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Andrology Nov 2020Males with short penises may suffer from sexual dysfunction and psychological problems. However, currently, managing short penis is a huge challenge.
BACKGROUND
Males with short penises may suffer from sexual dysfunction and psychological problems. However, currently, managing short penis is a huge challenge.
OBJECTIVES
To explore whether inhibition of lysyl oxidase (LOX) activity (anti-LOX) combined with a vacuum device could lengthen the penis of pubertal rat.
MATERIALS AND METHODS
Male rats of different ages were purchased, their exposed penile lengths and weights were measured, and protein expression and lysyl oxidase activity in the corpus cavernosum were analyzed. Fifteen-day-old rats were then purchased and divided into six groups: control, Anti-lysyl oxidase, -200 mm Hg (vacuum device under -200 mm Hg value), -200 mm Hg + Anti-lysyl oxidase, -300 mm Hg, and -300 mm Hg + Anti-lysyl oxidase groups. After the intervention duration of 7 weeks, rats' penile length was measured and erectile function was assessed. The corpus cavernosum was harvested for histopathology and molecular assessments.
RESULTS
Exposed penile length and weight significantly increased with age, especially between 4 and 8 weeks. Both the protein expression and lysyl oxidase activity in corpus cavernosum were the highest at 2 weeks; however, they quickly decreased with age and slowly declined after 8 weeks. Anti-lysyl oxidase significantly increased the penile length by 10.79% over controlled rats, -200 mm Hg + Anti-lysyl oxidase lengthened it by 14.05%, and -300 mm Hg + Anti-lysyl oxidase increased it by 19.84%. Anti-lysyl oxidase significantly reduced lysyl oxidase activity to decrease pyridinoline concentration; however, it did not change desmosine (P = .28), hydroxyproline (P = .14), and total elastin (P = .06) levels. Anti-lysyl oxidase with or without a vacuum device did not diminish erectile function or impair the normal microstructure of corpus cavernosum.
DISCUSSION AND CONCLUSION
The rats' penile growth peaks occurred between 4 and 8 weeks. Anti-lysyl oxidase with a vacuum device promoted penile lengthening by inhibiting pyridinoline production to induce tunica albuginea remodeling. The penile lengthening effect was more obvious in pubertal rats than the adult rats. None of the procedures decreased erectile function.
Topics: Animals; Arterial Pressure; Disease Models, Animal; Erectile Dysfunction; Male; Penile Erection; Penis; Protein-Lysine 6-Oxidase; Rats; Rats, Sprague-Dawley
PubMed: 32578359
DOI: 10.1111/andr.12845 -
Andrology Feb 2023Erectile dysfunction (ED) is a very common complication in men with diabetes mellitus (DM). Low-intensity extracorporeal shockwave therapy (Li-ESWT) offers a promising... (Review)
Review
BACKGROUND
Erectile dysfunction (ED) is a very common complication in men with diabetes mellitus (DM). Low-intensity extracorporeal shockwave therapy (Li-ESWT) offers a promising nonsurgical treatment option for ED. A systematic scoping review investigating the outcomes of Li-ESWT in diabetic men with ED has not yet been performed.
OBJECTIVES
To systematically review animal and clinical studies related to the use of Li-ESWT for treatment of DM-related ED.
DATA SOURCES
PubMed, Embase, The Cochrane Library, Scopus, and Web of Science were searched, unrestricted by dates or study design.
MATERIALS AND METHODS
We included qualitative studies, quantitative studies, primary research studies, meta-analyses, and research letters written in English. Full text reviewing was completed in all animal and human studies discussing Li-ESWT for the treatment of ED in subjects with DM. Data extracted included the journal citation, publication year, country of origin, study design, and a summary of the pertinent findings.
RESULTS
Our search yielded nine clinical studies and 10 animal studies. The results of the clinical studies suggest that Li-ESWT is a safe and effective treatment in men with well-controlled DM and moderate or better ED. However, the benefit is less durable in diabetic men than nondiabetic men. The results of the animal studies suggest that Li-ESWT can significantly improve erectile function in diabetic rat models with ED.
CONCLUSIONS
The examined studies present encouraging results for the use of Li-ESWT to treat diabetic men with ED. Future studies, particularly robust randomized controlled trials, are necessary to confirm these findings and provide long-term follow-up.
Topics: Male; Humans; Animals; Rats; Erectile Dysfunction; Extracorporeal Shockwave Therapy; Penile Erection; Treatment Outcome; Diabetes Mellitus
PubMed: 35642619
DOI: 10.1111/andr.13197 -
Archivio Italiano Di Urologia,... Sep 2022We report our long experience in the surgical treatment of patients requesting penile lengthening by suspensory ligament release and placement of a custom-made soft...
