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Sexual Medicine Reviews Jan 2019Peyronie's disease (PD) is associated with penile length loss due to atrophy that occurs as a result of fibrous inelastic scarring. Studies have shown diminished penile... (Review)
Review
INTRODUCTION
Peyronie's disease (PD) is associated with penile length loss due to atrophy that occurs as a result of fibrous inelastic scarring. Studies have shown diminished penile length and girth, as well as the inability to participate in sexual activity, can lead to decreased quality of life, emotional challenges, and sexual dissatisfaction in a large percentage of men.
AIM
To provide a summary of the new developments in the surgical techniques available for the PD patient, with a focus on procedures that provide penile size restoration.
METHODS
A MEDLINE PubMed search was used to identify articles related to surgical treatments for PD, including plication procedures, penile prosthesis placement, and techniques for size restoration.
MAIN OUTCOME MEASURE
Types of surgical treatments for PD and their outcomes regarding penile length and patient satisfaction.
RESULTS
The Nesbit procedure, among other plication procedures, and penile prosthesis placement with modeling or plication are likely to decrease penile length. Although plaque incision with grafting offers restoration of penile length, it carries a risk of postoperative erectile dysfunction (ED). For men with concomitant ED and severe curvature not amenable to prosthesis with modeling or plication, options include grafting, circumferential tunical incisions, subcoronal prosthesis placement, and the sliding technique with its modifications, allowing for management of both PD and ED while restoring penile length. Adjunct procedures, such as ventral phalloplasty and suspensory ligament release, have also been shown to restore length in PD patients. Novel therapies continue to evolve with the goal of preserving length while treating curvature.
CONCLUSION
There are numerous surgical options for correcting penile curvature in PD patients, with or without concomitant ED treatment. When determining the optimal procedure, it is important to consider possible preservation of penile length and to discuss possible complications to increase patient satisfaction and improve quality of life. Barrett-Harlow B, Clavell-Hernandez J, Wang R. New Developments in Surgical Treatment for Penile Size Preservation in Peyronie's Disease. Sex Med Rev 2019;7:156-166.
Topics: Humans; Male; Organ Size; Patient Satisfaction; Penile Erection; Penile Induration; Penile Prosthesis; Penis; Quality of Life; Plastic Surgery Procedures; Treatment Outcome
PubMed: 30301708
DOI: 10.1016/j.sxmr.2018.07.001 -
The Canadian Journal of Urology Feb 2022Prior studies evaluating the efficacy of penile prostheses (PP) and intracavernosal injections (ICI) have focused predominantly on sexual function, not psychosocial...
INTRODUCTION
Prior studies evaluating the efficacy of penile prostheses (PP) and intracavernosal injections (ICI) have focused predominantly on sexual function, not psychosocial health. We utilized the freelisting technique and the Self-Esteem and Relationship (SEAR) questionnaire to evaluate the impact of PP and ICI treatments on psychosocial functioning.
MATERIALS AND METHODS
IRB-approval was obtained to perform an evaluation of patients who underwent PP or ICI treatment for erectile dysfunction (ED). Using a modified freelisting approach, participants were asked to give three one-word responses to questions about sexual function and relationships. Participants also completed the SEAR questionnaire and results were calculated based on the previously described formulas.
RESULTS
Fifty patients agreed to participate in the study (25 ICI, 25 PP). In the freelisting portion of the study, PP patients had more positive responses than ICI patients in 2 out of 3 questions. The freelisting study also identified important areas of concern for ED patients such as self-esteem, confidence, and treatment reliability. PP patients reported numerically higher SEAR total scores than ICI patients (63.9 vs. 53.9, p = 0.12), especially in confidence with duration of (p = 0.003), satisfaction with sexual performance (p = 0.06), and confidence with sexual performance (p = 0.02). SEAR confidence domain (p = 0.83), self-esteem subscale (p = 0.68), and overall relationship sub-scales (p = 0.90) were similar between PP and ICI patients.
