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Andrologia Oct 2020Previous studies have found that the ratio of estradiol to testosterone (E2/T ratio) has a negative effect on sexual function, but the relationship between the E2/T...
Previous studies have found that the ratio of estradiol to testosterone (E2/T ratio) has a negative effect on sexual function, but the relationship between the E2/T ratio and erection of the penis is not clarified. We conducted a retrospective study of 183 patients with erectile dysfunction and 52 healthy men to investigate the relationship between penis base erection and tip erection. All participants underwent nocturnal penile tumescence tests and medical history checks and had relevant biochemical and endocrine indicators measured. The ratio of estradiol to testosterone was calculated. The relationship between E2/T ratio and erectile time of penile tip and penile base was determined by univariate analysis, multivariate analysis and stratification analysis. After adjusting for mixed factors, the results showed that the E2/T ratio had a more significant negative effect on the base of the penis compared with the tip of the penis (Hazard ratio: -4.34 95% CI: -6.52, -2.16 p = .0001). Moreover, when the effective erection time was ≥10 min, the negative effect of E2/T on penile root erection was more obvious (HR ratio: -4.46 95% CI: -6.50, -2.43 p < .0001). In summary, our study demonstrated a negative relationship between E2/T ratio and penile erection, particularly at the root of the penis.
Topics: Erectile Dysfunction; Estradiol; Humans; Male; Penile Erection; Penis; Retrospective Studies; Testosterone
PubMed: 32539180
DOI: 10.1111/and.13701 -
Current Urology Reports Feb 2019Radical prostatectomy, the preferred treatment option for organ-confined prostate cancer, is associated with a wide variety of sexual dysfunctions including erectile and... (Review)
Review
Radical prostatectomy, the preferred treatment option for organ-confined prostate cancer, is associated with a wide variety of sexual dysfunctions including erectile and orgasmic dysfunctions. Climacturia is a type of orgasmic dysfunction that has been reported to occur in 20-60% of men after radical prostatectomy. Several treatment strategies for climacturia have been evaluated and recommended including behavioral changes, use of special devices, medications, specialized therapies, and surgeries. Inflatable penile prosthesis implantation might be the treatment of choice when conservative management approaches fail to treat erectile dysfunction. In this review article, the different options and approaches for the management of climacturia during inflatable penile prosthesis surgery will be discussed.
Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Penile Implantation; Penile Prosthesis; Prostatectomy; Prostatic Neoplasms; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Urinary Incontinence
PubMed: 30806828
DOI: 10.1007/s11934-019-0879-3 -
Sexual Medicine Reviews Oct 2021The most common cause of patient dissatisfaction after penile prosthesis placement is penile shortening compared with one's memory of a natural erection. Surgical... (Review)
Review
INTRODUCTION
The most common cause of patient dissatisfaction after penile prosthesis placement is penile shortening compared with one's memory of a natural erection. Surgical techniques as well as preoperative and postoperative protocols have been reported to preserve and possibly enhance penile length in someone undergoing penile prosthesis surgery.
OBJECTIVES
This article presents a description of as well as the authors' experience with presurgical protocols, intraoperative techniques, and postsurgical protocols that allow for preservation or enhancement of penile length for patients who undergo inflatable penile prosthesis insertion.
METHODS
An extensive, systematic literature review was performed using PubMed searching for key terms including penile lengthening, inflatablepenile prosthesis, penile girth, buried penis, and penile enhancement. All articles with subjective and/or objective penile length outcomes were reviewed.
RESULTS
Several preoperative treatment protocols were found for penile length preservation and enhancement, which included use of a vacuum erection device as well as traction therapy. Intraoperative techniques included cavernosal sparing, channeling without dilatation, circumferential penile degloving, ventral phalloplasty, suprapubic lipectomy, liposuction, suspensory ligament release, sliding technique, modified sliding technique, multislice technique, and aggressive implant sizing. Postoperative protocols included early device inflation and cycling. Table 1 summarizes and compares the various preoperative, intraoperative, and postoperative strategies identified during literature review with their corresponding reported length gain.
