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International Journal of Impotence... May 2016The emerging of intracavernosal injection (ICI) of vasoactive materials was a major breakthrough in the treatment of erectile dysfunction (ED). However, the current... (Review)
Review
The emerging of intracavernosal injection (ICI) of vasoactive materials was a major breakthrough in the treatment of erectile dysfunction (ED). However, the current state and future direction of ICI role in the armamentarium of diagnosis, prevention and treatment of ED are not well defined. The aim of this study was to address the current place of ICI in the armamentarium of ED diagnosis and treatment. An English-language MEDLINE review for the utilization of 'intracavernosal injection & erectile dysfunction' was performed from 1990 to present time. Four hundred forty-eight articles were analyzed and classified according to the current utilization of ICI in the following conditions; diagnosis of ED, phosphodiesterase-5 inhibitor (PDE5I) non-responders, diabetes, post radical prostatectomy (RP), stem cells and gene therapy, new intracavernosal drugs, adverse effects and couple satisfaction. This paper is not a standard systematic review; it is eventually a literature review of original peer-reviewed manuscripts and clinical trials reported in Medline. The comprehensive analyses of all the reviewed data were not possible as the level of evidence for utility of ICI in each topic was not available. Current date have established the role of ICI of vasoactive materials as a very common alternative domain in treatment of severe ED particularly in diabetic patients, post-RP, PDE5I non-responders. Further, new studies have denoted the potential future role of intracavernosal treatment for ED in the era of stem cells and gene therapy. ICI of vasoactive material continues to be a highly effective and safe treatment tool for men with wide varieties of ED etiologies. Several experimental and clinical studies are currently investigating new ICI materials. Hopefully in the near future, we might witness evolved molecules and innovative strategies that could help to treat ED patients with different etiologies.
Topics: Diabetes Complications; Erectile Dysfunction; Female; Humans; Injections; Male; Patient Satisfaction; Penile Erection; Penis; Personal Satisfaction; Vasodilator Agents
PubMed: 27076113
DOI: 10.1038/ijir.2016.14 -
The Journal of Sexual Medicine Jan 2017Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been proposed as an effective non-invasive treatment option for erectile dysfunction (ED). (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been proposed as an effective non-invasive treatment option for erectile dysfunction (ED).
AIM
To use systematic review and meta-analysis to assess the efficacy of Li-ESWT by comparing change in erectile function as assessed by the erectile function domain of the International Index of Erectile Function (IIEF-EF) in men undergoing Li-ESWT vs sham therapy for the treatment of ED.
METHODS
Systematic search was conducted of MEDLINE, EMBASE, and ClinicalTrials.gov for randomized controlled trials that were published in peer-reviewed journals or presented in abstract form of Li-ESWT used for the treatment of ED from January 2010 through March 2016. Randomized controlled trials were eligible for inclusion if they were published in the peer-reviewed literature and assessed erectile function outcomes using the IIEF-EF score. Estimates were pooled using random-effects meta-analysis.
MAIN OUTCOME MEASURES
Change in IIEF-EF score after treatment with Li-ESWT in patients treated with active treatment vs sham Li-ESWT probes.
RESULTS
Data were extracted from seven trials involving 602 participants. The average age was 60.7 years and the average follow-up was 19.8 weeks. There was a statistically significant improvement in pooled change in IIEF-EF score from baseline to follow-up in men undergoing Li-ESWT vs those undergoing sham therapy (6.40 points; 95% CI = 1.78-11.02; I = 98.7%; P < .0001 vs 1.65 points; 95% CI = 0.92-2.39; I = 64.6%; P < .0001; between-group difference, P = .047). Significant between-group differences were found for total treatment shocks received by patients (P < .0001).
CONCLUSION
In this meta-analysis of seven randomized controlled trials, treatment of ED with Li-ESWT resulted in a significant increase in IIEF-EF scores.