CONCLUSIONS
PP appears to have a stronger psychosocial impact compared to ICI; however, both PP and ICI patients continue to struggle with self-esteem, confidence, and treatment reliability. Further patient counseling before and after treatment may help to address these concerns and improve patient satisfaction.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Erection; Penile Prosthesis; Psychosocial Functioning; Reproducibility of Results; Sexual Behavior; Surveys and Questionnaires
PubMed: 35150216
DOI: No ID Found -
Sexual Medicine Reviews Jul 2019Several data have clearly shown that the endocrine system-and androgens in particular-play a pivotal role in regulating all the steps involved in the male sexual... (Review)
Review
BACKGROUND
Several data have clearly shown that the endocrine system-and androgens in particular-play a pivotal role in regulating all the steps involved in the male sexual response cycle. Accordingly, testosterone (T) replacement therapy (TRT) represents a cornerstone of pharmacologic management of hypogonadal subjects with erectile dysfunction.
AIM
The aim of this review is to summarize all the available evidence supporting the role of T in the regulation of male sexual function and to provide a comprehensive summary regarding the sexual outcomes of TRT in patients complaining of sexual dysfunction.
METHODS
A comprehensive PubMed literature search was performed.
MAIN OUTCOME MEASURE
Specific analysis of preclinical and clinical evidence on the role of T in regulating male sexual function was performed. In addition, available evidence supporting the role of TRT on several sexual outcomes was separately investigated.
RESULTS
T represents an important modulator of male sexual response function. However, the role of T in sexual functioning is less evident in epidemiologic studies because other factors, including organic, relational, and intrapsychic determinants, can orchestrate their effect independently from the state of androgens. Nonetheless, it is clear that TRT can ameliorate several aspects of sexual functioning, including libido, erectile function, and overall sexual satisfaction. Conversely, data on the role of TRT in improving orgasmic function are more conflicting. Finally, further controlled studies are needed to investigate the combination of TRT and PDE5 inhibitors.
CONCLUSION
Positive effects of TRT are observed only in the presence of a hypogonadal status (ie, total T < 12 nmol/L). In addition, TRT alone can be effective in restoring only milder forms of erectile dysfunction, whereas the combined therapy with other drugs is required when more severe vascular damage is present. Rastrelli G, Guaraldi F, Reismann Y, et al. Testosterone Replacement Therapy for Sexual Symptoms. Sex Med Rev 2019;7:464-475.
Topics: Androgens; Behavior Therapy; Hormone Replacement Therapy; Humans; Male; Penile Erection; Sexual Behavior; Sexual Dysfunction, Physiological; Testosterone
PubMed: 30803919
DOI: 10.1016/j.sxmr.2018.11.005 -
British Journal of Pharmacology Mar 2015The ability to get and keep an erection is important to men for several reasons and the inability is known as erectile dysfunction (ED). ED has started to be accepted as... (Review)
Review
The ability to get and keep an erection is important to men for several reasons and the inability is known as erectile dysfunction (ED). ED has started to be accepted as an early indicator of systemic endothelial dysfunction and subsequently of cardiovascular diseases. The role of NO in endothelial relaxation and erectile function is well accepted. The discovery of NO as a small signalling gasotransmitter led to the investigation of the role of other endogenously derived gases, carbon monoxide (CO) and hydrogen sulphide (H2 S) in physiological and pathophysiological conditions. The role of NO and CO in sexual function and dysfunction has been investigated more extensively and, recently, the involvement of H2 S in erectile function has also been confirmed. In this review, we focus on the role of these three sister gasotransmitters in the physiology, pharmacology and pathophysiology of sexual function in man, specifically erectile function. We have also reviewed the role of soluble guanylyl cyclase/cGMP pathway as a common target of these gasotransmitters. Several studies have proposed alternative therapies targeting different mechanisms in addition to PDE-5 inhibition for ED treatment, since some patients do not respond to these drugs. This review highlights complementary and possible coordinated roles for these mediators and treatments targeting these gasotransmitters in erectile function/ED.
Topics: Animals; Carbon Monoxide; Cyclic GMP; Drug Design; Erectile Dysfunction; Guanylate Cyclase; Humans; Hydrogen Sulfide; Male; Molecular Targeted Therapy; Nitric Oxide; Penile Erection; Receptors, Cytoplasmic and Nuclear; Signal Transduction; Soluble Guanylyl Cyclase
PubMed: 24661203
DOI: 10.1111/bph.12700 -
Minerva Cardiology and Angiology Oct 2021Erectile dysfunction (ED) is defined as the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence... (Review)
Review
Erectile dysfunction (ED) is defined as the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence on quality of life, with significant implications for family and social relationships. Because atherosclerosis of penile arteries represents one of the most frequent causes of ED, patients presenting with it should always be investigated for potential coexistent coronary or peripheral disease. Up to 75% of patients with ED have a stenosis of the iliac-pudendal-penile arteries, supplying perfusion of the male genital organ. Recently the potential treatment of this pathological condition by percutaneous approaches has emerged with good angiographic results and with a significant improvement in symptoms and quality of life. This review will focus on the normal anatomy and physiology of erection, the pathophysiology of ED, the relation between ED and cardiovascular diseases and, lastly, on new treatment modalities aimed at restoration of normal erectile function.
