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Urologie (Heidelberg, Germany) Jun 2024Priapism is defined as penile erection lasting more than four hours that is unrelated to sexual arousal. Priapism is classified based on the oxygenation of the penile... (Review)
Review
Priapism is defined as penile erection lasting more than four hours that is unrelated to sexual arousal. Priapism is classified based on the oxygenation of the penile tissue into ischemic and non-ischemic subtypes. As the most common form, ischemic priapism is usually associated with pain and carries a significant risk of permanent loss of erectile function; thus, rapid intervention is necessary. Initial therapy consists of corporal aspiration and injection of sympathomimetic agents. If detumescence is not achieved, a cavernosal shunt is necessary. Non-ischemic priapism is less common than the ischemic type and is usually the result of perineal trauma. In this subtype, there is usually no pain and treatment is initially conservative. Recurrent (stuttering) priapism is a variant of the ischemic subtype, but is self-limiting and usually occurs during sleep with a duration of less than three to four hours. In the case of prolonged erection, therapy is analogous to that of the ischemic subtype.
Topics: Humans; Priapism; Male; Penis
PubMed: 38653788
DOI: 10.1007/s00120-024-02338-y -
Cellular and Molecular Biology... Mar 2024Plentiful studies have clarified miRNAs take on a key role in the sexual dysfunction of diabetic rats. This study aimed to figure out microRNA (miR)-503-5p/SYDE2 axis'...
Plentiful studies have clarified miRNAs take on a key role in the sexual dysfunction of diabetic rats. This study aimed to figure out microRNA (miR)-503-5p/SYDE2 axis' latent mechanisms in streptozotocin-induced diabetic rat sexual dysfunction. A model of erectile dysfunction (ED) in diabetic rats was established by injecting streptozotocin. MiR-503-5p and SYDE2 in ED rats were altered by injection of miR-503-5p mimic or si/oe-SYDE2. The targeting link between miR-503-5p and SYDE2 was testified. ICP/MAP value was tested by pressure sensor; Penile capillary abundance was assessed; Penile cGMP and AGEs were detected; penile smooth muscle cell apoptosis was assessed; MiR-503-5p and SYDE2 were tested. In streptozotocin-induced ED rats, miR-503-5p was reduced and SYDE2 was elevated. Elevating miR-503-5p or silencing of SYDE2 can enhance penile erection rate, ICP/MAP value, capillary abundance, and cGMP but reduce AGEs and penile smooth muscle cell apoptosis rate in ED rats. Strengthening SYDE2 with elevating miR-503-5p turned around the accelerating effect of elevated miR-503-5p on penile erection in ED rats. SYDE2 was a downstream target gene of miR-503-5p. MiR-503-5p protects streptozotocin-induced sexual dysfunction in diabetic rats by targeting SYDE2.
Topics: Animals; Male; MicroRNAs; Erectile Dysfunction; Diabetes Mellitus, Experimental; Apoptosis; Down-Regulation; Penis; Rats, Sprague-Dawley; Streptozocin; Penile Erection; Rats; Cyclic GMP; Intracellular Signaling Peptides and Proteins; Myocytes, Smooth Muscle; Glycation End Products, Advanced
PubMed: 38650154
DOI: 10.14715/cmb/2024.70.3.7 -
Zhonghua Nan Ke Xue = National Journal... Dec 2023To analyze the influential factors of erectile dysfunction (ED) in patients with localized prostate cancer (LPC) after radical surgery.
OBJECTIVE
To analyze the influential factors of erectile dysfunction (ED) in patients with localized prostate cancer (LPC) after radical surgery.
METHODS
The clinical data of 150 male patients diagnosed with LPC and normal erectile function (EF) before surgery admitted to the Department of Urology of the Eastern Theatre General Hospital from January 2021 to January 2023 were retrospectively analyzed. The EF status of the patients 6 months after surgery was assessed using the International Erectile Function Index -5(IIEF-5). Age, Gleason score, PSA level, TNM stage, preoperative International prostatic symptom score (IPSS), preoperative prostate volume, smoking index, alcohol consumption index, educational level, comorbidities, operation mode, and psychosexual state were used as influencing factors to analyze their effects on postoperative ED.
RESULTS
Of the 150 patients, 88 had ED and 62 had normal EF. Univariate analysis showed that age, preoperative IPSS, preoperative prostate volume, comorbidities and sexual and psychological status were significantly correlated with postoperative ED. Further multivariate logistic regression analysis showed that age, preoperative prostate volume, comorbidities and sexual and psychological status were independent factors influencing the occurrence of ED after RP in LPC patients.
