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Sexual Medicine Reviews Sep 2023Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a...
INTRODUCTION
Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes.
OBJECTIVES
The aim sought to review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer.
METHODS
A systematic review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed.
RESULTS
Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged.
CONCLUSION
OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.
Topics: Male; Humans; Penile Neoplasms; Erectile Dysfunction; Quality of Life; Penis; Penile Erection
PubMed: 37204120
DOI: 10.1093/sxmrev/qead021 -
The Journal of Sexual Medicine Jun 2022Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable.
AIM
To evaluate the prevalence of ED in the IBD population and the potential role of risk factors in the development of ED.
METHODS
An extensive search in the PubMed, Cochrane Library, and Web of Science was performed to identify relevant English-language articles published up to December 2021 that evaluated the prevalence of ED on IBD patients. The included studies were evaluated by 2 independent reviewers for eligibility. We used an adapted Assessment Tool for Prevalence Studies to evaluate the quality of enrolled studies. Data were analyzed and graphed using the STATA software (version 16.0; Stata Corporation, College Station, TX, USA). The ORs with 95% CIs were pooled using a fixed or random-effects model according to heterogeneity. Subgroup analysis was performed to explore the source of heterogeneity. Sensitivity analysis was conducted to evaluate the stability of the results.
OUTCOMES
The pooled prevalence of ED in IBD patients was calculated, and the OR value and 95% CIs were used to assess the strength of the association between IBD-related risk factors and ED.
RESULTS
Fourteen studies included 32,858 individuals totally were enrolled for this meta-analysis. The overall pooled prevalence estimate of ED in IBD patients was 27% (95% CI: 20-34%). Operation (OR 1.28; 95% CI: 1.17-1.39; P < .00001; I = 0.0%), disease activity (OR 2.06; 95% CI: 1.07-3.05; P < .00001), and depression (crude OR 3.31; 95% CI: 1.08-5.54; P = .004; I = 0.0%) significantly increase the risk of ED in people with IBD. The association of depression and ED was further confirmed by calculating the pooled estimates of adjusted OR (1.58; 95% CI: 0.05-3.12; P < .05; I = 0.0%). The pooled prevalence estimates of ED were 30, 33, and 17% in the age <40, IIEF diagnostic tool, and IPAA surgery subgroups, respectively.
CLINICAL IMPLICATIONS
IBD patients had a significantly increased prevalence of ED, indicating that erectile function in men with IBD should be concerned by clinicians.
STRENGTHS & LIMITATIONS
The strength of this study is that this is the first meta-analysis to assess the global prevalence and risk factors of ED in IBD patients. A limitation is that the results after pooling the included articles showed significant heterogeneity.
CONCLUSION
The results of our meta-analysis and systematic review provide evidence of the high prevalence and risk factors of ED in IBD patients. Wu X, Zhang Y, Zhang W, et al. The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Sex Med 2022;19:950-960.
Topics: Chronic Disease; Erectile Dysfunction; Humans; Inflammatory Bowel Diseases; Male; Penile Erection; Prevalence; Risk Factors
PubMed: 35491378
DOI: 10.1016/j.jsxm.2022.03.615 -
International Journal of Impotence... Feb 2024Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an... (Review)
Review
Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an arterial fistula and embolisation may be required. We conducted a systematic review on behalf of the EAU Sexual and Reproductive health Guidelines panel to analyse the available evidence on efficacy and safety of surgical modalities for IP and NIP. Outcomes were priapism resolution, sexual function and adverse events following surgery. Overall, 63 studies (n = 923) met inclusion criteria up to September 2021. For IP (n = 702), surgery comprised distal (n = 274), proximal shunts (n = 209) and penile prostheses (n = 194). Resolution occurred in 18.7-100% for distal, 5.7-100% for proximal shunts and 100% for penile prostheses. Potency rate was 20-100% for distal, 11.1-77.2% for proximal shunts, and 26.3-100% for penile prostheses, respectively. Patient satisfaction was 60-100% following penile prostheses implantation. Complications were 0-42.5% for shunts and 0-13.6% for IPP. For NIP (n = 221), embolisation success was 85.7-100% and potency 80-100%. The majority of studies were retrospective cohort studies. Risk of bias was high. Overall, surgical shunts have acceptable success rates in IP. Proximal/venous shunts should be abandoned due to morbidity/ED rates. In IP > 48 h, best outcomes are seen with penile prostheses implantation. Embolisation is the mainstay technique for NIP with high resolution rates and adequate erectile function.
