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International Braz J Urol : Official... 2021To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status.
PURPOSE
To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status.
MATERIALS AND METHODS
We identified patients who underwent partial penectomy due to penile cancer between 2009 and 2014. Clinical and pathological characteristics included patient age at the time of diagnosis, obesity, hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, Eastern Cooperative Oncology Group (ECOG) status, penile shaft length, tumor size, primary tumor stage (pT), clinical nodal status, and local recurrence. Erectile function was assessed prospectively with the International Index of Erectile Function (IIEF-5) at least 3 months after partial penectomy.
RESULTS
A total of 81 patients met analysis criteria. At the diagnosis, the median age was 62 years (range from 30 to 88). Median follow-up was 17 months (IQR 7-36). Of total patients, 37 (45%) had T2 or higher disease. Clinically positive nodes were present in 16 (20%) patients and seven (8.6%) developed local recurrence. Fifty patients (62%) had erectile dysfunction (ED) after partial penectomy, 30% had moderate or severe erectile dysfunction scores. Patients with ED versus without ED were similar in baseline characteristics except for age, penile shaft length, and presence of inguinal adenopathy (p <0.05). Multivariate analysis using logistic regression confirmed that older patients, shorter penile shaft length, and clinically positive lymph node were significantly associated with ED.
CONCLUSION
Partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery.
Topics: Adult; Aged; Aged, 80 and over; Erectile Dysfunction; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Penile Erection; Penile Neoplasms; Penis
PubMed: 33620995
DOI: 10.1590/S1677-5538.IBJU.2019.0119 -
Sexual Medicine Reviews Jan 2021Although available treatments for erectile dysfunction (ED) have expanded, there has been a concomitant shift in the treatment paradigm. Newer treatment options focus on... (Review)
Review
INTRODUCTION
Although available treatments for erectile dysfunction (ED) have expanded, there has been a concomitant shift in the treatment paradigm. Newer treatment options focus on disease modification and improving overall erectile function.
OBJECTIVE
The objective of this study is to review the evidence of 3 promising novel ED treatments.
METHODS
A thorough review of the literature was divided into sections corresponding to low-intensity extracorporeal shockwave therapy (Li-ESWT), stem cell therapy (SCT), and platelet-rich plasma (PRP). Search terms included "erectile dysfunction" or "ED" plus "extracorporeal shockwave therapy", "stem cell therapy" or "platelet rich plasma". International Index of Erectile Function (IIEF) scores were the primary outcome measure. Secondary outcome measures included peak systolic velocity and intracorporeal pressure.
RESULTS
Li-ESWT section includes 1 randomized controlled study, 2 prospective studies, 1 animal study, and 2 meta-analyses. IIEF score improvement was 3.54 (range 1.99-6.40). Authors concluded statistically significant short-term effect and improvement in erectile function (EF) with Li-ESWT. SCT section included 4 case series and 1 open-label study. Intraperitoneal, venous, and cavernosal SCT injections improved EF in animal models. 3 studies (n = 6-8) demonstrated 83-100% and 29-50% of patients regained erection and penetration ability, respectively. 2 studies (n = 12-16) found that all patients improved IIEF scores after SCT. Literature review for PRP yielded 3 animal, 1 retrospective, and 1 prospective study. Animal studies have shown that rats sustaining crush cavernosal injuries treated with PRP significantly improved EF and preservation of cavernous nerve axons. One retrospective analysis on humans showed mean improvement by 4.14 in IIEF scores. One prospective study on humans (n = 75) demonstrated improved peak systolic velocity (P = .005) and IIEF scores (P = .046) with PRP therapy.
CONCLUSIONS
This review reveals limited published evidence on current novel ED treatment options. Further research on Li-ESWT, SCT, and PRP therapy is necessary to elucidate the role of these therapies in ED treatment regimens. Raheem OA, Natale C, Dick B, et al. Novel Treatments of Erectile Dysfunction: Review of the Current Literature. Sex Med Rev 2021;9:123-132.
