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1.
Curr Urol Rep ; 22(4): 19, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33554283

RESUMO

PURPOSE OF THE REVIEW: The goal of this paper was to evaluate the impact on erectile and ejaculatory function after anterior and posterior urethroplasty. RECENT FINDINGS: With a rise in the use of urethroplasty, its impact on sexual function has come into question. For anterior urethroplasties, some degree of erectile dysfunction is common, but this tends to be transient, with most patients having a resolution of any de novo dysfunction by 12 months. Patients with posterior urethral strictures have a very high rate of erectile dysfunction prior to surgery and may show improvement after urethroplasty. Ejaculatory function tends to improve in patients due to alleviation of obstruction while some patients notice degradation in force of ejaculation. While urethroplasty has a minimal permanent effect on sexual function for most patients, there are some patients who notice improvement and others worsening. Patients should be counseled on these risks prior to urethroplasty.


Assuntos
Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Ejaculação/fisiologia , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Humanos , Masculino , Pênis/irrigação sanguínea , Pênis/inervação , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Risco , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Uretra/inervação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
2.
Clin Anat ; 34(1): 103-107, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32681804

RESUMO

Female ejaculation is a contentious topic. From a review of the literature, history indicates that it is not a modern concept; some females were aware of it in times past without understanding the role of the fluid or composition of the ejaculate. Over time, scholars experimented, mainly with anatomical studies, in an attempt to identify the source of the ejaculate and explore its physiological and anatomical benefits for the female sexual experience. Despite these studies, views about female ejaculation remain controversial and inconsistent, with no clear conclusion as to its function. This review discusses the history of studies of female ejaculation and presents various hypotheses from an anatomical and physiological perspective. After reviewing 44 publications from 1889 to 2019, it became apparent that clinical and anatomical studies conducted during recent decades provide substantial evidence in support of the female ejaculatory phenomenon. Anatomical studies have shown that the ejaculate originates in the paraurethral (Skene's) glands, but its composition has been debated. Female ejaculate differs from urine in its creatinine and urea concentrations. The fluid also contains prostate specific antigen (PSA) and could have antibacterial properties that serve to protect the urethra. While the specific function of female ejaculation remains a topic of debate, there is sufficient evidence to support the existence of the phenomenon.


Assuntos
Ejaculação/fisiologia , Orgasmo/fisiologia , Comportamento Sexual/história , Comportamento Sexual/fisiologia , Feminino , Genitália Feminina/anatomia & histologia , Genitália Feminina/fisiologia , História do Século XIX , História do Século XX , História do Século XXI , Humanos
3.
Anim Sci J ; 91(1): e13493, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33314533

RESUMO

Although successful fertilization is completed by only 150 sperm in the pig oviduct, more than 50,000 sperms are required to achieve a fertilization rate of more than 70% by pig in vitro fertilization (IVF). In this study, to improve the efficiency of pig IVF, the effects of hypoxic conditions and treatment with creatine and methyl-beta cyclodextrin (MßCD) on the glycolytic pathway were investigated. Under low O2 conditions, zig-zag motility was strongly induced within 30 min; however, the induction disappeared at 60 min. Although caffeine suppressed zig-zag motility under low O2 conditions, creatine induced and sustained zig-zag motility until 120 min. Additionally, pretreatment with MßCD for 15 min greatly enhanced zig-zag motility via ATP production in sperm incubated with creatine under low O2 conditions. Sperm pretreated with MßCD were used for IVF in medium containing creatine under low O2 conditions. A fertilization rate of approximately 70% was achieved with only 1.0 x 104 sperms/mL, and there were few polyspermic embryos. Therefore, our novel method was beneficial for efficient production of pig embryos in vitro. Moreover, the zig-zag motility may be a novel movement which boar capacitated sperm exhibit in the culture medium.


Assuntos
Anaerobiose/fisiologia , Creatina/farmacologia , Fertilização In Vitro/métodos , Fertilização In Vitro/veterinária , Fertilização/efeitos dos fármacos , Motilidade Espermática , Interações Espermatozoide-Óvulo/efeitos dos fármacos , Espermatozoides/fisiologia , Suínos/fisiologia , beta-Ciclodextrinas/farmacocinética , Animais , Sinergismo Farmacológico , Ejaculação/fisiologia , Feminino , Fertilização/fisiologia , Masculino , Interações Espermatozoide-Óvulo/fisiologia , beta-Ciclodextrinas/farmacologia
4.
Clin Ter ; 171(6): e523-e527, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33151251

