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International Journal of Impotence... May 2024Vacuum erection device (VED), for its capacity to improve the peak flow and elasticity of cavernous arteries, is a well-known tool to improve recovery of erectile... (Review)
Review
Vacuum erection device (VED), for its capacity to improve the peak flow and elasticity of cavernous arteries, is a well-known tool to improve recovery of erectile function (EF) after radical prostatectomy. Aim of this study is to compare the different therapeutic schemes proposed in literature to find the most effective timing for VED treatment and to evaluate its efficacy alone or associated with phosphodiesterase 5 inhibitors (PDE5i). We performed a systematic review of Literature in October 2022 using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials to retrieve all articles dealing with EF rehabilitation after radical prostatectomy (excluding non-English papers, reviews, or meeting abstracts). Patients were divided among those receiving VED alone or combined with other treatments. Study outcomes were compared dividing them between those with follow-up shorter or longer than 12 months. Sixteen papers were included according to selection criteria. Among them, seven were randomized-controlled trials, five were prospective observational studies and four were retrospective. VED alone was evaluated in eight articles, while the remaining papers evaluated the combination of VED with PDE5i. Regarding VED therapeutic protocol, 7/16 studies used it daily. Rehabilitation protocol lasted less than 1 year in 4 studies, up to 12 months in 6 studies and more than 1 year in 6 studies. All the studies show improvement in International Index of Erectile Function Questionnaire (IIEF-5), conservation of penile length and satisfactory intercourses when compared to controls. VED results appear to increase when patients were addressed to VED-dedicated programs to enhance their compliance with the device.
PubMed: 37085734
DOI: 10.1038/s41443-023-00700-w -
International Journal of Molecular... Jan 2023Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted... (Review)
Review
Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted into acute or chronic status, and it can differ when selecting the clinical therapeutics. PD would cause pain and penile deformity to diseased men and impair their erectile function. Occasionally, surgical revision of the penis might be needed to correct the penile curvature. We find that there are limited effective options of intra-lesion injections for the PD plaques. By searching the databases and screening the literature with the PRISMA 2020 guideline, we observed that several preclinical studies that applied stem cell therapy in treating PD were fruitful in the acute phase. Although in the chronic phase of PD, erectile parameters were not significantly improved, and therefore, future studies might be better elevated in certain aspects, such as the sites selected for harvesting stem cells or changing the centrifugation forces. In this review, we concluded the contemporary understanding of inflammatory microenvironments in PD, the stem cell therapy in PD, and our perspectives on future studies. We concluded that there may be great potential in stem cell therapy for treating both acute and chronic phases PD.
Topics: Male; Humans; Penile Induration; Penis; Penile Erection; Injections; Stem Cells
PubMed: 36614220
DOI: 10.3390/ijms24010777 -
Urologiia (Moscow, Russia : 1999) Nov 2022Clinical approbation of previously obtained normative criteria for evaluating erectograms using the Androscan MIT hardware complex, as well as comparing the monitoring...
OBJECTIVE
Clinical approbation of previously obtained normative criteria for evaluating erectograms using the Androscan MIT hardware complex, as well as comparing the monitoring indicators of nocturnal penile tumescence (NPT) with the results of the standard questionnaire International Index of Erectile Function-15 (IIEF-15).
MATERIALS AND METHODS
The study included 120 patients aged 19 to 72 years. Erectile function was assessed using the IIEF-15 questionnaire and the Androscan MIT hardware complex. To assess erectile function, previously developed normative criteria for the relative increase in the diameter of the penis (OP) and the duration of NTP were used. Statistical data processing was carried out using the STATISTICA 12 software. A systematic literature search on the normative criteria for monitoring NTP was carried out in the Medline database.
RESULTS
After performing androscanning, patients were divided according to the degree of ED: there were 12 patients without ED, 58 patients with grade 1 ED, 27 patients with grade 2 ED, and 23 patients with grade 3 ED. According to the results obtained, a positive correlation was found between the OD value and the results of the IIEF-15 questionnaire.
CONCLUSION
The obtained data on the correlation between the results of the IIEF -15 questionnaire and the NTP monitoring parameters are consistent with most of the currently available foreign data.