Topics: Erectile Dysfunction; High-Energy Shock Waves; Humans; Male; Middle Aged; Penile Erection; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 27986492
DOI: 10.1016/j.jsxm.2016.11.001 -
What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis.Sexual Medicine Reviews Jul 2017Obesity is a worldwide public health issue that has severe psychological and social implications. Erectile dysfunction also is a prevalent clinical situation, and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Obesity is a worldwide public health issue that has severe psychological and social implications. Erectile dysfunction also is a prevalent clinical situation, and obesity is one of the primary risk factors for its development.
AIM
To determine whether bariatric surgery can lessen erectile dysfunction in obese men because of evidence showing that weight loss in obese men contributes to decreasing erectile dysfunction and bariatric surgery contributes to significant weight loss.
METHODS
A search was conducted using Medline, LILACS, Cochrane, Scopus, CINAHL, Embase, Web of Science, Eric, and EBM up to April 13, 2016. The authors selected by title, abstract, and full text. Scottish Intercollegiate Guidelines Network checklists were used for comparative studies to show the limitations and biases of each article. RevMan 5.3 software from the Cochrane Library was used for meta-analyses. Results were demonstrated with forest plots.
MAIN OUTCOME MEASURES
The outcome selected was resolution of erectile dysfunction, which was analyzed by improvement in the International Index of Erectile Function (IIEF) score.
RESULTS
Of 185 articles analyzed, 7 were selected for systematic review. Meta-analysis of two articles that evaluated erectile function showed a 5.66-point increase in the five-item IIEF score of patients who underwent bariatric surgery (95% CI = 7.88-3.45, I = 35%, P < .00001), demonstrating statistical significance. Meta-analysis of three articles showed a 4.10-point increase in the IIEF erectile function score of patients who underwent bariatric surgery (95% CI = 6.10-2.10, I = 0%, P < .0001), demonstrating statistical significance.
CONCLUSION
Bariatric surgery leads to an improvement of erectile function. Glina FPI, de Freitas Barboza JW, Nunes VM, et al. What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis. Sex Med Rev 2017;5:393-402.
Topics: Bariatric Surgery; Erectile Dysfunction; Humans; Male; Obesity; Penile Erection
PubMed: 28526630
DOI: 10.1016/j.sxmr.2017.03.008 -
The Journal of Sexual Medicine May 2019Penile prostheses are commonly used to achieve erectile rigidity after phalloplasty in trans masculine patients. Implantation poses significant challenges because of the...
BACKGROUND
Penile prostheses are commonly used to achieve erectile rigidity after phalloplasty in trans masculine patients. Implantation poses significant challenges because of the delicate nature of the neophallus and lack of native erectile tissue. Many groups have developed novel phalloplasty and prosthesis insertion techniques, but none have proven superior.
AIM
To analyze and aggregate reported characteristics and outcomes of penile prosthesis implantation in the trans masculine patient.
METHODS
A comprehensive literature search of Medline, EMBASE, and Cochrane Registry databases was conducted for studies published through February 19, 2019, with multiple search terms related to penile prosthesis use in gender-affirming surgical procedures.
OUTCOMES
Studies were included and tabulated if they reported prosthesis outcomes in patients who received a neophallus as part of a gender-affirming procedure.
RESULTS
23 journal articles met inclusion criteria from 434 references identified. All selected articles were either retrospective or case series/reports. A total of 1,056 patients underwent phalloplasty, and 792 received a penile prosthesis. Most (83.6%) of the prostheses were inflatable, whereas 16.4% were non-inflatable. The number of cylinders used for each prosthesis was 61.0% single-cylinder and 39.0% double-cylinder. The mean follow-up duration was 3.0 years. Of patients who received a prosthesis, 36.2% reported a prosthesis complication; at follow-up 60.0% of patients had their original implant present, and 83.9% reported achieving penetration.
CLINICAL IMPLICATIONS
Prosthesis implantation in gender-affirming operations poses significant risk of complication, but it is still a reasonable and useful method to achieve rigidity necessary for sexual intercourse.
STRENGTH & LIMITATION
This is the first study to aggregate all reported penile prosthesis characteristics and outcomes in trans masculine patients. This study was significantly limited by inconsistent reporting of demographics, sensation, urinary health, patient satisfaction, and penetrative sex. The lack of comparative studies precluded any meaningful meta-analytical comparison.
