Preservación de la función eréctil tras la uretroplastia: ¿escisión y anastomosis primaria o injerto de mucosa oral? / The best method for erection function in urethroplasty; is excision and primary anastomosis or buccal mucosal graft urethroplasty?

Introducción El objetivo de este estudio es evaluar y comparar la función eréctil (FE) tras la uretroplastia por escisión y anastomosis primaria (UEAP) y la uretroplastia con injerto de mucosa oral (UIMO) en la estenosis de uretra bulbar. Métodos Se identificó retrospectivamente a los pacientes tratados mediante uretroplastia. Se determinaron como criterios de inclusión en el estudio la edad entre 18 y 70 años y ser sexualmente activo. Los criterios de exclusión fueron la disfunción eréctil grave preoperatoria, estenosis distinta de la uretra bulbar, incompatibilidad psicosocial, estenosis uretral relacionada con fractura pélvica y tiempo de seguimiento inferior a un año. Como criterio de valoración primario, se utilizó el International Index of Erectile Function-5 (IIEF-5) para la comparación de la FE en el preoperatorio y en el 3.°, 6.° y 12.° mes tras la intervención quirúrgica. El criterio de valoración secundario fue el efecto de los datos demográficos, las características de la estenosis y del tratamiento sobre la FE. Resultados Tras aplicar los criterios de inclusión y exclusión, se identificó a 50 pacientes. De ellos, 30 fueron tratados mediante UEAP y 20 mediante UIMO. Al 3.er mes de la intervención, la FE mostró una disminución estadísticamente significativa en el grupo UEAP. En ambos grupos de pacientes se observó una mejoría de los efectos negativos postoperatorios sobre la EF en el 6.° mes, que recuperaron su nivel basal a los 12 meses. Conclusión Las técnicas UEAP y UIMO tienen un efecto similar sobre la FE a medio y largo plazo y ambas pueden utilizarse con seguridad y eficacia en el grupo de pacientes adecuado. (AU)

Introduction The aim of this study is to evaluate and compare erection function (EF) after excision and primary anastomosis urethroplasty (EPAU) and buccal mucosal graft urethroplasty (BMGU) in bulbar urethral stricture. Methods Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are: preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and 3rd, 6th and 12th months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF. Results Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the 6th month and returned to the baseline level by the first year. Conclusion EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group. (AU)

Satisfaction assessment study in patients (and their partners) with/without Peyronie's disease and penile prosthesis implantation.

INTRODUCTION AND OBJECTIVE: Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. However, patients with coexistent Peyronie's disease (PD) and refractory erectile dysfunction and/or severe deformities may show different results. The aim of our study was to assess and to compare the level of satisfaction, with an inflatable penile prosthesis (IPP), in men with/without coexistent PD. MATERIAL AND METHODS: A survey study based on a five-item satisfaction questionnaire was submitted to all those live patients implanted in the period 1992-2022 at our center (n = 570) and their partners. Ninety-two percent of implants were inflatable devices. Surgeries were mainly performed by two surgeons. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after IPP. RESULTS: Of the 570 eligible patients, 479 (84%) completed the survey (393 Non-PD: GROUP 1; 70 non-complex PD-Group 2; 16 complex PD). Eighty-six per cent of patients in Group 1 reported satisfactory sexual intercourse (very or moderately satisfied). Non-complex PD implanted patients (Group 2) reported a global 81% satisfactory sexual intercourse (very or moderately satisfied) (p > 0.05). However, when we evaluated the PD subgroup of patients with severe PD who require incision/excision/grafting at the time of implant (Group 3: n = 20), only 61% reported satisfactory sexual intercourse (p < 0.01) with predominance of moderately satisfied patients over very satisfied: 78% vs. 22%). Additionally, 84% (Group 1), 80% (Group 2) and 54% (Group 3) of partners reported satisfactory intercourses, respectively (p < 0.01). Overall, 84% of Group 1 implants and 79% of Group 2 reported that they would undergo the procedure again if the IPP failed (p > 0.05; ns). Only 50% of Group 3 patients would do it again. With regard to cosmetic aspects, 48% of the Group 3 implant reported penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of total PP patients expressed difficulty in manipulating the device. CONCLUSION: The presence of PD alone may not impact PP patient and partner satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length and glans sensation.

The best method for erection function in urethroplasty; is excision and primary anastomosis or buccal mucosal graft urethroplasty?

INTRODUCTION: The aim of this study is to evaluate and compare erection function (EF) after Excision and Primary Anastomosis Urethroplasty (EPAU) and Buccal Mucosal Graft Urethroplasty (BMGU) in bulbar urethral stricture. METHODS: Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are; preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and third, sixth and twelfth months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF. RESULTS: Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the sixth month and returned to the baseline level by the first year. CONCLUSION: EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group.

Síntomas del tracto urinario inferior en pacientes con hipertensión arterial. Riesgo cardiovascular e impacto en su calidad de vida / Lower urinary tract symptoms in patients with arterial hypertension. Cardiovascular risk and impact on their quality of life