Topics: Male; Humans; Priapism; Retrospective Studies; Reproductive Health; Penis; Penile Erection; Penile Prosthesis
PubMed: 36151318
DOI: 10.1038/s41443-022-00604-1 -
The Journal of Sexual Medicine Nov 2023The health benefits of regular aerobic exercise are well established, although there is limited high-quality evidence regarding its impact on erectile function. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The health benefits of regular aerobic exercise are well established, although there is limited high-quality evidence regarding its impact on erectile function.
AIM
To determine the effect of aerobic exercise on erectile function in men and to identify factors that may influence this effect.
METHODS
This systematic review and meta-analysis included randomized controlled trials that evaluated the effects of aerobic exercise on erectile function via the Erectile Function domain of the International Index of Erectile Function (IIEF-EF). The mean difference in IIEF-EF scores between the aerobic exercise and nonexercising control groups was estimated by a random-effects meta-analysis. Meta-regression was used to evaluate the association of moderator variables on meta-analysis results.
OUTCOMES
The IIEF-EF score is reported on a 6-30 scale, with higher values indicating better erectile function.
RESULTS
Among 11 randomized controlled trials included in the analysis, aerobic exercise resulted in statistically significant improvements in IIEF-EF scores as compared with controls, with a mean difference of 2.8 points (95% CI, 1.7-3.9; P < .001) and moderate heterogeneity among studies (I2 = 53%). The effect of aerobic exercise on erectile function was greater in men with lower baseline IIEF-EF scores, with improvements of 2.3, 3.3, and 4.9 points for mild, moderate, and severe erectile dysfunction, respectively (P = .02). The meta-analysis results were not influenced by publication bias or individual study effects.
CLINICAL IMPLICATIONS
Health care providers should consider recommending regular aerobic exercise as a low-risk nonpharmacologic therapy for men experiencing erectile difficulties.
STRENGTHS AND LIMITATIONS
The primary strength of this review was the generation of level 1 evidence on a topic of general interest regarding sexual health in men. However, the included studies evaluated diverse groups, which may complicate data interpretation for specific segments of the population.
CONCLUSION
Regular aerobic exercise can improve the erectile function of men, particularly those with lower baseline IIEF-EF scores.
Topics: Male; Humans; Female; Erectile Dysfunction; Randomized Controlled Trials as Topic; Penile Erection; Exercise
PubMed: 37814532
DOI: 10.1093/jsxmed/qdad130 -
International Urology and Nephrology Sep 2022To apply a new review methodology, called reverse systematic review (RSR), to assess how different classification criteria can influence erectile dysfunction rates in... (Review)
Review
OBJECTIVE
To apply a new review methodology, called reverse systematic review (RSR), to assess how different classification criteria can influence erectile dysfunction rates in patients undergoing laparoscopic radical prostatectomy (LRP).
METHODS
We used RSR from January 1, 2000, until December 31, 2020. The post-prostatectomy erectile dysfunction (PPED) rates were evaluated at 1, 3, 6, 12, and 18 months after surgery in different criteria selected as the most commonly used and divided into four groups: "Erection Sufficient for Intercourse (ESI)", "IIEF-5 > 17", "IIEF-5 > 22" and "Not Available". Temporal distribution of different criteria was analyzed to identify patterns throughout the "natural history" of LRP.
RESULTS
40 systematic reviews on LRP evaluated 81 cohorts and 21,618 patients on PPED. ESI was the predominant form of PPED evaluation (75.3%) followed by IIEF-5 > 22 (11.1%). Despite being a simpler criterion, ESI showed worse PPED rates at 1, 3, 6 and 12 months (8%, 27%, 43% and 51%) than IIEF-5 > 22 (14%, 26%, 45% and 58%). The studies were published between 2005 and 2015, but it was in 2010 that the ESI criterion was established as predominant in the literature, reducing the application of others.
CONCLUSION
The RSR has proven effective in demonstrating how the PPED evaluation criteria behaved in the "natural history" of the LRP. It showed how a simple and easy-to-apply criterion, such as the ESI, was preferred by the authors, even showing worse PPED rates than other more complex.