CONCLUSIONS
There is a great need for a prosthesis designed to meet the specific needs of the trans masculine patient after phalloplasty. Standardized methods of reporting implant outcomes including sexual function, sensation, and patient satisfaction should be refined for future studies. This study can assist patients and surgeons about the risks and benefits of this procedure. Rooker SA, Vyas KS, DiFilippo EC, et al. The Rise of the Neophallus: A Systematic Review of Penile Prosthetic Outcomes and Complications in Gender-Affirming Surgery. J Sex Med 2019;16:661-672.
Topics: Female; Humans; Male; Patient Satisfaction; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Transsexualism
PubMed: 30956105
DOI: 10.1016/j.jsxm.2019.03.009 -
Journal of Cardiovascular Pharmacology... May 2016Published clinical practice guidelines have addressed antihypertensive therapy and sexual dysfunction (SD) in many different ways. (Review)
Review
BACKGROUND
Published clinical practice guidelines have addressed antihypertensive therapy and sexual dysfunction (SD) in many different ways.
OBJECTIVE
In this systematic review, we evaluated guidelines that address antihypertensive drug-associated SD, guideline recommendations, and recent guideline trends.
METHODS
Thirty sets of guidelines for hypertension management in adults that had been published in the English language since 2000 were reviewed. The primary outcome measure was antihypertensive-associated SD potential, which was independently evaluated using specific questions by 2 authors in a nonblinded standardized manner.
RESULTS
Sexual dysfunctions associated with thiazide-class diuretics, β-blockers, and centrally acting sympathoplegics were addressed by half of the guidelines reviewed. There is no clarity on β-blockers and thiazide-class diuretics because one-third of the guidelines are vague about individual β-blockers and diuretics, and there is no statement on third-generation β-blockers and thiazide-like diuretics that can improve erectile function. The revised guidelines never use terms such as loss of libido, ejaculatory dysfunction, lack of orgasm, and priapism. Summary versions of guidelines are inadequate to reflect the key interpretation of the primary guidelines on SD associated with antihypertensives, even in the major guidelines that were updated recently. Therapeutic issues such as exploring SD in clinical history, assessing SD prior to and during treatment with antihypertensives, substituting the offending agents with alternatives that possess a better safety profile, intervening with phosphodiesterase-5 inhibitors, and avoiding the concomitant use of nitrovasodilators are superficially addressed by most guidelines, with the exception of 2013 European Society of Hypertension/European Society of Cardiology and Seventh Joint National Committee recommendations.
CONCLUSION
Future guideline revisions, including both full and summary reports, should provide a balanced perspective on antihypertensive-related SD issues to improve the impact of hypertension treatment guidelines on patient care and quality of life.
Topics: Antihypertensive Agents; Blood Pressure; Erectile Dysfunction; Humans; Hypertension; Male; Patient Selection; Penile Erection; Practice Guidelines as Topic; Quality of Life; Risk Assessment; Risk Factors; Sexual Behavior
PubMed: 26450998
DOI: 10.1177/1074248415598321 -
The Journal of Sexual Medicine Jun 2019Erectile dysfunction supplements (ED-Ss) are featured on online marketplaces like Amazon.com, with dedicated pages and claims that they naturally treat ED. However,...
INTRODUCTION
Erectile dysfunction supplements (ED-Ss) are featured on online marketplaces like Amazon.com, with dedicated pages and claims that they naturally treat ED. However, their efficacy and safety are largely unknown, limiting the ability to counsel patients regarding their use.
AIM
To evaluate the highest rated and most frequently reviewed ED-Ss on Amazon.com to facilitate patient counseling regarding marketing myths, ingredient profiles, and evidence for product efficacy and safety.
METHODS
The Amazon marketplace was queried using the key term "erectile dysfunction" with default search settings and ranking items based on relevance. The top 6 ED-S products identified on September 29, 2018, were reviewed based on price, ratings, reviews, manufacturer, and ingredients. Consumer reviews were categorized using subtopics within the International Index of Erectile Function (IIEF) questionnaire to better understand ED-S efficacy and then reanalyzed following filtration of untrustworthy comments using ReviewMeta.com, a proprietary Amazon review analysis software.
