A Surgeon's Guide to the Various Antibiotic Dips Available During Penile Prosthesis Implantation.

PURPOSE OF REVIEW: Inflatable penile prosthesis (IPP) is a treatment for erectile dysfunction. IPPs have undergone improvements; however, post-surgical infections still occur. Furthermore, the type of pathogens infecting the implants has changed recently from Gram-positive to Gram-negative bacteria and fungi due to advances in antibiotic dips targeting the skin flora. To protect against infection, the AMS 700 is pre-coated with InhibiZone (mixture of Rifampin/Minocycline) and the Coloplast Titan, with several antibiotic dip options of differing efficacies. This review discusses strategies to decrease the infection rates in implant surgery, focusing on antibiotic dips. RECENT FINDINGS: Current research endorses the use of rifampin/gentamicin as the most studied combination; however, some studies have utilized different dips for additional coverage including the InhibiZone on the AMS 700. With the increasing prevalence of diabetes and Gram-negative organisms, there is a need to develop strategies for increased coverage against infections. Controlled studies with different antibiotic combinations are needed to identify the ideal cocktail to decrease infection.

Sleep-related erections throughout the ages.

INTRODUCTION: The occurrence of sleep-related erections (SREs) has been known since antiquity. AIM: To highlight historical, theological, and sexual medicine-related aspects of SREs throughout the ages. METHODS: Review of old medical books on male sexual functioning and review of scientific medical and theological articles on SREs from about 1900 on. RESULTS: The cyclic character of SREs was first noted by German researchers in the forties of the 20th century. However, already before the beginning of the Christian era, one knew that men had erections and ejaculations during sleep. In the Middle Ages, SREs were generally considered to be rebellious manifestations of the male body, while it seemed to disobey its owner and showed up its perverted and sinful side. From the fifteenth to the end of the 17th century, severe erectile dysfunction (ED) was ground for divorce. The ecclesiastical court records show that if necessary, the members of the jury sat at the defendant's bedside at night to be able to judge any SREs occurring. Since the 17th century, SREs were considered to be part of masturbation, which could cause many ailments and diseases. Psychoanalyst Stekel acknowledged in 1920 that a morning erection, the last SRE, is a naturally occurring phenomenon in healthy men from infancy to old age. Today, some scientists assume that SREs protect the integrity of the penile cavernous bodies. CONCLUSIONS: Throughout the ages, philosophers, theologians, physicians, members of ecclesial law courts, psychoanalysts, psychiatrists, sexologists, physiologists, and urologists have shown interest in SREs. Obviously, the observations and testing of SREs have a long history, from antiquity to modern sleep labs, in men and in women, in newborns and old adults, by penis rings with sharp spikes to fancy strain gauge devices. Despite all these efforts, the mechanisms leading to SREs and its function are however not yet completely understood.

A comprehensive history of injection therapy for erectile dysfunction, 1982-2023.

INTRODUCTION: Although oral phosphodiesterase 5 inhibitors represent a first choice and long-term option for about half of all patients with erectile dysfunction (ED), self-injection therapy with vasoactive drugs remains a viable alternative for all those who are not reacting or cannot tolerate oral drug therapy. This current injection therapy has an interesting history beginning in 1982. OBJECTIVES: To provide a comprehensive history of self-injection therapy from the very beginnings in 1982 by contemporary witnesses and some members of the International Society for Sexual Medicine's History Committee, a complete history of injection therapy is prepared from eyewitness accounts and review of the published literature on the subject, as well as an update of the current status of self-injection therapy. METHODS: Published data on injection therapy, as a diagnostic and therapeutic tool for ED, were reviewed thoroughly by PubMed and Medline research from 1982 until June 2023. Early pioneers and witnesses added firsthand details to this historical review. Therapeutic reports of injection therapy were reviewed, and results of side effects and complications were thoroughly reviewed. RESULTS: The pioneers of the first hours were Ronal Virag (1982) for papaverine, Giles Brindley (1983) for cavernosal alpha-blockade (phentolamine and phenoxybenzamine), Adrian Zorgniotti (1985) for papaverine/phentolamine, and Ganesan Adaikan and N. Ishii (1986) for prostaglandin E1. Moxisylyte (thymoxamine) was originally marketed but later withdrawn. The most common side effect is priapism, with the greatest risk of this from papaverine, which has modified its use for therapy. Currently, prostaglandin E1 and trimixes continue to be the agents of choice for diagnostic and therapeutic use in ED. A recent agent is a mixture of a vasoactive intestinal polypeptide (aviptadil) and phentolamine. CONCLUSIONS: After 40 years, self-injection therapy represents the medication with the highest efficacy and reliability rates and remains a viable option for many couples with ED. The history of this therapy is rich.