RESUMO

BACKGROUND: The aim of this study was to evaluate: 1) the prevalence of male infertility due to ejaculatory dysfunction (premature ejaculation-PE, intravaginal ejaculatory dysfunction-IVEjD, anejaculation-AE, and retrograde ejaculation-RE); and 2) the hormonal profile and semen characteristics of such subjects. METHODS: N.3280 subjects who were referred to our andrology unit for infertility were studied. Exclusion criteria: the presence of known causes of male infertility and erectile dysfunction. In all subjects were performed: medical history and andrological physical examination; hormonal profile; semen analysis or centrifugation/resuspension of post-orgasmic urine; IIEF-5 questionnaire for the diagnosis of ED; PEDT questionnaire for the diagnosis of EP. RESULTS: the prevalence of ejaculatory dysfunctions in infertile males was 1.8% (59/3280). The causes were: a) absence of ejaculation in 37/3280 subjects (1.1%); among them, 23/3280 (0.7%) subjects showed a condition of RE and 14/3280 (0.4%) of AE; b) PE in 16/3280 subjects (0.5%); and c) IVEjD in 6/3280 subjects (0.2%). Hormonal values and seminal parameters (when semen analysis was possible) were within the normal ranges in all the cases. In subjects with RE, sperm recovery was possible in 69.9% (16/23) subjects after centrifugation and resuspension of post-orgasmic urine. CONCLUSIONS: The prevalence of male infertility due to ejaculatory dysfunctions is overall just under 2%. The main cause is retrograde ejaculation; psychogenic origins could also have an important role. It is important to identify the cause of ejaculatory dysfunction in order to decide upon correct management (PE treatment, centrifugation and resuspension of post-orgasmic urine, penile vibratory stimulation, and psychological counselling).


Assuntos
Disfunção Erétil/epidemiologia , Infertilidade Masculina/etiologia , Disfunções Sexuais Psicogênicas , Adolescente , Adulto , Ejaculação/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Doenças Urológicas/epidemiologia , Adulto Jovem
5.
Proc Biol Sci ; 287(1938): 20202147, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-33171088

RESUMO

Sperm cells experience considerable post-ejaculation environmental variation. However, little is known about whether this affects their molecular composition, probably owing to the assumption that sperm are transcriptionally quiescent. Nevertheless, recent evidence shows sperm have distinct RNA profiles that affect fertilization and embryo viability. Moreover, RNAs are expected to be highly sensitive to extracellular changes. One such group of RNAs are heat shock protein (hsp) transcripts, which function in stress responses and are enriched in sperm. Here, we exploit the experimental tractability of the mussel Mytilus galloprovincialis by exposing paired samples of ejaculated sperm to ambient (19°C) and increased (25°C) temperatures, then measure (i) sperm motility phenotypes, and (ii) messenger RNA (mRNA) levels of two target genes (hsp70 and hsp90) and several putative reference genes. We find no phenotypic changes in motility, but reduced mRNA levels for hsp90 and the putative reference gene gapdh at 25°C. This could reflect either decay of specific RNAs, or changes in translation and degradation rates of transcripts to maintain sperm function under stress. These findings represent, to our knowledge, the first evidence for changes in sperm RNA profiles owing to post-ejaculation environments, and suggest that sperm may be more vulnerable to stress from rising temperatures than currently thought.


Assuntos
Ejaculação/fisiologia , Mytilus/fisiologia , RNA , Espermatozoides/fisiologia , Animais , Proteínas de Choque Térmico HSP70/genética , Proteínas de Choque Térmico HSP90/genética , Proteínas de Choque Térmico/metabolismo , Resposta ao Choque Térmico/fisiologia , Humanos , Masculino , RNA Mensageiro/metabolismo , Motilidade Espermática , Temperatura
6.
Curr Urol Rep ; 21(12): 54, 2020 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-33104947

RESUMO

PURPOSE OF REVIEW: To explore the sexual outcomes following the novel minimally invasive surgical procedures for benign prostatic hyperplasia- (BPH-) related lower urinary tract symptoms (LUTS), with an emphasis on ejaculatory dysfunction (EjD). RECENT FINDINGS: A database search with a 10-year time restriction was carried out until February 20, 2020 using MEDLINE through the PubMed Platform evaluating minimally invasive treatment modalities for BPH and their effect on EjD. After the article selection, we retrieved data for men randomized in 19 different studies with results in 40 separate published articles investigating minimally invasive BPH surgery and reporting EjD rates. To date, water vapor thermal therapy or Rezum, prostatic urethral lift (PUL) or UroLift®, prostate artery embolization (PAE), and Aquablation showed acceptable rates (< 2%) of retrograde ejaculation by 1 year and had very low adverse events related to the procedure. Both PUL and Rezum demonstrated lower rates when compared with PAE and Aquablation. With comparable sexual side effect profiles postoperatively, clinicians may determine which therapeutic modality is optimal for patients based on efficacy and cost-benefit. Further randomized clinical trials are required to directly compare the effect of novel minimally invasive surgical procedures for BPH-related LUTS on ejaculation and sexual function.


