery: far beyond sex hormones. Surg Obes Relat Dis 2015; 11:651-2. [PMID: 25737104 DOI: 10.1016/j.soard.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Leonardo O Reis
- Department of Medicine (Urology), Center for Life Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Campinas, Brazil.
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Diallo D, Zaitouna M, Alsaid B, Quillard J, Ba N, Allodji RS, Benoit G, Bedretdinova D, Bessede T. The visceromotor and somatic afferent nerves of the penis. J Sex Med 2015; 12:1120-7. [PMID: 25689562 DOI: 10.1111/jsm.12851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/20/2022]
Abstract
INTRODUCTION Innervation of the penis supports erectile and sensory functions. AIM This article aims to study the efferent autonomic (visceromotor) and afferent somatic (sensory) nervous systems of the penis and to investigate how these systems relate to vascular pathways. METHODS Penises obtained from five adult cadavers were studied via computer-assisted anatomic dissection (CAAD). MAIN OUTCOME MEASURES The number of autonomic and somatic nerve fibers was compared using the Kruskal-Wallis test. RESULTS Proximally, penile innervation was mainly somatic in the extra-albugineal sector and mainly autonomic in the intracavernosal sector. Distally, both sectors were almost exclusively supplied by somatic nerve fibers, except the intrapenile vascular anastomoses that accompanied both somatic and autonomic (nitrergic) fibers. From this point, the neural immunolabeling within perivascular nerve fibers was mixed (somatic labeling and autonomic labeling). Accessory afferent, extra-albugineal pathways supplied the outer layers of the penis. CONCLUSIONS There is a major change in the functional type of innervation between the proximal and distal parts of the intracavernosal sector of the penis. In addition to the pelvis and the hilum of the penis, the intrapenile neurovascular routes are the third level where the efferent autonomic (visceromotor) and the afferent somatic (sensory) penile nerve fibers are close. Intrapenile neurovascular pathways define a proximal penile segment, which guarantees erectile rigidity, and a sensory distal segment.
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Affiliation(s)
- Djibril Diallo
- U1195 (Neuroprotective, neuroregenerative and remyelinating small molecules), University Paris-Sud, INSERM, Le Kremlin-Bicêtre, France.,Urology Department, University Paris-Sud Hospital of Bicetre, Le Kremlin-Bicêtre, France
| | - Mazen Zaitouna
- U1195 (Neuroprotective, neuroregenerative and remyelinating small molecules), University Paris-Sud, INSERM, Le Kremlin-Bicêtre, France.,Urology Department, University Paris-Sud Hospital of Bicetre, Le Kremlin-Bicêtre, France
| | - Bayan Alsaid
- U1195 (Neuroprotective, neuroregenerative and remyelinating small molecules), University Paris-Sud, INSERM, Le Kremlin-Bicêtre, France
| | - Jeanine Quillard
- Anatomic Pathology Department, University Paris-Sud Hospital of Bicetre, Le Kremlin-Bicêtre, France
| | - Nathalie Ba
- INSERM i2b Institute, University Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - Gérard Benoit
- U1195 (Neuroprotective, neuroregenerative and remyelinating small molecules), University Paris-Sud, INSERM, Le Kremlin-Bicêtre, France
| | - Dina Bedretdinova
- INSERM CESP U1018 Institute, University Paris-Sud, Villejuif Cedex, France
| | - Thomas Bessede
- U1195 (Neuroprotective, neuroregenerative and remyelinating small molecules), University Paris-Sud, INSERM, Le Kremlin-Bicêtre, France.,Urology Department, University Paris-Sud Hospital of Bicetre, Le Kremlin-Bicêtre, France
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Abstract
