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Faculty Reviews 2022Priapism is a rare condition that can lead to long-term erectile dysfunction if left untreated. It is one of the few urological emergencies that require prompt medical... (Review)
Review
Priapism is a rare condition that can lead to long-term erectile dysfunction if left untreated. It is one of the few urological emergencies that require prompt medical intervention. Priapism refers to a penile erection that lasts for more than 4 hours and is unrelated to sexual stimulation or orgasm. The aims of immediate intervention for ischaemic priapism are to resolve the painful erection and preserve the cavernosal smooth muscle function. The aim of this review is to evaluate the latest advances in the management of priapism. Despite the continuous challenge in providing an optimal treatment for this rare urological condition, our understanding and management of it have been advanced by decades of clinical and basic science research. Proximal shunts (Quackels or Grayhack) are no longer routinely performed. Distal shunt procedures are currently the most commonly used techniques. A novel penoscrotal decompression technique has recently been described. Ischaemic priapism can be managed conservatively in most cases with the preservation of erectile function. In cases where ischaemic priapism has persisted for more than 36 hours, the majority will develop erectile dysfunction. Early penile prosthesis with thorough patient counselling should be considered in such cases. In some cases of long-standing non-ischaemic priapism, patients can develop fibrosis within the distal corpora, and, therefore, early treatment with super-selective embolisation is required to prevent this.
PubMed: 36118326
DOI: 10.12703/r/11-23 -
Fertility and Sterility Jan 2020This literature review presents two unusual and mystifying disorders of penile erection: painful nocturnal erections, alternatively termed sleep-related painful...
This literature review presents two unusual and mystifying disorders of penile erection: painful nocturnal erections, alternatively termed sleep-related painful erections, and idiopathic stuttering priapism, a variant of recurrent ischemic priapism in which no cause is discernible. The disorders are closely related although they are distinct clinically and pathologically. The main subject areas of discussion are recognition, clinical evaluation and management although current concepts surrounding their causes and mechanisms are also addressed. It is acknowledged that despite the perceived rarities of these disorders they are impactful in terms of their disease profiles and consequences. Future advances in their management will require continued development of evidence-based treatments.
Topics: Humans; Male; Penile Erection; Priapism; REM Sleep Parasomnias; Rare Diseases
PubMed: 32033724
DOI: 10.1016/j.fertnstert.2019.11.013 -
The World Journal of Men's Health Jan 2023Several studies have shown that zinc has a significant influence on erectile function. However, no studies evaluating the cellular distribution of free zinc in penile...
PURPOSE
Several studies have shown that zinc has a significant influence on erectile function. However, no studies evaluating the cellular distribution of free zinc in penile erectile tissue have been performed. Therefore, this study aimed to test whether free zinc is present in penile tissue and whether it may be involved in the electrical stimulation (ES)-induced penile erection.
MATERIALS AND METHODS
The subjects for this study were 26 young (8-week-old) male C57BL/6J mice. After the cavernous nerve was exposed through a midline stomach incision, 14 mice received ES of the cavernous nerve (ES group), whereas 12 mice did not (control group). Intracavernous pressure (ICP) (consisting of 10 V at a duration of 1 min, frequency of 12 Hz and a pulse width of 1 m/s) was recorded during ES. Immediately after ICP was recorded, penile tissues were harvested for histological and biochemical analysis, including analysis of zinc transporter 3 (ZnT3) and intracellular free zinc levels.
RESULTS
The expression of neuronal nitric oxide synthase (nNOS) and endothelial NOS (eNOS) in penile tissue was significantly greater in the ES group than in the control group (p=0.036 and 0.016, respectively). And then, ZnT3 and intracellular free zinc were present in the penile tissue of both groups. However, ZnT3 immunofluorescence in the ES group was more intense in the dorsal nerve bundle (22% increase, p=0.032). The ES group also showed higher intensity N-(6-methoxy-8-quinolyl)-para-toluenesulfonamide (TSQ) fluorescence signals indicative of intracellular free zinc level in the penile tissue compared to the control group (49% increase in dorsal nerve bundle, p=0.001; 50% increase in corpus cavernosum, p=0.001).
CONCLUSIONS
The results of the study supported the expression and distribution of free zinc in penile tissue and increased levels after penile erection. Therefore, this study provides anatomical evidence for the potential role of free zinc in penile erection.
PubMed: 35274500
DOI: 10.5534/wjmh.210168 -
Journal of Clinical Medicine May 2020Oxytocin (OXT) is hypothalamic neuropeptide synthetized in the brain by magnocellular and parvo cellular neurons of the paraventricular (PVN), supraoptic (SON) and... (Review)
Review
Oxytocin (OXT) is hypothalamic neuropeptide synthetized in the brain by magnocellular and parvo cellular neurons of the paraventricular (PVN), supraoptic (SON) and accessory nuclei (AN) of the hypothalamus. OXT acts in the central and peripheral nervous systems via G-protein-coupled receptors. The classical physiological functions of OXT are uterine contractions, the milk ejection reflex during lactation, penile erection and sexual arousal, but recent studies have demonstrated that OXT may have anti-inflammatory and anti-oxidant properties and regulate immune and anti-inflammatory responses. In the pathogenesis of various neurodegenerative diseases, microglia are present in an active form and release high levels of pro-inflammatory cytokines and chemokines that are implicated in the process of neural injury. A promising treatment for neurodegenerative diseases involves new therapeutic approaches targeting activated microglia. Recent studies have reported that OXT exerts neuroprotective effects through the inhibition of production of pro-inflammatory mediators, and in the development of correct neural circuitry. The focus of this review is to attribute a new important role of OXT in neuroprotection through the microglia-OXT interaction of immature and adult brains. In addition, we analyzed the strategies that could enhance the delivery of OXT in the brain and amplify its positive effects.