Topics: Animals; Erectile Dysfunction; Extracorporeal Shockwave Therapy; Humans; Male; Penile Erection; Prospective Studies; Rats; Retrospective Studies
PubMed: 32631812
DOI: 10.1016/j.sxmr.2020.03.005 -
The Journal of Sexual Medicine May 2020In recent years, the assessment of erectile dysfunction (ED) has experienced a paradigm shift from objective, quantitative methods to subjective, qualitative... (Review)
Review
BACKGROUND
In recent years, the assessment of erectile dysfunction (ED) has experienced a paradigm shift from objective, quantitative methods to subjective, qualitative patient-reported outcomes. Facilitated by this shift is the ongoing debate on questionnaire selection and need for standardization, particularly among sexual medicine specialists.
AIM
To review current literature on assessment of erectile function via patient-reported outcomes and discuss the context, advantages, and limitations of currently available questionnaires.
METHODS
A thorough literature search of erectile function questionnaires developed from 1990 through 2019 was carried out using 3 methods: a search of the MedLine databases; hand-search of peer-reviewed urologic, sexual medicine, and health policy journals; and expert review. The following keywords were used: [assessment of], [inventory], [questionnaire], or [validated measure]; in combination with: [sexual function] or [erectile function]. Measures were stratified into one of the following 3 groups: screening, outcome, or disease-specific. 3 screening measures (International Index of Erectile Function, the Male Sexual Health Questionnaire, and Brief Male Sexual Inventory); 5 outcome measures (Sexual Health Inventory for Men, Erection Hardness Score, Erectile Dysfunction Inventory for Treatment and Satisfaction, and Treatment Satisfaction Scale); and 3 categories of disease-specific measures (cancer, Peyronie's disease, and spinal cord injury) were included.
OUTCOMES
Strengths, limitations, and valid uses of each erectile function questionnaire.
RESULTS
There currently exists a wide variety of screening, outcome, and disease-specific measures for ED diagnosis, assessment, and treatment. Rigor of psychometric validation varies greatly across studies. However, depending on purpose of use, all abovementioned questionnaires have merit for use in clinical practice, are nonredundant, and can complement and supplement one another.
CLINICAL IMPLICATIONS
Before choosing a specific measure for ED diagnosis, assessment, or treatment, there must be careful consideration of the questionnaire's psychometric properties, context of validation, and its possible limitations.
STRENGTHS & LIMITATIONS
The patient reported outcome measures highlighted in this article complement and supplement one another, as each emphasizes a related yet distinct central theme. During selection for use in clinical practice and research studies, special attention needs to be paid to the context, strengths, and weaknesses of each measure.
CONCLUSION
When used conscientiously, patient-reported questionnaires can significantly optimize patient management. Yafi FA, Huynh LM, Ahlering T, et al. What Is a "Validated Questionnaire"? A Critical Review of Erectile Function Assessment. J Sex Med 2020;17:849-860.
Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Penile Induration; Sexual Behavior; Surveys and Questionnaires
PubMed: 32146130
DOI: 10.1016/j.jsxm.2020.02.005 -
The Aging Male : the Official Journal... Dec 2023HAART has been shown to impair sexual function and penile erection via perturbation of penile redox balance, while zinc has been established to exert antioxidant...
PURPOSE
HAART has been shown to impair sexual function and penile erection via perturbation of penile redox balance, while zinc has been established to exert antioxidant activity. Therefore, this study focused on the role and associated molecular mechanism of zinc in HAART-induced sexual and erectile dysfunction.
MATERIALS AND METHODS
Twenty male Wistar rats were randomly grouped into four (n = 5 rats per group); the control, zinc-treated, HAART-treated, and HAART + zinc-treated groups. Treatments were per os daily for eight weeks.
