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Journal of Andrology 2009Penile rehabilitation has been an area of intense study and debate over the last decade. Interest in this topic was stimulated by the observation that erectile... (Review)
Review
Penile rehabilitation has been an area of intense study and debate over the last decade. Interest in this topic was stimulated by the observation that erectile dysfunction remained a significant problem after radical prostatectomy despite meticulous nerve-sparing technique. Smooth muscle alterations and fibrotic changes in the penis were identified as the underlying causes of penile atrophy, veno-occlusive dysfunction, and Peyronie's-like changes that were observed after surgery. Initial observations that intracavernous injection therapies used on a regular basis postoperatively resulted in improvements in the return of spontaneous erectile function led to the development of penile rehabilitation protocols. Chronic dosing of oral type V phosphodiesterase inhibitors is now commonly used by urologists after radical prostatectomy despite a lack of convincing evidence from randomized, placebo-controlled clinical trials. Use of local therapies to heal the penis may have applications beyond the postprostatectomy patient. This article reviews the current evidence behind penile rehabilitation therapy.
Topics: Alprostadil; Animals; Clinical Trials as Topic; Humans; Male; Penile Erection; Penis; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Prostatectomy; Purines; Sildenafil Citrate; Sulfones
PubMed: 19023141
DOI: 10.2164/jandrol.108.005835 -
Sexual Medicine Reviews Jul 2019Rear tip extenders (RTEs) are often used in penile prosthesis surgery, and their value and use have varied with the evolution of penile prostheses. (Review)
Review
INTRODUCTION
Rear tip extenders (RTEs) are often used in penile prosthesis surgery, and their value and use have varied with the evolution of penile prostheses.
AIM
To review the literature addressing RTEs and to introduce a new term, rigidity factor, which quantifies the ratio of inflatable to non-inflatable component of the cylinders.
METHODS
The urologic literature was reviewed for all mention of RTEs. In addition, literature regarding penile prostheses was explored for mention of RTEs.
MAIN OUTCOME MEASURE
A search on PubMed for "rear tip extender" resulted in 17 publications. These publications were reviewed, and references were also explored for related publications.
RESULTS
The history of the development of RTEs, complications associated with the use of RTEs, and current practices in the use of RTEs are all discussed. In addition, recent publications regarding RTEs were examined in detail. RTEs were introduced in the 1980s to improve mechanical survival of prostheses. They were thought to decrease input tubing wear. Although the trend recently has been to place more rear tips, evidence has surfaced suggesting a link to increased need for reoperation with additional RTEs. In addition, we believe that increased length of RTEs can decrease erectile quality. Rigidity factor, defined as the ratio of the live (inflatable) portion of cylinder to the total cylinder length, can be used to quantify the effect of RTE on erectile strength. However, the effects of RTEs on biomechanical properties of the penis when fully inflated are still not fully understood.
CONCLUSION
The use of RTEs is a relatively underexplored area of penile prosthesis placement. Further laboratory and in vivo work will allow for a better understanding of the optimal role of RTEs in penile prosthesis surgery. Thirumavalavan N, Cordon BH, Gross MS, et al. The Rear Tip Extender for Inflatable Penile Prostheses: Introduction of "Rigidity Factor" and Review of the Literature. Sex Med Rev 2019;7:516-520.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Prosthesis Design
PubMed: 30551977
DOI: 10.1016/j.sxmr.2018.11.001 -
Current Opinion in Urology Nov 2017Erectile dysfunction and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play... (Review)
Review
PURPOSE OF REVIEW
Erectile dysfunction and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play in men with low testosterone levels. The aim of this review is to provide an overview of these findings and the utility of TTh. We specifically examine the role of TTh on erectile function, coadministration with phosphodiesterase type 5 inhibitors, and libido.