PubMed: 32438751
DOI: 10.3390/jcm9051534 -
Scientific Reports Oct 2023Penile size is closely concerned and short penis contributes serious sexual dysfunction and tremendous psychological problems to couples. Androgen is essential for...
Penile size is closely concerned and short penis contributes serious sexual dysfunction and tremendous psychological problems to couples. Androgen is essential for penile development and testosterone replacement is recommended to patients with micropenis. We previously proved that inhibiting activity of lysyl oxidase (Anti-lysyl oxidase, Anti-LOX) combined with vacuum erectile device (VED) lengthened penis by remodeling tunica albuginea. We thus explored whether HCG supplement could accelerate tunica albuginea remodeling (induced by Anti-LOX + VED) to promote penile growth. Forty-two SD male rats (4 weeks old) were purchased and divided into 7 groups: control, Anti-LOX, HCG, VED (with a negative aspirated pressure of - 300 mmHg), Anti-LOX + VED, HCG + VED, and Anti-LOX + HCG + VED. After an intervention for 4 weeks, all rats' penile length, exposed penile length, and erectile function were measured. Serum samples were collected to detect hormone levels and penile corpus cavernosum were harvested for histo-pathological analysis. All intervention groups showed significantly longer penis than controlled rats. Anti-LOX sharply increased penile length and exposed length by 15% and 9% respectively, this lengthening effect was more obvious in Anti-LOX + VED group (26% and 19%, respectively). Although HCG promoted penile length by 8%, this effect was slight for exposed length (3%). Moreover, Anti-LOX + HCG + VED dramatically increased penile length and exposed length by 22% and 18%, respectively, which was similar with that in Anti-LOX + VED (26% and 19%, respectively). HCG dramatically stimulated testosterone and dihydrotestosterone secretions than control group, whether with or without Anti-LOX and VED; while it induced more AR expression than other groups. Finally, all procedures did not improve or deteriorate normal erectile function. Although we verified that Anti-LOX + VED lengthened penis by inducing tunica albuginea remodeling, however, HCG supplement did not synergize with Anti-LOX + VED to accelerate albuginea remodeling to facilitate penile growth.
Topics: Humans; Male; Rats; Animals; Erectile Dysfunction; Penis; Penile Erection; Testosterone
PubMed: 37783699
DOI: 10.1038/s41598-023-38888-y -
Applied Bionics and Biomechanics 2021A pathological disorder of human penile function, known as Peyronie's disease, is characterized by the formation of plaque particles within the tunica albuginea. The...
A pathological disorder of human penile function, known as Peyronie's disease, is characterized by the formation of plaque particles within the tunica albuginea. The plagues in the shape of rigid plate form in the scars as a result of the imperfect healing process. Due to high stiffness, plagues are the source of pain and anomalous deformations during erectile penis function. The authors simulate the biomechanical behavior of the penile structure by a 3D finite element model. The numerical model is based on the real geometrical shape and the tissue structure with consideration of large nonlinear deformations. The penile erection is modeled by the initial strains imposed on the corpus cavernosa. The stress analysis is performed in a case study of various plague locations. The Peyronie's syndrome manifested by the penis angular deviation simulated by the analysis is compared with the clinical data. The computational simulations provide a rational explanation for the clinical observations on patients. The objective is to apply the proposed modeling approach for the development and validation of treatment methods based on the application of shock waves.
PubMed: 33790989
DOI: 10.1155/2021/6669822 -
Sexual Medicine Feb 2022Over the years, scattered cases of acquired penile girth increase have been published with different terms, the common clinical feature being a mechanically hampered... (Review)
Review
INTRODUCTION
Over the years, scattered cases of acquired penile girth increase have been published with different terms, the common clinical feature being a mechanically hampered penetration.
AIM
To search for all published cases of acquired penile girth increase, and to propose a geometrically-based reduction corporoplasty.
METHODS
A case of acquired penile bilateral albuginea herniation prompted us to a PubMed, EMBASE and Google Scholar literature review from 1970 to 2021, in search for similar conditions.
MAIN OUTCOME MEASURE
We identified 7 cases of acquired penile girth increase; the geometric approach used to surgically correct bilateral corporal herniation proved successful in our case.
RESULTS
In 5 of the 7 cases of acquired penile girth increase, priapistic episodes were deemed the causal factor; in the remaining 2 and in ours, a clear etiology could not be identified.