Objetivos: Determinar la prevalencia de síntomas del tracto urinario inferior en pacientes hipertensos, el riesgo cardiovascular y el impacto en la calidad de vida. Material y métodos: Ámbito: Centro de Salud (Vilagarcía, Pontevedra). Periodo: abril del 2015-junio del 2017. Criterios de inclusión: varones hipertensos con consentimiento informado. Mediciones: Variables sociodemográficas, hábitos tóxicos, comorbilidad, presión arterial, riesgo cardiovascular, parámetros analíticos y de exploración. Cuestionarios: escala internacional síntomas prostáticos (IPSS), índice internacional función eréctil (IIEF-15), calidad de vida en hipertensión arterial (MINICHAL). Tamaño muestral: n=262 (± 6% precisión, 95% seguridad). Análisis estadístico bivariado y multivariado de regresión logística. Aprobado por el Comité Ético de Investigación (2014/237). Resultados: La edad media fue de 65,84 (12,70), con una media de evolución de la hipertensión de 13,25 (9,84) años. El 76,7% refirió síntomas del tracto urinario inferior, siendo el 91,6% de grado leve. El análisis bivariado mostró asociación con: edad, nivel estudios, profesión, actividad laboral, tabaco, hipertrofia benigna de próstata, años de diagnóstico, medicación concomitante, score de Framingham-Wilson, electrocardiograma, hemoglobina glicosilada, filtrado glomerular (Cockroft-Gault), LDL-colesterol, manifestaciones somáticas (MINICHAL), disfunción eréctil. El análisis multivariante mostró aumento del riesgo con: obesidad abdominal, electrocardiograma patológico, riesgo alto del score de Framingham-Wilson, disfunción eréctil, uso de hipouricemiantes y disminuía con no fumar y uso de diuréticos. (AU)

Objetives: To determine the prevalence of erectile lower urinary tract symptoms in hypertensive patients, cardiovascular risk and the impact on quality of life. Material and methods: Setting: Health Center (Vilagarcia, Pontevedra). Period: April 2015-June 2017. Inclusion criteria: Hypertensive patient with informed consent. Measurements: sociodemographic variables, toxic habits, comorbidity, blood pressure, cardiovascular risk, analytical and examination parameters. Questionaries: International Prostate Symptom Scale (IPSS), International Index of Erectile Function (IIEF-15) and quality of life in arterial hypertension (MINICHAL). Sample size: n=262 (± 6% accuracy, 95% confidence). Statistical analysis: Bivariate and multivariate statistical analysis. Informed consent and ethics committee approval were obtained (2024/237) Results: The mean age was 65.84 (12.70), and mean hypertension duration of 13.25 (9.84) years. 76.7% reported lower tract urinary symptoms, 91.6% being mild. The bivariate analysis showed an association with the variables: age, educational level, profession, work activity, tobacco, benign prostatic hypertrophy, years of diagnosis, concomitant medication, Framingham-Wilson score, electrocardiogram, glycated hemoglobin, glomerular filtration (Crockroft-Gault), LDL-cholesterol, somatic manifestations (MINICHAL), erectile dysfunction. The multivariate analysis showed increased risk with:abdominal obesity, pathological electrocardiogram, high risk of Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents and decreased with not smoking and use diuretics. (AU)

A possible mechanism of erectile dysfunction in coronavirus disease-19: Cavernosal smooth muscle damage: A pilot study / Un posible mecanismo de disfunción eréctil en la enfermedad por coronavirus-19: daño del músculo liso cavernoso: un estudio piloto

Introduction: Studies have reported that coronavirus disease 2019 (COVID-19) may cause erectile dysfunction (ED), however, its role in the pathophysiology of ED has not yet been fully elucidated. We aimed to elucidate COVID-19's effects on cavernosal smooth muscle, which has a pretty important role in erection physiology, by corpus cavernosum electromyography (cc-EMG). Materials and methods: Twenty-nine male patients aged 20–50 years who applied to the urology outpatient clinic due to ED were included in the study. Nine patients that had COVID-19 and were treated as outpatients were classified as group 1, 10 patients who were hospitalized due to COVID-19 were classified as group 2, and 10 patients who did not have COVID-19 were classified as the control group (group 3). Patients underwent diagnostic evaluation including International Index of Erectile Function (IIEF)-5 form, penile color Doppler ultrasonography (CDUS), cc-EMG, and fasting serum levels of reproductive hormones (07–11am). Results: According to penile CDUS and hormonal values results, there was no significant difference between the groups. According to cc-EMG results, amplitudes and relaxation capacities of the cavernosal smooth muscle of patients in group 3 were significantly higher than those in the other groups. Conclusions: COVID-19 can cause ED not only by psychogenic and hormonal factors but also with cavernosal smooth muscle damage. (AU)

Introducción: Los estudios han informado que la COVID-19 puede causar disfunción eréctil, sin embargo, su papel en la fisiopatología de la disfunción eréctil aún no se ha aclarado por completo. Nuestro objetivo era dilucidar los efectos de la COVID-19 en el músculo liso cavernoso, que tiene un papel bastante importante en la fisiología de la erección, mediante electromiografía del cuerpo cavernoso (cc-EMG). Materiales y métodos: Se incluyeron en el estudio 29 pacientes varones de 20 a 50 años de edad que solicitaron la consulta externa de urología debido a disfunción eréctil. Nueve pacientes que tenían COVID-19 y fueron tratados como pacientes ambulatorios se clasificaron como grupo 1, 10 pacientes que fueron hospitalizados debido a COVID-19 se clasificaron como grupo 2 y 10 pacientes que no tenían COVID-19 se clasificaron como grupo control (grupo 3). Los pacientes se sometieron a una evaluación diagnóstica que incluyó el índice internacional de función eréctil (IIEF)-5, ecografía Doppler color del pene (CDUS), cc-EMG y niveles séricos en ayunas de hormonas reproductivas (07-11 am). Resultados: De acuerdo con los resultados de los valores de CDUS y hormonales del pene, no hubo diferencias significativas entre los grupos. De acuerdo con los resultados de cc-EMG, las amplitudes y las capacidades de relajación de las actividades EMG del músculo liso cavernoso de los pacientes del grupo 3 fueron significativamente mayores que las de los otros grupos. Conclusiones: La COVID-19 puede causar disfunción eréctil no solo por factores psicógenos y hormonales, sino también por daño del músculo liso cavernoso. (AU)

[Lower urinary tract symptoms in patients with arterial hypertension. Cardiovascular risk and impact on their quality of life]. / Síntomas del tracto urinario inferior en pacientes con hipertensión arterial. Riesgo cardiovascular e impacto en su calidad de vida.