RESULTS
Zinc co-administration significantly improved HAART-induced increase in the latencies of mount, intromission, and ejaculations. Zinc also attenuated HAART-induced reduction in the motivation to mate, penile reflex/erection, and frequencies of mount, intromission, and ejaculations. In addition, zinc co-treatment improved HAART-induced decline in penile NO and cGMP, dopamine, and serum testosterone. More so, zinc prevented HAART-induced rise in penile activities of monoamine oxidase, acetylcholinesterase, phosphodiesterase-5, and arginase. Furthermore, concomitant treatment with zinc ameliorated HAART-induced penile oxidative stress and inflammation.
CONCLUSION
In conclusion, our present findings show that zinc improves sexual and erectile function in HAART-treated rats by upregulating erectogenic enzymes via the maintenance of penile redox balance.
Topics: Humans; Male; Rats; Animals; Penile Erection; Erectile Dysfunction; Acetylcholinesterase; Up-Regulation; Antiretroviral Therapy, Highly Active; Zinc; Rats, Wistar; Oxidation-Reduction
PubMed: 37144473
DOI: 10.1080/13685538.2023.2205517 -
Andrology Feb 2022There has been recent interest in the use of botulinum neurotoxin (BoNT) in the field of Andrology, whereby it has been investigated in the treatment of penile... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
There has been recent interest in the use of botulinum neurotoxin (BoNT) in the field of Andrology, whereby it has been investigated in the treatment of penile retraction and premature ejaculation.
OBJECTIVES
To evaluate the safety and efficacy of intracavernosal BoNT-A injection in the treatment of patients with erectile dysfunction (ED) refractory to oral phosphodiesterase inhibitors (PDE5Is).
PATIENTS AND METHODS
A double-blind randomized placebo-controlled prospective comparative study conducted at one center and involved 70 patients with ED refractory to PDE5Is. At baseline, the following data were collected: erection hardness score (EHS), peak systolic velocity (PSV), end diastolic velocity (EDV), sexual health inventory for men (SHIM), and the sexual encounter profile 2&3 (SEP-2&3) questionnaires. Treatment group (n = 35) received a single ICI of 100 units of BoNT-A in 2 ml of saline and control group (n = 35) received a single ICI of 2 ml of saline. EHS, PSV, and EDV were assessed at 2 weeks post treatment. SHIM, SEP-2, SEP-3, and global assessment questionnaire (GAQ-Q1&Q2) were completed at 2-, 6-, and 12-weeks post treatment.
RESULTS
Two weeks post treatment, the treatment group showed a statistically significant improvement in the mean EHS, PSV, EDV, and GAQ-Q1 positive responders (p < 0.001) compared to the control group. At 6- and 12-weeks post treatment, the treatment group showed a statistically significant improvement in the SHIM scores, SEP-2, and GAQ-Q1&Q2 positive responders compared to the control group. At 6 weeks, where there was a 5-point improvement in the mean SHIM score of the treatment group (10±5.9 from 5.4±1.7 at baseline) versus no improvement in the placebo group, 18 patients in the treatment group (53%) were able to have an erection hard enough for vaginal penetration versus only one patient in the control group.
CONCLUSION
BoNT-A is safe and effective as a potential treatment for ED refractory to PDE5I therapy.
Topics: Blood Flow Velocity; Botulinum Toxins; Double-Blind Method; Erectile Dysfunction; Humans; Injections; Male; Middle Aged; Penile Erection; Penis; Prospective Studies; Severity of Illness Index; Sexual Behavior; Treatment Outcome
PubMed: 34618409
DOI: 10.1111/andr.13104 -
Frontiers in Endocrinology 2022To assess the diverse cell populations of human corpus cavernosum in patients with severe erectile dysfunction (ED) at the single-cell level.
PURPOSE
To assess the diverse cell populations of human corpus cavernosum in patients with severe erectile dysfunction (ED) at the single-cell level.