INTRODUCTION Risk factors associated with erectile dysfunction (ED) that results from recurrent ischemic priapism (RIP) in sickle cell disease (SCD) are incompletely defined. AIM This study aims to determine and compare ED risk factors associated with SCD and non-SCD-related "minor" RIP, defined as having ≥2 episodes of ischemic priapism within the past 6 months, with the majority (>75%) of episodes lasting <5 hours. METHODS We performed a retrospective study of RIP in SCD and non-SCD patients presenting from June 2004 to March 2014 using the International Index of Erectile Function (IIEF), IIEF-5, and priapism-specific questionnaires. MAIN OUTCOME MEASURES Prevalence rates and risk factor correlations for ED associated with RIP. RESULTS The study was comprised of 59 patients (40 SCD [mean age 28.2 ± 8.9 years] and 19 non-SCD [15 idiopathic and four drug-related etiologies] [mean age 32.6 ± 11.7 years]). Nineteen of 40 (47.5%) SCD patients vs. four of 19 (21.1%) non-SCD patients (39% overall) had ED (IIEF <26 or IIEF-5 <22) (P = 0.052). SCD patients had a longer mean time-length with RIP than non-SCD patients (P = 0.004). Thirty of 40 (75%) SCD patients vs. 10 of 19 (52.6%) non-SCD patients (P = 0.14) had "very minor" RIP (episodes regularly lasting ≤2 hours). Twenty-eight of 40 (70%) SCD patients vs. 14 of 19 (73.7%) non-SCD patients had weekly or more frequent episodes (P = 1). Of all patients with very minor RIP, ED was found among 14 of 30 (46.7%) SCD patients vs. none of 10 (0%) non-SCD patients (P = 0.008). Using logistic regression analysis, the odds ratio for developing ED was 4.7 for SCD patients, when controlling for RIP variables (95% confidence interval: 1.1-21.0). CONCLUSIONS ED is associated with RIP, occurring in nearly 40% of affected individuals overall. SCD patients are more likely to experience ED in the setting of "very minor" RIP episodes and are five times more likely to develop ED compared with non-SCD patients.
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Affiliation(s)
- Uzoma A Anele
- Department of Urology, The James Buchanan Brady Urological Institute, School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
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Delage F, Perrouin-Verbe MA, Le Fur E, Papin G, Thoulouzan M, Malhaire JP, Pradier O, Fournier G, Valéri A. [Erectile dysfunction evaluation after brachytherapy for low risk prostate adenocarcinoma: prospective study of patients with a baseline IIEF5>16]. Prog Urol 2014; 25:68-74. [PMID: 25497176 DOI: 10.1016/j.purol.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/27/2014] [Revised: 09/12/2014] [Accepted: 11/03/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate erectile function (EF) prospectively from 1 to 2 years post-brachytherapy in patients with a baseline IIEF5 score>16. METHODS Between 2007 and 2012, 179 patients underwent an exclusive brachytherapy for localised low risk prostate adenocarcinoma. Neo-adjuvant hormotherapy (15.6%) and post-brachytherapy intake phosphodiesterase inhibitors (PDE5i) were not considered as exclusion criteria. EF was evaluated via a scoring questionnaire IIEF5 before the surgical implantation, at month 12 and 24 post-operation. Only patients with an initial IIEF5 score>16 were included. RESULTS Of the 179 patients, 102 (57%) had a baseline IIEF5>16. At 12 months, 51.1% maintained an IIEF5>16 and 24.5% had a mild to moderate erectile dysfunction (ED), so that a total of 75.6% with IIEF5≥12. About 18% of patients had used PDE5i. At 24 months, 53.2% had an IIEF5>16 and 80.6% had an IIEF5≥12. Severe ED was reported in only 14.5% of the patients. The mean IIEF5 was 16.2 with an average decline of 5 points from the initial stage. All patients who were treated with PDE5i (27%) could have sexual intercourse. EF at baseline was reported as the only predictive factor of ED in multivariate analysis, 70% of patient without ED initially, had an IIEF5>16 at 1 and 2 years. CONCLUSION Severe ED was quite rare (14%) during the first 2 years post-brachytherapy and more than half of patients maintained an IIEF5>16. The main predictive factor was the erectile function at baseline. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F Delage
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - E Le Fur
- Service de radiothérapie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - G Papin
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - M Thoulouzan
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - J-P Malhaire
- Service de radiothérapie, CHU de Brest, 29200 Brest, France.
| | - O Pradier
- Service de radiothérapie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - G Fournier
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France; CeRePP, hôpital Pitié-Salpétrière, 75013 Paris, France.
| | - A Valéri
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France; CeRePP, hôpital Pitié-Salpétrière, 75013 Paris, France.