OBJETIVES: To determine the prevalence of erectile lower urinary tract symptoms in hypertensive patients, cardiovascular risk and the impact on quality of life. MATERIAL AND METHODS: Setting: Health Center (Vilagarcia, Pontevedra). PERIOD: April 2015-June 2017. INCLUSION CRITERIA: Hypertensive patient with informed consent. MEASUREMENTS: sociodemographic variables, toxic habits, comorbidity, blood pressure, cardiovascular risk, analytical and examination parameters. Questionaries: International Prostate Symptom Scale (IPSS), International Index of Erectile Function (IIEF-15) and quality of life in arterial hypertension (MINICHAL). SAMPLE SIZE: n=262 (± 6% accuracy, 95% confidence). STATISTICAL ANALYSIS: Bivariate and multivariate statistical analysis. Informed consent and ethics committee approval were obtained (2024/237) RESULTS: The mean age was 65.84 (12.70), and mean hypertension duration of 13.25 (9.84) years. 76.7% reported lower tract urinary symptoms, 91.6% being mild. The bivariate analysis showed an association with the variables: age, educational level, profession, work activity, tobacco, benign prostatic hypertrophy, years of diagnosis, concomitant medication, Framingham-Wilson score, electrocardiogram, glycated hemoglobin, glomerular filtration (Crockroft-Gault), LDL-cholesterol, somatic manifestations (MINICHAL), erectile dysfunction. The multivariate analysis showed increased risk with:abdominal obesity, pathological electrocardiogram, high risk of Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents and decreased with not smoking and use diuretics. CONCLUSIONS: Three quarters of hypertensive men presented lower urinary tract symptoms, increasing the risk of cardiovascular disease early according to the Framingham-Wilson score. Other predictive factors were: abdominal obesity, tobacco, pathological electrocardiogram, high Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents.

Management of erectile dysfunction and premature ejaculation: The perspective of Spanish urologists. Results of the PANDORA Project (Part II) / Manejo de la disfunción eréctil y la eyaculación precoz: la perspectiva de los urólogos españoles. Resultados del Proyecto PANDORA (Parte II)

Introduction: ED and PE are the most common male sexual dysfunctions, although they remain underdiagnosed and undertreated. Aim: To ascertain how a group of Spanish urologists currently address ED and PE. Methods: Descriptive study based on a self-designed questionnaire about the clinical practice in ED and PE upon diagnosis, treatment and monitoring, patient–physician relationship and the role of the patient's partner. Results: The survey was completed by 188 experienced urologists. Most patients went to the urologist's office without a previous diagnosis (92% of the urologists found <10 PE-diagnosed patients in public settings). The diagnosis of ED and/or PE was mainly carried out by the current urologist and not by another professional, particularly in private centres as opposed to public centres (78.8% vs 57.0% for ED; 82.0% vs 62.6% for PE). Most urologists believed that these disorders are underdiagnosed and deemed them as general health issues. 38% of urologists acknowledged using validated questionnaires to diagnose ED. PE was considered a subjective problem rather than a true disease and the use of PRO-based diagnosis of PE was not generally accepted (14%). Treatment options of both disorders were chosen as expected. Referral to the andrologist is usually scheduled in moderate-to-severe PE or severe ED. The cohort seemed to be mostly neutral (50%–75% for ED and 40%–55% for PE) regarding patient reluctancy to talk about their sexual problem. Patients’ partners play an important role in helping men seeking treatment. (AU)

Introducción: A pesar de que, la DE y la EP son las disfunciones sexuales masculinas más frecuentes, siguen estando infradiagnosticadas e infratratadas. Objetivo: Conocer cómo es el abordaje actual de la DE y la EP, a partir de un grupo de urólogos españoles. Método: Estudio descriptivo, mediante un cuestionario predefinido, con relación a la práctica clínica de la DE y la EP, incluyendo su diagnóstico, su tratamiento y su seguimiento, la relación médico-paciente y el papel de la pareja. Resultados: Ciento ochenta y ocho urólogos expertos dieron respuesta al cuestionario predefinido. La mayoría de los pacientes acudieron a la consulta del urólogo sin un diagnóstico previo (el 92% de los urólogos hallaron <10 pacientes diagnosticados de PE en el ámbito público). El diagnóstico de la DE y/o la EP fue realizado mayoritariamente por el urólogo, y no por otro profesional, especialmente en el ámbito privado frente al público (78,8 frente al 57,0% para la DE; 82,0 frente al 62,6% para la EP). La gran mayoría de los urólogos señalaron que ambas disfunciones estaban siendo infradiagnosticadas y, por tanto, las consideraron como un problema de salud general. El 38% de los urólogos indicó utilizar cuestionarios validados para el diagnóstico de la DE. La EP se percibió como un problema subjetivo más que como una verdadera enfermedad, y el uso de PRO en el diagnóstico de la EP no fue generalmente aceptado (14%). La elección de las opciones de tratamiento de ambas disfunciones aconteció según lo esperado. Se consideró la derivación a andrología en los casos de la EP moderada-grave o en los casos de la DE grave. En cuanto a la reticencia de los pacientes a hablar de su problema sexual, la respuesta fue mayoritariamente neutra (50-75% para la DE y 40-55% para la EP). Las parejas de los pacientes desempeñan un papel importante en el momento que estos buscan opciones de tratamiento. (AU)

Disfunción eréctil y YouTube: calidad de los vídeos en español / Erectile dysfunction and YouTube: Quality of videos in Spanish

