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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 Apr 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.
PubMed: 38604613
DOI: 10.1111/bph.16362 -
Zhonghua Nan Ke Xue = National Journal... May 2023To analyze the blood flow parameters of the cavernous arteries of ED patients after injection of vasoactive drugs, and to explore the differences in blood flow of the...
OBJECTIVE
To analyze the blood flow parameters of the cavernous arteries of ED patients after injection of vasoactive drugs, and to explore the differences in blood flow of the cavernous arteries in different erectile states.
METHODS
Retrospectively analyzed the penile cavernous arterial blood flow parameters of 2568 adult male ED patients after injection of the vasoactive drug (alprostadil). The patients were divided into three groups: maintaining erection group with EHS (erection hardness score) ≥ 3 and sustained erection time ≥ 20 minutes (967 cases), nonpersistent erection group with EHS≥3 and sustained erection time<5 minutes (788 cases), and incomplete erection group with EHS<3 (813 cases). Compared the parameters of age, EHS, duration of erection, cavernous artery peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) among the three groups respectively. The maintaining erection group was divided into the youth group (757 cases) which aged less than 40 years old and the middle-aged and elderly group (210 cases) with 40 years old or over. The parameters of PSV, EDV and RI between the two groups were compared. The incomplete erection group were divided into the good blood supply group (407 cases) with the bilateral PSV ≥35cm/s and the insufficient blood supply group (252 cases) with the bilateral PSV<35cm/s. The parameters of age, EHS, EDV and RI between the two groups were compared.
RESULTS
The age, PSV, EDV and RI of the three groups were significantly different (P<0.01). In the maintaining erection group, the PSV of the young group was significantly higher than that of the middle-aged and elderly group (P<0.05), but there was no statistically significant difference in EDV and RI (P>0.05). In the incomplete erection group, the EHS, PSV, EDV, and RI of the good blood supply group were significantly higher than those of the insufficient blood supply group (P<0.05), while the age was significantly lower than that of the latter (P<0.01).
CONCLUSION
The injection of vasoactive drugs combined with color Doppler ultrasound can directly reflect the blood supply of the cavernous arteries of the penis. The better the erection state, the better the blood supply of cavernous arteries. The middle-aged and elderly people are more likely to have cavernous arteries problem of insufficient blood supply than the young people.
Topics: Adult; Aged; Middle Aged; Adolescent; Humans; Male; Erectile Dysfunction; Retrospective Studies; Penis; Arteries; Alprostadil
PubMed: 38602761
DOI: No ID Found -
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 -
Cureus Mar 2024Tri-tubular penile fracture (PF) is a rare urological subdivision of PFs commonly caused by a blow to the erect penis during sexual intercourse or aggressive...
Tri-tubular penile fracture (PF) is a rare urological subdivision of PFs commonly caused by a blow to the erect penis during sexual intercourse or aggressive manipulation. PF associated with complete urethral injury and bleeding is an extremely rare presentation. This is a case report of a healthy 20-year-old male who presented to the emergency room after a motorcycle accident, experiencing rapid penile swelling and urethral bleeding. The accident happened while he was riding his motorcycle with a full erection. The patient reported a tearing sensation, immediate detumescence, and excruciating penile pain. A clinical diagnosis of PF was made, and the patient was immediately taken to the operating room for surgical intervention. At the three-month follow-up, the patient reported satisfactory erections and good voiding function. This case highlights the importance of immediate surgical intervention and urethral evaluation to avoid PF complications.
PubMed: 38576651
DOI: 10.7759/cureus.55535 -
The Aging Male : the Official Journal... Dec 2024Penile erection (PE) is a hemodynamic event that results from a neuroendocrine process, and it is influenced by the cardiovascular status of the patient. However, it may... (Review)
Review
Penile erection (PE) is a hemodynamic event that results from a neuroendocrine process, and it is influenced by the cardiovascular status of the patient. However, it may also modulate an individual's cardiovascular events. The present study provides the mechanisms involved in the association of PE and cardiovascular function. Erection upsurges the cardiac rate, blood pressure, and oxygen uptake. Sex-enhancing strategies, such as phosphodiesterase inhibitors, alprostadil, and testosterone also promote vasodilatation and cardiac performance, thus preventing myocardial infarction. More so, drugs that are used in the treatment of hypertensive heart diseases (such as angiotensin system inhibitors and β-blockers) facilitate vasodilatation and PE. These associations have been linked with nitric oxide- and testosterone-dependent enhancing effects on the vascular endothelium. In addition, impaired cardiovascular function may negatively impact PE; therefore, impaired PE may be a pointer to cardiovascular pathology. Hence, evaluation of the cardiovascular status of an individual with erectile dysfunction (ED) is essential. Also, employing strategies that are used in maintaining optimal cardiac function may be useful in the management of ED.
