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Sexual Development : Genetics,... 2021Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of... (Review)
Review
Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of erectile tissues in the penis and/or disruptions in adulthood that impact sexual stimuli, neural pathways, molecular changes, and endocrine signalling that are required to drive erection. Sexual stimulation activates the parasympathetic system which causes nerve terminals in the penis to release nitric oxide (NO). As a result, the penile blood vessels dilate, allowing the penis to engorge with blood. This expansion subsequently compresses the veins surrounding the erectile tissue, restricting venous outflow. As a result, the blood pressure localised in the penis increases dramatically to produce a rigid erection, a process known as tumescence. The sympathetic pathway releases noradrenaline (NA) which causes detumescence: the reversion of the penis to the flaccid state. Androgen signalling is critical for erectile function through its role in penis development and in regulating the physiological processes driving erection in the adult. Interestingly, estrogen signalling is also implicated in penis development and potentially in processes which regulate erectile function during adulthood. Given that endocrine signalling has a prominent role in erectile function, it is likely that exposure to endocrine disrupting chemicals (EDCs) is a risk factor for ED, although this is an under-researched field. Thus, our review provides a detailed description of the underlying biology of erectile function with a focus on the role of endocrine signalling, exploring the potential link between EDCs and ED based on animal and human studies.
Topics: Adult; Androgens; Animals; Endocrine Disruptors; Erectile Dysfunction; Humans; Male; Penile Erection; Penis
PubMed: 34134123
DOI: 10.1159/000516600 -
Asian Journal of Andrology 2016A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis...
A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.
Topics: Adult; Aged; Follow-Up Studies; Humans; Male; Middle Aged; Patient Satisfaction; Penile Diseases; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Postoperative Period
PubMed: 26459782
DOI: 10.4103/1008-682X.163266 -
International Braz J Urol : Official... 2010Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a... (Review)
Review
PURPOSE
Nerve sparing radical prostatectomy is the gold standard for the treatment of prostate cancer. Over the past decade, more and more surgeons and patients are opting for a robot-assisted procedure. The purpose of this paper is to briefly review different techniques and outcomes of nerve sparing robot assisted laparoscopic prostatectomy (RALP).
MATERIALS AND METHODS
We performed a MEDLINE search from 2001 to 2009 using the keywords "robotic prostatectomy", "cavernosal nerve", "pelvic neuroanatomy", "potency", "outcomes" and "comparison". Extended search was also performed using the references from these articles.
RESULTS
Several techniques of nerve sparing are available in literature for RALP, which have been described in this manuscript. These include, "the veil of Aphrodite", "athermal retrograde neurovascular release", "clipless antegrade nerve sparing" and "clipless cautery free technique". The comparative and the non comparative series showing outcomes of RALP have been described in the manuscript.
CONCLUSIONS
The basic principles for nerve sparing revolve around minimal traction, athermal dissection, and approaching the correct planes. It has not been documented if any one technique is better than the other. Regardless of technique, patient selection, wise clinical judgment and a careful dissection are the keys to achieve optimal oncological outcomes following RALP.
Topics: Erectile Dysfunction; Humans; Laparoscopy; Male; Penile Erection; Penis; Prostate; Prostatectomy; Prostatic Neoplasms; Robotics; Treatment Outcome
PubMed: 20602818
DOI: 10.1590/s1677-55382010000300002 -
Biomedicine & Pharmacotherapy =... Oct 2020Male erectile dysfunction (ED) refers to incompetency to reaching and retaining adequate penile tumescence for sexual intercourse. Over 152 million men globally suffer... (Review)
Review
Male erectile dysfunction (ED) refers to incompetency to reaching and retaining adequate penile tumescence for sexual intercourse. Over 152 million men globally suffer from ED and by 2025, the number of affected individuals is anticipated to be around 322 million. Pharmacological and nonpharmacological therapies such as phosphodiesterase (PDE) inhibitors, alprostadil, penile prosthesis surgery, and hormonal replacement are available for management and recuperation of ED. Nevertheless, such therapies are reported to have adverse effects as well as life-threatening. Accordingly, diversity of medicinal plant species and bioactive active compounds are preferred as therapeutic options because they are natural, abundant, available, low-cost and cause fewer or no side effects. This current review will emphasise the aetiology, risk factors, mechanisms underlying the pathophysiology of ED, treatments of ED as well as their side effects. It also provides medicinal plants that are proven effective in vivo and in vitro for the mitigation and treatment of male ED. This knowledge could be used in the future in drug discovery for the development of more natural drugs with no side effects.
Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Phytotherapy; Plants, Medicinal
PubMed: 32795922
DOI: 10.1016/j.biopha.2020.110555 -
Andrology Nov 2020Males with short penises may suffer from sexual dysfunction and psychological problems. However, currently, managing short penis is a huge challenge.