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Burnett AL, Anele UA, Trueheart IN, Strouse JJ, Casella JF. Randomized controlled trial of sildenafil for preventing recurrent ischemic priapism in sickle cell disease. Am J Med 2014; 127:664-8. [PMID: 24680796 PMCID: PMC4085689 DOI: 10.1016/j.amjmed.2014.03.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Successful preventive therapy for ischemic priapism, a disorder of penile erection with major physical and psychologic consequences, is limited. We conducted a randomized, double-blind, placebo-controlled clinical trial to assess the efficacy and safety of sildenafil by a systematic dosing protocol to prevent recurrent ischemic priapism associated with sickle cell disease. METHODS Thirteen patients with sickle cell disease reporting priapism recurrences at least twice weekly were randomized to receive sildenafil 50 mg or placebo daily, unassociated with sleep or sexual activity, for 8 weeks, followed by open-label use of this sildenafil regimen for an additional 8 weeks. RESULTS Priapism frequency reduction by 50% did not differ between sildenafil and placebo groups by intention-to-treat or per protocol analyses (P = 1.0). However, during open-label assessment, 5 of 8 patients (62.5%) by intention-to-treat analysis and 2 of 3 patients (66.7%) by per protocol analysis met this primary efficacy outcome. No significant differences were found between study groups in rates of adverse effects, although major priapism episodes were decreased 4-fold in patients monitored "on-treatment." CONCLUSIONS Sildenafil use by systematic dosing may offer a strategy to prevent recurrent ischemic priapism in patients with sickle cell disease.
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Affiliation(s)
- Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Md.
| | - Uzoma A Anele
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Md
| | - Irene N Trueheart
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Md
| | - John J Strouse
- Division of Pediatric Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - James F Casella
- Division of Pediatric Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
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Vignozzi L, Filippi S, Comeglio P, Cellai I, Morelli A, Rastrelli G, Maneschi E, Mannucci E, Maggi M. Metformin in vitro and in vivo increases adenosine signaling in rabbit corpora cavernosa. J Sex Med 2014; 11:1694-708. [PMID: 24844317 DOI: 10.1111/jsm.12572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 01/14/2023]
Abstract
INTRODUCTION In subjects with erectile dysfunction responding poorly to sildenafil, metformin was reported to improve erections. AIMS The aim of this study is to investigate metformin's mechanism of action on erectile function, particularly focusing on adenosine (ADO) and nitric oxide (NO) signaling in an animal model of high-fat diet (HFD)-induced metabolic syndrome. METHODS In vitro contractility studies of penile strips. Penile expression of genes related to ADO or NO signaling was also evaluated. MAIN OUTCOME MEASURE In vitro contractility studies were used to investigate the effect of in vivo and ex vivo metformin administration on ADO- or acetylcholine (Ach)-induced relaxation of penile strips from HFD as compared with animals fed a regular diet (RD). RESULTS Expression of ADO receptor type 3 (A3 R), ADO deaminase (ADA), AMP deaminase type 1 (AMPD1), and 2 (AMPD2) was decreased in HFD as compared with RD. Accordingly, in HFD the ADO relaxant effect was potentiated as compared with RD (P < 0.02). In vivo metformin treatment in both RD and HFD significantly increased the ADO relaxing effect (P < 0.0001 and P < 0.01, respectively, vs. relative untreated groups) although to a different extent. In fact, the half-maximal inhibitory concentration (IC50 )/IC50 ratio in RD increased fourfold vs. HFD (RD IC50 ratio = 13.75 ± 2.96; HFD IC50 ratio = 2.85 ± 0.52). In corpora cavernosa (CC) from HFD, in vivo metformin (i) normalized A3 R, ADA, and AMPD1; (ii) further decreased AMPD2; (iii) increased dimethylarginine dimethylamino-hydrolase; and (iv) partially restored impaired Ach-induced relaxation. Ex vivo metformin time and dose dependently increased the relaxant effect of ADO in RD. The potentiating effect of metformin on ADO-induced relaxation was significantly reduced by preincubation with NO synthase inhibitor N(ω) -Nitro-L-arginine methyl ester hydrochloride (L-NAME). Interestingly, in vivo testosterone supplementation in HFD rabbits (i) increased penile expression of endothelial NO synthase and AMPD2 and (ii) restored metformin's potentiating effect on ADO-induced relaxation up to RD level. CONCLUSION Metformin in vivo and ex vivo increases ADO signaling in CC, most probably interfering with NO formation and ADO breakdown.