INTRODUCTION
We report our long experience in the surgical treatment of patients requesting penile lengthening by suspensory ligament release and placement of a custom-made soft silicone pubo-cavernous spacer. The aim was to show that with this surgical technique the results obtained are maintained over time. It is crucial to achieve postoperative satisfaction of these patients who show fragility and self-esteem problems.
METHODS
From 1999 to 2020, we treated 245 patients with congenital or acquired penile brevity. We carefully analysed the preoperative and postoperative (at 6, 12, 24 and 48 months) penile size of the patients to evaluate whether this technique could allow the long-term maintenance of aesthetic results. We also assessed preoperative erectile function and we focused on the psychological aspects to avoid surgery in patients with dysmorphophobia. This original technique involves the section of the suspensory ligament and the implantation of a silicone spacer between the pubic symphysis and the corpora cavernosa. This spacer is conformed to the patient anatomy and maintains the relationship between the anatomical structures unchanged over time. Sexual self-esteem and patient satisfaction were assessed with the APPSSI questionnaire.
RESULTS
The mean increase in penile length was about 2.5 cm in flaccid state and 1.9 cm in stretched state. There were no injuries of the neurovascular bundle or urethra, and no erectile dysfunction was noted. These results persisted at 6, 12, 24 and 48 months without significant differences. Over 80% of patients stated that they were completely satisfied with the results obtained. This satisfaction remained stable along follow up.
CONCLUSION
The section of the suspensory ligament and the implant of the soft silicone spacer provide real penis elongation with satisfactory results that persist over time. This technique avoids the frequent complication of short-term shortening due to the scar adhesions of the edges of the dissected ligament. The high aesthetic satisfaction of patients is stable at controls at 6, 12, 24 and 48 months.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Erection; Penis; Silicones; Treatment Outcome
PubMed: 36165482
DOI: 10.4081/aiua.2022.3.339 -
Andrology Jan 2022Intracavernous pressure measurement following cavernous nerve electrostimulation has been extensively adopted for the evaluation of erectile function in animals....
BACKGROUND
Intracavernous pressure measurement following cavernous nerve electrostimulation has been extensively adopted for the evaluation of erectile function in animals. However, the effect of measurement time and acidosis during anesthesia is still lacking.
OBJECTIVE
To explore the effect of measurement time and acidosis during anesthesia.
MATERIALS AND METHODS
Fifty-six male Sprague-Dawley rats were used and anesthetized by a spontaneous inhalation of isoflurane. In the first step, rats were randomly divided into four groups: a control group and three time-delayed measurement groups (intracavernous pressure measurement beginning at 15, 30, and 45 min after cavernous nerve exposure). In the second step, rats were randomly divided into three groups: a control group and two time-delayed measurement groups. Two intravenous fluid support strategies were used in time-delayed measurement groups: a normal saline solution and an isotonic Na CO solution.
RESULTS
Isoflurane-anesthetized rats developed systemic acidosis that worsens with time during intracavernous pressure measurement, which results in a significant decrease in the maximum intracavernous pressure value, intracavernous pressure/mean arterial pressure ratio, and total intracavernous pressure measured. The Na CO infusion could effectively correct acidosis. The decrease in intracavernous pressure was related to the reduced nitric oxide synthase activity, decreased cyclic guanosine monophosphate concentration, and reactive oxygen species activation in rat penis under acidosis conditions.
DISCUSSION AND CONCLUSION
Prolonged isoflurane anesthesia-induced acidosis markedly depresses the erectile response to cavernous nerve electrostimulation in rats. In this situation, it is recommended to supplement with a Na CO infusion to maintain a normal acid-base balance.
Topics: Acidosis; Anesthetics, Inhalation; Animals; Arterial Pressure; Disease Models, Animal; Electric Stimulation; Erectile Dysfunction; Isoflurane; Male; Penile Erection; Penis; Rats; Rats, Sprague-Dawley
PubMed: 34333872
DOI: 10.1111/andr.13085 -
Archives of Sexual Behavior Nov 2020Three experiments investigated the influence of penile erection on ascriptions of mental capabilities to men. Drawing on sexual objectification literature and the...
