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Prostate Cancer and Prostatic Diseases Mar 2021Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the...
BACKGROUND
Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the advent of modern technology. The purpose of this project was to evaluate modern external beam radiotherapy and brachytherapy techniques to determine the incidence of radiotherapy (RT) induced ED.
METHODS
A systematic review of the literature published between January 2002 and December 2018 was performed to obtain patient reported rates of ED after definitive external beam radiotherapy, ultrafractionated stereotactic radiotherapy, and brachytherapy (BT) to the prostate in men who were potent prior to RT. Univariate and multivariate analyses of radiation dose, treatment strategy, and length of follow-up were analyzed to ascertain their relationship with RT-induced ED.
RESULTS
Of 890 articles reviewed, 24 met inclusion criteria, providing data from 2714 patients. Diminished erectile function status post RT was common and similar across all studies. The median increase in men reporting ED was 17%, 26%, 23%, and 23%, 3DCRT, IMRT, low dose rate BT, and SBRT, respectively, at 2-year median follow-up.
CONCLUSION
ED is a common side effect of RT. Risk of post-RT ED is similar for both LDR brachytherapy and external beam RT with advanced prostate targeting and penile-bulb sparing techniques utilized in modern RT techniques.
Topics: Brachytherapy; Erectile Dysfunction; Humans; Male; Penile Erection; Prostatic Neoplasms; Radiotherapy Dosage
PubMed: 32647352
DOI: 10.1038/s41391-020-0247-x -
Revista Internacional de Andrologia 2021To determine the effectiveness and safety in the short, medium, and long term of LISWT in patients with Erectile Dysfunction who do not respond to PDE5 inhibitors. (Review)
Review
OBJECTIVE
To determine the effectiveness and safety in the short, medium, and long term of LISWT in patients with Erectile Dysfunction who do not respond to PDE5 inhibitors.
METHODOLOGY
Clinical study, quasi-experimental cohort and systematic review following the guidelines of the Cochrane collaboration and the PRISMA writing guides. The measurement of the variables was determined as a primary outcome to the evaluation of erectile function, by means of a validated questionnaire. The baseline scale was evaluated, as well as the difference at 1, 3 and 6 months, evidenced by the possibility of maintaining an erection or responding to therapy with PDEi5. An information search was carried out from its beginning to the current date, in the databases: Medline, Embase, Central, Science Direct and Lilacs.
RESULTS
The studies found used different outcome variables to show efficacy in the follow-up: All the studies used the IIEF-EF as outcome variable in its different variations.
CONCLUSION
LISWT could be an effective and safe treatment in patients not responding to PDEi5. It is important to point out that the evidence is currently limited, randomized studies with greater methodological rigidity and follow-up longer than 12 months are needed in order to verify the medium and long-term effect of the application of shock waves in this group of patients.
Topics: Erectile Dysfunction; Extracorporeal Shockwave Therapy; Humans; Male; Penile Erection; Phosphodiesterase 5 Inhibitors; Treatment Outcome
PubMed: 32605764
DOI: 10.1016/j.androl.2020.04.004 -
BJU International Mar 2021To systematically review the literature in order to investigate the efficacy and safety of surgical and non-invasive penile enhancement procedures for aesthetic and...
OBJECTIVE
To systematically review the literature in order to investigate the efficacy and safety of surgical and non-invasive penile enhancement procedures for aesthetic and therapeutic purposes.
METHODS
A systematic search for papers investigating penile enhancement procedures was performed using the MEDLINE database. Articles published from January 2010 to December 2019, written in English, including >10 cases, and reporting objective length and/or girth outcomes, were included. Studies without primary data and conference abstracts were excluded. The main outcome measure was objective length and/or girth improvement. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
RESULTS
Out of 220 unique records, a total of 57 were reviewed. Eighteen studies assessed interventions for penile enhancement in 1764 healthy men complaining of small penis. Thirty-nine studies investigated 2587 men with concomitant pathologies consisting mostly of Peyronie's disease and erectile dysfunction. Twenty-five studies evaluated non-invasive interventions and 32 studies assessed surgical interventions, for a total of 2192 and 2159 men, respectively. Non-invasive interventions, including traction therapies and injection of fillers, were safe and mostly efficacious, whereas surgical interventions were associated with minor complications and mostly increased penile dimensions and/or corrected penile curvature. Overall, the quality of studies was low, and standardized criteria to evaluate and report efficacy and safety of procedures, as well as patient satisfaction, were missing.