Assuntos
Hiperplasia Prostática/terapia , Ejaculação/fisiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/fisiopatologia , Hiperplasia Prostática/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Disfunções Sexuais Fisiológicas/etiologia
7.
Medicine (Baltimore) ; 99(34): e21866, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846840

RESUMO

INTRODUCTION: Premature ejaculation (PE) affects 8% to 30% of adult men worldwide. Recently, the incidence of PE is on the rise. A series of prior studies suggested that the incidence of PE is related to various biological factors as low testosterone, low serum vitamin D, diabetes, lower urinary tract symptoms, and other psychological factors. At present, the major treatments include selective serotonin reuptake inhibitors antidepressants (dapoxetine, paroxetine), topical anesthetics, phosphodiesterase-5 inhibitor, circumcision, and selective dorsal neurotomy (SDN). The previous study found that SDN is effective for PE. METHODS AND ANALYSIS: The electronic databases of MEDLINE, PubMed, Web of Science, EMBASE, Cochrane Library, Clinicaltrials. org, China National Knowledge Infrastructure Database (CNKI), Wan fang Database, China Biology Medicine Database (CBM), VIP Science Technology Periodical Database, Chinese Clinical Trial Registry will be retrieved. All the randomized controlled trials of selective dorsal penile neurotomy for patients with PE will be included. The outcome includes intravaginal ejaculation latency time and Chinese Index of Sexual Function for Premature Ejaculation-5. We will conduct this study strictly according to the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: The present study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings on June 30th of 2021. CONCLUSION: SDN can effectively prolong IELT, but its efficacy has not been assessed scientifically and systematically. To address this limitation, this study will inspect the efficacy and safety of the SDN treatment in patients with PE. ETHICS AND DISSEMINATION: Formal ethical approval is not required in this protocol. We will collect and analyze data based on published studies, and since there are no patients involved in this study, individual privacy will not be under concerns. The results of this review will be disseminated to peer-reviewed journals or submit to related conferences. PROTOCOL REGISTRATION NUMBER: INPLASY202070084.


Assuntos
Pênis/inervação , Ejaculação Precoce/terapia , Nervo Pudendo/cirurgia , Adulto , Anestésicos Locais/uso terapêutico , Benzilaminas/uso terapêutico , Circuncisão Masculina/métodos , Ejaculação/fisiologia , Humanos , Incidência , Masculino , Naftalenos/uso terapêutico , Paroxetina/uso terapêutico , Pênis/fisiopatologia , Inibidores da Fosfodiesterase 5/uso terapêutico , Ejaculação Precoce/epidemiologia , Ejaculação Precoce/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores de Captação de Serotonina/uso terapêutico
8.
Rev. int. androl. (Internet) ; 18(2): 43-49, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193758

RESUMO

OBJETIVOS: Evaluar los efectos de la resección transuretral de próstata (RTUP) monopolar (M-RTUP) y bipolar (B-RTUP) sobre la función sexual general. MÉTODOS: De diciembre de 2014 a septiembre de 2016, 100 candidatos elegibles con hiperplasia benigna de próstata fueron reclutados prospectivamente y aleatorizados 1:1 en 2 grupos M-RTUP/B-RTUP (58 y 42 pacientes, respectivamente) y seguidos al mes, 3 y 6 meses. Se realizó un análisis univariado y multivariado utilizando la prueba de chi cuadrado y un modelo de regresión logística. Analizamos la edad, los antecedentes médicos de hipertensión arterial y diabetes, los antecedentes de tabaquismo, el volumen prostático preoperatorio, la escala de síntomas prostáticos, la evaluación de la función sexual, la experiencia del cirujano, los gramos resecados, el porcentaje de tejido resecado y la presencia de eyaculación retrógrada. Los síntomas prostáticos y la evaluación de la función eréctil (FE) se cuantificaron utilizando puntuaciones de IPSS autoadministradas y IIEF-5, respectivamente, al inicio del estudio y en cada visita posterior. RESULTADOS: La edad promedio fue de 66 años (50-82). No se encontraron diferencias estadísticas entre ambos grupos con respecto a comorbilidades médicas, IPSS preoperatorio e IIEF-5. El volumen prostático medio fue de 37,2cm3 (10-68) y la cantidad media de tejido resecado fue de 11,75g (6-58). Al inicio del estudio, el 77,6% de los pacientes presentaban STUI graves, y el 50% tenía una disfunción eréctil moderada-grave. El análisis univariado demostró que, en ambos grupos, los antecedentes de diabetes mellitus, la edad y el IIEF-5 preoperatorio se asociaron con una peor FE. Sin embargo, el análisis multivariado reveló que la edad fue el único factor asociado con una peor FE. Estos resultados fueron similares a los 3 y 6 meses postoperatorios. No encontramos una asociación entre la experiencia del cirujano, el tipo de energía empleada o el porcentaje de tejido resecado con el desarrollo de eyaculación retrógrada postoperatoria (52%). En el primer mes postoperatorio, el 44% de los pacientes aún referían síntomas prostáticos moderados y el 50% tenían disfunción eréctil grave mantenida a los 6 meses en ambos grupos. CONCLUSIONES: No existen diferencias estadísticamente significativas con respecto al tipo de energía empleada y los cambios en la función sexual global. La edad es el único factor que se asocia a una peor FE