Topics: Erectile Dysfunction; Humans; Laparoscopy; Male; Penile Erection; Prostate; Prostatectomy
PubMed: 35764756
DOI: 10.1007/s11255-022-03262-w -
Andrologia Jul 2022Atorvastatin may be an effective treatment for erectile dysfunction (ED). The purpose of this meta-analysis was to determine whether atorvastatin therapy is effective in... (Meta-Analysis)
Meta-Analysis Review
Atorvastatin may be an effective treatment for erectile dysfunction (ED). The purpose of this meta-analysis was to determine whether atorvastatin therapy is effective in the treatment of ED. All published research on atorvastatin in the treatment of ED patients in EMBASE, PubMed, Web of Science and Cochrane were investigated till 30 October 2021. A meta-analysis of randomized controlled trials (RCTs) was done to investigate the efficacy of atorvastatin and placebo in the treatment of ED. Moreover, we also performed a meta-analysis based on single-arm trials (SATs) to explore the atorvastatin treatment on the efficacy of ED. In a meta-analysis based on RCTs, the weighted mean difference of the change of International Index for Erectile Function-5 (IIEF-5) score in the atorvastatin treatment group with or without treatment was 4.53 (95 per cent confidence interval [CI] of 3.28-5.79) higher than in the control group. In an SAT-based meta-analysis, the ES of the change in IIEF-5 score in the atorvastatin treatment group before and after treatment was 3.22 (95 per cent CI of 1.32-5.12). Atorvastatin is an effective therapeutic drug for patients with ED. However, we expect that more multicentre clinical trials will be conducted to support this assertion.
Topics: Atorvastatin; Erectile Dysfunction; Humans; Male; Penile Erection; Treatment Outcome
PubMed: 35224753
DOI: 10.1111/and.14408 -
Sexual Medicine Reviews Sep 2023There has been tremendous growth in regenerative medicine during the last decade. For erectile dysfunction (ED), after the inclusion of low-intensity shockwave therapy...
INTRODUCTION
There has been tremendous growth in regenerative medicine during the last decade. For erectile dysfunction (ED), after the inclusion of low-intensity shockwave therapy as a treatment modality for ED management by the European Association of Urology sexual health guidelines, intracavernosal injection of platelet-rich plasma (PRP) has gained popularity between urologists and patients as a novel ED therapeutic modality with initial promising results. However, limited clinical data exist regarding efficacy and safety in patients with ED. Furthermore, despite numerous preclinical studies in other tissues and organs, the mechanism of action for restoring erectile function remains undetermined.
OBJECTIVES
This systematic review aims to present the current status of preclinical and clinical evidence regarding the use of PRP as treatment option for ED.
METHODS
A systematic literature search was conducted using PubMed, Cochrane, and ScienceDirect databases, until February 2023 for studies exploring the effect of PRP on ED.
RESULTS
We identified 517 articles, 23 of which were included in this review. These were 7 preclinical (of which 1 was a comparative trial and 6 were placebo-controlled randomized controlled trials) and 16 clinical studies (of which 1 was a comparative trial, 5 were randomized trials, and 2 were placebo-controlled randomized controlled trials). Preclinical data support the regenerative role of PRP in erectile tissue, in accordance with existing evidence in other tissues. Randomized clinical studies, as well as the first 2 available randomized, placebo-controlled clinical trials, showed promising efficacy and a lack of any adverse events.
CONCLUSION
As PRP for ED is widely used worldwide, there is an urgent need for high-quality studies with long-term follow-up. Standardization of research protocols, especially on the quality of PRP preparation, is also needed.
Topics: Male; Humans; Erectile Dysfunction; Platelet-Rich Plasma; Penile Erection; Randomized Controlled Trials as Topic
PubMed: 37528499
DOI: 10.1093/sxmrev/qead027 -
Sexual Medicine Reviews Dec 2023Erectile dysfunction (ED) is a common condition that negatively affects men's quality of life. It can have various causes, including psychological, vascular, and...
INTRODUCTION
Erectile dysfunction (ED) is a common condition that negatively affects men's quality of life. It can have various causes, including psychological, vascular, and neurologic factors. Existing treatments for ED mainly focus on symptom relief rather than addressing the underlying cause. Stem cells (SCs) have shown potential as a therapeutic approach for ED due to their anti-inflammatory properties.
OBJECTIVES
This systematic review aims to assess the current status of trials and determine the potential impact of SCs on male sexual health.