BACKGROUND
Males with short penises may suffer from sexual dysfunction and psychological problems. However, currently, managing short penis is a huge challenge.
OBJECTIVES
To explore whether inhibition of lysyl oxidase (LOX) activity (anti-LOX) combined with a vacuum device could lengthen the penis of pubertal rat.
MATERIALS AND METHODS
Male rats of different ages were purchased, their exposed penile lengths and weights were measured, and protein expression and lysyl oxidase activity in the corpus cavernosum were analyzed. Fifteen-day-old rats were then purchased and divided into six groups: control, Anti-lysyl oxidase, -200 mm Hg (vacuum device under -200 mm Hg value), -200 mm Hg + Anti-lysyl oxidase, -300 mm Hg, and -300 mm Hg + Anti-lysyl oxidase groups. After the intervention duration of 7 weeks, rats' penile length was measured and erectile function was assessed. The corpus cavernosum was harvested for histopathology and molecular assessments.
RESULTS
Exposed penile length and weight significantly increased with age, especially between 4 and 8 weeks. Both the protein expression and lysyl oxidase activity in corpus cavernosum were the highest at 2 weeks; however, they quickly decreased with age and slowly declined after 8 weeks. Anti-lysyl oxidase significantly increased the penile length by 10.79% over controlled rats, -200 mm Hg + Anti-lysyl oxidase lengthened it by 14.05%, and -300 mm Hg + Anti-lysyl oxidase increased it by 19.84%. Anti-lysyl oxidase significantly reduced lysyl oxidase activity to decrease pyridinoline concentration; however, it did not change desmosine (P = .28), hydroxyproline (P = .14), and total elastin (P = .06) levels. Anti-lysyl oxidase with or without a vacuum device did not diminish erectile function or impair the normal microstructure of corpus cavernosum.
DISCUSSION AND CONCLUSION
The rats' penile growth peaks occurred between 4 and 8 weeks. Anti-lysyl oxidase with a vacuum device promoted penile lengthening by inhibiting pyridinoline production to induce tunica albuginea remodeling. The penile lengthening effect was more obvious in pubertal rats than the adult rats. None of the procedures decreased erectile function.
Topics: Animals; Arterial Pressure; Disease Models, Animal; Erectile Dysfunction; Male; Penile Erection; Penis; Protein-Lysine 6-Oxidase; Rats; Rats, Sprague-Dawley
PubMed: 32578359
DOI: 10.1111/andr.12845 -
The Canadian Journal of Urology Feb 2012
Topics: Emigrants and Immigrants; History, 20th Century; Humans; Penile Erection; Urology
PubMed: 22316506
DOI: No ID Found -
The Journal of Nutrition Oct 2004The NO-cGMP pathway plays a key role in the male and female genital sexual arousal response. Nitric oxide synthase (NOS) utilizes L-arginine and oxygen as substrates to... (Review)
Review
The NO-cGMP pathway plays a key role in the male and female genital sexual arousal response. Nitric oxide synthase (NOS) utilizes L-arginine and oxygen as substrates to produce nitric oxide (NO) and citrulline. Arginase is a metalloenzyme that catalyzes the hydrolysis of L-arginine to produce L-ornithine and urea. It is proposed that arginase competes for L-arginine and reduces NOS activity in genital tissues, thus modulating sexual function. Using 2 transition state analogue inhibitors of arginase, 2(S)-Amino-6-boronohexanoic acid (ABH) and S-(2-boronoethyl)-L-cysteine (BEC), we have characterized arginase activity in penile and vaginal tissue. Neither of these inhibitors has activity against NOS. Thus, ABH and BEC are useful compounds for examining the role of arginase in genital tissue physiology, without directly influencing NOS activity. We present data to suggest that arginase may regulate NO production by competing for endogenous pools of L-arginine. In this fashion, arginase is an indirect regulator of penile and vaginal blood flow and specific arginase inhibitors may improve genital blood flow during sexual arousal. As evidenced by the upregulation of arginase in specific disease states, its distribution in the vagina, and its modulation by sex steroid hormones, this enzyme may also participate in numerous other physiological and pathophysiological processes, such as tissue growth, fibrosis, and immune function.
Topics: Animals; Arginase; Female; Genitalia, Female; Hemodynamics; Humans; Male; Penile Erection; Sexual Behavior
PubMed: 15465804
DOI: 10.1093/jn/134.10.2873S -
Expert Opinion on Emerging Drugs Sep 2010Erectile dysfunction (ED) is the most common male sexual dysfunction presented for treatment affecting between 10 and 20% of men. PDE type 5 inhibitors (PDE5I) now... (Review)
Review
IMPORTANCE OF THE FIELD
Erectile dysfunction (ED) is the most common male sexual dysfunction presented for treatment affecting between 10 and 20% of men. PDE type 5 inhibitors (PDE5I) now account for the largest segment of the ED market. While these drugs are highly efficacious for many men, a relatively large subset of ED patients who do not respond to PDE5I is increasingly recognized.