OUTCOMES
Quantitative and qualitative evaluation of ED-S products sold on Amazon.com.
RESULTS
The top 6 ED-Ss had an average of 2,121 ± 1,282 reviews and a mean rating of 3.92 ± 0.42 stars. A total of 21 ingredients were identified in these ED-Ss. Ginseng, horny goat weed, L-arginine, and tongkat ali were the most popular ingredients included in the analyzed products. Our literature review identified 413 studies involving the 21 identified ingredients, of which 59 (16%) involved human subjects. Among these 69 human studies, only 12 (17%) investigated supplement ingredients individually and reported improvement in ED. Analysis of top-ranked customer reviews from the first 2 pages of reviews for each supplement revealed differences in IIEF scores before and after ReviewMeta.com filtration. After filtration, we observed a 77% decrease in reviews reporting improved erection strength, an 83% decrease in reviews reporting improved ability to maintain erection, a 90% decrease in reviews reporting increased sexual satisfaction, an 88% decrease in reviews reporting increased enjoyment with intercourse, and an 89% decrease in reviews reporting increased erection confidence.
STRENGTHS & LIMITATIONS
Study strengths include a novel approach to ascertaining consumers' perceptions and satisfaction with ED-Ss and practical summary information that clinicians can provide to patients. Limitations include selection bias, the small number of supplements analyzed, and the proprietary nature of the Amazon review analysis software.
CONCLUSIONS
Our investigation revealed that human studies evaluating the efficacy of ED-S ingredients are limited and have yielded no definitive findings of the effects on ED. Patients considering ED-S use should receive appropriate counseling, given the prevalence of disingenuous reviews and the ready availability of Food and Drug Administration-approved drug therapies. Balasubramanian A, Thirumavalavan N, Srivatsav A, et al. An Analysis of Popular Online Erectile Dysfunction Supplements. J Sex Med 2019;16:843-852.
Topics: Adult; Aged; Arginine; Coitus; Dietary Supplements; Erectile Dysfunction; Fatty Acids; Humans; Internet; Male; Middle Aged; Orgasm; Panax; Penile Erection; Plant Extracts; Treatment Outcome
PubMed: 31036522
DOI: 10.1016/j.jsxm.2019.03.269 -
PloS One 2022Penile cancer is a rare but debilitating condition, which often requires aggressive treatment. Partial penectomy is considered as a treatment option when a sufficient...
Penile cancer is a rare but debilitating condition, which often requires aggressive treatment. Partial penectomy is considered as a treatment option when a sufficient portion of the penile shaft can be maintained to preserve functionality. This systematic review, which followed the PRIMSA guidelines, aimed to evaluate the effects of partial penectomy for penile cancer on sexual function-the maintenance of which is often a priority in patient groups-and to identify potential factors which may moderate these effects. A systematic search of PubMed, The Cochrane Library, and Open Grey as well as MEDLINE, CINAHL and Open Dissertations via EBSCOhost was conducted from inception through to 24th March, 2022. Studies were required to include adults aged ≥18 years who had undergone partial penectomy for the treatment of penile cancer, with a quantitative measure of sexual function available pre- and post-surgery. Four eligible articles were identified for inclusion in this review, three of which reported a decrease in sexual function pre- to post-surgery across all domains of the International Index of Erectile Function (IIEF) questionnaire (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction). Conversely, one study reported an increase in sexual function across IIEF domains, except for orgasmic function, which decreased, pre- to post-surgery. Greater penile length was associated with higher post-operative sexual function, whilst increasing age and higher anxiety levels were associated with lower post-operative sexual function levels in one study. Despite the overall drop in sexual function, many patients were still able to maintain satisfactory sex lives following partial penectomy. Given the limited research in this area and small sample sizes across studies, additional well-controlled investigations are warranted to provide further evidence on the effects of partial penectomy for penile cancer on sexual function.