CONCLUSION
The quality of the studies on penile enhancement procedures published in the last decade is still low. This prevents us from establishing recommendations based on scientific evidence regarding the efficacy and safety of interventions that are performed to increase the penis size for aesthetic or therapeutic indications.
Topics: Erectile Dysfunction; Humans; Hyaluronic Acid; Male; Microspheres; Organ Size; Patient Satisfaction; Penile Erection; Penile Induration; Penis; Polyesters; Polymethyl Methacrylate; Prostheses and Implants; Traction; Urogenital Surgical Procedures
PubMed: 32575166
DOI: 10.1111/bju.15145 -
Journal of the European Academy of... Feb 2021Hidradenitis suppurativa (HS) can cause considerable impact on several aspects of quality of life. Sexuality is a central aspect of quality of life. In recent years,...
Hidradenitis suppurativa (HS) can cause considerable impact on several aspects of quality of life. Sexuality is a central aspect of quality of life. In recent years, there has been an increase in the number of articles on HS and sexuality. To achieve our aim of synthesizing the available scientific evidence on HS and sexual health, we conducted a systematic review in February 2020. The clinical databases used included Medline and Embase. All types of epidemiological articles were included; reviews, guidelines, protocols, conference abstracts and case report articles were excluded. Eleven studies were included for review, representing 42 729 patients with HS. The most common study design was cross-sectional with or without comparison group(s), conducted in an outpatient setting or through surveys. Prevalence of sexual dysfunction ranged between 51-62%, and in the case of erectile dysfunction, a specific kind of sexual dysfunction affecting penile erection, it ranged from between 52% and 60% of patients studied using validated questionnaires. Potential risk factors for sexual dysfunction among men and women were identified, mainly related to disease activity, symptoms and partners. Mood disorders like depression and anxiety appear to be associated with sexual dysfunction. Women were more affected by sexual distress. HS patients with sexual dysfunction had a decreased overall quality of life. With respect to treatment, surgery did not improve sexual function and there is no scientific evidence regarding medical treatments. Patients stated that they would like to treat their sexual problems with healthcare professionals. In conclusion, sexual and erectile dysfunction are common in HS patients, and negatively affect their quality of life. There are clinical factors potentially associated with this which should be identified and treated by dermatologists in the comprehensive care of HS patients. Prospective studies are needed to provide more scientific evidence on this unmet need.
Topics: Cross-Sectional Studies; Female; Hidradenitis Suppurativa; Humans; Male; Prospective Studies; Quality of Life; Surveys and Questionnaires
PubMed: 32531099
DOI: 10.1111/jdv.16726 -
Progres En Urologie : Journal de... Sep 2020The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial.
INTRODUCTION
The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial.
METHODS
A systematic review of the literature published between 2000 and 2019 was conducted using the PRISMA methodology. We used Medline data with the following.
KEYWORDS
"extracorporeal shock wave therapy" ; "Peyronie's disease"; "Sexuality"; Penile erection.
RESULTS
Thirteen articles were selected. Our review showed that SW were beneficial in terms of pain. Regarding plaques size and penile curvature, the results remain divergent.
CONCLUSION
SW may be useful in the management of pain in selected patients with PD. Its effectiveness on plaques size and penile curvature needs to be demonstrated through controlled and randomized trials. The population has to be targeted, and the treatment protocol must also be standardized.
Topics: Extracorporeal Shockwave Therapy; Humans; Male; Penile Induration
PubMed: 32370921
DOI: 10.1016/j.purol.2020.04.003 -
The Journal of Sexual Medicine Jun 2020Erectile dysfunction (ED) is the most common side effect of prostate radiotherapy (RT), but reported rates over time and across modalities have varied widely.