OBJECTIVES: To assess the effects of monopolar transurethral resection of the prostate (M-TURP) and bipolar TURP (B-TURP) on overall sexual function. METHODS: From December 2014 to September 2016, 100 eligible candidates with benign prostatic hyperplasia were prospectively recruited and randomized 1:1 into M-TURP/B-TURP arms (58 and 42 patients, respectively) and followed up at 1, 3 and 6 months. A univariate and multivariate analyses using the chi-squared test and a logistic regression model were performed. We recorded the age, medical conditions such as hypertension and diabetes, history of smoking, preoperative prostatic volume, prostatic symptoms scale, sexual function assessment, surgeon experience, resected grams, percentage of resected tissue and presence of retrograde ejaculation. Prostatic symptoms and erectile function (EF) assessment were quantified using self-administered IPSS scores and IIEF-5, respectively, at baseline and in each subsequent visit. RESULTS: Mean age was 66 years (50-82). No statistical differences were found between both groups regarding medical comorbidities, preoperative IPSS and IIEF-5. Mean prostatic volume was 37.2 cm3 (10-68) and mean amount of resected tissue was 11.75g (6-58). At baseline 77,6% of patients has severe LUTS, and 50% has moderate-severe erectile dysfunction. Univariate analyses show that in both groups, history of diabetes mellitus, age and preoperative IIEF-5 were associated with poor EF. However, multivariate analyses revealed that age was the only factor associated with a poor EF. These results were similar at 3 and 6 postoperative months. We did not find an association between surgeon experience, source of energy employed or percentage of resected tissue with the development of postoperative retrograde ejaculation (52%). At first postoperative month, 44% of patients were still referring moderate prostatic symptoms and 50% had severe erectile dysfunction maintained at 6 months in both groups. CONCLUSIONS: There were no differences between the source of energy employed and changes on overall sexual function. Age is the only factor associated with a poor EF status


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Hiperplasia Prostática/complicações , Disfunção Erétil , Disfunção Erétil/etiologia , Estudos Prospectivos , Ejaculação/fisiologia , Doenças Urogenitais Masculinas/fisiopatologia , Período Pré-Operatório , Período Pós-Operatório , Análise Multivariada , Modelos Logísticos , Fatores de Risco
9.
Rev. int. androl. (Internet) ; 18(2): 79-83, abr.-jun. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-193764

RESUMO

Situational anejaculation means that a man can ejaculate in some situations but not in others. Intercourse type of anejaculation means existence of ejaculation by masturbation, but not during sexual intercourse. In some cases, men may be able to ejaculate and attain orgasm with one partner but not with another. Performance anxiety, hostility toward the partner, dysfunctional psychosexual development, and unconscious desire to avoid pregnancy are the possible underlying conditions. We herein reported a case of wife-specific intercourse anejaculation succesfully treated with sexual therapy. According to our best knowledge, this is an important case study in literature about intercourse type of situational anejaculation specific to the patient's wife that was treated with psychosexual counseling. The authors conclude that this clinical course of situational intercourse anejaculation suggests a psychological problem in these patients and sexual therapy is effective


La aneyaculación situacional significa que un varón puede eyacular en algunas situaciones, pero en otras no. El tipo de aneyaculación sexual implica la existencia de eyaculación mediante la masturbación, pero no durante las relaciones sexuales. En algunos casos, los varones pueden ser capaces de eyacular y alcanzar el orgasmo con un compañero, pero no con otro. La ansiedad subyacente, la hostilidad hacia la pareja, el desarrollo psicosexual disfuncional y el deseo inconsciente de evitar el embarazo son las posibles situaciones de fondo. En este documento, informamos de un caso de aneyaculación sexual específica de la esposa tratada con éxito con terapia sexual. Según nuestro mejor conocimiento, este es el primer estudio de caso en la bibliografía sobre el tipo de relación sexual de la aneyaculación situacional específica de la esposa del paciente que fue tratado con asesoramiento psicosexual. Los autores concluyen que este curso clínico de aneyaculación del coito situacional sugiere un problema psicológico en estos pacientes y la terapia sexual es efectiva


Assuntos
Humanos , Masculino , Feminino , Adulto , Disfunções Sexuais Psicogênicas/psicologia , Ejaculação/fisiologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Coito/psicologia , Disfunções Sexuais Psicogênicas/etiologia
10.
Am J Mens Health ; 14(2): 1557988320910870, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32146870

RESUMO

The vast majority of men undergoing prostatectomy experience permanent retrograde ejaculation (RE). While newer, selective techniques of prostatectomy result in lower rates of RE by preserving the innervation to the urethra, the vast majority of men undergoing the classical techniques experience permanent RE due to destruction of the natural mechanisms preventing backflow of the ejaculate into the urinary bladder. A review of online information available to men reveals a lack of information on the importance of RE and explanation of the methods used for prostatectomy. This review provides evidence that the true effects of RE in men can be serious. With the lack of studies aiming at the psychological effects of RE on men's response, it is important for practicing family physicians and urologists to present RE as a serious adverse effect and not to trivialize it.