Introducción: La disfunción eréctil (DE) es una de las enfermedades urológicas más prevalentes, pero los datos de la calidad de su información en redes sociales son escasos. El objetivo de nuestro estudio fue evaluar la calidad de la información sobre DE contenida en los vídeos de YouTube. Material y métodos: Estudio descriptivo transversal de los 50 primeros vídeos en castellano publicados en YouTube, evaluados por tres urólogos mediante dos cuestionarios validados: Patient Education Materials Assessment Tool (PEMAT) y DISCERN, clasificándolos según puntuación DISCERN en calidad pobre y moderada-buena. Resultados: La mediana de duración fue de 2,42 minutos, y la de visualizaciones, de 94.197 (2.313-3.027.890), con 682,5 (0-54.020) «me gusta» y 39 (0-2.843) «no me gusta». La mediana de PEMAT fue del 29% en inteligibilidad y del 29% en factibilidad. Con DISCERN, 27 vídeos (57,4%) fueron de calidad pobre y 20 (42,6%), de calidad moderada-buena. No observamos diferencias significativas entre ambos grupos en duración, visualizaciones, número de «me gusta» o de «no me gusta». Sí existieron diferencias en PEMAT de inteligibilidad y de factibilidad. El 86,7% de los protagonizados por personal médico fueron de calidad moderada-buena (p=0,001). El 85,7% de los que describían el tratamiento fueron de calidad moderada-buena y el 84% de los vídeos no médicos fueron de calidad pobre (p=0,001). Conclusiones: La mayoría de los vídeos sobre DE en YouTube son de calidad pobre. Los vídeos de mayor calidad son aquellos realizados por profesionales, aunque no son los más vistos. Sería importante el desarrollo de medidas para evitar la difusión de desinformación entre los usuarios de redes sociales. (AU)

Introduction: Erectile dysfunction (ED) is one of the most prevalent urological diseases, but there is limited data about the quality of its information in social networks. The aim of our study was to assess the quality of ED information contained in YouTube videos. Material and methods: Descriptive study of the first 50 Spanish-language videos, published on YouTube, evaluated by three urologists. We used two validated questionnaires: PEMAT (Patient Education Materials Assessment Tool) and DISCERN. Videos were classified according to DISCERN score into poor or moderate-good quality. Results: The median time duration was 2.42minutes (0.15-3.58), 94,197 views (2,313-3,027,890), 682.5 «likes» (0-54,020) and 39 «dislikes» (0-2843). The median of PEMAT score was 29% (9%-95.5%) in understandability and 29% (0-95.5%) in actionability. According to DISCERN score 27 videos (57.4%) had poor quality and 20 (42.6%) moderate-good quality. There were no significant differences between the two groups in time duration, views, «likes» or «dislikes». There were differences in PEMAT score in understandability and actionability. The 86.7% of the moderate-good quality videos were starred by health care provider (P=.001). Also, the 85.7% of videos that describes treatment had moderate-good quality (P=.001). The 84% of the non-medical videos had a poor quality (P=.001). Conclusion: Most ED videos on YouTube have poor quality. The highest quality videos are those made by professionals, although they are not the most viewed. It would be important to develop measures to prevent the spread of misinformation among social network users. (AU)

Revisión sistemática de la implantación de prótesis de pene en cirugía mayor ambulatoria / Systematic review of the implantation of penile prosthesis in major ambulatory surgery

Introducción y objetivo La implantación de prótesis deZ pene (PP) es una alternativa eficaz para la disfunción eréctil. Aunque inicialmente la cirugía de PP se realizaba en régimen hospitalario, existe una tendencia creciente a realizar el implante de PP en un modelo de cirugía mayor ambulatoria (CMA). El objetivo de este estudio es realizar una revisión sistemática de la literatura para identificar la evidencia disponible sobre la implantación de PP en el marco de la CMA en comparación con el procedimiento realizado en régimen hospitalario. Material y métodos Se realizó una búsqueda en las bases de datos electrónicas PubMed, EMBASE, Cochrane Library y MEDES y en los suplementos no indexados de los congresos científicos para identificar artículos relacionados con la implantación quirúrgica de PP en CMA hasta febrero de 2021. Los términos de búsqueda incluyeron prótesis de pene, disfunción eréctil, cirugía ambulatoria, atención ambulatoria y cirugía. Resultados Entre las 171 publicaciones obtenidas (51 en PubMed, 73 en EMBASE, 3 en Cochrane, 2 mediante MEDES y 42 mediante búsqueda manual), se seleccionaron finalmente 5 estudios. No hubo diferencias significativas entre la CMA y el régimen hospitalario en términos del tipo de dispositivo, el abordaje quirúrgico o la ubicación del reservorio. Las tasas de complicaciones observadas en ambos grupos fueron similares. La implantación de PP en régimen de CMA supuso un menor coste que la cirugía en régimen hospitalario y se asoció con tasas aceptables de satisfacción de los pacientes y un adecuado control del dolor. Conclusiones Los estudios demostraron que la implantación de PP en régimen de CMA puede lograr resultados similares en términos de seguridad y satisfacción a la implantación de PP en el régimen hospitalario, pudiendo también reducir los costes y mejorar la eficiencia. Esta investigación podría ayudar a los responsables de la toma de decisiones a extender la cirugía de PP al régimen ambulatorio (AU)

Introduction and objective Penile prosthesis (PP) implantation is an effective option for erectile dysfunction. Although initially PP surgery was carried out in an inpatient setting, there is a growing trend to implant PP in a major ambulatory surgery (MAS). This study aimed to perform a systematic review of the literature to identify available evidence of the implantation of PP under MAS setting and go carry out a comparison between MAS and inpatient procedures. Material and methods PubMed, EMBASE, Cochrane Library and MEDES electronic databases and non-indexed supplements for scientific congresses were searched to identify articles related to the surgical implantation of PP in MAS up to February 2021. Key search terms included penile prosthesis, erectile dysfunction, ambulatory surgery, ambulatory care, and surgery. Results Among 171 publications retrieved (51 PubMed, 73 EMBASE, 3 Cochrane, 2 using MEDES and 42 manual searching), 5 studies were finally selected. There were no significant differences between MAS or inpatient setting in terms of the type of device, surgical approach, or location of reservoir. Complication rates observed in both groups were similar. Implantation of PP in MAS was less expensive than inpatient surgery and was associated with acceptable patient satisfaction rates and adequate pain control. Conclusions Studies demonstrated that outpatient PP surgery can achieve similar outcomes in terms of safety and satisfaction to implantation of PP in the inpatient setting, while it could reduce costs and improve the efficiency. This research could provide support decision makers to extend PP surgery into the ambulatory setting (AU)

A possible mechanism of erectile dysfunction in coronavirus disease-19: Cavernosal smooth muscle damage: A pilot study.