RECENT FINDINGS
Recent publications suggest that TTh improves mild erectile dysfunction, though may be less useful in men with more severe erectile dysfunction. In men unresponsive to phosphodiesterase type 5 inhibitors and with mild erectile dysfunction, TTh can further improve erectile function. TTh has also shown consistent benefit in improving libido in men with low testosterone levels at baseline, with no additional improvements once testosterone levels are normalized.
SUMMARY
The available literature supports a role for TTh in men with low testosterone levels, erectile dysfunction, and low libido, with symptomatic improvement in these men.
Topics: Erectile Dysfunction; Humans; Hypogonadism; Libido; Male; Penile Erection; Testosterone
PubMed: 28816715
DOI: 10.1097/MOU.0000000000000442 -
Peptides Oct 2005Melanocortin receptors in the forebrain and spinal cord can be activated by endogenous or synthetic ligands to induce penile erection in rats and human subjects. To... (Review)
Review
Melanocortin receptors in the forebrain and spinal cord can be activated by endogenous or synthetic ligands to induce penile erection in rats and human subjects. To better understand how melanocortin circuits play a role in sex behavior, we review the contribution of melanocortin receptors and/or neurons in the hypothalamus, hindbrain, spinal cord and peripheral nerves to erectile function. New information regarding neuropeptides that mediate penile erection has extended our understanding of the central control of sex behavior, and melanocortin agonists may provide alternatives to existing treatment for highly prevalent problems including erectile dysfunction.
Topics: Animals; Humans; Male; Melanocyte-Stimulating Hormones; Neural Pathways; Penile Erection; Pro-Opiomelanocortin; Prosencephalon; Spinal Cord
PubMed: 15992962
DOI: 10.1016/j.peptides.2004.11.035 -
British Journal of Haematology Jul 2012Priapism is a rare presenting feature of chronic myeloid leukaemia (CML). It is a urological emergency requiring urgent treatment to prevent long-term complications, in... (Review)
Review
Priapism is a rare presenting feature of chronic myeloid leukaemia (CML). It is a urological emergency requiring urgent treatment to prevent long-term complications, in particular erectile dysfunction. In males with CML, ischaemic priapism is believed to result from hyperleucocytosis and associated leucostasis or hyperviscosity, and is seen in patients presenting with a high white cell count. Increasingly, a combined modality approach is being used to treat CML patients presenting with priapism. This includes systemic therapy with chemotherapy (hydroxycarbamide or tyrosine kinase inhibitors) and therapeutic leukapheresis to reduce the white cell count as well as local intracavernous therapy. This review will examine the literature and discuss the presenting features, investigations and management of priapism in CML.
Topics: Antineoplastic Agents; Humans; Leukapheresis; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Penile Erection; Penis; Priapism
PubMed: 22571386
DOI: 10.1111/j.1365-2141.2012.09151.x -
Vascular Health and Risk Management 2012Avanafil is a medication that was recently approved by the US Food and Drug Administration for the management of erectile dysfunction. Avanafil is a new... (Review)
Review
Avanafil is a medication that was recently approved by the US Food and Drug Administration for the management of erectile dysfunction. Avanafil is a new phosphodiesterase type 5 inhibitor similar to sildenafil and tadalafil. Avanafil was studied in over 1300 patients during clinical trials, including patients with diabetes mellitus and those who had undergone radical prostatectomy, and was found to be more effective than placebo in all men who were randomized to the drug. The medication was studied with on-demand dosing that may occur after food and/or alcohol. Avanafil is dosed as 50 mg, 100 mg, or 200 mg tablets. Avanafil may differentiate itself from the other phosphodiesterase type 5 inhibitors with its quicker onset and higher specificity for phosphodiesterase type 5 versus other phosphodiesterase subtypes, but may lead to complications of therapy.
Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Phosphodiesterase 5 Inhibitors; Pyrimidines
PubMed: 22973106
DOI: 10.2147/VHRM.S26712 -
European Review For Medical and... Apr 2023Erectile dysfunction (ED) refers to an inability to achieve or maintain a firm penile erection sufficient for satisfactory sexual intercourse. Insufficient, irregular...