METHODS
Penile tissues collected from three patients were subjected to single-cell RNA sequencing using the BD Rhapsody™ platform. Common bioinformatics tools were used to analyze cellular heterogeneity and gene expression profiles from generated raw data, including the packages Seurat, Monocle, and CellPhoneDB.
RESULTS
Disease-related heterogeneity of cell types was determined in the cavernous tissue such as endothelial cells (ECs), smooth muscle cells, fibroblasts, and immune cells. Reclustering analysis of ECs identified an arteriole ECs subcluster and another one with gene signatures of fibroblasts. The proportion of fibroblasts was higher than the other cell populations and had the most significant cellular heterogeneity, in which a distinct subcluster co-expressed endothelial markers. The transition trajectory of differentiation from smooth muscle cells into fibroblasts was depicted using the pseudotime analysis, suggesting that the expansion of corpus cavernosum is possibly compromised as a result of fibrosis. Cell-cell communications among ECs, smooth muscle cells, fibroblasts, and macrophages were robust, which indicated that inflammation may also have a crucial role in the development of ED.
CONCLUSIONS
Our study has demonstrated a comprehensive single-cell atlas of cellular components in human corpus cavernosum of ED, providing in-depth insights into the pathogenesis. Future research is warranted to explore disease-specific alterations for individualized treatment of ED.
Topics: Endothelial Cells; Erectile Dysfunction; Humans; Male; Penile Erection; Penis; Sequence Analysis, RNA
PubMed: 35518933
DOI: 10.3389/fendo.2022.874915 -
Urology Aug 2021To establish predictive factors of patients who failed intra-cavernosal injection therapy and ultimately required corporoglandular shunting during first-time ischemic...
OBJECTIVE
To establish predictive factors of patients who failed intra-cavernosal injection therapy and ultimately required corporoglandular shunting during first-time ischemic priapism episodes.
METHODS
A retrospective review was performed of all patients over the age of 18 who presented to our institution with first-time episode of ischemic priapism from 2009 to 2019. Variables assessed included: body mass index, diabetes, hypertension, race, insurance-type, hypertension, etiology, age, duration of erection prior to evaluation, total amount of phenylephrine injected, and use of corporal irrigation. A receiver operating characteristic (ROC) curve was performed utilizing duration of erection and amount of phenylephrine.
RESULTS
One-hundred and forty-seven patients met inclusion criteria of which 24 patients required surgical intervention. There were differences associated with mean total phenylephrine used, duration of erection between shunted patients and non-shunted patients with regards to age (P = .38) or etiology (P = .81). Multivariable analysis revealed differences between duration of erection and BMI greater than 25 kg/m. ROC curve analyses revealed total amount of phenylephrine injected and duration of erection were acceptable and excellent predictors of need for shunt procedures with area under the curves of 0.72 and 0.90, respectively. Optimal cut-off values for each were found to be 950 mcg and 15.5 hours.
CONCLUSION
Our study suggests that patients who require greater than 950 mcg of total phenylephrine or present with erections lasting greater than 15.5 hours are significantly more likely to require corporoglandular shunting and should be counseled appropriately as such.
Topics: Adult; Erectile Dysfunction; Humans; Ischemia; Male; Penile Erection; Penis; Phenylephrine; Priapism; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 33823171
DOI: 10.1016/j.urology.2021.03.030 -
Sensors (Basel, Switzerland) Dec 2021Erection measurements are the most important indicator of male urological disease diagnosis, treatment, and results. Rigiscan has been used widely in studies and...