CONCLUSION
"Circumferential acquired macropenis" describes the unusual syndrome of acquired penile girth increase, that encompasses 2 distinct etiologies: post-priapistic cases, characterized by penile girth increase both in flaccidity and erection, and idiopathic cases, characterized by girth increase in erection only, and at surgery by a thinned albuginea in the affected area. Pescatori ES, Drei B, Rabito S Circumferential Acquired Macropenis: Definition, Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty. Sex Med 2022;10:100460.
PubMed: 34818603
DOI: 10.1016/j.esxm.2021.100460 -
Medical Sciences (Basel, Switzerland) Aug 2019Contemporary treatment algorithms for erectile dysfunction (ED) involve the use of medical therapies such as phosphodiesterase type 5 (PDE5) inhibitors and... (Review)
Review
Contemporary treatment algorithms for erectile dysfunction (ED) involve the use of medical therapies such as phosphodiesterase type 5 (PDE5) inhibitors and intracavernosal injection therapy of vasoactive agents, as well as vacuum erection devices and penile prosthesis implants in medically refractory cases. However, the current therapeutic options only address the symptoms of ED and not the underlying pathogenesis that results in ED. Newer and novel ED therapies aspire to reverse ED conditions by preventing cavernosal fibrosis, promoting endothelial revascularization and modulating various neuro-hormonal pathways. Regenerative therapeutic strategies such as low-intensity shock wave, gene and cellular-based therapies, and penile transplants are designed to improve penile hemodynamics and revitalize the cavernosal smooth muscle to mitigate and/or reverse underlying ED. This state-of-art article evaluates current and emerging therapeutic options for ED.
PubMed: 31470689
DOI: 10.3390/medsci7090091 -
Redox Report : Communications in Free... Dec 2023The present study evaluated the effect of lead exposure with and without zinc therapy on male sexual and erectile function.
AIM
The present study evaluated the effect of lead exposure with and without zinc therapy on male sexual and erectile function.
METHODS
Twenty male Wistar rats were randomly assigned into four groups; the control, zinc-treated, lead-exposed, lead + zinc-treated groups. Administrations were per os daily for 28 days.
RESULTS
Zinc co-administration significantly improved absolute and relative penile weights and the latencies and frequencies of mount, intromission, and ejaculation in lead-exposed rats. Also, zinc ameliorated lead-induced reductions in motivation to mate and penile reflex/erection. These findings were accompanied by attenuation of lead-induced suppression of circulating nitric oxide (NO), penile cyclic guanosine monophosphate (cGMP), dopamine, serum luteinizing hormone, follicle-stimulating hormone, and testosterone. In addition, zinc alleviated lead-induced upregulation of penile activities of acetylcholinesterase and xanthine oxidase (XO), and uric acid (UA) and malondialdehyde (MDA) levels. Furthermore, zinc ameliorated the lead-induced decline in penile nuclear factor erythroid 2-related factor 2 (Nrf2) and reduced glutathione (GSH) levels, and catalase, superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione-S-transferase (GST) activities.
CONCLUSION
This study revealed that co-administration of zinc improves lead-induced sexual and erectile dysfunction by suppressing XO/UA-driven oxidative stress and upregulating testosterone via Nrf2-mediated signaling.
Topics: Male; Rats; Animals; Humans; Testosterone; Zinc; Erectile Dysfunction; Acetylcholinesterase; NF-E2-Related Factor 2; Rats, Wistar; Uric Acid
PubMed: 37345699
DOI: 10.1080/13510002.2023.2225675 -
Expert Opinion on Biological Therapy 2023While phosphodiesterase type 5 inhibitors (PDE5is) and others are used to treat Erectile dysfunction (ED), many patients are either unresponsive or resistant to it. Stem... (Review)
Review
INTRODUCTION
While phosphodiesterase type 5 inhibitors (PDE5is) and others are used to treat Erectile dysfunction (ED), many patients are either unresponsive or resistant to it. Stem cell therapy (SCT) is a promising alternative approach. Numerous preclinical trials have demonstrated improved erectile function in animal models using SCT, although the number of clinical trials investigating SCT for men with ED is limited. Nonetheless, findings from human clinical trials suggest that SCT may be a useful treatment option.
AREAS COVERED
Biomedical literature, including PubMed, ClinicalTrials.gov, and European Union Clinical Trials Registry, were analyzed to summarize and synthesize information on stem cell therapy for ED in this narrative review. The achievements in preclinical and clinical evaluations are presented and critically analyzed.
EXPERT OPINION
SCT has demonstrated some benefits in improving erectile function, while further studies are urgently needed. Such studies would provide valuable insights into the optimal use of stem cell therapy and its potential as a therapeutic option for ED. Taking advantage of different mechanisms of action involved in various regenerative therapies, combination therapies such as SCT and low-energy shock waves or platelet-rich plasma may provide a more effective therapy and warrant further research.
Topics: Male; Animals; Humans; Erectile Dysfunction; Stem Cell Transplantation; Penile Erection
PubMed: 37078259
DOI: 10.1080/14712598.2023.2203811