INTRODUCTION: Studies have reported that coronavirus disease 2019 (COVID-19) may cause erectile dysfunction (ED), however, its role in the pathophysiology of ED has not yet been fully elucidated. We aimed to elucidate COVID-19's effects on cavernosal smooth muscle, which has a pretty important role in erection physiology, by corpus cavernosum electromyography (cc-EMG). MATERIALS AND METHODS: Twenty-nine male patients aged 20-50 years who applied to the urology outpatient clinic due to ED were included in the study. Nine patients that had COVID-19 and were treated as outpatients were classified as group 1, 10 patients who were hospitalized due to COVID-19 were classified as group 2, and 10 patients who did not have COVID-19 were classified as the control group (group 3). Patients underwent diagnostic evaluation including International Index of Erectile Function (IIEF)-5 form, penile color Doppler ultrasonography (CDUS), cc-EMG, and fasting serum levels of reproductive hormones (07-11am). RESULTS: According to penile CDUS and hormonal values results, there was no significant difference between the groups. According to cc-EMG results, amplitudes and relaxation capacities of the cavernosal smooth muscle of patients in group 3 were significantly higher than those in the other groups. CONCLUSIONS: COVID-19 can cause ED not only by psychogenic and hormonal factors but also with cavernosal smooth muscle damage. CLINICAL TRIAL REGISTRATION NUMBER: NCT04980508.

An observational, national and multicentric study to describe the detection, diagnosis and treatment of erectile dysfunction and premature ejaculation from the patient's perspective / Estudio observacional, nacional y multicéntrico, para describir la detección, el diagnóstico y el tratamiento de la disfunción eréctil y la eyaculación precoz desde la perspectiva del paciente

Introduction and objectives: To examine the opinions, attitudes and perceptions of patients regarding the diagnosis and treatment protocols of erectile dysfunction (ED) and premature ejaculation (PE) and their interaction with the urology specialists. Material and methods: Observational, national and multicentric study based on a self-designed online questionnaire in which ED and PE patients described their perception of ED and PE at diagnosis and during treatment and monitoring, the patient-physician relationship and the role of the patient's partner in the course of the disease. Results: 306 ED and 70 PE participants were recruited. After the occurrence of the first symptoms, the time elapsed until the patient decided to go to the doctor was 28.6 months for PE and 14.0 months for ED (p<0.001). ED patients saw physicians more frequently (especially those aged between 60 and 69 years: 60.7%, p<0.001) than PE patients (52.1% vs 36.8%, respectively; p<0.001) and discussed this problem with their partner more (34.0% vs 22.8%, p<0.001). These disorders were mainly diagnosed at the urologist's office (ED: 74.8% vs 42.5%; PE: 75.7% vs 34.3%; diagnosis vs detection). One third of all participants reported that the sexual problem was not the main reason for the visit. The time elapsed between the first consultation for related symptoms and therapy was 8.7 months (oral drugs) and 7.6 months (dapoxetine) for ED and PE, respectively. ED patients and their partners felt particularly better once treatment had started (p<0.001). PE patients presented the highest degree of sexual dissatisfaction (78%). 50% of the patients agreed with the statement that initiating a discussion about sexual concerns was regarded as taboo and most of them did not say that their partner had encouraged them to seek medical advice. (AU)

Introducción y objetivos: Analizar las opiniones, actitudes y percepciones de los pacientes respecto a los protocolos de diagnóstico y tratamiento de la disfunción eréctil (DE) y la eyaculación precoz (EP) así como su interacción con los especialistas en urología. Material y métodos: Estudio observacional, nacional y multicéntrico, a través de un cuestionario online predefinido, en el que los pacientes con DE y EP describieron su percepción acerca de la DE y la EP, en el diagnóstico, durante el tratamiento y seguimiento, así como la relación médico-paciente y el papel de la pareja en el trascurso de la enfermedad. Resultados: Se incluyeron 306 participantes con DE y 70 con PE. El tiempo transcurrido, desde la aparición de los primeros síntomas hasta que el paciente decidió acudir al médico, fue de 28,6 meses para la EP y de 14,0 meses para la DE (p < 0,001). Los pacientes con DE acudieron al médico con mayor frecuencia (especialmente en edades entre 60 y 69 años: 60,7%, p < 0,001) respecto a los pacientes con EP (52,1 vs. 36,8%, respectivamente; p < 0,001) y comentaron más el problema con su pareja (34,0 vs. 22,8%, p < 0,001). El diagnóstico de ambas disfunciones se llevó a cabo principalmente en consultas de urología (DE: 74,8 vs. 42,5%; EP: 75,7 vs. 34,3%; diagnóstico vs. detección). Una tercera parte de todos los participantes indicó que el problema sexual no motivó principalmente la visita. El tiempo transcurrido, desde la primera consulta motivada por síntomas relacionados y el establecimiento de terapia, fue de 8,7 meses (fármacos orales) y 7,6 meses (dapoxetina) para la DE y la EP, respectivamente. Los pacientes con EP presentaron mayor grado de insatisfacción sexual (78%). De los pacientes estudiados, 50% mostró acuerdo con la afirmación de que iniciar una conversación sobre las preocupaciones sexuales se consideraba un tabú y la mayoría reconoció que su pareja no le había animado a la hora de buscar consejo médico. (AU)

[Erectile dysfunction and YouTube: Quality of videos in Spanish]. / Disfunción eréctil y YouTube: calidad de los vídeos en español.