CONCLUSIONS
Many preoperative, intraoperative, and postoperative surgical techniques can be performed by high-volume implanters to improve one's perceived or true penile length. In the hands of experienced, high-volume implanters, these techniques can be very meaningful for patients undergoing penile prosthesis insertion, particularly those who are concerned with penile length. Shah B, Kent M, Valenzuela R. Advanced Penile Length Restoration Techniques to Optimize Penile Prosthesis Placement Outcomes. Sex Med Rev 2021;9:641-649.
Topics: Humans; Male; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Sex Reassignment Surgery
PubMed: 32653404
DOI: 10.1016/j.sxmr.2020.05.007 -
International Journal of Impotence... Mar 2020Data regarding the size of the adult penis is of great importance to both clinicians and researchers. Currently, there is no consensus regarding the preferred method for... (Review)
Review
Data regarding the size of the adult penis is of great importance to both clinicians and researchers. Currently, there is no consensus regarding the preferred method for the evaluation of penile size. Various and conflicting methods are reported in the literature. We review the data on measurement methods of the flaccid, stretched, and erected penis with the aim of constructing a recommendation for best practice. A systematic search for articles on penile length and girth measurement techniques was performed using PubMed, Google Scholar, and Cochran Library. Only peer-reviewed articles published in English before August 2018 were reviewed. All authors evaluated the methods and results sections presented in each publication. Relevant, demonstrative publications are reported in this review. We did not find definitive evidence favoring one measuring method over the other. Therefore, we advocate the use of our recommendations for penile size measurement in future publications.
Topics: Adult; Anthropometry; Humans; Male; Organ Size; Penile Erection; Penis
PubMed: 31171853
DOI: 10.1038/s41443-019-0157-4 -
Zhonghua Nan Ke Xue = National Journal... Jul 2019Four types of cytokines are found to be related to the pathogenesis and treatment of ED. The cytokines capable of promoting angiogenesis can improve vascular endothelial... (Review)
Review
Four types of cytokines are found to be related to the pathogenesis and treatment of ED. The cytokines capable of promoting angiogenesis can improve vascular endothelial function, promote endothelial regeneration and thus improve erectile function, those capable of promoting nerve regeneration can improve erectile function by protecting cavernous nerves, those capable of protecting the smooth muscle function can improve erectile function by promoting the smooth muscle expression and inhibiting penile fibrosis, and those inflammation-related cytokines can induce penile erection by acting on the corresponding receptor relaxing smooth muscle. Compared with PDE-5 inhibitors, cytokines are more targeted for the treatment of ED. However, current studies are mostly dependent on rat models and lack of large sample sizes, which has restricted further clinical application of cytokines. Although VEGF, IGF-1, BDNF and NGF can significantly improve the erectile function of ED rats, experiments with larger samples and larger animals are needed to further confirm their efficacy and safety.
Topics: Animals; Cytokines; Disease Models, Animal; Erectile Dysfunction; Humans; Male; Penile Erection; Penis; Rats
PubMed: 32223111
DOI: No ID Found -
Current Opinion in Urology May 2020Several imaging modalities exist for the assessment of Peyronie's disease. However, comprehensive recommendations for using these objective modalities based on... (Review)
Review
PURPOSE OF REVIEW
Several imaging modalities exist for the assessment of Peyronie's disease. However, comprehensive recommendations for using these objective modalities based on large-scale evidence-based studies do not yet exist. Our objective is to evaluate current imaging techniques and provide a model that we follow in our clinic in the workup and management of Peyronie's disease.
RECENT FINDINGS
Computed tomography and radiography excellently visualize penile plaque calcifications, and MRI adeptly identifies plaques in complex locations, such as the corporal septum. Ultrasonography has extensive applications in plaque localization and characterization. Used along with color Doppler ultrasound, it is capable of detecting vascular abnormalities. Sonoelastography is an emerging subtype of ultrasongraphy that utilizes elastic properties of tissue to identify penile plaques that may not be visualized with other modalities.
SUMMARY
Ultrasonography is the preferred imaging modality in Peyronie's disease and noninvasively characterizes penile plaques and monitors plaque response to various treatments. At our center, we perform ultrasonography with intracavernosal injection in all patients with Peyronie's disease to evaluate the degree of curvature, plaque characteristics, and concomitant erectile dysfunction to better guide management decisions.
