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The Urologic Clinics of North America Aug 2022Surgical treatments for Peyronie's disease and erectile dysfunction are generally straightforward and associated with excellent outcomes. However, severe (>60°) and... (Review)
Review
Surgical treatments for Peyronie's disease and erectile dysfunction are generally straightforward and associated with excellent outcomes. However, severe (>60°) and multidirectional curvature, hourglass deformity, severe penile shortening, and ossified plaque may complicate surgery in patients with Peyronie's disease. Similarly, a history of priapism, prior implant infection, and penile injury can pose challenges to successful implant surgery secondary to severe corporal fibrosis. Thus, when these pathophysiological processes cause severe fibrosis and loss of function of the tunica albuginea and deep cavernosal spaces, adjunctive reconstructive techniques are necessary. Herein, we integrate the literature regarding surgical management of complex Peyronie's disease and erectile dysfunction with emphasis on plication, grafting, and implants to achieve satisfactory outcomes across the full range of etiology and degree of surgical complexity.
Topics: Erectile Dysfunction; Fibrosis; Humans; Male; Penile Induration; Penis; Plastic Surgery Procedures
PubMed: 35931434
DOI: 10.1016/j.ucl.2022.04.006 -
Journal of Ethnopharmacology Mar 2021The prevalence and distress caused by erectile dysfunction (ED) to both male and female partners are increasing at a steady rate. ED has now become the most treated... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
The prevalence and distress caused by erectile dysfunction (ED) to both male and female partners are increasing at a steady rate. ED has now become the most treated sexual disorder for men among young and old age groups due to varying physical and psychological factors. The treatment with synthetic Phosphodiesterase-5 (PDE5) inhibitors are cost-effective but due to adverse effects such as priapism, loss of vision, heart attack and syncope, the daily life patterns of these patients are distressed and hence the need for alternative medicaments or sources are of utmost important. Therefore, the exploration of medicinal plants as PDE5 inhibitors will be worthwhile in tackling the problems as many plant extracts and fractions have been long used as aphrodisiacs and sexual stimulants which may be found to be active against PDE5 enzyme.
AIM OF THE STUDY
To provide a review on the different medicinal herbs traditionally used as natural aphrodisiacs, libido or sexual enhancers which are proven for their PDE5 inhibitory effect.
MATERIALS AND METHODS
Ethnobotanical and scientific information was procured, reviewed and compiled from the literature search of electronic databases and search engines.
RESULTS
A total of 97 medicinal plants exhibiting PDE5 inhibitory effect are reviewed in this paper which is supported by preclinical experimental evidence. Among them, 77 plants have been selected according to their traditional and ethnobotanical uses as aphrodisiacs and the rest are screened according to their effectiveness against predisposing factors responsible for ED and sexual dysfunction such as diabetes and hypertension or due to the presence of phytochemicals having structural similarity towards the identified natural PDE5 inhibitors. In addition, sixteen alkaloids, sixty-one phenolics and eight polycyclic aromatic hydrocarbons have been isolated or identified from active extracts or fractions that are exhibiting PDE5 inhibitory activity. Among them, isoflavones and biflavones are the major active constituents responsible for action, where the presence of prenyl group for isoflavones; and the methoxy group at C-5 position of flavones are considered essential for the inhibitory effect. However, the prenylated flavonol glycoside, Icariin and Icariside II isolated from Epimedium brevicornum Maxim (hory goat weed) are the most effective inhibitor, till date from natural sources. Traditional medicines or formulations containing extracts of Ginkgo biloba L., Kaempferia parviflora Wall. ex Baker, Clerodendrum colebrookianum Walp., Eurycoma longifolia Jack and Vitis vinifera L. are also found to be inhibitors of PDE5 enzyme.
CONCLUSION
The review suggests and supports the rational use of traditional medicines that can be further studied for the development of potential PDE5 inhibitors. Many traditional medicines are still used in various regions of Africa, Asia and South America that are poorly characterized and experimented. Despite the availability of a vast majority of traditional formulations as aphrodisiacs or sexual stimulants, there exists a need for systemic evaluation on the efficacy as well as the mechanism of action of the herbal constituents for the identification of novel chemical moieties that can be further developed for maximum efficacy.