INTRODUCTION: Erectile dysfunction (ED) is one of the most prevalent urological diseases, but there is limited data about the quality of its information in social networks. The aim of our study was to assess the quality of ED information contained in YouTube videos. MATERIAL AND METHODS: Descriptive study of the first 50 Spanish-language videos, published on YouTube, evaluated by three urologists. We used two validated questionnaires: PEMAT (Patient Education Materials Assessment Tool) and DISCERN. Videos were classified according to DISCERN score into poor or moderate-good quality. RESULTS: The median time duration was 2.42minutes (0.15-3.58), 94,197 views (2,313-3,027,890), 682.5 «likes¼ (0-54,020) and 39 «dislikes¼ (0-2843). The median of PEMAT score was 29% (9%-95.5%) in understandability and 29% (0-95.5%) in actionability. According to DISCERN score 27 videos (57.4%) had poor quality and 20 (42.6%) moderate-good quality. There were no significant differences between the two groups in time duration, views, «likes¼ or «dislikes¼. There were differences in PEMAT score in understandability and actionability. The 86.7% of the moderate-good quality videos were starred by health care provider (P=.001). Also, the 85.7% of videos that describes treatment had moderate-good quality (P=.001). The 84% of the non-medical videos had a poor quality (P=.001). CONCLUSION: Most ED videos on YouTube have poor quality. The highest quality videos are those made by professionals, although they are not the most viewed. It would be important to develop measures to prevent the spread of misinformation among social network users.

Management of erectile dysfunction and premature ejaculation: The perspective of Spanish urologists. Results of the PANDORA Project (Part II).

INTRODUCTION: ED and PE are the most common male sexual dysfunctions, although they remain underdiagnosed and undertreated. AIM: To ascertain how a group of Spanish urologists currently address ED and PE. METHODS: Descriptive study based on a self-designed questionnaire about the clinical practice in ED and PE upon diagnosis, treatment and monitoring, patient-physician relationship and the role of the patient's partner. RESULTS: The survey was completed by 188 experienced urologists. Most patients went to the urologist's office without a previous diagnosis (92% of the urologists found <10 PE-diagnosed patients in public settings). The diagnosis of ED and/or PE was mainly carried out by the current urologist and not by another professional, particularly in private centres as opposed to public centres (78.8% vs 57.0% for ED; 82.0% vs 62.6% for PE). Most urologists believed that these disorders are underdiagnosed and deemed them as general health issues. 38% of urologists acknowledged using validated questionnaires to diagnose ED. PE was considered a subjective problem rather than a true disease and the use of PRO-based diagnosis of PE was not generally accepted (14%). Treatment options of both disorders were chosen as expected. Referral to the andrologist is usually scheduled in moderate-to-severe PE or severe ED. The cohort seemed to be mostly neutral (50%-75% for ED and 40%-55% for PE) regarding patient reluctancy to talk about their sexual problem. Patients' partners play an important role in helping men seeking treatment. CONCLUSION: Urologists should show more proactivity during anamnesis and routine visits to improve management of ED and PD.

Safety and efficacy of Rezum™ in erectile dysfunction patients with and without an inflatable penile prosthesis[[es]]Seguridad y eficacia del sistema Rezum® en pacientes con disfunción eréctil con y sin prótesis de pene inflable.

PURPOSE: This study evaluates the safety and efficacy of Rezum™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). MATERIALS AND METHODS: This was a retrospective review of ED patients who underwent Rezum™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmax), and uroflowmetry average flow rate (Qavg) before and after Rezum™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmax or Qavg. RESULTS: A total of 17 patients with ED who underwent Rezum™ were identified, including 11 patients with an IPP. The median follow-up after Rezum™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmax (10.9 mL/s vs 9.8 mL/s, p = 0.04) and Qavg (7.5 mL/s vs 6.0 mL/s, p = 0.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmax or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. CONCLUSION: Rezum™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP.

Disfunción eréctil en pacientes con EPOC. Una revisión sistemática y metaanálisis / Erectile dysfunction in patients with COPD. A systematic review and meta-analysis

Introducción Los estudios sobre sexualidad en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) son escasos y han arrojado resultados contradictorios. Nuestro objetivo fue determinar la prevalencia de disfunción eréctil (DE) y los factores asociados en pacientes con EPOC. Métodos Se buscaron artículos con datos sobre prevalencia de DE en pacientes diagnosticados de EPOC mediante espirometría en las bases de datos PubMed, Embase, Cochrane Library y Biblioteca Virtual de Salud, desde el año desde su creación hasta el 31 de enero de 2021. La prevalencia de DE se valoró con una media ponderada de los estudios. Se realizó un metaanálisis con el modelo de efectos fijos de Peto para valorar la asociación de EPOC con DE. Resultados Se incluyeron finalmente 15 estudios. La prevalencia ponderada de DE fue de 74,6%. Un metaanálisis con cuatro estudios y 519 individuos mostró una asociación de EPOC con DE (odds ratio ponderado estimado de 2,89, IC 95% 1,93-4,32, p < 0,001), con un grado de heterogeneidad no desdeñable (I2 57%). En la revisión sistemática, la edad, el tabaquismo, el grado de obstrucción, la saturación de oxígeno y el estado de salud previo se asociaron con mayor prevalencia de DE. Concusiones La DE es frecuente en los pacientes con EPOC y su prevalencia es mayor que en la población general (AU)