CONCLUSION
The recovery of sexual function of patients with localized prostate cancer after radical surgery is generally poor, and the incidence of ED is high. Its independent influencing factors include age, preoperative prostate volume, comorbidities and sexual psychological state, etc. Correct intervention of different influencing factors is required in clinical work. In order to provide a better diagnosis and treatment scheme for LPC patients undergoing radical treatment, reduce the incidence of postoperative ED and improve the quality of life of patients after surgery.
Topics: Humans; Male; Erectile Dysfunction; Quality of Life; Retrospective Studies; Prostatectomy; Penile Erection; Prostatic Neoplasms
PubMed: 38639951
DOI: No ID Found -
Journal of Radiology Case Reports Nov 2023High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow...
INTRODUCTION
High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow priapism, i.e., conservative management, the use of ice packs, mechanical decompression, surgery, and super-selective arterial embolization. Embolization is currently widely accepted in patients who fail from conservative management. This study aimed to report the use of Gelfoam and microcoil embolization in recurrent high-flow priapism compared to PVA embolization.
CASE STUDY
A 36-year-old man complained of prolonged erection. The erection occurred three days before admission while waking up in the morning, not accompanied by either sexual stimulation or pain. There was a history of fall four days ago in the afternoon, with the patient's groin hitting a rocky ground. Physical examination revealed an erect penis, which felt warm, with an EHS of 4. Blood gas analysis of the corpus cavernosum showed bright red blood with a pH of 7.47, pCO of 23.6, pO of 145, HCO of 17.3, BE of -6, and SaO of 99%. Doppler ultrasound examination of the penis showed high-flow priapism. Embolization with PVA was performed, and there were decreased complaints. A few hours later, the erection occurred. Reevaluation was then performed and continued with embolization using Gelfoam and microcoil. There were immediate successful results (EHS of 3) accompanied by a decrease in symptoms. Long-term follow-up has shown a return to normal erectile function six months following the injury.
CONCLUSION
Priapism may happen due to various etiologies. Differentiating high-flow and low-flow is paramount during the acute phase because of different treatment strategies. Conservative management may be applied to high-flow priapism. If conservative management fails, embolization may be attempted. The choice of embolization agent must be taken into account.
Topics: Male; Humans; Adult; Priapism; Penis; Penile Erection; Arteries; Embolization, Therapeutic; Fistula
PubMed: 38638553
DOI: 10.3941/jrcr.v17i11.5230 -
BJUI Compass Apr 2024The objective of this study is to assess the impact of overnight environmental conditions on erectile penile temperature within a controlled setting, with the aim of...
'Staying Hot': Investigating the influence of overnight conditions on the penile skin temperature during male sexual arousal-A novel methodology for nocturnal erection detection.
OBJECTIVE
The objective of this study is to assess the impact of overnight environmental conditions on erectile penile temperature within a controlled setting, with the aim of investigating the feasibility of using temperature measurements for nocturnal erection detection in erectile dysfunction diagnostics.
SUBJECTS/PATIENTS AND METHODS
We conducted a proof-of-concept study involving 10 healthy male participants aged 20 to 25. The study was carried out at the Department of Urology, St. Antonius Ziekenhuis, the Netherlands. Penile temperature thermistor measurements were taken during visually aroused erections of participants in naked state and in simulated overnight condition (underwear and blankets). Main outcome variables were peak and baseline temperature during erectile periods. To minimize the impact of differences in erectile strength and duration between consecutive measurements, we applied randomization to the order of the environmental conditions.
RESULTS
We observed a significant increase in penile temperature during erection in both the naked ( < 0.01) and simulated overnight condition ( < 0.01). The mean temperature increase was 1.70 and 0.67C, respectively. While penile temperature returned to baseline immediately after naked erections, the 'Staying Hot effect' was noted in the simulated overnight condition measurements, where the temperature remained elevated at peak temperature for the entire 30-min period following the erection.
CONCLUSIONS
The findings from this study indicate that the penile temperature not only significantly increases during naked sexual arousal but is also detectable under simulated overnight conditions. This underscores the potential of using temperature measurements for nocturnal erection detection, representing a crucial initial step in developing a modernized, non-invasive sensor system for ambulatory erectile dysfunction diagnostics. Further research, including an overnight study, is needed to gain insights into the feasibility of utilizing penile temperature measurements for nocturnal erection detection and to assess the impact of the 'Staying Hot effect' on subsequent erection detection.
PubMed: 38633824
DOI: 10.1002/bco2.328 -
Journal of Pediatric Urology Jun 2024Ventral penile curvature is a key factor in determining the surgical approach to proximal hypospadias repair. However, there is limited evidence regarding the efficacy...