The Pathophysiology and Therapy of Erectile Dysfunction in a Newly Discovered Treatise by Wolfgang Reichart (1486-circa 1547).

BACKGROUND: A newly-found treatise by Wolfgang Reichart (1486-circa 1547), town physician of Ulm, challenges the contemporary view that bewitchment as a cause of impotence defies any natural explanation. OBJECTIVE: To understand the pathophysiological concept and therapy of erectile dysfunction in Reichart's treatise by examination of his sources and previous concepts. METHODS: Source analysis of Reichart's treatise by comparison of the pathophysiological concepts and therapy of erectile dysfunction with original texts of the Corpus Hippocraticum (5th-3rd century BC) and Constantinus Africanus (11th century). RESULTS: By using rational thinking and medical knowledge mainly drawn from antiquity, especially Constantinus Africanus, Reichart shows that a supposed supernatural cause for impotence can be explained by reason and natural means. Reichart's treatise changes the view of bewitchment as cause of impotence. He makes eclectical use of previous concepts to explain his patient's condition. From the Middle Ages on, bewitchment was accepted as a cause for erectile dysfunction. Usually, physicians of that time accepted this etiology and advised a treatment based on theological concepts. Reichart challenges this view by emphasizing reason and medical knowledge as crucial for treating the patient, rejecting supernatural treatment approaches. CONCLUSIONS: In the 16th century, a type of rational thinking and medical knowledge emerges, which puts supernatural explanations into question and aims at treating patients with natural means. The analysis of Reichart's treatise is a much-needed contribution to understanding the historic development of pathophysiological concepts of and therapeutic measures for impotence, which is yet underresearched.

Sigmund Freud and his impact on our understanding of male sexual dysfunction.

INTRODUCTION: Sigmund Freud was one of the most influential thinkers and theorists of the 20th century. His groundbreaking work laid the foundation to many concepts and theories relevant to modern sexual medicine. AIM: To evaluate Freud's approaches to the understanding of male sexual dysfunction both in their historical context and with respect to their significance for contemporary research and therapy of sexual problems. METHODS: After a brief biographical sketch, two of Freud's writings, the widely acclaimed "Three Essays on the Theory of Sexuality" from 1905, and a short article entitled "The Most Prevalent Form of Degradation in Erotic Life" from 1912, were analyzed, especially for their relevance to present treatment concepts of male sexual dysfunction. RESULTS: In Freud's clinical practice "psychical impotence" was a highly prevalent complaint. In his view, this dysfunction was caused by an inhibition due to an unresolved neurotic fixation leading to an arrest of the libidinal development. The result is a splitting of the tender and the sensual dimension of sexuality, most notably in the so-called madonna-whore complex. The degree of this dissociation (total or partial) determines the severity of the ensuing sexual dysfunction. In Freud's rather pessimistic view, the erotic life of civilized people tends to be characterized by some degree of this condition. CONCLUSIONS: While some of Freud's theories are obsolete today, many parts of his work appear to be astonishingly modern, even in the light of current neurobiological research and recent models of sexual dysfunction. Above all, Freud was an extremely gifted observer of human behavior who shows us that in many cases, sexual dysfunctions are no isolated phenomena, but have their roots in biographically based intrapsychic or interpersonal conflicts.

Impotence in the 18th and 19th century: concepts of etiology and approaches to therapy.

The old word impotence is derived from the Latin word impotencia, which literally translated means "lack of power." Impotence, in the course of the history, has been attributed to mental pathology, anxiety, or demons or witches. Historically, the pharmacological treatments for impotence started in Greek times, when a myriad of herbal medications were applied locally to the genitals to enhance "sexual strength." In the 18th century, theories about the main factors inducing impotence saw it as an abnormal state of the fibers, a defect in the solid or liquid substances or a bad structure (tumor, inflammation, abscess, ulcer or foreign body). According to these mechanisms, when impotence depended on the state of the muscular fibers, treatment included a tepid bath and a clyster. In very fat or very weak people, who get particularly tired, it was important to use the remedies able to give energy to the fibers, such as ferrous mineral waters, for a month. Moreover, other suggestions were to ride a horse, to sleep few hours, to breathe good country air, to take a purge every 2 weeks, to drink half a glass of wine from Borgogne or to distract the mind continuously. In the 19th century, therapies regarding impotence included slight electric stimulation through the application of stimulators on the scrotum in the testis or epididymis areas, until pain was induced. In the same period, another method for treating impotence was flagellation. This method consisted of little flagellations with leather strips.