Three experiments investigated the influence of penile erection on ascriptions of mental capabilities to men. Drawing on sexual objectification literature and the distinction between agency and experience in mind perception, three competing predictions were formulated. The mind redistribution hypothesis assumed that penile erection would lower agency and heighten experience attributions, the animalistic dehumanization hypothesis predicted the decrease in agency, but not experience, and the literal objectification hypothesis implied the simultaneous decrease in both agency and experience. In Experiment 1 (N = 219; 128 females), erection salience lowered agency, but not experience capabilities ascribed to male targets. Experiment 2 (N = 201, 113 females) replicated the negative effect of erection salience on perceived agency (but not experience) and revealed that erection salience lowered intentions to hire a male target. This effect was explained with the loss of perceived agency. Experiment 3 (N = 203, 98 females) verified the causal relationship between penile erection, agency and hiring intentions. Taken together, these results supported the animalistic dehumanization hypothesis.
Topics: Adult; Aged; Animals; Humans; Male; Middle Aged; Penile Erection; Sexual Behavior; Social Perception; Young Adult
PubMed: 32895871
DOI: 10.1007/s10508-020-01800-0 -
Medicinski Glasnik : Official... Aug 2021Aim To provide evidence regarding the effectiveness of aripiprazole in improving penile erection with a therapeutic strategy of add-on or switching therapy in patients...
Aim To provide evidence regarding the effectiveness of aripiprazole in improving penile erection with a therapeutic strategy of add-on or switching therapy in patients with schizophrenia. Methods. PubMed, Cochrane, Clinical Key, ProQuest, EBSCOhost, and ScienceDirect were searched for any design study that evaluated aripiprazole only or versus control (placebo or other antipsychotic) for erectile dysfunction in patients with schizophrenia. Three studies were identified and analysed from 295 initial articles. Data were then extracted from the studies and summarized descriptively. Results Two hundred ninety-five articles were screened, and three studies were identified and eventually selected. After the add-on or switching antipsychotic therapy to aripiprazole, the prevalence of erectile dysfunction and the score of erectile dysfunction or penile erection assessed by Nagoya and Sexual Function Questionnaire (NSFQ) and Arizona Sexual Experience Scale (ASEX) decreased. Conclusion Aripiprazole was effective to improve penile erectile function in patients with schizophrenia. The therapeutic strategy is adjunctive treatment or switching therapy to aripiprazole.
Topics: Antipsychotic Agents; Aripiprazole; Erectile Dysfunction; Humans; Male; Penile Erection; Schizophrenia
PubMed: 33871221
DOI: 10.17392/1360-21 -
Sexual Medicine Reviews Jul 2019Rear tip extenders (RTEs) are often used in penile prosthesis surgery, and their value and use have varied with the evolution of penile prostheses. (Review)
Review
INTRODUCTION
Rear tip extenders (RTEs) are often used in penile prosthesis surgery, and their value and use have varied with the evolution of penile prostheses.
AIM
To review the literature addressing RTEs and to introduce a new term, rigidity factor, which quantifies the ratio of inflatable to non-inflatable component of the cylinders.
METHODS
The urologic literature was reviewed for all mention of RTEs. In addition, literature regarding penile prostheses was explored for mention of RTEs.
MAIN OUTCOME MEASURE
A search on PubMed for "rear tip extender" resulted in 17 publications. These publications were reviewed, and references were also explored for related publications.
RESULTS
The history of the development of RTEs, complications associated with the use of RTEs, and current practices in the use of RTEs are all discussed. In addition, recent publications regarding RTEs were examined in detail. RTEs were introduced in the 1980s to improve mechanical survival of prostheses. They were thought to decrease input tubing wear. Although the trend recently has been to place more rear tips, evidence has surfaced suggesting a link to increased need for reoperation with additional RTEs. In addition, we believe that increased length of RTEs can decrease erectile quality. Rigidity factor, defined as the ratio of the live (inflatable) portion of cylinder to the total cylinder length, can be used to quantify the effect of RTE on erectile strength. However, the effects of RTEs on biomechanical properties of the penis when fully inflated are still not fully understood.
CONCLUSION
The use of RTEs is a relatively underexplored area of penile prosthesis placement. Further laboratory and in vivo work will allow for a better understanding of the optimal role of RTEs in penile prosthesis surgery. Thirumavalavan N, Cordon BH, Gross MS, et al. The Rear Tip Extender for Inflatable Penile Prostheses: Introduction of "Rigidity Factor" and Review of the Literature. Sex Med Rev 2019;7:516-520.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Prosthesis Design
PubMed: 30551977
DOI: 10.1016/j.sxmr.2018.11.001 -
Current Opinion in Urology Nov 2017Erectile dysfunction and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play... (Review)
Review
PURPOSE OF REVIEW
Erectile dysfunction and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play in men with low testosterone levels. The aim of this review is to provide an overview of these findings and the utility of TTh. We specifically examine the role of TTh on erectile function, coadministration with phosphodiesterase type 5 inhibitors, and libido.