AREAS COVERED IN THIS REVIEW
In this review, we discuss clinical and preclinical evidence supporting various emerging compounds that regulate penile erection both centrally (clavulanic acid, dopamine and melanocortin receptor agonists) and peripherally (novel PDE5I, soluble and particulate guanylil cyclase activators, rho-kinase inhibitors and maxi-K channel openers).
WHAT THE READER WILL GAIN
The reader will gain a broad understanding of erectile (patho-)physiology and gain insights in the mechanisms of action, efficacy and adverse events of various compounds under development for the treatment of ED.
TAKE HOME MESSAGE
We expect emerging drugs to allow treatment protocols tailored to the specific needs of each individual patient, taking into consideration the efficacy of erectile performance enhancement and the potential for adverse events. This tailored approach may include combination of various emerging drugs to enhance efficacy in difficult-to-treat patients.
Topics: Animals; Clinical Trials as Topic; Drug Delivery Systems; Drug Design; Erectile Dysfunction; Humans; Male; Penile Erection; Phosphodiesterase 5 Inhibitors
PubMed: 20415601
DOI: 10.1517/14728214.2010.480973 -
Urology Aug 2015To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG).
OBJECTIVE
To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG).
METHODS
We identified men with completed staged penile urethroplasty with OMG from the Trauma and Urologic Reconstruction Network of Surgeons database between January 1, 2010 and May 1, 2014. Our primary outcome was change in total Sexual Health Inventory for Men (SHIM) and total Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) Short Form at baseline vs after the second stage of the procedure. Second, we assessed subjective changes in penile curvature, length, and sensation.
RESULTS
Thirty-three patients were included with a mean age of 45 years and mean body mass index of 27.6 kg/m(2). Urethral strictures arose from failed hypospadias repair in 52% and lichen sclerosus in 27%. Fifty-two percent of patients reported a previous urethroplasty. The median follow-up time between the second stage procedure and postoperative questionnaires was 6.3 months (interquartile range: 3.5-13.3). There was no significant change in the total SHIM (Δ0.64, 95% confidence interval [CI]: -3.00∼1.72) and MSHQ-EjD (Δ1.55, 95% CI: -1.53∼4.63) scores preoperatively vs postoperatively. In addition, 32% reported improved and 52% no change in satisfaction with sexual intercourse (SHIM Q5). Forty percent of patients reported reduced and 45% no change in bother with ejaculation after surgery (MSHQ-EjD Q4). Men reported new penile curvature (23%), loss of penile length (55%), and altered penile sensitivity (45%) after surgery.
CONCLUSION
Patients undergoing staged penile urethroplasty with OMG are likely to have minimal changes in erectile and ejaculatory function postoperatively, although many may experience new penile curvature, reduced penile length, and/or reduced penile sensitivity.
Topics: Diagnostic Self Evaluation; Ejaculation; Humans; Male; Middle Aged; Mouth Mucosa; Penile Erection; Penis; Prospective Studies; Sexuality; Surveys and Questionnaires; Urethra; Urethral Stricture; Urologic Surgical Procedures, Male
PubMed: 26199158
DOI: 10.1016/j.urology.2015.04.055 -
Archives of Sexual Behavior Nov 2020Three experiments investigated the influence of penile erection on ascriptions of mental capabilities to men. Drawing on sexual objectification literature and the...
Three experiments investigated the influence of penile erection on ascriptions of mental capabilities to men. Drawing on sexual objectification literature and the distinction between agency and experience in mind perception, three competing predictions were formulated. The mind redistribution hypothesis assumed that penile erection would lower agency and heighten experience attributions, the animalistic dehumanization hypothesis predicted the decrease in agency, but not experience, and the literal objectification hypothesis implied the simultaneous decrease in both agency and experience. In Experiment 1 (N = 219; 128 females), erection salience lowered agency, but not experience capabilities ascribed to male targets. Experiment 2 (N = 201, 113 females) replicated the negative effect of erection salience on perceived agency (but not experience) and revealed that erection salience lowered intentions to hire a male target. This effect was explained with the loss of perceived agency. Experiment 3 (N = 203, 98 females) verified the causal relationship between penile erection, agency and hiring intentions. Taken together, these results supported the animalistic dehumanization hypothesis.
Topics: Adult; Aged; Animals; Humans; Male; Middle Aged; Penile Erection; Sexual Behavior; Social Perception; Young Adult
PubMed: 32895871
DOI: 10.1007/s10508-020-01800-0