Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.142
Filtrar
1.
Zhonghua Nan Ke Xue ; 26(2): 167-173, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-33346422

RESUMO

Objective: To investigate the effect of Xiongcan Yishen Prescription (XYP) on the expressions of eNOS and cGMP in the penile tissue of ED rats with liver depression and kidney deficiency (LDKD). METHODS: The model of ED-LDKD was established in 30 eight-week-old SPF-class male SD rats by injecting hydrocortisone intramuscularly and binding the limbs for 14 days, and another 10 rats were taken as blank controls. Then, the model rats were randomized into six groups of equal number and treated intragastrically with distilled water (model control), tadalafil tablets at 0.52 mg/kg/d (tadalafil control), Shugan Yiyang Capsules 0.3125 g/kg/d (SYC control), and XYP at 10.4 g/kg/d (low-dose XYP), 20.8 g/kg/d (medium-dose XYP) and 41.6 g/kg/d (high-dose XYP), bid, for 28 successive days, respectively. Before and after modeling and after 28-day treatment, the animals were subjected to tail suspension and mating tests. The next day after medication, the penile tissues of the rats were harvested for determining the expression levels of eNOS and cGMP proteins by immunohistochemical analysis of the mean optical density. RESULTS: Compared with the model controls, the rats of the high-, medium- and low-dose XYP and SYC control groups all showed significant decreases in the tail suspension time (ï¼»3.17 ± 0.11ï¼½ vs ï¼»2.58 ± 0.25ï¼½, ï¼»2.52 ± 0.31ï¼½, ï¼»2.51 ± 0.3ï¼½ and ï¼»2.57 ± 0.29ï¼½ min, P < 0.05) and mount latency (ML) (ï¼»9.23 ± 0.11ï¼½ vs ï¼»1.21 ± 0.12ï¼½, ï¼»2.17 ± 0.16ï¼½, ï¼»2.26 ± 0.13ï¼½, ï¼»1.23 ± 0.15ï¼½ and ï¼»2.48 ± 0.18ï¼½ min, P < 0.05) but increases in mount frequency (MF) (ï¼»0.48 ± 0.18ï¼½ vs ï¼»3.29 ± 0.11ï¼½, ï¼»3.18 ± 0.11ï¼½, ï¼»3.05 ± 0.05ï¼½, ï¼»3.23 ± 0.12ï¼½ and ï¼»3.2 ± 0.28ï¼½ times, P < 0.05) and intromission frequency (IF) (ï¼»0.8 ± 0.84ï¼½ vs ï¼»11.8 ± 0.84ï¼½, ï¼»11.2 ± 1.48ï¼½, ï¼»9.4 ± 1.14ï¼½, ï¼»11.4 ± 1.14ï¼½ and ï¼»10 ± 1.22ï¼½ times, P < 0.05). The eNOS and cGMP proteins were mainly expressed in the nucleus and cytoplasm of the arterial and venous endothelial cells and sinusoidal endothelial cells of the cavernous, as brownish yellow particles in a scattered and focal pattern. Both the expressions of eNOS and cGMP in the penile tissue were remarkably upregulated in the high-, medium- and low-dose XYP and SYC control groups as compared with those in the model control (P < 0.05) but exhibited no statistically significant difference between the tadalafil and model control groups (P > 0.05). CONCLUSIONS: Xiongcan Yishen Prescription can relieve the depression symptoms, increase the mount frequency, activate the NO/cGMP pathway, and upregulate the expressions of eNOS and cGMP in the penile tissue of ED rats with liver depression and kidney deficiency.


Assuntos
GMP Cíclico/metabolismo , Medicamentos de Ervas Chinesas/uso terapêutico , Disfunção Erétil/tratamento farmacológico , Óxido Nítrico Sintase Tipo III/metabolismo , Pênis/metabolismo , Animais , Células Endoteliais , Rim/fisiopatologia , Fígado/fisiopatologia , Masculino , Ereção Peniana , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
2.
Zhonghua Nan Ke Xue ; 26(3): 223-227, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33346961

RESUMO

Objective: To investigate the expression of the kallistatin gene in the corpus cavernosum and search for some new molecular targets for the regulation of penile erectile function and treatment of ED. METHODS: Using reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR), Western blot and immunofluorescence staining, we detected the expression of kallistatin in the rat corpus cavernosum and compared it with that in the aorta. RESULTS: The results of RT-qPCR and Western blot revealed both mRNA and protein expressions of kallistatin in the rat corpus cavernosal tissue, with no statistically significant difference from those in the aorta (P > 0.05). Immunofluorescence staining showed that kallistatin was expressed in both endothelial and smooth muscle cells in the corpus cavernosum and localized in the cytoplasm, with no statistically significant difference from its expression in the aorta (P > 0.05) either. CONCLUSIONS: The kallistatin gene is highly expressed in the corpus cavernosum and localized in cavernosal endothelial and smooth muscle cells, suggestive of its involvement in the cellular function of cavernosal endothelial and smooth muscle cells and its participation in the regulation of penile erectile function.