Topics: Humans; Male; Erectile Dysfunction; Penile Erection; Penis; Surveys and Questionnaires; Young Adult; Adult; Middle Aged; Aged
PubMed: 36382816
DOI: No ID Found -
International Journal of Impotence... Feb 2024Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an... (Review)
Review
Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an arterial fistula and embolisation may be required. We conducted a systematic review on behalf of the EAU Sexual and Reproductive health Guidelines panel to analyse the available evidence on efficacy and safety of surgical modalities for IP and NIP. Outcomes were priapism resolution, sexual function and adverse events following surgery. Overall, 63 studies (n = 923) met inclusion criteria up to September 2021. For IP (n = 702), surgery comprised distal (n = 274), proximal shunts (n = 209) and penile prostheses (n = 194). Resolution occurred in 18.7-100% for distal, 5.7-100% for proximal shunts and 100% for penile prostheses. Potency rate was 20-100% for distal, 11.1-77.2% for proximal shunts, and 26.3-100% for penile prostheses, respectively. Patient satisfaction was 60-100% following penile prostheses implantation. Complications were 0-42.5% for shunts and 0-13.6% for IPP. For NIP (n = 221), embolisation success was 85.7-100% and potency 80-100%. The majority of studies were retrospective cohort studies. Risk of bias was high. Overall, surgical shunts have acceptable success rates in IP. Proximal/venous shunts should be abandoned due to morbidity/ED rates. In IP > 48 h, best outcomes are seen with penile prostheses implantation. Embolisation is the mainstay technique for NIP with high resolution rates and adequate erectile function.
Topics: Male; Humans; Priapism; Retrospective Studies; Reproductive Health; Penis; Penile Erection; Penile Prosthesis
PubMed: 36151318
DOI: 10.1038/s41443-022-00604-1 -
PloS One 2022Penile cancer is a rare but debilitating condition, which often requires aggressive treatment. Partial penectomy is considered as a treatment option when a sufficient...
Penile cancer is a rare but debilitating condition, which often requires aggressive treatment. Partial penectomy is considered as a treatment option when a sufficient portion of the penile shaft can be maintained to preserve functionality. This systematic review, which followed the PRIMSA guidelines, aimed to evaluate the effects of partial penectomy for penile cancer on sexual function-the maintenance of which is often a priority in patient groups-and to identify potential factors which may moderate these effects. A systematic search of PubMed, The Cochrane Library, and Open Grey as well as MEDLINE, CINAHL and Open Dissertations via EBSCOhost was conducted from inception through to 24th March, 2022. Studies were required to include adults aged ≥18 years who had undergone partial penectomy for the treatment of penile cancer, with a quantitative measure of sexual function available pre- and post-surgery. Four eligible articles were identified for inclusion in this review, three of which reported a decrease in sexual function pre- to post-surgery across all domains of the International Index of Erectile Function (IIEF) questionnaire (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction). Conversely, one study reported an increase in sexual function across IIEF domains, except for orgasmic function, which decreased, pre- to post-surgery. Greater penile length was associated with higher post-operative sexual function, whilst increasing age and higher anxiety levels were associated with lower post-operative sexual function levels in one study. Despite the overall drop in sexual function, many patients were still able to maintain satisfactory sex lives following partial penectomy. Given the limited research in this area and small sample sizes across studies, additional well-controlled investigations are warranted to provide further evidence on the effects of partial penectomy for penile cancer on sexual function.