Topics: Elasticity Imaging Techniques; Erectile Dysfunction; Humans; Male; Penile Erection; Penile Induration; Penis; Ultrasonography
PubMed: 32205808
DOI: 10.1097/MOU.0000000000000754 -
Urology Aug 2015
Topics: Diagnostic Self Evaluation; Ejaculation; Humans; Male; Penile Erection; Sexuality; Surveys and Questionnaires; Urethra; Urethral Stricture
PubMed: 26199156
DOI: 10.1016/j.urology.2015.04.060 -
Urology Dec 2015
Topics: Humans; Male; Penile Erection; Penis; Veins
PubMed: 26719117
DOI: 10.1016/j.urology.2015.07.055 -
Current Vascular Pharmacology 2016Erectile dysfunction (ED) affects approximately half of men during middle age. Erectile dysfunction is often an early symptom of systemic vascular disease, which may... (Review)
Review
Erectile dysfunction (ED) affects approximately half of men during middle age. Erectile dysfunction is often an early symptom of systemic vascular disease, which may precipitate significant cardiac events. The pathophysiology of ED and cardiovascular disease is closely linked. Endothelial dysfunction occurs at an early stage in ED and cardiovascular disease (CVD). In normal conditions, nitric oxide dependent and independent mechanisms regulate penile vascular tone ensuring an appropriate balance of vasoconstriction and vasodilatation. A normal endothelium is responsible for mediating the effect of pro-erectile mediators derived from the endothelium and is critical in normal erectile function. Endothelial dysfunction disrupts the homeostatic mechanisms responsible for regulation of smooth muscle contraction and penile vascular tone. Reduced bioavailability of nitric oxide (NO) occurs as a response to endothelial damage. Phosphodiesterases further degrade levels of cyclic guanosine monophosphate (cGMP) and impair smooth muscle relaxation and erectile function. A number of endothelium derived NO independent mediators of erectile function have been described and are known to contribute to ED in the presence of endothelial damage. This review provides an up to date analysis of the role of the endothelium in ED describing the pathways involved and how these represent current and potential therapeutic targets.
Topics: Animals; Endothelium, Vascular; Erectile Dysfunction; Humans; Male; Oxidative Stress; Penile Erection; Vasoconstriction; Vasodilation
PubMed: 26638795
DOI: 10.2174/1570161114666151202205950 -
Revista Da Associacao Medica Brasileira... Sep 2020The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process.... (Review)
Review
INTRODUCTION
The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process. Unfortunately, there is no standard procedure for CDDU conduction, a fact that results in high result-interpretation variability.
OBJECTIVE
The aims of this review are to promote greater standardization during CDDU of the penis and discuss the fundamental principles for its accurate conduction.
METHODS
CDDU is initially conducted with the penis in the flaccid state; the whole penis must be assessed (images at B mode) with a high-frequency linear transducer (7.5-18 MHz). Intracavernous injection of vasodilating agents (prostaglandin E1, papaverine, phentolamine) is performed to induce a rigid erection. Serial measurements at different times should be taken during the CDDU session and penile rigidity must be assessed in each evaluation.
RESULTS
It is important to monitor the erection response after the vasoactive agent (hardness scale), and scanning during the best-quality erection should be contemplated. Manual self-stimulation, audiovisual sexual stimulation (AVSS), and vasoactive agent re-dosing protocols must be taken into account to reduce the influence of psychogenic factors and to help the patient to get the hardest erection possible. Such measurements contribute to the maximal relaxation of the erectile tissue, so the hemodynamic parameters are not underestimated.
CONCLUSIONS
CDDU is a relevant specialized tool to assess patients with erectile dysfunction; therefore, this guideline will help to standardize and establish uniformity in its conduction and interpretation, taking into consideration the complexity and heterogeneity of CDDU evaluations of the penis.
Topics: Erectile Dysfunction; Hemodynamics; Humans; Male; Penile Erection; Penis; Ultrasonography, Doppler, Color
PubMed: 33027442
DOI: 10.1590/1806-9282.66.9.1180