BACKGROUND
Erectile dysfunction (ED) is the most common side effect of prostate radiotherapy (RT), but reported rates over time and across modalities have varied widely.
AIM
To evaluate the published literature between 2002 and 2018 for high quality data utilizing prospectively gathered patient-reported ED, and to summarize the challenges in reporting of RT-induced ED (RIED).
METHODS
A PubMed search and literature review was performed to identify articles describing rates of ED before and after definitive external beam RT or brachytherapy without androgen deprivation.
OUTCOMES
Patient-reported ED, patient and treatment variables, and study follow-up constituted the main outcomes of this study.
RESULTS
24 articles were identified, reporting RIED rates between 17% and 90%. Variables contributing to this range included patient, treatment, and study characteristics known to impact ED reporting.
CLINICAL IMPLICATIONS
For future studies, we recommend the use of validated patient-reported questionnaires and reporting of baseline function and comorbidities, RT type and dose, and use of androgen deprivation therapy and erectile aids at the time of ED measurement. With sufficient follow-up to understand the late nature of RIED, these recommendations will improve comparison of results between studies and the applicability of results to patients undergoing pretreatment counseling regarding the risks of RIED.
STRENGTHS & LIMITATIONS
The literature search and formulation of results were based on a broad understanding of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the literature, but because of the focus on data reporting, a comprehensive systematic review of all RIED literature was not performed.
CONCLUSION
Reported rates of ED after RT vary widely due to differences in patients' baseline reported erectile function, age, comorbidities, and characteristics of the treatment delivered. The methodology of ED measurement has significant impact on the applicability and comparability of results to other studies and clinical practice. Nukala V, Incrocci L, Hunt AA, et al. Challenges in Reporting the Effect of Radiotherapy on Erectile Function. J Sex Med 2020;17:1053-1059.
Topics: Androgen Antagonists; Brachytherapy; Erectile Dysfunction; Humans; Male; Penile Erection; Prostatic Neoplasms
PubMed: 32312661
DOI: 10.1016/j.jsxm.2020.03.008 -
Journal of Endourology Oct 2020Although the transurethral resection of the prostate (TURP) has been regarded as the gold standard surgical option for lower urinary tract symptoms due to benign... (Meta-Analysis)
Meta-Analysis
Impact on Sexual Function of Endoscopic Enucleation Transurethral Resection of the Prostate for Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis.
Although the transurethral resection of the prostate (TURP) has been regarded as the gold standard surgical option for lower urinary tract symptoms due to benign prostatic hyperplasia, the endoscopic enucleation of the prostate (EEP) with novel techniques is also recommended. However, whether there are differences on male sexual functions after these two procedures is still controversial. We performed this meta-analysis to investigate the impact on erectile function (EF) and ejaculation of EEP and TURP, and to explore the potential superiority between these two approaches. Literature search was conducted on Medline, Embase, and the Cochrane library, to obtain all relevant randomized controlled trials published before December 13, 2018. Outcome data were pooled and analyzed with Review Manager 5.3 to compare the International Index of Erectile Function 5 (IIEF-5) scores and retrograde ejaculation (RE) rates from short- to long-term follow-ups. Ten articles with 1435 patients were included. EEP group showed higher IIEF-5 scores than TURP group with mean difference (MD) = 1.00, confidence interval (95% CI): 0.95-1.05 at 48 months and MD = 1.08, 95% CI: 1.03-1.13 at ≥60 months, respectively. In subgroup analysis, the holmium laser enucleation of the prostate showed significantly better IIEF scores than TURP group at 48 months (MD = 1.00, 95% CI: 0.95-1.05) and ≥72 months (MD = 1.08, 95% CI: 1.03-1.13). Additionally, no significant difference in RE rate was found between EEP and TURP (risk ratio = 1.02, 95% CI: 0.85-1.23). Compared with TURP, EEP may produce a more durable benefit for postoperative preservation of EF at long-term stage.