RECENT FINDINGS
Recent publications suggest that TTh improves mild erectile dysfunction, though may be less useful in men with more severe erectile dysfunction. In men unresponsive to phosphodiesterase type 5 inhibitors and with mild erectile dysfunction, TTh can further improve erectile function. TTh has also shown consistent benefit in improving libido in men with low testosterone levels at baseline, with no additional improvements once testosterone levels are normalized.
SUMMARY
The available literature supports a role for TTh in men with low testosterone levels, erectile dysfunction, and low libido, with symptomatic improvement in these men.
Topics: Erectile Dysfunction; Humans; Hypogonadism; Libido; Male; Penile Erection; Testosterone
PubMed: 28816715
DOI: 10.1097/MOU.0000000000000442 -
The Journal of Sexual Medicine Aug 2016The biological importance of testosterone is generally accepted by the medical community; however, controversy focuses on its relevance to sexual function and the sexual... (Review)
Review
INTRODUCTION
The biological importance of testosterone is generally accepted by the medical community; however, controversy focuses on its relevance to sexual function and the sexual response, and our understanding of the extent of its role in this area is evolving.
AIM
To provide scientific evidence examining the role of testosterone at the cellular and molecular levels as it pertains to normal erectile physiology and the development of erectile dysfunction and to assist in guiding successful therapeutic interventions for androgen-dependent sexual dysfunction.
METHODS
In this White Paper, the Basic Science Committee of the Sexual Medicine Society of North America assessed the current basic science literature examining the role of testosterone in sexual function and dysfunction.
RESULTS
Testosterone plays an important role in sexual function through multiple processes: physiologic (stimulates activity of nitric oxide synthase), developmental (establishes and maintains the structural and functional integrity of the penis), neural (development, maintenance, function, and plasticity of the cavernous nerve and pelvic ganglia), therapeutically for dysfunctional regulation (beneficial effect on aging, diabetes, and prostatectomy), and phosphodiesterase type 5 inhibition (testosterone supplement to counteract phosphodiesterase type 5 inhibitor resistance).
CONCLUSION
Despite controversies concerning testosterone with regard to sexual function, basic science studies provide incontrovertible evidence for a significant role of testosterone in sexual function and suggest that properly administered testosterone therapy is potentially advantageous for treating male sexual dysfunction.
Topics: Androgens; Erectile Dysfunction; Humans; Male; Muscle Contraction; Muscle, Smooth; Nitric Oxide Synthase; North America; Penile Erection; Penis; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Premature Ejaculation; Prostatectomy; Sexual Behavior; Testosterone
PubMed: 27436075
DOI: 10.1016/j.jsxm.2016.06.004 -
Urology Aug 2019To report success and patient reported urinary and sexual outcomes of patients who underwent anastomotic urethroplasty and dorsal buccal onlay urethroplasty.
OBJECTIVE
To report success and patient reported urinary and sexual outcomes of patients who underwent anastomotic urethroplasty and dorsal buccal onlay urethroplasty.
MATERIALS AND METHODS
Patients who underwent primary transecting anastomotic or dorsal buccal onlay urethroplasty for bulbar strictures at our institution between 1998 and 2015 were analyzed. Patients who had a prior urethroplasty, involvement of a different portion of the urethra, or a diagnosis of lichen sclerosis (LS) or hypospadias were excluded. Outcomes were assessed by cystoscopy at 4 months, validated questionnaires assessing urinary, erectile, and ejaculatory function at the time of their most recent assessment.
RESULTS
A total of 40 and 139 patients were included in the dorsal buccal and anastomotic groups, respectively. Wide patency at 4-month cystoscopy was 97.5% and 100% (P= .06) and the long-term success was 95% and 99.3% (P= .06) with a mean follow-up of 51.4 and 63.3 months. Patient reported outcomes were similar with 2 exceptions: postvoid dribbling was reported more often in the onlay group (28.1% vs 8.3%, P< .0001), and tethering with erections in the anastomotic group (23.4% vs 3.1%, P= .008). Ninety-eight percent of patients in the anastomotic group and 91% in the dorsal buccal onlay group would choose their surgery again (P= .07).
CONCLUSION
Both anastomotic urethroplasty and dorsal onlay graft are associated with high success with comparable satisfaction. Patient reported outcome measures were similar regardless of approach, despite inherent differences in stricture length. Our data indicates that anastomotic urethroplasty should not be avoided due to concerns of sexual side effects.
Topics: Adult; Anastomosis, Surgical; Ejaculation; Humans; Male; Penile Erection; Retrospective Studies; Treatment Outcome; Urethra; Urethral Stricture; Urination; Urologic Surgical Procedures, Male
PubMed: 31009742
DOI: 10.1016/j.urology.2019.02.042