METHODS
A comprehensive search strategy was employed to gather relevant articles from 6 electronic databases. The search included articles published until March 2023. The reference lists of articles were manually reviewed to identify additional studies of relevance. The eligibility criteria for inclusion in the analysis focused on clinical trials involving humans that evaluated the safety and efficacy of SC therapy for ED. Exclusion criteria encompassed case reports, case series, abstracts, reviews, and editorials, as well as studies involving animals or SC derivatives. Data extraction was performed via a standardized form with a focus on erectile outcomes.
RESULTS
A total of 2847 articles were initially identified; 18 were included in the final analysis. These studies involved 373 patients with ED and various underlying medical conditions. Multiple types of SC were utilized in the treatment of ED: mesenchymal SCs, placental matrix-derived mesenchymal SCs, mesenchymal SC-derived exosomes, adipose-derived SCs, bone marrow-derived mononuclear SCs, and umbilical cord blood SCs.
CONCLUSION
SC therapy shows promise as an innovative and safe treatment for organic ED. However, the lack of standardized techniques and controlled groups in many studies hampers the ability to evaluate and compare trials.
Topics: Female; Pregnancy; Animals; Male; Humans; Erectile Dysfunction; Quality of Life; Placenta; Stem Cell Transplantation; Penile Erection
PubMed: 37758225
DOI: 10.1093/sxmrev/qead040 -
The Journal of Sexual Medicine Jun 2020Erectile dysfunction (ED) is the most common side effect of prostate radiotherapy (RT), but reported rates over time and across modalities have varied widely.
BACKGROUND
Erectile dysfunction (ED) is the most common side effect of prostate radiotherapy (RT), but reported rates over time and across modalities have varied widely.
AIM
To evaluate the published literature between 2002 and 2018 for high quality data utilizing prospectively gathered patient-reported ED, and to summarize the challenges in reporting of RT-induced ED (RIED).
METHODS
A PubMed search and literature review was performed to identify articles describing rates of ED before and after definitive external beam RT or brachytherapy without androgen deprivation.
OUTCOMES
Patient-reported ED, patient and treatment variables, and study follow-up constituted the main outcomes of this study.
RESULTS
24 articles were identified, reporting RIED rates between 17% and 90%. Variables contributing to this range included patient, treatment, and study characteristics known to impact ED reporting.
CLINICAL IMPLICATIONS
For future studies, we recommend the use of validated patient-reported questionnaires and reporting of baseline function and comorbidities, RT type and dose, and use of androgen deprivation therapy and erectile aids at the time of ED measurement. With sufficient follow-up to understand the late nature of RIED, these recommendations will improve comparison of results between studies and the applicability of results to patients undergoing pretreatment counseling regarding the risks of RIED.
STRENGTHS & LIMITATIONS
The literature search and formulation of results were based on a broad understanding of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the literature, but because of the focus on data reporting, a comprehensive systematic review of all RIED literature was not performed.
CONCLUSION
Reported rates of ED after RT vary widely due to differences in patients' baseline reported erectile function, age, comorbidities, and characteristics of the treatment delivered. The methodology of ED measurement has significant impact on the applicability and comparability of results to other studies and clinical practice. Nukala V, Incrocci L, Hunt AA, et al. Challenges in Reporting the Effect of Radiotherapy on Erectile Function. J Sex Med 2020;17:1053-1059.
Topics: Androgen Antagonists; Brachytherapy; Erectile Dysfunction; Humans; Male; Penile Erection; Prostatic Neoplasms
PubMed: 32312661
DOI: 10.1016/j.jsxm.2020.03.008 -
Progres En Urologie : Journal de... Sep 2020The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial.
INTRODUCTION
The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial.
METHODS
A systematic review of the literature published between 2000 and 2019 was conducted using the PRISMA methodology. We used Medline data with the following.
KEYWORDS
"extracorporeal shock wave therapy" ; "Peyronie's disease"; "Sexuality"; Penile erection.
RESULTS
Thirteen articles were selected. Our review showed that SW were beneficial in terms of pain. Regarding plaques size and penile curvature, the results remain divergent.
CONCLUSION
SW may be useful in the management of pain in selected patients with PD. Its effectiveness on plaques size and penile curvature needs to be demonstrated through controlled and randomized trials. The population has to be targeted, and the treatment protocol must also be standardized.
Topics: Extracorporeal Shockwave Therapy; Humans; Male; Penile Induration
PubMed: 32370921
DOI: 10.1016/j.purol.2020.04.003