[Orgasm after curietherapy with permanent iodine-125 radioimplants for localized prostate cancer]

OBJECTIVES

Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer.

PATIENTS AND METHODS

In a series of 270 sexually active men treated by prostate brachytherapy (125I permanent implantation), 241 (89%), mean age of 65 (43-80), participated in a mailed survey about sexual function after a mean time of 36 months (9-70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often).

RESULTS

After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P=0.0001). More than 50% of the patients had an altered orgasm (weak, difficult, absent) after brachytherapy, vs 16% before implantation (P=0.001). Men with a diminished ejaculation volume often had a weak/difficult orgasm (P=0.007). Neoadjuvant hormonal therapy did not seem to impact the quality of orgasm or the frequency of painful ejaculation. Patients who had an IIEF-5 score higher than 12 had frequently intense orgasm (26.7% vs 2.7%; P<0.001) after brachytherapy. Sixty patients (30.3%) experienced often/sometimes painful ejaculation 12.9% (n=31) before implantation (P=0.0001).

CONCLUSION

Most of the patients treated by prostate brachytherapy conserved orgasm after treatment. However, most of the patients described a deterioration of the quality of orgasm.

Time of decline in sexual function after external beam radiotherapy for prostate cancer

PURPOSE

Erectile dysfunction is one of the most concerning toxicities for patients in the treatment of prostate cancer. The inconsistent evaluation of sexual function (SF) and limited follow-up data have necessitated additional study to clarify the rate and timing of erectile dysfunction after external beam radiotherapy (EBRT) for prostate cancer.

METHODS AND MATERIALS

A total of 143 men completed baseline data on SF before treatment and at the subsequent follow-up visits. A total of 1187 validated SF inventories were analyzed from the study participants. Multiple domains of SF (sex drive, erectile function, ejaculatory function, and overall satisfaction) were analyzed for < or =8 years of follow-up.

RESULTS

The median follow-up was 4.03 years. The strongest predictor of SF after EBRT was SF before treatment. For all domains of SF, the only statistically significant decrease in function occurred in the first 24 months after EBRT. SF stabilized 2 years after treatment completion, with no statistically significant change in any area of SF >2 years after the end of EBRT.

CONCLUSION

These data suggest that SF does not have a continuous decline after EBRT. Instead, SF decreases maximally within the first 24 months after EBRT, with no significant changes thereafter.

Sacrolumbar intersegmental reflex circuit in men and its relation to the ejaculatory process

OBJECTIVE

We aimed to investigate electrophysiologically the intersegmental reflex circuit from sacral to lumbar cord segments in normopotent adult men, in patients with spinal cord injury and in patients with premature ejaculation.

METHODS

Reflex EMG activity of the cremasteric (CM) and bulbocavernosus (BC) muscles was recorded simultaneously by needle electrodes during electrical stimulation of the upper lumbar and sacral dermatomes, respectively. Thirty-three healthy male volunteers, 16 patients with spinal cord injury (SCI) at the thoracic or cervical levels, and 26 men with premature ejaculation (PME) were included in the study.

RESULTS

In controls, upper lumbar dermatomal stimulation (ULS) at the inner side of thigh only elicited a reflex response from the CM muscle and did not produce a regular response from the lower sacral myotomes such as in the BC muscle. However lower sacral dermatomal stimulation (LSS) at the dorsal nerve of penis consistently evoked reflex responses from both CM and BC muscles. These basic electrophysiological features were not different in patients with SCI. LSS did not elicit a reflex response from the CM muscle in about 39% of patients with PME, while the BC reflex was obtained from all patients with PME.

CONCLUSIONS

The neurophysiological pattern in BC and CM muscles during sacral or lumbar dermatomal stimulation reflects the sacrolumbar intersegmental reflex linkage that may be related to the ejaculatory process in men. The intersegmental sacrolumbar reflex circuit may be functionally disturbed in some patients with PME.

SIGNIFICANCE

Interaction between the reflex activity of sacral to lumbar dermatomes could prove useful in defining electrophysiological mechanisms related to ejaculation in men.

Long-term persistence of male copulatory behavior in castrated and photo-inhibited Siberian hamsters

Gonadal steroids are essential for the long-term maintenance of the full repertoire of sexual behavior in male rodents. Typically, all individuals of several species cease to display the ejaculatory reflex within a few weeks of castration. The present study documents the persistence of the ejaculatory reflex 19 weeks after orchidectomy in 40% of male Siberian hamsters maintained in long or short day lengths; testosterone was undetectable in the circulation of these animals. Intact hamsters transferred from a long to a short photoperiod underwent gonadal regression: 50% of these animals continued to display mating behavior culminating in ejaculation throughout 25 weeks of testing. The remaining animals failed to ejaculate after approximately 11 weeks of short day treatment but resumed mating coincident with spontaneous gonadal recrudescence. Activation of sex behavior in the latter cohort appears to depend on gonadal steroids and is in contrast to the copulatory behavior of the substantial proportion of the study population that sustains the full sexual repertoire in the long-term absence of gonadal steroids. Sex behavior of the latter animals may be dependent on nongonadal steroids or mediation by steroid-independent mechanisms.