Erection measurements are the most important indicator of male urological disease diagnosis, treatment, and results. Rigiscan has been used widely in studies and diagnoses for nocturnal penile tumescence for evaluating erectile dysfunction by measuring the number and timing of erectile dysfunctions during sleep. However, this device has limitations such as the weight and bulk of the device and has been questioned for its role as a standard for ED Erectile Dysfunction (ED) diagnosis. In this study, we propose a real-time wearable monitoring system that can quantitatively measure the length and circumference of the penis using electronic textiles (E-textile) and carbon nanotube (CNT) sensors. The E-textile sensor is used to measure the length, circumference, and gradient with portability, convenience, and comfort. Sensors were created by coating CNTs on latex for flexibility. The CNT-based latex condom-type sensor in our proposed system shows the length, circumference, and curvature measurements with changes in resistance, and the E-textile performance shows a 1.44% error rate and a cavity radius of 110 to 300. The results of this conceptual study are for supplementary sensor development with a combination of new technologies with alternatives or existing methods for measuring erection function.
Topics: Erectile Dysfunction; Humans; Male; Nanotubes, Carbon; Penile Erection; Textiles; Wearable Electronic Devices
PubMed: 35009773
DOI: 10.3390/s22010231 -
Asian Journal of Andrology 2019Although elevated prolactin levels have been shown to inhibit penile erection, the relationship between prolactin and erection of the penile tip or base has not been...
Although elevated prolactin levels have been shown to inhibit penile erection, the relationship between prolactin and erection of the penile tip or base has not been extensively researched. We therefore investigated the prolactin's effects on erection of the penile tip and base, with a cross-sectional study of 135 patients with erectile dysfunction, based on scores of ≤21 on the International Index of Erectile Function-5. All patients were tested for nocturnal penile tumescence, blood pressure, serum glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol, testosterone, and progesterone. Univariate and multivariate analyses were used to assess the associations between prolactin levels and erection at the penile tip and base. We found no obvious relationship between erection time at penile tip and prolactin levels, but observed a negative correlation between base erection time and prolactin level (hazard ratio: -2.68; 95% confidence interval [CI]: -5.13--0.22). With increasing prolactin concentration, multivariate analysis showed obvious reduction in base erection time among patients with normal Rigiscan results (hazard ratio: -3.10; 95% CI: -7.96-1.77; P < 0.05). Our data indicate that prolactin inhibits penile erection, particularly at the penile base. In addition, when the effective erection time of the penile base lasts longer than 10 min, prolactin has a more obvious inhibitory effect on penile base erection.
Topics: Adult; Cross-Sectional Studies; Erectile Dysfunction; Humans; Male; Penile Erection; Prolactin; Time Factors
PubMed: 31044754
DOI: 10.4103/aja.aja_22_19 -
The Aging Male : the Official Journal... Dec 2024To evaluate the efficacy of a novel approach to achieve the optimal penile erection during the penile doppler ultrasound (PDU) examination, which was oral sildenafil... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate the efficacy of a novel approach to achieve the optimal penile erection during the penile doppler ultrasound (PDU) examination, which was oral sildenafil combined alprostadil injection.
MATERIALS AND METHODS
A total of 60 ED patients were enrolled in our prospective study, and they were randomly assigned to two group with different PDU order. The approaches assisted the PDU included two models, mode A meaning injection of 15 μg alprostadil and model B meaning oral sildenafil 100 mg plus injection of 15 μg alprostadil. The PDU parameters were measured continuously before induced erection, and 5, 10, 15, 20, 25 min.
RESULTS
Each group included 30 ED patients with similar clinical characteristics. After pooling the results together, the PSV, EDV, and RI were all improved significantly, when adding the oral sildenafil administration to assist PDU. Also, the clinical response of oral sildenafil administration plus alprostadil injection was better than that in alprostadil injection alone ( = 0.016). The arterial ED were decreased from 31.67% to 15.00% with the P value 0.031, and the mixed ED was also decreased statistically (23.33% vs 8.33%, = 0.024).
CONCLUSION
Oral sildenafil administration plus alprostadil injection could improve the diagnostic accuracy of PDU.
Topics: Male; Humans; Sildenafil Citrate; Penile Erection; Alprostadil; Erectile Dysfunction; Prospective Studies; Penis; Ultrasonography, Doppler
PubMed: 38590113
DOI: 10.1080/13685538.2024.2339352