Topics: Adolescent; Adult; Erectile Dysfunction; Humans; Male; Penile Erection; Penile Neoplasms; Penis; Quality of Life; Surveys and Questionnaires
PubMed: 36137121
DOI: 10.1371/journal.pone.0274914 -
Journal of the College of Physicians... Sep 2022This present systemic review and meta-analysis was conducted to assess the effectiveness of low-intensity extracorporeal shockwave therapy (Li-ESWT) on erectile... (Meta-Analysis)
Meta-Analysis
This present systemic review and meta-analysis was conducted to assess the effectiveness of low-intensity extracorporeal shockwave therapy (Li-ESWT) on erectile dysfunction (ED) based on the relevant randomised controlled trials (RCTs). A comprehensive search of databases, including Medline and Embase databases, from 1st January 2012 to 31st July 2020, that investigated the efficacy of Li-ESWT for ED, was searched. All the trials were divided into two groups: the experimental group received a different shockwave treatment, and the control group received the same treatment as the corresponding experimental group vibration, sound, etc) but no energy transmission. The primary endpoint was the International Index of Erectile Function-Erectile Function domain (IIEF-EF) score/questionnaire or erectile hardness score (EHS). The average IIEF-EF score was increased with statistical significance in the Li-ESWT group relative to the control group (p<0.001). Besides, the Li-ESWT group had evidently elevated changes in IIEF-EF score (p<0.001). Altogether seven articles reported the remarkably elevated EHS score with different total pulses (p<0.001). The favourable outcomes in terms of the average IIEF scores were observed in the cases developing mild or moderate ED (p<0.001). Compared with placebo treatment, Li-ESWT alleviates ED symptoms in patients, particularly those who have mild or moderate ED. Taken together, these results suggest that the Li-ESWT may hold promise for patients with ED. Key Words: Erectile dysfunction, Low-intensity extracorporeal shockwave therapy, Meta-analysis, Randomised controlled trials.
Topics: Erectile Dysfunction; Extracorporeal Shockwave Therapy; Humans; Male; Penile Erection; Treatment Outcome
PubMed: 36089717
DOI: 10.29271/jcpsp.2022.09.1181 -
International Urology and Nephrology Sep 2022To apply a new review methodology, called reverse systematic review (RSR), to assess how different classification criteria can influence erectile dysfunction rates in... (Review)
Review
OBJECTIVE
To apply a new review methodology, called reverse systematic review (RSR), to assess how different classification criteria can influence erectile dysfunction rates in patients undergoing laparoscopic radical prostatectomy (LRP).
METHODS
We used RSR from January 1, 2000, until December 31, 2020. The post-prostatectomy erectile dysfunction (PPED) rates were evaluated at 1, 3, 6, 12, and 18 months after surgery in different criteria selected as the most commonly used and divided into four groups: "Erection Sufficient for Intercourse (ESI)", "IIEF-5 > 17", "IIEF-5 > 22" and "Not Available". Temporal distribution of different criteria was analyzed to identify patterns throughout the "natural history" of LRP.
RESULTS
40 systematic reviews on LRP evaluated 81 cohorts and 21,618 patients on PPED. ESI was the predominant form of PPED evaluation (75.3%) followed by IIEF-5 > 22 (11.1%). Despite being a simpler criterion, ESI showed worse PPED rates at 1, 3, 6 and 12 months (8%, 27%, 43% and 51%) than IIEF-5 > 22 (14%, 26%, 45% and 58%). The studies were published between 2005 and 2015, but it was in 2010 that the ESI criterion was established as predominant in the literature, reducing the application of others.
CONCLUSION
The RSR has proven effective in demonstrating how the PPED evaluation criteria behaved in the "natural history" of the LRP. It showed how a simple and easy-to-apply criterion, such as the ESI, was preferred by the authors, even showing worse PPED rates than other more complex.
Topics: Erectile Dysfunction; Humans; Laparoscopy; Male; Penile Erection; Prostate; Prostatectomy
PubMed: 35764756
DOI: 10.1007/s11255-022-03262-w -
Andrology Feb 2023Erectile dysfunction (ED) is a very common complication in men with diabetes mellitus (DM). Low-intensity extracorporeal shockwave therapy (Li-ESWT) offers a promising... (Review)
Review
BACKGROUND
Erectile dysfunction (ED) is a very common complication in men with diabetes mellitus (DM). Low-intensity extracorporeal shockwave therapy (Li-ESWT) offers a promising nonsurgical treatment option for ED. A systematic scoping review investigating the outcomes of Li-ESWT in diabetic men with ED has not yet been performed.
OBJECTIVES
To systematically review animal and clinical studies related to the use of Li-ESWT for treatment of DM-related ED.
DATA SOURCES
PubMed, Embase, The Cochrane Library, Scopus, and Web of Science were searched, unrestricted by dates or study design.