[A method and the clinico-laboratory results of laser therapy for patients with chronic prostatitis]

Local exposures to low-intensity laser radiation (LILR) in chronic prostatis (CP) patients diminish basic symptoms of the disease (pain, dysuria, sex disorders, objective picture). Clinical response was obtained in 93.2% of cases. LILR markedly improved prostatic function, promoted trends to normalization of quantitative and biochemical ejaculate composition. LILR may act as antiaggregator contributing to less ejaculate viscosity and stimulate spermatozoal activity and motility. The above results were seen in 72.4-80% of the exposed patients. CP laser therapy should be wider introduced in clinical practice because its resolving, antiedema, anti-inflammatory, analgetic and deaggregation effects potential.

Ejaculatory dysfunction after transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia

The possibility of retrograde ejaculation or impotence after transurethral resection of the prostate has led to searches for other treatments for benign hyperplasia (BPH). Transurethral microwave thermotherapy (TUMT) was administered to 100 men with a mean age of 61 years and moderate to severe BPH in one 60-minute outpatient session without anesthesia. A urethral catheter was frequently maintained for 5 to 7 days to avoid urinary complaints. Of the 100 original patients, 79 were followed from 3 to 24 months (mean 7.3 months). The prostate volume, irritative and obstructive symptoms, residual urine volume, and urinary flow improved (P < 0.01). No systemic complications were encountered. There were minor complications such as epididymitis, urethral bleeding, and severe micturition discomfort within the first 30 days postoperatively. A total of 7 ejaculatory disorders occurred among 64 patients (11%), 6 complete absences and 1 retrograde ejaculation without recovery for more than 6 months. As TUMT is a fairly new method, further studies must be done to define its effectiveness and safety.

[The use of laser therapy for restoring the fertilizing capacity of the ejaculate in men with a chronic genital inflammation]

The study aimed at investigation of laser radiation effect on reproductive male function which has failed as a result of genital inflammation, versus the efficacy of routine chemotherapy. The treatment was given to 50 males of reproductive age who had been infertile for 1-12 years. 25 of them (group 1) were exposed to laser, the other 25 received standard drugs. The responses were assessed clinically and by ejaculate potency. Due to laser application clinical and ejaculate characteristics improved in the absence of side effects either on the reproductive system or the body as a whole. The author recommends laser application for treatment of ejaculate infertility in males with chronic genital inflammation.

[Disorders of spermatogenesis in people working at the clean-up of the Chernobyl nuclear power plant accident]

It has been studied the state of ejaculate of 125 men, participated in liquidation of Chernobyl disaster consequences in 1986-1986 and irradiated by doses up to 25 rem. For all checked men the decrease of ejaculate volume and the number of spermatozoa with increasing of part of immovable and degenerated forms has been found. Maximal changes have been observed for men being at Chernobyl NPS in 1986 and exposed by dose more than 10 rem. The majority of these persons have asthenooligospermia in 1st degree. The majority of men exposed by total dose more than 1 rem have teratozoospermia. Two men exposed by dose more than 10 rem suffer from azoospermia.

Prediction of long-term gonadal toxicity after standard treatment for testicular cancer

Long-term post-treatment gonadal toxicity was examined (median 3 years after treatment discontinuation) in 125 testicular cancer patients treated with standard regimens: no radiotherapy or chemotherapy (36 patients), infradiaphragmatic radiotherapy (38 patients), and 3-4 cycles of cisplatin-based chemotherapy (51 patients). Radiotherapy and chemotherapy had no impact on serum testosterone, but led to a slight increase in serum follicle-stimulating hormone (FSH). The lowest median value of post-treatment sperm cell count was observed after infradiaphragmatic radiotherapy, the highest value after standard chemotherapy. After more intensive cytotoxic treatment recovery of the gonadal function seemed to be delayed. In testicular cancer long-term post-treatment gonadal toxicity is correlated to the patient's pretreatment gonadal function and age rather than to the standard treatment of the malignancy. In patients with pretreatment normal gonadal function the risk of permanent treatment-induced toxicity is minimal after present standard treatment.

Sexual function and fecundity after treatment for testicular tumors

Questionnaires were mailed to patients who had undergone either radiotherapy, lymphadenectomy, or a combination of both as treatment for malignant disease of the testis in an attempt to define the effects of their therapy on sexual function, ejaculation, and fecundity. The forms returned by 29 patients with seminoma treated with irradiation alone indicated that little change had occurred in their sexual performance or sex drive. Diminished semen volume was reported by 10 patients but was severe in only 1. Two of 3 patients who desired children after therapy were successful. In patients with nonseminomatous testis tumor treated surgically, 42 of 50 reported a significant decrease in semen volume, but 7 of 12 who desired children following therapy were successful. The physiology of ejaculation is reviewed, and comments are offered on the means by which retroperitoneal lymphadenectomy may disrupt normal ejaculation.