Introduction Studies on sexuality in patients with chronic obstructive pulmonary disease (COPD) are scarce and have yielded conflicting results. Our aim was to determine the prevalence of erectile dysfunction (ED) and associated factors in patients with COPD. Methods Articles with data on ED prevalence in patients diagnosed with COPD through spirometry were searched for in the PubMed, Embase, Cochrane Library, and Virtual Health Library databases from the year of their creation until January 31, 2021. The prevalence of ED was assessed with a weighted mean of the studies. A meta-analysis was performed using the Peto fixed-effect model to evaluate the association of COPD with ED. Results Fifteen studies were ultimately included. The weighted prevalence of ED was 74.6%. A meta-analysis with four studies and 519 individuals showed an association of COPD with ED (estimated weighted odds ratio 2.89, 95% CI 1.93-4.32, p < 0.001), with a non-negligible degree of heterogeneity (I2 57%). In the systematic review, age, smoking, degree of obstruction, oxygen saturation, and previous health status were associated with a higher prevalence of ED. Conclusions ED is common in patients with COPD and its prevalence is higher than in the general population (AU)

Seguridad y eficacia del sistema Rezum en pacientes con disfunción eréctil con y sin prótesis de pene inflable / Safety and efficacy of Rezum in erectile dysfunction patients with and without an inflatable penile prosthesis

Objetivo Este estudio evalúa la seguridad y la eficacia del sistema Rezūm® en los pacientes con disfunción eréctil (DE) con y sin prótesis peneana inflable (PPI). Materiales y métodos Se trata de una revisión retrospectiva de los pacientes con DE tratados con Rezūm® por un único cirujano durante 12 meses. De cada paciente se obtuvo la edad, la presencia de PPI, el número de medicamentos para la hiperplasia prostática benigna, la puntuación internacional de síntomas prostáticos (IPSS), el índice de calidad de vida (QOL) de la IPSS, la tasa de flujo máximo (Qmáx) en la uroflujometría y la tasa de flujo promedio (Qavg) en la uroflujometría antes y después del tratamiento con Rezūm®. Se utilizaron pruebas T para 2 muestras independientes con objeto de comparar las características preoperatorias y postoperatorias entre los pacientes con y sin PPI. Se realizó una regresión lineal para identificar los factores asociados con el Qmáx o Qavg postoperatorio. Resultados Se identificaron un total de 17 pacientes con DE sometidos al sistema Rezūm®, incluyendo 11 pacientes con una PPI. La mediana de seguimiento tras el tratamiento con Rezūm® fue de 65 días. No hubo diferencias significativas en cuanto a los datos demográficos y las características clínicas basales entre los pacientes con y sin PPI. El Qmáx postoperatorio (10,9 frente a 9,8ml/s; p=0,04) y el Qavg (7,5 frente a 6,0ml/s; p=0,03) fueron significativamente mayores en los pacientes con PPI en comparación con los pacientes sin PPI. No hubo factores asociados con el Qmáx o el Qavg postoperatorio en la regresión lineal. Dos pacientes sin PPI resultaron en retención urinaria, mientras que en los pacientes con PPI no se produjeron complicaciones. Conclusión Rezūm® es un procedimiento seguro y eficaz para realizar en pacientes con DE, especialmente en aquellos con una PPI. Los pacientes con PPI pueden experimentar un incremento mayor en los parámetros de uroflujometría en comparación con los pacientes con DE sin PPI (AU)

Purpose This study evaluates the safety and efficacy of Rezūm™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). Materials and methods This was a retrospective review of ED patients who underwent Rezūm™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmáx), and uroflowmetry average flow rate (Qavg) before and after Rezūm™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmáx or Qavg. Results A total of 17 patients with ED who underwent Rezūm™ were identified, including 11 patients with an IPP. The median follow-up after Rezūm™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmáx (10.9ml/s vs. 9.8ml/s, P=.04) and Qavg (7.5ml/s vs. 6.0ml/s, P=.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmáx or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. Conclusion Rezūm™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP (AU)

Comparison of early period sexual function parameters between surgical repair and conservative treatment after penile fracture / Comparación de los parámetros de función sexual en el período temprano entre la reparación quirúrgica y el tratamiento conservador después de una fractura de pene

Introduction and objectives: Comparison of early period sexual function parameters in patients who had surgical repair and conservative follow-up after penile fracture and the evaluation of surgical intervention time on these parameters were planned in this study. Materials and methods: Total of 26 patients who were treated for penile fracture were evaluated. 19 patients had surgical repair and 7 patients had conservative treatment.Sexual function and erectile dysfunction (ED) degree of the patients before penile fracture and in the 12th week after fracture were evaluated with 5-question International Index of Erectile Function (IIEF-5) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile(SEP) 2 and SEP 3. Parameters showing sexual function before and after the fracture were compared. Results: In both groups, a significant change was detected in IIEF-5 score, EHS, SEP-2 and SEP-3 parameters of the patients measured after penile fracture compared to the values before the fracture (all parameters, p<0.05). No difference was detected in the parameters measured before and after the fracture among surgical repair and conservative treatment groups (all parameters p>0.05). Mean time passing until the surgery after fracture was measured as 9.6±6.85h in 19 patients who had surgery. Conclusion: A difference wasn’t detected in sexual parameters in conservative treatment and surgical repair groups in this study. As a significant decrease was observed in sexual function parameters even in conservative treatment cases without sudden detumescence and tunica albuginea rupturing, we think that quick surgical exploration would be useful in cases considered to have penile fracture. (AU)