Assuntos
Ejaculação/fisiologia , Prostatectomia/efeitos adversos , Hiperplasia Prostática/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade
11.
J Vis Exp ; (157)2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32202532

RESUMO

Sexual behavior is highly species-specific. Although rodents have slightly different sexual behaviors, mice and rats have a similar sexual behavioral pattern. The purpose of this article is to describe the hormone-induced estrus ovariectomized female model and the experimental procedure for the assessment of sexual behavior of male mice. The most important sexual behavioral elements are demonstrated in the video and illustrations. The critical steps, advantages, and limitations of the sexual behavior test are explained as well. Finally, the behavior parameters are presented, and mounting, intromission, and ejaculation processes in mating are distinguished. Behavioral parameters are assessed in terms of the occurred duration and counts during the test period.


Assuntos
Comportamento Sexual Animal/fisiologia , Animais , Bioensaio , Ejaculação/fisiologia , Estro/efeitos dos fármacos , Feminino , Habituação Psicofisiológica , Hormônios/farmacologia , Masculino , Camundongos , Ovariectomia , Ratos
12.
Prog Urol ; 30(3): 147-154, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32127310

RESUMO

INTRODUCTION: Urolift® system is a mini-invasive technique, proposed as an alternative treatment for classic surgery of benign prostatic hyperplasia (BPH). Our objective was to report the results of Urolift® system in our center after 7years experience. PATIENTS AND METHODS: Urolift® implants were proposed between February 2012 and March 2019 for patients presenting symptomatic BPH in our center, as an alternative for classic surgery. The efficacy was evaluated with questionnaires about lower urinary tract symptoms (IPSS) and its impact on quality of life (IPSS-QdV). Tolerance was evaluated with questionnaires about erectile (IIEF5) and ejaculatory function (MSHQ-EjD) and complication rate. Survival without additional treatment was assessed using Kaplan-Meier method. RESULTS: Forty patients were treated during this period, with a median follow-up of 32months [12-67]. Three months after the procedure, IPSS and IPSS-QdV were significantly improved (respectively 8 [4-11] vs 20 [17-24]; P<0.0001 and 2 [1-2] vs 5 [4-6]; P<0.0001). MSHQ-EjD and IIEF5 were not modified (respectively 13 [11-14] vs 12 [9-13]; P=0.69 and 21 [18-23] vs 21 [18-23]; P=0.13). Two patients (5%) experienced a urinary retention and needed a bladder catheter. No complication with a Clavien-Dindo score>2 were reported. Survival without additional treatment at 5years was 63%. CONCLUSION: Urolift® implants improved significantly the lower urinary tract symptoms in our population, with a good tolerance profile. More than 60% of the patients did not need an additional treatment after 5years of follow-up. LEVEL OF EVIDENCE: 3.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Uretra/cirurgia , Idoso , Ejaculação/fisiologia , Seguimentos , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Próteses e Implantes , Inquéritos e Questionários , Retenção Urinária/epidemiologia
13.
Urologe A ; 59(3): 347-358, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32072200

RESUMO

In recent years new surgical techniques to treat benign prostatic hyperplasia have been introduced into urological practice and evaluated in clinical studies. Complications of standard procedures, e.g. transurethral resection of the prostate (TURP), can be avoided while maintaining equivalent clinical outcomes. The main goal is preservation of erectile and ejaculatory function. Furthermore, outpatient treatment associated with a rapid patient recovery would be desirable. This article presents the course of the interventions, the mechanisms of action and current clinical evidence for novel mechanical approaches of recanalization, water-based ablation as well as prostate artery embolization. Initial study results partially indicate that in the future practically all patients can be offered an individualized surgical technique, which provides optimal symptomatic and functional improvements with a minimized risk of complications.


Assuntos
Ejaculação , Ereção Peniana , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Ejaculação/fisiologia , Humanos , Masculino , Tratamentos com Preservação do Órgão , Ereção Peniana/fisiologia , Resultado do Tratamento
14.
Prostate ; 80(6): 471-480, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32049374

RESUMO

BACKGROUND: The shape and function of the longitudinal muscular column (LMC) of the prostate have not been established in detail. The present study was undertaken to elucidate the roles of the LMC of the posterior wall of the prostatic urethra (PSU) in the emission phase of ejaculation by investigating the form and muscular arrangement of the LMC. METHODS: Prostates and urinary bladders were obtained from 14 Korean adult cadavers. Nine specimens were histologically analyzed using hematoxylin and eosin, Masson's trichrome, and Verhoeff-van Gieson staining. Two specimens were scanned using microcomputed tomography (micro-CT), and all scanned images were reconstructed into a three-dimensional model. RESULTS: At the proximal level of the prostate, the ejaculatory ducts (EDs) and prostatic utricle (PU) together were surrounded by circular smooth-muscle fibers. However, at the seminal colliculus (SC) where the EDs and PU opened, they were mainly surrounded by an abundance of longitudinal fibers. The longitudinal fibers posterior to the EDs and PU formed a distinctive LMC in the posterior urethral wall. In histologic sections and micro-CT images, the LMC extended distally from the level of the SC to the level of the membranous urethra (MBU). We simulated a potential mechanism of LMC using a mathematical model of its movements. CONCLUSIONS: Comprehensive analyses based on in-depth assessment of histologic characteristics and micro-CT images demonstrated extension of the LMC from the level of the SC to the level of the MBU, enabling a better understanding of ejaculation physiology involving the LMC. These results suggest that the LMC in the posterior wall of the PSU is a critical component of ejaculation by facilitating the ejection of seminal vesicle fluid into the PSU via well-coordinated contractions.