Topics: Endovascular Procedures; Erectile Dysfunction; Humans; Male; Penile Erection; Penis; Quality of Life
PubMed: 32492987
DOI: 10.23736/S2724-5683.20.05136-1 -
Transactions of the American Clinical... 2019The field of sexual medicine, in reference to the science of the sexual response and the clinical management of sexual dysfunctions, has evolved remarkably in the last... (Review)
Review
The field of sexual medicine, in reference to the science of the sexual response and the clinical management of sexual dysfunctions, has evolved remarkably in the last 25 years. Erection biology has been central in driving this progress and is measured considerably by the discovery, study, and clinical translation of a simple gaseous molecule, nitric oxide, which is operative in the penis. Nitric oxide functions extraordinarily as a neurotransmitter and molecular signal transducer. It is now well understood to be the principal molecular mediator of penile erection and to be a critical element involved in dysregulatory mechanisms of erection disorders ranging from erectile dysfunction to priapism. It is most familiarly associated with the scientific development of oral medications for treating erectile dysfunction, which has modernized the clinical management of this condition.
Topics: Erectile Dysfunction; Humans; Male; Nitric Oxide; Nitric Oxide Synthase Type I; Nitric Oxide Synthase Type III; Penile Erection; Phosphodiesterase 5 Inhibitors; Sildenafil Citrate
PubMed: 31516164
DOI: No ID Found -
International Journal of Impotence... Sep 2016The efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie's disease (PD) has been controversial for a very long time. We aimed to evaluate the efficiency... (Meta-Analysis)
Meta-Analysis Review
The efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie's disease (PD) has been controversial for a very long time. We aimed to evaluate the efficiency of ESWT for PD and provide possible evidence on the basis of a meta-analysis of existing comparative studies. All controlled studies, including randomized controlled trials (RCTs), cohort studies and case-control studies, that focused on the efficiency of ESWT for PD, were prospectively identified through comprehensive searches of PubMed, the Cochrane Library and Embase databases. We conducted a meta-analysis of these studies. Six studies including 443 patients were selected for the meta-analysis. Pooling data of these studies showed that ESWT could significantly increase the percentage of men with lessening of penile plaques (odds ratio (OR) 2.07, 95% confidence interval (CI) 1.11-3.85, P=0.02), relief of pain (OR 4.46, 95% CI 2.29-8.68, P<0.0001) and complete remission of pain (OR 5.86, 95% CI 2.66-12.92, P<0.0001). However, insignificant differences were found in improvement of penile curvature (OR 1.88, 95% CI 0.97-3.65, P=0.06) and sexual function (OR 2.22, 95% CI 0.69-7.11, P=0.18) between ESWT and placebo groups. Further, similar results were shown for sensitivity and publication bias analysis when only RCTs were included. However, sporadic complications caused by ESWT were reported, but no patient needed additional treatment aside from conservative observation. ESWT may be an effective and safe treatment for lessening of penile plaques and relieving pain for men with PD, but not for improving of penile curvature and sexual function.
Topics: High-Energy Shock Waves; Humans; Male; Penile Erection; Penile Induration; Penis; Treatment Outcome
PubMed: 27250868
DOI: 10.1038/ijir.2016.24 -
The Journal of Sexual Medicine Mar 2020The role of testosterone (T) replacement therapy (TRT) in men is still conflicting. In particular, safety concerns and cardiovascular (CV) risk related to TRT have not... (Review)
Review
INTRODUCTION
The role of testosterone (T) replacement therapy (TRT) in men is still conflicting. In particular, safety concerns and cardiovascular (CV) risk related to TRT have not been completely clarified yet. Similarly, the clear beneficial effects of TRT are far to be established.
AIM
To systematically and critically analyze the available literature providing evidence of the benefit-risk ratio derived from TRT in aging men.