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Affiliation(s)
- Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Clavijo RI, Miner MM, Rajfer J. Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder? Rev Urol 2014; 16:167-171. [PMID: 25548543 PMCID: PMC4274173] [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] [Indexed: 06/04/2023]
Abstract
An erection is a mechanical event dependent primarily on corporeal vascular dynamics wherein arterial inflow and storage of blood within the corpora is greater than the egress of blood from the corpora. The most common cause of erectile dysfunction (ED) is the inability of the corporal tissue to store the blood within the corporal sinusoids once inflow into the corpora begins. This failure to store is primarily due to a corporal smooth muscle dysfunction and, in most men, is most likely an aging-related occurrence. Because the corporal smooth muscle is embryologically and physiologically indistinguishable from the smooth muscle within our arterial system, the authors hypothesize that the aging-related dysfunction that occurs within the penis also occurs within the arterial system, and that this smooth muscle dysfunction within the arterial media is most likely the cause of what is called essential hypertension. This panvascular smooth muscle myopathy could explain why hypertension is the most common comorbidity associated with ED and appears to indicate that both ED and essential hypertension are the same disorder, albeit in two different organ systems.
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Affiliation(s)
- Raul I Clavijo
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Jacob Rajfer
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Dobberfuhl AD, Oti T, Sakamoto H, Marson L. Identification of CNS neurons innervating the levator ani and ventral bulbospongiosus muscles in male rats. J Sex Med 2013; 11:664-77. [PMID: 24373488 DOI: 10.1111/jsm.12418] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 12/17/2022]
Abstract
INTRODUCTION The pelvic striated muscles play an important role in mediating erections and ejaculation, and together these muscles compose a tightly coordinated neuromuscular system that is androgen sensitive and sexually dimorphic. AIM To identify spinal and brains neurons involved in the control of the levator ani (LA) and bulbospongiosus (BS) in the male adult and preadolescent rat. METHODS Rats were anesthetized, and the transsynaptic retrograde tracer pseudorabies virus (PRV) was injected into the LA muscle of adults or the ventral BS muscle in 30-day-old rats. After 3-5 days rats were sacrificed, and PRV-labeled neurons in the spinal cords and brains were identified using immunohistochemistry. The presence of gastrin-releasing peptide (GRP) in the lumbar spinal neurons was examined. MAIN OUTCOMES MEASURES The location and number of PRV-labeled neurons in the spinal cord and brain and GRP colocalization in the lumbar spinal cord. RESULTS PRV-labeled spinal interneurons were found distributed throughout T11-S1 of the spinal cord, subsequent to dorsal medial motoneuron infection. The majority of spinal interneurons were found in the lumbosacral spinal cord in the region of the dorsal gray commissure and parasympathetic preganglionic neurons. Preadolescent rats had more PRV-labeled spinal interneurons at L5-S1 where the motoneurons were located but relatively less spread rostrally in the spinal cord compared with adults. Lumbar spinothalmic neurons in medial gray of L3-L4 co-localized PRV and GRP. In the brain consistent labeling was seen in areas known to be involved in male sexual behavior including the ventrolateral medulla, hypothalamic paraventricular nucleus, and medial preoptic area. CONCLUSION Common spinal and brain pathways project to the LA and BS muscles in the rat suggesting that these muscles act together to coordinate male sexual reflexes. Differences may exist in the amount of synaptic connections/neuronal pathways in adolescents compared with adults.