Assuntos
Ejaculação/fisiologia , Modelos Biológicos , Próstata/anatomia & histologia , Próstata/fisiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Elastina/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Músculo Liso/anatomia & histologia , Músculo Liso/citologia , Músculo Liso/fisiologia , Próstata/citologia , Próstata/diagnóstico por imagem , Uretra/anatomia & histologia , Uretra/citologia , Uretra/fisiologia , Microtomografia por Raio-X/métodos
15.
J Sex Med ; 17(4): 614-622, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32037229

RESUMO

BACKGROUND: Although abnormal sympathetic nerve system (SNS) activity has been demonstrated in the pathogenesis of ejaculation disorders, few data are available on its underlying mechanism. AIM: To investigate whether differences in ejaculatory behavior of rats were associated with the state of SNS activity and gamma-aminobutyric (GABA) receptor expressions in the paraventricular nucleus (PVN) of the hypothalamus and the effects of GABA receptors in the PVN on ejaculatory behavior. METHODS: Based on ejaculatory performance, Sprague-Dawley rats were divided into "sluggish," "normal," and "rapid" ejaculators. PVN microinjection was performed to evaluate the role of GABA receptors on sexual behavior. OUTCOMES: The outcomes include differences in expression and distribution of GABA receptors and norepinephrine level among the 3 groups and changes in copulation behavior parameters after PVN microinjection. RESULTS: Compared with "normal" rats, the "rapid" group ejaculated more times with shorter latency (P < .001, P < .001) and had lower expression and distribution of both GABA-A and GABA-B receptors, while the opposed results appeared in the "sluggish" group. The norepinephrine level was successively increased among "sluggish," "normal," and "rapid" rats (P < .001) and correlated with ejaculation frequency (r = 0.896, P < .001) and ejaculation latency (r = -0.835, P < .001). In addition, bilateral microinjection of the GABA-A and GABA-B receptor agonist (isoguvacine and baclofen) into the PVN both significantly prolonged the intromission latency and inhibited ejaculation, which could be blocked by antagonist gabazine and CGP-35348, respectively. Vigabatrin, the GABA-transaminase inhibitor, caused a significantly reduced ejaculation frequency and extended ejaculation latency in rats, which could be offset by simultaneous injections of gabazine and CGP-35348. CLINICAL IMPLICATIONS: Our findings provide new understanding about GABA receptors in the PVN on sexual behavior and enhance the comprehension of neurobiological mechanisms involved in premature ejaculation. STRENGTHS & LIMITATIONS: Our results have indicated that GABA receptors in the PVN may inhibit ejaculation through restraining the activity of SNS. However, our study did not analyze the changes of GABA receptors in other brain areas, which needs further study. CONCLUSION: Ejaculation behaviors in male rats are associated with SNS activity and could be regulated by GABA receptors in the PVN, which may be of assistance in the treatment of ejaculation disorders in the future. Zhang QJ, Yang BB, Yang J, et al. Inhibitory Role of Gamma-Aminobutyric Receptors in Paraventricular Nucleus on Ejaculatory Responses in Rats. J Sex Med 2020;17:614-622.


Assuntos
Ejaculação/fisiologia , Núcleo Hipotalâmico Paraventricular/fisiologia , Receptores de GABA/metabolismo , Animais , Copulação/fisiologia , Feminino , Masculino , Piridazinas/farmacologia , Ratos , Ratos Sprague-Dawley , Sistema Nervoso Simpático/fisiologia
16.
J Sex Med ; 17(4): 634-644, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32089486