Topics: Animals; Ethnobotany; Humans; Medicine, Traditional; Phosphodiesterase 5 Inhibitors; Phytotherapy; Plant Extracts; Plants, Medicinal
PubMed: 33137431
DOI: 10.1016/j.jep.2020.113536 -
International Journal of Impotence... Jan 2020Priapism is a urological emergency that is defined as a prolonged penile erection lasting more than 4 h, remaining despite orgasm and in the absence of sexual... (Review)
Review
Priapism is a urological emergency that is defined as a prolonged penile erection lasting more than 4 h, remaining despite orgasm and in the absence of sexual stimulation. Without prompt and complete detumescence, time-dependent changes occur to the smooth muscle of the corpus cavernosa that can result in permanent erectile dysfunction and penile deformity (curvature, shortening and loss of girth). The diagnosis is confirmed with a hypoxic and acidotic blood sample from the corpus cavernosa. The trapped blood inside the corpus cavernosa is aspirated and can be irrigated with 0.9% normal saline. Intracavernosal injection of a sympathomimetic agent is used to cause smooth muscle contraction if the previous measures fail. Failure or recurrence of priapism following these conservative measures is an indication for surgical management. Shunt procedures that create a connection with the corpus cavernosa and a neighbouring structure are often used first line. Multiple shunt procedures have been described and these are summarised in this article. Distal shunt procedures are the most commonly used as they are easier to perform and seem to have at least comparable detumescence and potency rates. Refractory or prolonged (>48 h) ischaemic priapism maybe an indication of immediate placement of a penile prosthesis.
Topics: Erectile Dysfunction; Humans; Ischemia; Male; Penile Prosthesis; Penis; Priapism; Vascular Surgical Procedures
PubMed: 31570823
DOI: 10.1038/s41443-019-0197-9 -
International Journal of Impotence... Feb 2024
Topics: Humans; Male; Priapism; Penis
PubMed: 38238483
DOI: 10.1038/s41443-024-00825-6 -
International Journal of Impotence... Jun 2024Imaging has a specific role in the diagnosis and management of priapism. The primary imaging modality is ultrasound with colour Doppler (CDUS) which can accurately... (Review)
Review
Imaging has a specific role in the diagnosis and management of priapism. The primary imaging modality is ultrasound with colour Doppler (CDUS) which can accurately assess the hemodynamics of the cavernosal arteries. This is particularly useful in equivocal cases and can help differentiate ischemic from non-ischemic priapism as well as confirm the presence and location of arterio-venous fistulae post penile trauma. Furthermore, CDUS is invaluable in the post treatment follow up of non-ischemic priapism. Contrast enhanced magnetic resonance imaging (MRI) can demonstrate the extent of cavernosal necrosis in ischemic priapism and in conjunction with computer tomography (CT) has an important role in excluding underlying malignancy. MRI and CT angiography are used to evaluate pudendal arterial anatomy, which can be extremely variable and aids in the management of non-ischemic priapism. In selected cases of non-ischemic priapism, catheter angiography and transcatheter embolization of arteriovenous fistulae is an effective treatment. This review will examine the specific roles of different imaging modalities in the subtypes of priapism as well as highlight some of the pitfalls encountered in imaging.
PubMed: 38862625
DOI: 10.1038/s41443-024-00928-0 -
Current Problems in Diagnostic Radiology 2021Sickle cell disease is a debilitating hematologic process that affects the entire body. Disease manifestations in the abdomen most commonly result from vaso-occlusion,... (Review)
Review
Sickle cell disease is a debilitating hematologic process that affects the entire body. Disease manifestations in the abdomen most commonly result from vaso-occlusion, hemolysis, or infection due to functional asplenia. Organ specific manifestations include those involving the liver (eg, hepatopathy, iron deposition), gallbladder (eg, stone formation), spleen (eg, infarction, abscess formation, sequestration), kidneys (eg, papillary necrosis, infarction), pancreas (eg, pancreatitis), gastrointestinal tract (eg, infarction), reproductive organs (eg, priapism, testicular atrophy), bone (eg, marrow changes, avascular necrosis), vasculature (eg, vasculopathy), and lung bases (eg, acute chest syndrome, infarction). Imaging provides an important clinical tool for evaluation of acute and chronic disease manifestations and complications. In summary, there are multifold abdominal manifestations of sickle cell disease. Recognition of these sequela helps guide management and improves outcomes. The purpose of this article is to review abdominal manifestations of sickle cell disease and discuss common and rare complications of the disease within the abdomen.