OBJECTIVE
Erectile dysfunction (ED) refers to an inability to achieve or maintain a firm penile erection sufficient for satisfactory sexual intercourse. Insufficient, irregular sleep and sleep disorders adversely affect human health, including sexual function. Significant differences between biological rhythms (chronotypes) have been reported. In the present study we examine the effect of sleep quality and chronotype differences on ED patients and a control group.
PATIENTS AND METHODS
The study included 69 patients who presented with ED and 64 healthy controls. The respondents completed a sociodemographic data form, and disease severity in the ED group was measured using the International Index of Erectile Function (IIEF). The participants were further administered the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and Morningness-Eveningness Questionnaire (MEQ), and the scale scores were compared statistically between the patient and control groups.
RESULTS
There was no difference in the age, body mass index (BMI), alcohol use and smoking of the ED and healthy control groups, while the IIEF score was significantly lower in the ED group than in the control group. The PSQI subscale scores other than for sleep duration subscale, the PSQI global score and the HADS score were higher in the ED group than in the control group, while there was no difference between the groups in the MEQ and ISI scores. The IIEF score was correlated with the PSQI and HADS scores, and the PSQI score with the ISI and HADS scores.
CONCLUSIONS
It would be useful to evaluate sleep quality in addition to anxiety and depression while evaluating patients with ED. Our study found no relationship between chronotype differences and ED.
Topics: Male; Humans; Erectile Dysfunction; Sleep Quality; Chronotype; Penile Erection; Smoking; Surveys and Questionnaires; Sleep
PubMed: 37070877
DOI: 10.26355/eurrev_202304_31907 -
International Journal of Impotence... May 2013Inhibition of phosphodiesterase-5 (PDE5) is a well-known mechanism for the effective treatment of erectile dysfunction (ED). Androgen supplementation has also been... (Review)
Review
Inhibition of phosphodiesterase-5 (PDE5) is a well-known mechanism for the effective treatment of erectile dysfunction (ED). Androgen supplementation has also been prescribed for treating ED. However, it has been widely accepted that androgen can upregulate PDE5 expression, and thus creating a paradox in which a positive regulator of erectile function (androgen) could possibly increase the level of a negative regulator (PDE5). To solve this paradox, we conducted a systematic search of the PubMed and a non-systematic search of the Internet using PDE5, erectile, penis, testosterone and androgen as keywords. The retrieved papers were analyzed for data concerning the expression and regulation of PDE5 by androgens. Human and rat PDE5A gene sequences were retrieved from GenBank and computer-analyzed. The results showed that a putative androgen-response element (ARE) was reported in a study of human PDE5A gene promoter, and this prompted a separate study on whether androgen regulates PDE5 expression. The positive outcome in the latter study has since been cited in 17 review and editorial articles as the underlying mechanism for androgen's therapeutic effects on ED. In addition, five other research studies also reached the same conclusion. On the other hand, two independent studies on the genome-wide searches for androgen-regulated genes did not find PDE5A as a candidate. Sequence analysis conducted in this study also failed to find ARE in rat PDE5A gene. Two independent studies on Leydig cells also failed to find positive regulation of PDE5 expression by androgen. Two other studies found concomitant reduction of cavernous smooth muscle and PDE5 expression in castrated rats. One of these studies also found no effect of androgen on PDE5 expression in cultured cavernous smooth muscle cells. Thus, it appears that reduced PDE5 expression in castrated animals is due to reduced smooth muscle content and that PDE5A gene is not directly regulated by androgens.