RESUMO

BACKGROUND: Clinical trials evaluating new treatments for premature ejaculation (PE) should ideally include both objective end points and patient reported outcomes (PROs), but there is no consensus currently over the optimal measures or combination of outcomes. In addition, many PROs use a 1-month recall period, despite concerns about potential recall bias. AIMS: Data from a clinical trial of men with lifelong PE were used to examine the consistency of 2 core items of the Premature Ejaculation Profile (PEP), a widely used PRO for assessing subjective aspects of PE. The specific aim was to assess the level of agreement between the original 1-month recall version compared with a new event-based version of the scale in men meeting current definitions of lifelong PE. A further aim was to investigate the convergent validity between an objective end point of intravaginal ejaculatory latency time (IELT), subjective PEP responses, and a patient's Clinical Global Impression of Change (CGIC) measure. METHODS: For assessment of consistency of PEP responses (short-term [ie, sexual event driven] vs 1-month recall), descriptive statistics, correlation coefficients (Pearson and Spearman), and Bland-Altman plots are presented for each time interval. For assessment of convergent validity, descriptive statistics and correlation coefficients (Pearson and Spearman) are presented for each assessment with geometric mean IELT values. Results are also depicted graphically. Geometric mean IELT over the last 4 weeks of treatment and change from baseline (absolute and fold change) were estimated via a general linear model for each category of change in PEP and CGIC, adjusting for baseline IELT. OUTCOMES: PEP items administered via 1-month recall and short-term event-driven responses gave virtually identical results. There was a strong correlation (very good convergent validity) between IELT and responses to PEP and the CGIC. CLINICAL TRANSLATION: Men with lifelong PE can accurately recall their level of sexual functioning over the previous month. The PEP and CGIC are appropriate instruments to measure the subjective response of men with PE to new treatments. STRENGTHS AND LIMITATIONS: Our analyses address gaps in previously published research on PE assessment methodology. Men with acquired PE, men without partners, and men in homosexual relationships were not studied. CONCLUSIONS: In a clinical trial setting, PEP and CGIC are appropriate end points and are likely the optimal combination of PROs for use with IELT to enable a global assessment of patient response to new PE treatments. Althof S, Rosen R, Harty B, et al. Objective and Subjective Measures of Premature Ejaculation: How Closely Do They Correspond and How Well Are the Subjective Measures Recalled? J Sex Med 2020;17:634-644.


Assuntos
Ejaculação/fisiologia , Medidas de Resultados Relatados pelo Paciente , Ejaculação Precoce/tratamento farmacológico , Humanos , Libido , Masculino
17.
J Urol ; 203(4): 792-801, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31763948

RESUMO

PURPOSE: In a preliminary clinical trial we assessed the efficacy of ejaculatory hood sparing GreenLight™ Laser prostate photoselective vaporization to preserve antegrade ejaculation and urodynamic relief of obstruction compared to standard GreenLight prostate photoselective vaporization. MATERIALS AND METHODS: Standard prostate photoselective vaporization was classically performed in 24 patients. Ejaculatory hood sparing vaporization was performed with preservation of the paracollicular and supracollicular tissue proximal to the verumontanum in 25 patients. Patients were assessed at baseline, and 1, 3, 6 and 12 months postoperatively using the Ej-MSHQ (Ejaculatory Domain of Male Sexual Health Questionnaire) and the IIEF-15 (International Index of Erectile Function-15). The I-PSS (International Prostate Symptom Score), uroflowmetry and post-void residual urine volume were reported at each followup visit. A standard urodynamic study was performed at 6 months. RESULTS: Antegrade ejaculation was reported in 85% and 31.6% of patients after hood sparing and standard prostate vaporization, respectively (p=0.001). A significant reduction in the EJ-MSHQ score was reported after standard vaporization at 6 and 12 months (each p <0.001) with no significant difference after hood sparing vaporization (p=0.18 and 0.078, respectively). The median EJ-MSHQ score was 28.5 (range 1 to 33) and 27 (range 1 to 33) for hood sparing vaporization, and 9.5 (range 1 to 35) and 9 (range 0 to 33) for standard vaporization at 6 (p=0.005) and 12 months (p <0.001), respectively. Each group showed a decline in the mean total IIEF-15 score at 1 year but it was statistically significant only after standard vaporization (p=0.001). All urinary outcome measures revealed comparable significant improvement at all followups. Postoperative urodynamic assessment demonstrated a significant comparable decrease in the Bladder Outlet Obstruction Index from a median of 64 (range 21 to 207) to 23.5 (range 10 to 53) after hood sparing vaporization (p=0.005) and from 87 (range 38 to 186) to 19.5 (range 7 to 51) after standard vaporization (p=0.001). At 1 year the overall re-treatment rate was comparable in the 2 groups (p=0.26). CONCLUSIONS: In well informed, sexually interested patients ejaculatory hood sparing GreenLight prostate photoselective vaporization is feasible and effective treatment of small to moderate sized benign prostatic hyperplasia with a superior sexual function related outcome. Short-term relief of obstruction is objectively comparable to that of standard prostate photoselective vaporization.


Assuntos
Disfunção Erétil/diagnóstico , Terapia a Laser/efeitos adversos , Tratamentos com Preservação do Órgão/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Prostatectomia/efeitos adversos , Hiperplasia Prostática/cirurgia , Método Duplo-Cego , Ejaculação/fisiologia , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/prevenção & controle , Estudos de Viabilidade , Seguimentos , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Próstata/patologia , Próstata/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/patologia , Fatores de Tempo , Resultado do Tratamento , Urodinâmica/fisiologia
18.
Biol Rev Camb Philos Soc ; 95(2): 365-392, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31737992