Topics: Abdomen; Anemia, Sickle Cell; Disease Progression; Humans; Male; Priapism; Vascular Diseases
PubMed: 32564896
DOI: 10.1067/j.cpradiol.2020.05.012 -
In Vivo (Athens, Greece) 2020Malignancy as an etiological factor involved in priapism pathogenesis is rare. Malignant priapism (MP) can arise as a result of penile tumor invasion, either from... (Review)
Review
Malignancy as an etiological factor involved in priapism pathogenesis is rare. Malignant priapism (MP) can arise as a result of penile tumor invasion, either from primary penile tumors or from metastatic penile tumors, or due to hematological malignancies. Non-urological penile metastases are associated with significant worse prognosis compared to urological penile metastases, the appearance of priapism in such cases affecting even more the prognosis and the survival of these patients. Patients diagnosed with hematological malignancies and priapism present significant higher survival rates compared to those who develop MP in the context of a non-hematological malignancy, this being related to the fact that hematological malignancies are more sensitive to chemo- and radiotherapy. Most malignant priapism cases are ischemic; therefore the management should be based on the initial steps of the IP therapeutic protocol. Considering the trigger factor that has led to the priapic event specific oncologic treatment can be added as well.
Topics: Humans; Ischemia; Male; Penile Neoplasms; Penis; Priapism
PubMed: 32871745
DOI: 10.21873/invivo.12033 -
Der Urologe. Ausg. A Jun 2021The insertion of a penile prosthesis (PP) is a definitive treatment option for erectile dysfunction (ED), induratio penis plastica, after phalloplasty or priapism. The... (Review)
Review
The insertion of a penile prosthesis (PP) is a definitive treatment option for erectile dysfunction (ED), induratio penis plastica, after phalloplasty or priapism. The aim is a "normal" erection with the possibility of a satisfactory sexual life. The costs of the operation are covered by the health insurance. In addition, manual dexterity, concomitant diseases and possible contraindications should be considered preoperatively. While semirigid PPs are simply aligned in the desired position when used, inflatable PPs must be activated and deactivated via a pump. In addition to injury to local structures and postoperative infections, long-term complications such as mechanical implant failure or an undesirable cosmetic result may also occur. Careful patient selection and a detailed counselling and information session are therefore of decisive importance. Implantation is performed in the supine or lithotomy position via an infrapubic or penoscrotal approach. PPs should not be implanted if cutaneous, systemic or urinary tract infections are present. Inflatable PPs are preferred by most patients as they come closest to a "natural" erection. A PP offers one of the highest satisfaction rates among treatment options, regardless of indication, and is highly rated by patients and their partners across models due to product reliability. Differences between the models of the various manufacturers could not be demonstrated. The choice of prosthesis should therefore be adapted to the patient's individual requirements and health conditions.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Prosthesis Design; Reproducibility of Results
PubMed: 33928422
DOI: 10.1007/s00120-021-01531-7 -
Current Urology Dec 2022
PubMed: 36628403
DOI: 10.1097/CU9.0000000000000139 -
Archivio Italiano Di Urologia,... Jun 2022Priapism is a persistent penile erection lasting longer than 4 hours, that needs emergency management. This disorder can induce irreversible erectile dysfunction. There... (Review)
Review
Priapism is a persistent penile erection lasting longer than 4 hours, that needs emergency management. This disorder can induce irreversible erectile dysfunction. There are three subtypes of priapism: ischemic, non-ischemic, and stuttering priapism. If the patient has ischemic priapism (IP) of less than 24-hours (h) duration, the initial management should be a corporal blood aspiration followed by instillation of phenylephrine into the corpus cavernosum. If sympathomimetic fails or the patient has IP from 24 to 48h, surgical shunts should be performed. It is recommended that distal shunts should be attempted first. If distal shunt failed, proximal, venous shunt, or T-shunt with tunneling could be performed. If the patient had IP for 48 to 72h, proximal and venous shunt or T-shunt with tunneling is indicated, if those therapies failed, a penile prosthesis should be inserted. Non-ischemic priapism (NIP) is not a medical emergency and many patients will recover spontaneously. If the NIP does not resolve spontaneously within six months or the patient requests therapy, selective arterial embolization is indicated. The goal of the management of a patient with stuttering priapism (SP) is the prevention of future episodes. Phosphodiesterase type 5 (PDE5) inhibitor therapy is considered an effective tool to prevent stuttering episodes but it is not validated yet. The management of priapism should follow the guidelines as the future erectile function is dependent on its quick resolution. This review briefly discusses the types, pathophysiology, and diagnosis of priapism. It will discuss an updated approach to treat each type of priapism.
Topics: Algorithms; Humans; Male; Penile Erection; Penis; Phosphodiesterase 5 Inhibitors; Priapism; Stuttering
PubMed: 35775354
DOI: 10.4081/aiua.2022.2.237