METHODS
A comprehensive PubMed literature search was performed to collect all trials, either randomized controlled trials (RCTs) or observational studies, evaluating the effects of TRT on different outcomes.
MAIN OUTCOME MEASURE
Whenever possible, data derived from RCTs were compared with those resulting from observational studies. In addition, a discussion of the available meta-analyses has been also provided.
RESULTS
Data derived from RCT and observational studies clearly documented that TRT can improve erectile function and libido as well as other sexual activities in men with hypogonadism (total T < 12 nM). Conversely, the effect of TRT on other outcomes, including metabolic, mood, cognition, mobility, and bone, is more conflicting. When hypogonadism is correctly diagnosed and managed, no CV venous thromboembolism or prostate risk is observed.
CLINICAL IMPLICATIONS
Before prescribing TRT, hypogonadism (total T < 12 nM) must be confirmed through an adequate biochemical evaluation. Potential contraindications should be ruled out, and an adequate follow-up after the prescription is mandatory.
STRENGTH & LIMITATIONS
When correctly diagnosed and administered, TRT is safe, and it can improve several aspects of sexual function. However, its role in complicated vasculogenic erectile dysfunction is limited. Conversely, TRT is not recommended for weight reduction and metabolic improvement. Further well-powered studies are advisable to better clarify TRT for long-term CV risk and prostate safety in complicated patients as well as in those curatively treated for prostate cancer.
CONCLUSION
TRT results in sexual function improvement when men with hypogonadism (total T < 12 nM) are considered. Positive data in other outcomes need to be confirmed. Corona G, Torres LO, Maggi M. Testosterone Therapy: What We Have Learned From Trials. J Sex Med 2020;17:447-460.
Topics: Aging; Erectile Dysfunction; Hormone Replacement Therapy; Humans; Hypogonadism; Libido; Male; Penile Erection; Randomized Controlled Trials as Topic; Sexual Behavior; Testosterone
PubMed: 31928918
DOI: 10.1016/j.jsxm.2019.11.270 -
Current Medicinal Chemistry May 2017This review examines brain sites involved in sexual stimulation. New data on brain activation sites in individuals having erections concomitant with visual erotic... (Review)
Review
This review examines brain sites involved in sexual stimulation. New data on brain activation sites in individuals having erections concomitant with visual erotic stimulation were documented. The activation was chiefly at the midbrain around the cerebral peduncle, and in the pons centering on the tegmentum, they are indicated by blood oxygenation level dependent (BOLD) images captured by functional magnetic resonance imaging (fMRI). The cerebellum and inferior temporal lobe were activated more extensively in individuals viewing pornographic movie with a concomitant erection than those without. Similarly, individuals with erection had activations in the midbrain and pons, while drug addicts had neither erections nor any of these brainstem active sites. From our observation in the new data, we deduced three possible transmitters might be involved in erection: i) cholinergic neurons forming descending pathways and associated with motor activity ii) gamma-aminobutyric acid (GABA), directly or indirectly via decreasing pathways, modulating autonomic vascular responses in the penile vasculature causing the filling of blood iii) GABA decreases to stimulate dopamine increase in ventral tegmentum of the brain, leading to euphoric responses.
Topics: Animals; Brain; Brain Mapping; Dopamine; Humans; Magnetic Resonance Imaging; Male; Penile Erection; Photic Stimulation; gamma-Aminobutyric Acid
PubMed: 27978801
DOI: 10.2174/0929867323666161213102528 -
Archivio Italiano Di Urologia,... Mar 2023Penile compression using a tourniquet is common with several materials and designs that have been previously described. The objective of the tourniquet is to induce an...
INTRODUCTION
Penile compression using a tourniquet is common with several materials and designs that have been previously described. The objective of the tourniquet is to induce an artificial erection through corporal occlusion for intra-operative penile curvature assessment or to obtain a clear visible bloodless surgical field.
OBJECTIVE
We sought to describe our novel step-by-step technique of applying penile tourniquet using silicone Penrose drain tube designed as a strap by creating a small hole on the side of the tube to obtain a loop at the base of the penis Conclusions: This novel technique is simple, effective and requires no additional materials nor special equipment, and facilitates the application and release of a tourniquet during penile surgery.
Topics: Male; Humans; Penis; Penile Erection
PubMed: 36924367
DOI: 10.4081/aiua.2023.11201