Topics: Adolescent; Adult; Erectile Dysfunction; Humans; Male; Penile Erection; Penile Neoplasms; Penis; Quality of Life; Surveys and Questionnaires
PubMed: 36137121
DOI: 10.1371/journal.pone.0274914 -
International Journal of Impotence... Mar 2022COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected... (Review)
Review
COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected as well. We performed a systematic review of the published articles about the change in EF among patients and health care providers during the COVID-19 pandemic. We searched PubMed and Cochrane databases for English literature using a combination of medical subject headings (MeSH) terms and keywords. We extracted data of erectile dysfunction (ED) rate, international index of erectile function (IIEF), changes related to exposure to the pandemic (Primary objectives), and factors affecting these differences (Secondary objectives). Twenty articles were included in the screening phase. Only 3 articles were eligible for primary objectives, and 2 articles were included for the secondary objective. Three articles revealed an increase in ED cases and a reduction in IIEF-5 scores during the pandemic. Rates of ED have ranged from 32% to 87% of the study populations. Anxiety, depression, and post-traumatic stress disorder (PTSD) were associated with increased ED rates. We conclude that the COVID-19 pandemic is associated with increased rates of ED. Anxiety and depression augment this increase. Health care providers are at higher risk for PTSD, which increases the risk of ED.
Topics: COVID-19; Erectile Dysfunction; Health Personnel; Humans; Male; Pandemics; Penile Erection
PubMed: 34992226
DOI: 10.1038/s41443-021-00504-w -
Prostate Cancer and Prostatic Diseases Mar 2021Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the...
BACKGROUND
Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the advent of modern technology. The purpose of this project was to evaluate modern external beam radiotherapy and brachytherapy techniques to determine the incidence of radiotherapy (RT) induced ED.
METHODS
A systematic review of the literature published between January 2002 and December 2018 was performed to obtain patient reported rates of ED after definitive external beam radiotherapy, ultrafractionated stereotactic radiotherapy, and brachytherapy (BT) to the prostate in men who were potent prior to RT. Univariate and multivariate analyses of radiation dose, treatment strategy, and length of follow-up were analyzed to ascertain their relationship with RT-induced ED.
RESULTS
Of 890 articles reviewed, 24 met inclusion criteria, providing data from 2714 patients. Diminished erectile function status post RT was common and similar across all studies. The median increase in men reporting ED was 17%, 26%, 23%, and 23%, 3DCRT, IMRT, low dose rate BT, and SBRT, respectively, at 2-year median follow-up.
CONCLUSION
ED is a common side effect of RT. Risk of post-RT ED is similar for both LDR brachytherapy and external beam RT with advanced prostate targeting and penile-bulb sparing techniques utilized in modern RT techniques.
Topics: Brachytherapy; Erectile Dysfunction; Humans; Male; Penile Erection; Prostatic Neoplasms; Radiotherapy Dosage
PubMed: 32647352
DOI: 10.1038/s41391-020-0247-x -
International Journal of Molecular... Jan 2023Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted... (Review)
Review
Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted into acute or chronic status, and it can differ when selecting the clinical therapeutics. PD would cause pain and penile deformity to diseased men and impair their erectile function. Occasionally, surgical revision of the penis might be needed to correct the penile curvature. We find that there are limited effective options of intra-lesion injections for the PD plaques. By searching the databases and screening the literature with the PRISMA 2020 guideline, we observed that several preclinical studies that applied stem cell therapy in treating PD were fruitful in the acute phase. Although in the chronic phase of PD, erectile parameters were not significantly improved, and therefore, future studies might be better elevated in certain aspects, such as the sites selected for harvesting stem cells or changing the centrifugation forces. In this review, we concluded the contemporary understanding of inflammatory microenvironments in PD, the stem cell therapy in PD, and our perspectives on future studies. We concluded that there may be great potential in stem cell therapy for treating both acute and chronic phases PD.
Topics: Male; Humans; Penile Induration; Penis; Penile Erection; Injections; Stem Cells
PubMed: 36614220
DOI: 10.3390/ijms24010777