Topics: Androgens; Animals; Base Sequence; Cyclic Nucleotide Phosphodiesterases, Type 5; Erectile Dysfunction; Gene Expression Regulation; Humans; Leydig Cells; Male; Myocytes, Smooth Muscle; Orchiectomy; Penile Erection; Penis; Phosphodiesterase Inhibitors; Promoter Regions, Genetic; RNA, Messenger; Rats; Response Elements; Sequence Alignment; Triptorelin Pamoate
PubMed: 23486196
DOI: 10.1038/ijir.2013.11 -
Andrology Mar 2015Although there are several methods for assessing erectile function in rats, the standard methods for telemetric monitoring have not been established. Theoretically... (Comparative Study)
Comparative Study
Although there are several methods for assessing erectile function in rats, the standard methods for telemetric monitoring have not been established. Theoretically assessment of spontaneous erection (SE) seems to be a physiologic method but it needs long measuring time and additional efforts. Apomorphine-induced erection (AIE) is one available and simple method; however, the correlation with SE has not been assessed. We compared erection profiles of AIE and SE in normal and two disease rat models using telemetric assessment of intracavernosal pressure (ICP). Seven-week-old male Sprague-Dawley rats were assigned to normal control, diabetes mellitus (DM) and hypercholesterolemia (HC) group. After 19 weeks a telemetric pressure sensor (C40; Data Sciences) was surgically implanted in the corpus cavernosum. One week later, ICP was recorded in freely moving rats after intraperitoneal apomorphine (100 μg/kg) injection (AIE) or during SE. Sexual events were visually identified and recorded. Only the pressure increases that occurred during sexual behavior were analyzed. We compared the erectile profiles such as duration, maximal ICP and the area under the curve (AUC, area under time × ICP curves). Two-way anova revealed no significant effect of the measuring methods on the mean AUC (F1,43 = 2.756, p-value = 0.104), but a significant effect of different disease models on mean AUC (two-way anova: F2,43 = 12.929, p-value < 0.001) was observed. The mean AUC of normal control rats was significantly higher than that of DM and HC rats (Bonferroni post hoc test: p < 0.001 and p = 0.001, respectively). ICP measurements using a telemetric device showed no significant difference in AUC between AIE and SE. AIE is easy and requires less time than SE measurements. Therefore, AIE could be a useful method to evaluate ICP in rats.
Topics: Animals; Apomorphine; Male; Penile Erection; Rats; Rats, Sprague-Dawley; Telemetry
PubMed: 25656097
DOI: 10.1111/andr.12004 -
Hinyokika Kiyo. Acta Urologica Japonica May 1988Recording of nocturnal penile tumescence (NPT) is useful for the objective diagnosis of impotence. However, criteria for evaluating obtained results have not been firmly... (Comparative Study)
Comparative Study
Recording of nocturnal penile tumescence (NPT) is useful for the objective diagnosis of impotence. However, criteria for evaluating obtained results have not been firmly established. Since the increase in the penile circumference varies among individuals, differential diagnosis based on only certain changes in the circumference during NPT is difficult. Therefore, we infused heparinized saline into the corpora cavernosa to induce artificial full erection (AFE), and the increase in the penile circumference was compared with that during NPT. In all controls with normal ability to attain erection, the percentage of the increase in the penile circumference during NPT to that with AFE (NPT/AFE) was 80% or more. In 27 patients with impotence, an NPT/AFE of 80% or more was observed in 14 patients, 11 of whom had no particular organic factors for impotence. Eleven patients had an NPT/AFE of less than 60%, 9 of them had apparent organic factors and the remaining 2 had abnormal PBPI. Patients showing less than a 10 mm increase in the penile circumference during NPT could be diagnosed with organic impotence. However, in those with an increase of 10 mm or more during NPT, a differential diagnosis was difficult to make, and the comparison with AFE seemed to be a useful method. Therefore, AFE which requires no special equipment and is a simple and safe procedure, can be a valuable adjunctive examination in assessing NPT.
Topics: Adult; Aged; Biometry; Erectile Dysfunction; Humans; Infusions, Parenteral; Male; Middle Aged; Penile Erection; Penis; Sleep, REM; Sodium Chloride
PubMed: 3177125
DOI: No ID Found