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Affiliation(s)
- Amy D Dobberfuhl
- Division of Urology, Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
Male sexual response is controlled by a series of neurally mediated phenomena regulating libido, motivation, arousal and genital responses such as penile erection and ejaculation. These neural events that occur in a hormonally defined milieu involve different neurophysiological, neurochemical, and neuropsychological parameters controlled by central mechanisms, spinal reflexes and peripheral nervous system. Epidemiologic studies have suggested the high prevalence of male sexual dysfunction worldwide with significant impact on the quality of life of patients suffering from this problem. The incidence of sexual dysfunction is particularly high among men with neurologic disorders. Sexual dysfunction in men, such as loss of sexual desire, erectile dysfunction (ED), changes in arousal, and disturbances in orgasm and ejaculation may involve organic causes, psychological problems, or both. Organic male sexual disorders include a wide variety of neurologic, vasculogenic, neurovascular or hormonal factors that interfere with libido, erection, ejaculation and orgasm. Neurogenic sexual dysfunction may result from a specific neurologic problem or it could be the presenting symptom of a developing neurologic disease. Neurologic ED could result from complications of chronic neurologic disorders, trauma, surgical injury or iatrogenic causes. These etiologic factors and the underlying pathophysiologic conditions could overlap, which should be considered when making a diagnosis and selecting a treatment. A detailed history of physical examination, neurologic disorders, as well as any past history of psychological and psychiatric disturbances, and a thorough neurological examination will provide better understanding of the underlying causes of neurogenic sexual dysfunction. In patients with spinal cord injury, the location of the lesion and the time of onset of injury should be determined. Therapeutic strategies against erectile dysfunction are initiated with the least invasive options using the phosphodiesterase inhibitors. When oral medication options are exhausted, intraurethral and intracavernosal therapies and ultimately vacuum constriction devices and penile implants are considered. Recent basic research has suggested the potential role of stem cell-based therapeutic strategies to protect penile neural integrity and reverse cavernosal neurodegeneration in experimental models. Further insight into the central, spinal and peripheral neural mechanisms of male sexual response may help precise diagnosis and better management of neurogenic sexual dysfunction in men.
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Guillot-Tantay C, Phé V, Chartier-Kastler E, Mozer P, Bitker MO, Rouprêt M. [Medical and surgical treatments of congenital and acquired penile curvatures: a review]. Prog Urol 2013; 24:203-11. [PMID: 24560211 DOI: 10.1016/j.purol.2013.08.328] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 04/06/2013] [Revised: 08/05/2013] [Accepted: 08/30/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. MATERIALS AND METHODS [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. RESULTS The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. CONCLUSION Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies.
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Affiliation(s)
- C Guillot-Tantay
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - V Phé
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France.
| | - E Chartier-Kastler
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - P Mozer
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - M-O Bitker
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
| | - M Rouprêt
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France
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Njomnang Soh P, Delaunay B, Thoulouzan M, Jonca F, Bachaud JM, Delannes M, Soulie M, Huyghe E. Erectile function after permanent 125I prostate brachytherapy for localized prostate cancer. Basic Clin Androl 2013; 23:2. [PMID: 25780566 PMCID: PMC4346293 DOI: 10.1186/2051-4190-23-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE To analyze erectile function in men treated by prostate brachytherapy (PB) for localized prostate cancer. MATERIAL AND METHODS Of a series of 270 sexually active men treated by PB, 241 (89%), mean age 65 yr (range, 43-80 yr), participated in a study on erectile function that was evaluated using the International Index of Erectile Function 5-item (IIEF-5) questionnaire before implantation and by postal survey after a mean follow-up of 36 months (range, 6-70 months). RESULTS After PB, 27 patients (11%) had no erectile dysfunction (ED), 36 (15%) had mild ED, 58 (24%) had mild to moderate ED, 24 (10%) had moderate ED, 53 (22%) had severe ED and 43 (18%) were not sexually active. In patients with a preimplant IIEF score >12 (cut-off for intercourse with penetration), 73% had a deterioration of erectile function by at least one class after PB. Risk factors for ED after PB were age, preimplant IIEF score and prostate volume. Median time to ED onset was 16 months and was shorter with androgen deprivation (p = 0.007), diabetes (p = 0.03) and age over 55 (p = 0.01). CONCLUSIONS Following PB, the majority of patients progressively develop or major ED after a free interval that may last several months. SUPPORT Ligue Nationale contre le Cancer, France.
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Affiliation(s)
- Patrice Njomnang Soh
- Department of Andrology, University Hospital Paule de Viguier, Paul Sabatier University, EA 3694 Toulouse, France
| | - Boris Delaunay
- Department of Andrology, University Hospital Paule de Viguier, Paul Sabatier University, EA 3694 Toulouse, France ; Department of Urology, University Hospital of rangueil, Toulouse, France
| | | | | | | | | | - Michel Soulie
- Department of Urology, University Hospital of rangueil, Toulouse, France
| | - Eric Huyghe
- Department of Andrology, University Hospital Paule de Viguier, Paul Sabatier University, EA 3694 Toulouse, France ; Department of Urology, University Hospital of rangueil, Toulouse, France ; Département d'Urologie CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
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