Topics: Male; Humans; Penile Erection; Erectile Dysfunction; Hypertension; Nitric Oxide; Testosterone
PubMed: 38567396
DOI: 10.1080/13685538.2024.2336627 -
Reproductive Medicine and Biology 2024The pathophysiology of penis extends to erectile dysfunction (ED) to conditions including sexually transmitted diseases (STDs) and cancer. To date, there has been little...
PURPOSE
The pathophysiology of penis extends to erectile dysfunction (ED) to conditions including sexually transmitted diseases (STDs) and cancer. To date, there has been little research evaluating vascular drainage from the penis. We aimed to evaluate penile blood flow in vivo and analyze its possible relationship with the lymphatic maker.
MATERIALS AND METHODS
We established an in vivo system designed to assess the dynamic blood outflow from the corpus cavernosum (CC) by dye injection. To analyze lymphatic characteristics in the CC, the expression of Lyve-1, the key lymphatic endothelium marker, was examined by the in vitro system and lipopolysaccharide (LPS) injection to mimic the inflammatory conditions.
RESULTS
A novel cavernography methods enable high-resolution morphological and functional blood drainage analysis. The expression of Lyve-1 was detected along the sinusoids. Furthermore, its prominent expression was also observed after penile LPS injection and in the erectile condition.
CONCLUSIONS
The current in vivo system will potentially contribute to the assessment of penile pathology from a novel viewpoint. In addition, current analyses revealed inducible Lyve-1 expression for LPS injection and the erection state, which requires further analyses on penile lymphatic system.
PubMed: 38566911
DOI: 10.1002/rmb2.12570 -
Frontiers in Cardiovascular Medicine 2024Erectile Dysfunction (ED) is a common sexual dysfunction in men who are unable to consistently obtain and maintain sufficient penile erection to accomplish a...
Does erectile dysfunction predict cardiovascular risk? A cross-sectional study of clinical characteristics in patients with erectile dysfunction combined with coronary heart disease.
BACKGROUND
Erectile Dysfunction (ED) is a common sexual dysfunction in men who are unable to consistently obtain and maintain sufficient penile erection to accomplish a satisfactory sexual life. ED is currently considered to be a predictor of cardiovascular disease (CVD), but few studies have observed the association between ED and clinical features of coronary heart disease (CHD). An investigation of the association between ED and clinical characteristics of CHD was carried out using a cross-sectional study design.
METHODS
This cross-sectional single-center study was conducted in the Department of Cardiology and included 248 patients. Associations between patients' general information, underlying disease information, coronary heart disease information, and ED severity were statistically and analytically analyzed using SPSS 26.0 software. Patients with comparable clinical characteristics were grouped together using K-means clustering. Finally, ordered logistic regression analysis was performed for general and underlying disease information.
RESULTS
In the comparison of general data, age, education, and weekly exercise were associated with the distribution of ED severity. In the comparison of underlying disease information, the number of underlying diseases, hypertension, diabetes, hyperlipidemia, anxiety state, and depressive state were associated with the distribution of ED severity. In the comparison of CHD information, the degree of ED severity was associated with CHD subtypes, lesion sites, number of stenoses, degree of stenosis, and interventional interventions. The time from ED to CHD onset was associated with the subtypes of CHD and the number of stenoses. We clustered the main characteristics of low-risk and high-risk patients and ordered logistic regression analysis found that BMI, smoking, alcoholism, number of underlying diseases, diabetes, anxiety state, and depression state were all risk factors for CHD severity ( < 0.05); the higher the value of the above factors, the more severe the degree of CHD. Age was a protective factor for CHD severity; the younger the patient, the lower the likelihood of myocardial infarction.
CONCLUSION
ED severity and the time from ED to CHD onset may be predictive of coronary heart disease severity. Reducing smoking and alcohol consumption, maintaining a healthy body weight, and regular physical activity are important in preventing CVD in ED patients.
PubMed: 38562188
DOI: 10.3389/fcvm.2024.1341819