[Forbidden sexualities: madness and the male gender]. / Sexualidades interditadas: loucura e gênero masculino.

The article identifies and studies male sexuality and affectivity as forbidden and imprisoned in Brazilian asylums in the first decades of the Republic. By analyzing psychiatric records from that era, it explores the notion that sexual and affective behavior had little to do with the construction of male profiles deemed 'deviant' and/or 'pathological'. This reflection shifts the focus of analysis to the gender specificities that determine the various traits displayed in 'mental disturbances' attributed to certain sexual and affective behavior.

Impotence in the XVIII-XIX century as described by Gian Pietro Fusanacci and Tommaso Eduardo Beatty.

In 1992, the definition of erectile dysfunction (ED) replaced the old term of impotence that had been used for many centuries, in order to avoid the general confusion existing until today in this field. In the past, the origin of impotence had been attributed to different causes such as psychological diseases, or witches and demons. In 1764, Fusanacci described impotence that can occur in the male as well as in the female, as a defect in reproduc-tion. The main causes responsible for impotence were identified as inability to achieve erection, a very fluid seminal ejaculation, a defective organ, dryness of testicles, and lack of copulative power after many sexual intercourses with healthy women. Some decades later in 1847, Beatty affirmed that one of the most remarkable changes that can be observed in the passage from childhood to maturity is the development of the sexual organs, followed by the appearance of new sensations. He distinguished impotence that occurs only in men from sterility that for him affects women, and divided the causes of impotence into 3 classes: organic, functional and moral (today defined as psychological). For Beatty, the progress of knowledge had taken away magic and sorcery from the human mind and now it was widespread only among the lowest and most ignorant classes of humble people. In this way, he shows the evolution of medical science in XIX century in accepting only the rational explanation of the human diseases.

Leaky Bodies, Bawdy Books: Gonorrhea and Reading in Eighteenth-Century Britain.

In eighteenth-century Britain, reading lewd books was understood to exacerbate gonorrhea. That pathology corresponded to a specific physiological model, which historians describe as the leaky male body. This article demonstrates how the connection between reading and gonorrhea correlated to three phenomena: 1) the neuro-sexual economy of bodily fluids; 2) the effects of reading on the sensible mind and body; and 3) the crossover of erotic and medical literatures. Aware of the physiological power of imagination, authors intentionally wrote to elicit strong physiological and sexual responses in readers. Concerns about the pathological and moral consequences of reading provocative material similarly informed criticisms of both the outright pornographic and the ostensibly medical. Partly in response to such criticisms, medical authors developed a more careful, decorous, and objective tone for writing about sexual topics. Ultimately, the culture of sensibility receded, as did anxieties about involuntary leaks of bodily fluids caused by reading.

Reproduction concepts and practices in ancient Egypt mirrored by modern medicine.

The treasured ancient papyri provide a glimpse into understanding of common concepts and practices in ancient Egypt. The Kahun gynecological papyrus and other texts unveil the traditions of reproduction, conception and delivery. This article addresses the rationale of beliefs and practices of that era. Frequently, the reason for common traditions exercised at the time is based on medical knowledge of female anatomy and physiology during pregnancy. Surprisingly some of the remedies commonly used in ancient Egypt were recently explored and found intriguing. This paper was aimed to look at the reflection of archaic practices and concepts of ancient Egypt by the modern mirror of evidence-based medicine.

Male pelvic floor: history and update.

Our understanding of the male pelvic floor has evolved over more than 2,000 years. Gradually medical science has sought to dispel ancient myths and untruths. The male pelvic floor has many diverse functions. Importantly, it helps to support the abdominal contents, maintains urinary and fecal continence, and plays a major role in gaining and maintaining penile erection. Weakness of the male pelvic floor muscles may cause urinary and fecal incontinence and erectile dysfunction. Function may be restored in each of these areas by a comprehensive pelvic floor muscle training program. Spasm of the pelvic floor muscles may produce pain and require relaxation techniques. Additional research is needed to add further evidence to our knowledge base.

[Sant'Ippazio (St. Hypatius of Gangra): A southern Italian cult of virility and red carrots]. / Sant'Ippazio (St. Hypatius von Gangra) : Ein süditalienischer Kult um Potenz und Pastinaken.