INTRODUCTION
Ventral penile curvature is a key factor in determining the surgical approach to proximal hypospadias repair. However, there is limited evidence regarding the efficacy and long-term effects of the procedures used to address curvature. This study aimed to evaluate the effects of urethral plate transection alone with tissue traction therapy on penile curvature in two-stage repair of proximal hypospadias.
MATERIAL AND METHODS
This was a prospective study of primary hypospadias patients who underwent a two-stage repair with urethral plate transection as the sole straightening procedure. After stage 1, taping was applied as tissue traction therapy and continued until stage 2. Penile curvature was measured using a goniometer under artificial erection before and immediately after urethral plate transection and during the second stage of repair. The primary focus of this investigation is the angle of curvature after 6-month taping.
RESULTS
The study included 46 patients with a median age of 13 months at the start of treatment. The median angle of penile ventral curvature was 70° after degloving, 60° after urethral plate transection, and 0° during the second stage of repair. Full correction of ventral curvature was achieved in 42 patients (91 %).
DISCUSSION
This publication is the first of its kind to propose taping as a method for penile traction therapy in hypospadias. The study reveals that penile ventral lengthening can be achieved through tissue traction therapy following UP transection alone. These findings challenge the current consensus that complete straightening of the penis in the first stage is necessary to prevent recurrent curvature and that ventral lengthening is required to correct corporal disproportion. However, further validation and long-term data are needed to definitively confirm the effectiveness of tissue traction therapy after urethral plate transection.
CONCLUSIONS
This study demonstrated significant resolution rate of penile ventral curvature in proximal hypospadias following urethral plate transection alone with taping. Long-term follow-up studies are needed to confirm the sustainability of the results through puberty.
Topics: Hypospadias; Male; Humans; Prospective Studies; Urethra; Urologic Surgical Procedures, Male; Infant; Penis; Child, Preschool; Treatment Outcome; Traction; Follow-Up Studies; Surgical Tape
PubMed: 38631939
DOI: 10.1016/j.jpurol.2023.10.035 -
Zhonghua Nan Ke Xue = National Journal... Aug 2023To investigate whether androgens regulate the expression of endothelial nitric oxide synthase (eNOS) in rat penile cavernous tissue through endothelial-rich adventitial...
OBJECTIVE
To investigate whether androgens regulate the expression of endothelial nitric oxide synthase (eNOS) in rat penile cavernous tissue through endothelial-rich adventitial endothelial cell kinase 2 (Tie2)/phosphokinase (AKT) and affect penile erectile function.
METHODS
Eight-week-old male SD (Sprague Dawley) rats were randomly divided into 6 groups (n=6): sham group, cast group, cast+testosterone replacement group (cast+T group, subcutaneous injection of testosterone propionate 3mg/kg every other day after castration), sham+Tie2 transfection group (sham+Tie2 group, 20ul Tie2 gene lentivirus injection into penile cavernosa of rats 4 weeks after castration, titer 1×108TU/ml), cast+Tie2 group, cast+empty vector group. Five weeks after castration, the ratio of maximum penile intracavernous pressure to mean arterial pressure (ICPmax/MAP), serum testosterone (T), nitric oxide (NO), and the expression levels of Tie2, AKT, P-AKT, eNOS and P-eNOS in the corpus cavernosa of the penis in each group of rats were measured.
RESULTS
The contents of T、NO and ICPmax/MAP in the penile cavernous tissues of the cast group were significantly lower than the sham group (P< 0.01). After transfection with Tie2 overexpressing lentivirus, the NO content and ICPmax/MAP of the cast+Tie2 group were significantly higher than the cast group (P< 0.01). The expression of Tie2 and P-AKT/AKT and P-eNOS/eNOS in penile cavernous tissue of rats in the cast group were significantly lower than those in the sham group, and the expression of Tie2 and P-AKT/AKT and P-eNOS/eNOS in the cast+Tie2 group were significantly higher than the cast group.
CONCLUSION
Hypoandrogen may inhibit penile erection by inhibiting the Tie2/AKT/eNOS signaling pathway, reducing the concentration of P-eNOS/eNOS and NO in penile cavernous tissue. Up-regulating the expression of Tie2 in penile cavernous tissue can increase the concentrations of P-AKT/AKT, P-eNOS/eNOS and NO, and improve ED.