Topics: Humans; Lower Urinary Tract Symptoms; Male; Penile Erection; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 32242462
DOI: 10.1089/end.2020.0141 -
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 Journal of Sexual Medicine Apr 2020Erectile dysfunction is one potential complication after radical prostatectomy; often pelvic floor muscle training is offered as an intervention to improve quality of...
BACKGROUND
Erectile dysfunction is one potential complication after radical prostatectomy; often pelvic floor muscle training is offered as an intervention to improve quality of life and erectile function post-operatively.
AIM
To provide a summary of current evidence regarding the effectiveness of pelvic floor muscle training in the management of erectile dysfunction after radical prostatectomy and provide recommendations for future research.
METHODS
An electronic search was conducted for relevant research studies using PubMed, EMBASE, CINAHL, Medline, and PEDro. Quality of selected trials was assessed by 2 independent reviewers using the Modified Downs and Black Checklist; disagreements were resolved by consensus.
MAIN OUTCOME MEASURE
The main outcome measure is the International Index of Erectile function (IIEF-5).
RESULTS
9 studies of various study design were included in this review. Most studies demonstrated improvements in erectile dysfunction with pelvic floor muscle training; however, lack of methodological rigor for several studies and variability among training protocols limited interpretation of results.
CLINICAL IMPLICATIONS
Further well powered and rigorously designed randomized controlled trials are needed to investigate the effect of pelvic floor muscle training on erectile dysfunction after radical prostatectomy.
STRENGTHS & LIMITATIONS
This review employed a systematic method of appraising the available evidence for pelvic floor muscle training for erectile dysfunction after radical prostatectomy. Limited high-quality articles were identified and few conclusions could be drawn from the existing evidence.
CONCLUSION
Future high-quality randomized controlled trials should include strategies to improve adherence to exercise, clearly describe exercise protocols, and integrate new evidence for verbal cues and biofeedback for muscles involved in erection. Wong C, Louie DR, Beach C. A Systematic Review of Pelvic Floor Muscle Training for Erectile Dysfunction After Prostatectomy and Recommendations to Guide Further Research. J Sex Med 2020;17:737-748.
Topics: Erectile Dysfunction; Exercise Therapy; Humans; Male; Outcome Assessment, Health Care; Pelvic Floor; Penile Erection; Postoperative Period; Prostatectomy; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 32029399
DOI: 10.1016/j.jsxm.2020.01.008 -
Sexual Medicine Reviews Oct 2020Evidence for noninvasive management of Peyronie's disease contains many options with varying levels of evidence for each. Many first-line treatments recommended by...
INTRODUCTION
Evidence for noninvasive management of Peyronie's disease contains many options with varying levels of evidence for each. Many first-line treatments recommended by urologists lack strong evidence for their use.
AIM
We summarize the noninvasive (oral medications, topical medications, traction, vacuum erection devices, extracorporeal shock wave therapy, intracavernosal injections and electromotive therapy) treatment options for Peyronie's disease and provide the levels of evidence for each.
METHODS
A literature search of PubMed, EMBASE, Cochrane Library, and ClinicalKey databases was conducted, current up to April 2019.
MAIN OUTCOME MEASURE
For each treatment modality, we measured level of evidence, change in penile curvature, change in erectile function, the percentage of patients with improved angulation, and pain scores.
RESULTS
There is weak evidence to support the use of oral or topical medications. Higher levels of evidence exist for intracavernosal injections and extracorporeal shock wave therapy and may be helpful in certain patient populations.
CONCLUSION
The mechanisms behind Peyronie's disease are not fully understood. Penile injections provide the highest quality of evidence for noninvasive treatment. Ory J, MacDonald L, Langille G. Noninvasive Treatment Options for Peyronie's Disease. Sex Med Rev 2020;8:603-614.
Topics: Disease Management; Evidence-Based Medicine; Humans; Male; Penile Induration; Treatment Outcome
PubMed: 31983573
DOI: 10.1016/j.sxmr.2019.12.002