MATERIALS AND METHODS
We included qualitative studies, quantitative studies, primary research studies, meta-analyses, and research letters written in English. Full text reviewing was completed in all animal and human studies discussing Li-ESWT for the treatment of ED in subjects with DM. Data extracted included the journal citation, publication year, country of origin, study design, and a summary of the pertinent findings.
RESULTS
Our search yielded nine clinical studies and 10 animal studies. The results of the clinical studies suggest that Li-ESWT is a safe and effective treatment in men with well-controlled DM and moderate or better ED. However, the benefit is less durable in diabetic men than nondiabetic men. The results of the animal studies suggest that Li-ESWT can significantly improve erectile function in diabetic rat models with ED.
CONCLUSIONS
The examined studies present encouraging results for the use of Li-ESWT to treat diabetic men with ED. Future studies, particularly robust randomized controlled trials, are necessary to confirm these findings and provide long-term follow-up.
Topics: Male; Humans; Animals; Rats; Erectile Dysfunction; Extracorporeal Shockwave Therapy; Penile Erection; Treatment Outcome; Diabetes Mellitus
PubMed: 35642619
DOI: 10.1111/andr.13197 -
The Prostate Sep 2022Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly... (Review)
Review
BACKGROUND
Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies.
OBJECTIVE
This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research.
METHOD
Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database.
RESULTS
Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies.
CONCLUSION
This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, low-intensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.
Topics: Androgen Antagonists; Erectile Dysfunction; Humans; Male; Penile Erection; Prostatectomy; Prostatic Neoplasms
PubMed: 35579053
DOI: 10.1002/pros.24366 -
The Journal of Sexual Medicine Jun 2022Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable.
AIM
To evaluate the prevalence of ED in the IBD population and the potential role of risk factors in the development of ED.
METHODS
An extensive search in the PubMed, Cochrane Library, and Web of Science was performed to identify relevant English-language articles published up to December 2021 that evaluated the prevalence of ED on IBD patients. The included studies were evaluated by 2 independent reviewers for eligibility. We used an adapted Assessment Tool for Prevalence Studies to evaluate the quality of enrolled studies. Data were analyzed and graphed using the STATA software (version 16.0; Stata Corporation, College Station, TX, USA). The ORs with 95% CIs were pooled using a fixed or random-effects model according to heterogeneity. Subgroup analysis was performed to explore the source of heterogeneity. Sensitivity analysis was conducted to evaluate the stability of the results.
OUTCOMES
The pooled prevalence of ED in IBD patients was calculated, and the OR value and 95% CIs were used to assess the strength of the association between IBD-related risk factors and ED.
RESULTS
Fourteen studies included 32,858 individuals totally were enrolled for this meta-analysis. The overall pooled prevalence estimate of ED in IBD patients was 27% (95% CI: 20-34%). Operation (OR 1.28; 95% CI: 1.17-1.39; P < .00001; I = 0.0%), disease activity (OR 2.06; 95% CI: 1.07-3.05; P < .00001), and depression (crude OR 3.31; 95% CI: 1.08-5.54; P = .004; I = 0.0%) significantly increase the risk of ED in people with IBD. The association of depression and ED was further confirmed by calculating the pooled estimates of adjusted OR (1.58; 95% CI: 0.05-3.12; P < .05; I = 0.0%). The pooled prevalence estimates of ED were 30, 33, and 17% in the age <40, IIEF diagnostic tool, and IPAA surgery subgroups, respectively.
CLINICAL IMPLICATIONS
IBD patients had a significantly increased prevalence of ED, indicating that erectile function in men with IBD should be concerned by clinicians.
STRENGTHS & LIMITATIONS
The strength of this study is that this is the first meta-analysis to assess the global prevalence and risk factors of ED in IBD patients. A limitation is that the results after pooling the included articles showed significant heterogeneity.
CONCLUSION
The results of our meta-analysis and systematic review provide evidence of the high prevalence and risk factors of ED in IBD patients. Wu X, Zhang Y, Zhang W, et al. The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Sex Med 2022;19:950-960.
Topics: Chronic Disease; Erectile Dysfunction; Humans; Inflammatory Bowel Diseases; Male; Penile Erection; Prevalence; Risk Factors
PubMed: 35491378
DOI: 10.1016/j.jsxm.2022.03.615