Introducción y objetivos: En este estudio se planificó la comparación de los parámetros de función sexual en el período temprano en pacientes sometidos a reparación quirúrgica y seguimiento conservador después de una fractura de pene y la evaluación del tiempo de intervención quirúrgica sobre estos parámetros. Materiales y métodos: Se evaluaron un total de 26 pacientes que fueron tratados por fractura de pene: 19 fueron sometidos a reparación quirúrgica y 7 tuvieron un seguimiento conservador. La función sexual y el grado de disfunción eréctil de los pacientes antes de la fractura de pene y en la semana 12 después de la fractura se evaluaron con el cuestionario International Index of Erectile Function de 5 preguntas (IIEF-5), el Erection Hardness Score (EHS), y el Sexual Encounter Profile (SEP) 2 y SEP 3. Se compararon los parámetros que muestran la función sexual antes y después de la fractura. Resultados: En ambos grupos se detectó un cambio significativo en la puntuación IIEF-5 y los parámetros EHS, SEP 2 y SEP 3 de los pacientes medidos después de la fractura de pene en comparación con los valores antes de la fractura (todos los parámetros, p<0,05). No se detectaron diferencias en los parámetros medidos antes y después de la fractura entre los grupos de reparación quirúrgica y tratamiento conservador (todos los parámetros p>0,05). El tiempo medio transcurrido hasta la cirugía después de la fractura se midió como 9,6±6,85h en los 19 pacientes intervenidos. Conclusión: No se detectaron diferencias en los parámetros sexuales entre los grupos de observancia conservadora y reparación quirúrgica en este estudio. Como se observó una disminución significativa de los parámetros de función sexual incluso en casos de seguimiento conservador sin detumescencia súbita y desgarro de la túnica albugínea, pensamos que la exploración quirúrgica rápida sería útil en los casos en los que se considere que tienen fractura de pene. (AU)

Erectile dysfunction in patients with COPD. A systematic review and meta-analysis.

INTRODUCTION: Studies on sexuality in patients with chronic obstructive pulmonary disease (COPD) are scarce and have yielded conflicting results. Our aim was to determine the prevalence of erectile dysfunction (ED) and associated factors in patients with COPD. METHODS: Articles with data on ED prevalence in patients diagnosed with COPD through spirometry were searched for in the PubMed, Embase, Cochrane Library, and Virtual Health Library databases from the year of their creation until January 31, 2021. The prevalence of ED was assessed with a weighted mean of the studies. A meta-analysis was performed using the Peto fixed-effect model to evaluate the association of COPD with ED. RESULTS: Fifteen studies were ultimately included. The weighted prevalence of ED was 74.6%. A meta-analysis with four studies and 519 individuals showed an association of COPD with ED (estimated weighted odds ratio 2.89, 95% CI 1.93-4.32, p<0.001), with a non-negligible degree of heterogeneity (I2 57%). In the systematic review, age, smoking, degree of obstruction, oxygen saturation, and previous health status were associated with a higher prevalence of ED. CONCLUSIONS: ED is common in patients with COPD and its prevalence is higher than in the general population.

Incidencia de la disfunción sexual eréctil asociada a la prostatectomía radical abierta y laparoscópica

Introducción: la dificultad o imposibilidad de lograr una actividad sexual satisfactoria a pesar de estar presentes las condiciones adecuadas para su desarrollo exitoso, se conoce como disfunción sexual. Si la dificultad consiste en alcanzar y mantener la erección necesaria para una penetración se produce una disfunción eréctil. Objetivo: describir la disfunción eréctil en los pacientes con cáncer de próstata sometidos a prostatectomía radical por vía abierta vs. laparoscópica, en el Hospital Universitario Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2010 y enero de 2020. Materiales y métodos: se realizó un estudio longitudinal retrospectivo en los 40 pacientes que acudieron a la Consulta Provincial de Cáncer de Próstata y les fue realizado cirugía radical, entre enero de 2010 y enero de 2020. Resultados: el 52,5 % de los pacientes tienen un promedio de edad entre 65 y 74 años. Un índice de comorbilidad de Charlson de 3 a 5 puntos predominó en un 75 % de la muestra. En la vía laparoscópica, todos los casos presentaron disfunción eréctil, siendo severa en el 50 % de ellos. El 22,5 % del total no la tuvieron, representando un 30 % de los operados por cirugía abierta. Conclusiones: la prostatectomía radical continúa siendo considerada uno de los tratamientos de elección del cáncer de próstata órgano-confinado. La causa principal de la presencia de disfunción eréctil se atribuye al procedimiento quirúrgico; la edad avanzada puede contribuir a empeorar el pronóstico y las enfermedades coadyuvantes. Son heterogéneos los resultados en la esfera sexual de la prostatectomía radical laparoscópica y la prostatectomía radical abierta, comparados con la bibliografía internacional.

Introduction: the difficulty or impossibility of achieving a successful sexual activity despite being present the adequate conditions for its successful development is known as sexual dysfunction. If the difficulty consists in reaching and maintaining the erection necessary for a penetration, erectile dysfunction occurs. Objective: to describe the erectile dysfunction in patients with prostate cancer undergoing open vs. laparoscopic radical prostatectomy, in the Comandante Faustino Perez Hernandez University Hospital, of Matanzas, between January 2010 and January 2020. Materials and methods: a longitudinal retrospective study was carried out in the 40 patients who attended Prostate Cancer Provincial Consultation and underwent radical surgery between January 2010 and January 2020. Results: 52.5% of the patients were aged between 65 and 74 on average. A Charlson comorbidity index of 3 to 5 points prevailed in 75% of the sample. In the laparoscopic pathway all the cases presented erectile dysfunction, being severe in 50% of them. 22.5% of the total did not have it, representing 30% of those operated by open surgery. Conclusions: radical prostatectomy continues to be considered one of the treatments of choice for organ-confined prostate cancer. The main cause of the presence of erectile dysfunction is attributed to the surgical procedure; advanced age can contribute to a worse prognosis and adjuvant diseases. The results in the sexual sphere of laparoscopic radical prostatectomy and open radical prostatectomy are heterogeneous compared with the international bibliography.