RESUMO

Mammalian sperm must spend a minimum period of time within a female reproductive tract to achieve the capacity to fertilize oocytes. This phenomenon, termed sperm 'capacitation', was discovered nearly seven decades ago and opened a window into the complexities of sperm-female interaction. Capacitation is most commonly used to refer to a specific combination of processes that are believed to be widespread in mammals and includes modifications to the sperm plasma membrane, elevation of intracellular cyclic AMP levels, induction of protein tyrosine phosphorylation, increased intracellular Ca2+ levels, hyperactivation of motility, and, eventually, the acrosome reaction. Capacitation is only one example of post-ejaculatory modifications to sperm (PEMS) that are widespread throughout the animal kingdom. Although PEMS are less well studied in non-mammalian taxa, they likely represent the rule rather than the exception in species with internal fertilization. These PEMS are diverse in form and collectively represent the outcome of selection fashioning complex maturational trajectories of sperm that include multiple, sequential phenotypes that are specialized for stage-specific functionality within the female. In many cases, PEMS are critical for sperm to migrate successfully through the female reproductive tract, survive a protracted period of storage, reach the site of fertilization and/or achieve the capacity to fertilize eggs. We predict that PEMS will exhibit widespread phenotypic plasticity mediated by sperm-female interactions. The successful execution of PEMS thus has important implications for variation in fitness and the operation of post-copulatory sexual selection. Furthermore, it may provide a widespread mechanism of reproductive isolation and the maintenance of species boundaries. Despite their possible ubiquity and importance, the investigation of PEMS has been largely descriptive, lacking any phylogenetic consideration with regard to divergence, and there have been no theoretical or empirical investigations of their evolutionary significance. Here, we (i) clarify PEMS-related nomenclature; (ii) address the evolutionary origin, maintenance and divergence in PEMS in the context of the protracted life history of sperm and the complex, selective environment of the female reproductive tract; (iii) describe taxonomically widespread types of PEMS: sperm activation, chemotaxis and the dissociation of sperm conjugates; (iv) review the occurence of PEMS throughout the animal kingdom; (v) consider alternative hypotheses for the adaptive value of PEMS; (vi) speculate on the evolutionary implications of PEMS for genomic architecture, sexual selection, and reproductive isolation; and (vii) suggest fruitful directions for future functional and evolutionary analyses of PEMS.


Assuntos
Ejaculação/fisiologia , Espermatozoides/fisiologia , Reação Acrossômica/fisiologia , Animais , Masculino , Capacitação Espermática/fisiologia
19.
Andrology ; 8(2): 392-399, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31610095

RESUMO

INTRODUCTION: Recent neuroimaging studies have indicated that some brain areas are involved in the sexual behavior process. Pre-mature ejaculation patients exhibit altered brain activation and abnormal cortical structures. However, there has been no research evaluating the topological organization of structural brain network in anejaculation (AE). METHODS: We employed diffusion tensor imaging data and graph theory to examine the whole-brain structural networks among 16 AE patients and 23 healthy controls. In addition, the results of sexual function assessment were also obtained from each patient for symptom assessment. Moreover, the relationships between these clinical features and the altered topological characteristics of AE patients were also explored. RESULTS: Decreased clustering coefficient was found in the right amygdala, inferior temporal gyrus, and left pallidum of AE. AE also showed increased path length in the right post-central gyrus, supramarginal gyrus, putamen, pallidum and left heschl gyrus, temporal pole (superior temporal gyrus); however, these altered brain regions showed no significant differences after false discovery rate correction. Moreover, the path length between subcortical and frontal regions was increased in AE. In addition, negative correlations were found between the altered nodal parameters and the amplitudes of somatosensory evoked potentials of dorsal nerve, sympathetic skin response located in the penis. CONCLUSION: Together, our results suggest that AE was associated with disruptions in the topological organization of structural brain networks. The decreased clustering coefficient in temporal and subcortical regions and the increased path length between subcortical and frontal regions may contribute to AE. These findings provide new insights into the pathophysiological mechanisms of AE.


Assuntos
Encéfalo/fisiopatologia , Ejaculação/fisiologia , Vias Neurais/fisiopatologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Adulto , Conectoma/métodos , Imagem de Tensor de Difusão , Humanos , Masculino , Nervo Pudendo/fisiopatologia , Sistema Nervoso Simpático/fisiologia
20.
J Sex Res ; 57(2): 213-221, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30500271

RESUMO

Boys experience their first ejaculation (thorarche) during adolescence, but this event is often overlooked as a milestone in male adolescent development. The purpose of this article is to draw attention to thorarche and consider it in comparison with the female milestone of menarche. A critical analysis is provided of how thorarche has been interpreted to date and the complexities in construing thorarche from a biological perspective are outlined. Despite potential tenability of characterizing thorarche as a comparable milestone to menarche, two particular points challenge this notion: (a) While thorarche may befall the boy involuntarily, it may also be induced by the boy's own will; and (b) Thorarche occurs concomitantly with (pubertal) orgasmarche and has an innate connection with sexuality. The answer to the title question remains contentious, but open topics for future research are noted throughout the article as essential steps towards attaining a better understanding of thorarche.


Assuntos
Ejaculação/fisiologia , Menarca/fisiologia , Puberdade/fisiologia , Maturidade Sexual/fisiologia , Adolescente , Idade de Início , Feminino , Humanos , Masculino , Menarca/psicologia , Puberdade/psicologia
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