Topics: Animals; Male; Rats; Androgens; Erectile Dysfunction; Lentivirus; Nitric Oxide; Penile Erection; Penis; Proto-Oncogene Proteins c-akt; Rats, Sprague-Dawley; Testosterone; Receptor, TIE-2
PubMed: 38619512
DOI: No ID Found -
British Journal of Pharmacology Aug 2024An estimated 40% of patients with erectile dysfunction have a poor prognosis for improvement with currently available treatments. The present study investigated whether...
BACKGROUND AND PURPOSE
An estimated 40% of patients with erectile dysfunction have a poor prognosis for improvement with currently available treatments. The present study investigated whether a newly developed monoamine transport inhibitor, IP2015, improves erectile function.
EXPERIMENTAL APPROACH
We investigated the effects of IP2015 on monoamine uptake and binding, erectile function in rats and diabetic mice and the effect on corpus cavernosum contractility.
KEY RESULTS
IP2015 inhibited the uptake of 5-HT, noradrenaline and dopamine by human monoamine transporters expressed in cells and in rat brain synaptosomes. Intracavernosal pressure measurement in anaesthetized rats revealed that IP2015 dose-dependently increased the number and the duration of spontaneous erections. Whereas pretreatment with the dopamine D-like receptor antagonists, clozapine and (-)-sulpiride, or cutting the cavernosal nerve inhibited IP2015-induced erectile responses, the phosphodiesterase type 5 inhibitor sildenafil further enhanced the IP2015-mediated increase in intracavernosal pressure. IP2015 also increased the number of erections in type 2 diabetic db/db mice. Direct intracavernosal injection of IP2015 increased penile pressure, and in corpus cavernosum strips, IP2015 induced concentration-dependent relaxations. These relaxations were enhanced by sildenafil and blunted by endothelial cell removal, a nitric oxide synthase inhibitor, N-nitro-l-arginine and a D-like receptor antagonist, SCH23390. Quantitative polymerase chain reaction (qPCR) showed the expression of the dopamine transporter in the rat corpus cavernosum.
CONCLUSION AND IMPLICATIONS
Our findings suggest that IP2015 stimulates erectile function by a central mechanism involving dopamine reuptake inhibition and direct NO-mediated relaxation of the erectile tissue. This novel multi-modal mechanism of action could offer a new treatment approach to erectile dysfunction.
Topics: Male; Animals; Dopamine; Nitric Oxide; Penile Erection; Rats; Mice; Humans; Rats, Sprague-Dawley; Mice, Inbred C57BL; Erectile Dysfunction; Piperazines; Penis; Dose-Response Relationship, Drug
PubMed: 38604613
DOI: 10.1111/bph.16362 -
Cancer Radiotherapie : Journal de La... Apr 2024Erectile function preservation is an important quality of life factor in patients treated for prostate cancer. A dose-optimization approach on sexual structures was...
PURPOSE
Erectile function preservation is an important quality of life factor in patients treated for prostate cancer. A dose-optimization approach on sexual structures was developed and evaluated to limit erectile dysfunction after radiotherapy.
MATERIALS AND METHODS
Twenty-three men with localized prostate cancer and no erectile dysfunction were enrolled in the study. All patients received a prescription dose between 76 and 78Gy. Computed tomography/magnetic resonance image registration was used to delineate the prostatic volume and the sexual structures: internal pudendal arteries (IPA), penile bulb and corpus cavernosum. Erectile function was evaluated using the 5-items International Index of Erectile Function (IIEF-5) score every 6 months during the 2 years after radiotherapy and once a year afterwards. No erectile dysfunction, mild erectile dysfunction and severe erectile dysfunction were defined if the IIEF-5 scores were 20-25, 17-19 and < 17, respectively.
RESULTS
The mean follow-up was 4.5 years. The mean age of the patients was 66.3 years. At 2 years, 67% of the patients had no erectile dysfunction, 11% had mild erectile dysfunction and 22% had severe erectile dysfunction. No significant difference was found between the patients with and without erectile dysfunction (IIEF-5≥20 and IIEF-5<20, respectively) for any of the parameters: dosimetric values (internal pudendal arteries, penile bulb, corpus cavernosum), age, comorbidity and smoking status. The biochemical-relapse free survival was 100% at 2 years.
CONCLUSION
This approach with dose-optimization on sexual structures for localized prostate cancer found excellent results on erectile function preservation after radiotherapy, with 78% of the patients with no or mild erectile dysfunction at 2 years.
Topics: Male; Humans; Aged; Erectile Dysfunction; Quality of Life; Neoplasm Recurrence, Local; Penile Erection; Prostatic Neoplasms
PubMed: 38599939
DOI: 10.1016/j.canrad.2023.08.010 -
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