Sant'Ippazio (St. Hypatius of Gangra) is a saint, martyr, and advocate in cases of impotency, inguinal hernia, and other abdominal disorders. In Tiggiano, a small town at the southernmost point of Italy, Sant'Ippazio, bishop of Gangra, is venerated as a patron saint. According to legend, during an excited dispute on the question of the Arian heresy at the synod of Nicaea (325 AD), Bishop Ippazio was kicked in the lower abdominal region by an Arian presbyter, which caused an inguinal hernia. Therefore, his help is sought for relief and cure of hernia or impotency. Every January 19th, the day of the parish fair, particular carrots (the "pastinache") which have a reddish to violet color are sold. They are said to be similar to the saint's penis after the kick. Also described in this article are other pagan fertility rituals which have been christianized by the veneration of a saint and which are still kept alive among local populations.

Historical advances in penile prostheses.

In the 25 y since their introduction, semi-rigid and inflatable penile implants have become remarkably dependable mechanical instruments associated with high patient satisfaction. This report attempts to quantify the historical milestones of significance pertaining to these devices. As with any historical 'best of ' list, there will be controversy and omissions. Three broad topics contributing to the advancement of penile prosthetic surgery, devices and techniques are discussed: (1) Prosthetic design changes contributing to freedom from revision: distention controlled cylinders, Bioflex cylinders, connectionless systems and reservoir lockout valves; (2) Instrument innovations to facilitate prosthetic surgery: Scott retractor, Furlow inserter, Brooks dilators, Carrion-Rossello cavernotomes; (3) Clever surgical applications: SST repair, transverse scrotal incision, modeling for Peyronie's disease, salvage for infection and natural tissue repair. International Journal of Impotence Research (2000) 12, Suppl 4, S101-S107.

Some mythologic, religious, and cultural aspects of impotence before the present modern era.

Impotence is not only a problem of modern society. Centuries ago man has sought for causes and remedies for impotence, originally looking much more outside himself rather than within himself. This article reviews and reflects on mythological, religious and cultural aspects of impotence, especially before the beginning of the 18th century.

Natural remedies for impotence in medieval Persia.

Man's preoccupation with potency, or the lack thereof, has been present through the ages. Several documents still exist from which the clinical approaches of erectile dysfunction (ED) in medieval Persia can be ascertained. The medieval physicians described definitions and apparent causes of ED. They also noted hygienic and dietary rules as well as long lists of natural substances used in the treatment of ED. Many of the approaches of practitioners in medieval Persia are accurate and accepted even today; however, still more of them could be of use to modern medicine. The present review provides an overview of the knowledge of ED at the time.

Sexual life in Pharaonic Egypt: towards a urological view.

Sex is a basic human need, common to all people at all times. It is evident that the ancient Egyptians were real human beings, not only a people who built massive pyramids and made mummies of their dead. The ancient Egyptians had a rich and varied sexual life, which they found an opportunity to describe in words and pictures. As in the other early primitive civilizations, erotic matters were of prime importance and became an integral part of life. In Pharaonic times, the Egyptians described impotence and recorded several methods to increase the sexual power. In the present paper, we will shed light on some aspects of the sexual life in ancient Egypt that may be interesting to the urologists, including ancient Egyptian concepts of sex and erotic matters, their own way of treatment of impotence and Min, the Egyptian fertility God.

The history of erectile dysfunction management.

This article describes the evolution or revolution in the management of erectile dysfunction over the centuries. In recent history there has been a rapid movement away from a predominant role for the specialist towards the primary care physician. The physician is increasingly faced with the need to individualize therapy to meet patient expectations.

Apomorphine to Uprima: the development of a practical erectogenic drug: a personal perspective.

The development process for apomorphine SL as an effective treatment for patients with erectile dysfunction has been somewhat unusual. As often is the case, much of the impetus for the basic research originated in academia. However, somewhat unusually, the impetus for early stage clinical research also lay in the hands of the academics. This article represents a historical perspective from one of those involved throughout.

History of the prosthetic treatment of impotence.

Early records of observations of the os penis or baculum in mammals go back to Aristotle. These heritable cartilaginous supports were noted to help the penis during copulation. Prosthetic surgery for treatment of impotence was born from the initial experience with the use of the "artificial os penis" (rib cartilage) in post-traumatic reconstruction in 1936. Slow progress was made with the use of extracavernosal acrylic stents, followed by intracavernosal polypropylene rods, and finally the silicone prosthesis over the next 20 years. The introduction in 1973 of the inert silicone semirigid prosthesis and inflatable prosthesis met with great successes. Most recently (1985), there has been development of self-contained prostheses that are technically more simple to insert. Today, much more is known about specific organic causes of impotence that are amenable to many successful nonprosthetic alternative therapies, adding more stimuli to continued innovations in prosthetic surgery for erectile dysfunction.