Assuntos
Ereção Peniana/genética , Pênis/metabolismo , Serpinas/genética , Animais , Aorta , Western Blotting , Células Endoteliais/metabolismo , Disfunção Erétil/genética , Masculino , Miócitos de Músculo Liso/metabolismo , Ratos
3.
Cochrane Database Syst Rev ; 12: CD012867, 2020 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-33368143

RESUMO

BACKGROUND: A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach. OBJECTIVES: To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH. SEARCH METHODS: We performed a comprehensive search using multiple databases (The Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up until 25 September 2020. SELECTION CRITERIA: We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 with LUTS attributed to BPH undergoing PAE versus TURP or other surgical interventions.  DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs.  MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT). Mean age, IPSS, and prostate volume of participants were 66 years, 22.8, and 72.8 mL, respectively. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. PAE versus TURP We included six RCTs and two NRSs with short-term (up to 12 months) follow-up and one RCT with long-term follow-up (13 to 24 months).  Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement (mean difference [MD] 1.55, 95% confidence interval [CI] -0.40 to 3.50; 369 participants; 6 RCTs; I² = 75%; low-certainty evidence) measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms. There may be little to no difference in quality of life (MD 0.16, 95% CI -0.37 to 0.68; 309 participants; 5 RCTs; I² = 56%; low-certainty evidence) as measured by the IPSS quality of life question on a scale from 0 to 6, with higher scores indicating worse quality of life between PAE and TURP, respectively. While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.71, 95% CI 0.16 to 3.10; 250 participants; 4 RCTs; I² = 26%; very low-certainty evidence), PAE may increase re-treatments (RR 3.64, 95% CI 1.02 to 12.98; 204 participants; 3 RCTs; I² = 0%; low-certainty evidence). Based on 18 re-treatments per 1000 men in the TURP group, this corresponds to 47 more (0 more to 214 more) per 1000 men undergoing PAE.   We are very uncertain about the effects on erectile function (MD -0.03, 95% CI -6.35 to 6.29; 129 participants; 2 RCTs; I² = 78%; very low-certainty evidence) measured by the International Index of Erectile Function at 5 on a scale from 1 to 25, with higher scores indicating better function. NRS evidence when available yielded similar results. Based on evidence from NRS, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 260 participants; 1 NRS; low-certainty evidence). Longer-term follow-up: based on RCT evidence, we are very uncertain about the effects of PAE on urologic symptom scores (MD 0.30, 95% CI -3.17 to 3.77; 95 participants; very low-certainty evidence) compared to TURP. Quality of life may be similar (MD 0.20, 95% CI -0.49 to 0.89; 95 participants; low-certainty evidence). We are also very uncertain about major adverse events (RR 1.96, 95% CI 0.63 to 6.13; 107 participants; very low-certainty evidence). We did not find evidence on erectile function and ejaculatory disorders. Based on evidence from NRS, PAE may increase re-treatment rates (RR 1.51, 95% CI 0.43 to 5.29; 305 participants; low-certainty evidence); based on 56 re-treatments per 1000 men in the TURP group. this corresponds to 143 more (25 more to 430 more) per 1000 men in the PAE group.  AUTHORS' CONCLUSIONS: Compared to TURP up to 12 months (short-term follow-up), PAE may provide similar improvement in urologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE may increase re-treatment rates. We are uncertain about erectile function, but PAE may reduce ejaculatory disorders. Longer term (follow-up of 13 to 24 months), we are very uncertain as to how both procedures compare with regard to urologic symptom scores, but quality of life appears to be similar. We are very uncertain about major adverse events but PAE may increase re-treatments. We did not find longer term evidence on erectile function and ejaculatory disorders. Certainty of evidence for the main outcomes of this review was low or very low, signalling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.


Assuntos
Embolização Terapêutica/métodos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/complicações , Ressecção Transuretral da Próstata , Idoso , Artérias , Ejaculação , Embolização Terapêutica/efeitos adversos , Humanos , Masculino , Ereção Peniana , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Retratamento/estatística & dados numéricos , Disfunções Sexuais Fisiológicas/etiologia , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento
4.
Urologiia ; (6): 70-74, 2020 Dec.
Artigo em Russo | MEDLINE | ID: mdl-33377682

RESUMO

INTRODUCTION: Erectile dysfunction (ED) is a condition characterized by the inability to achieve or maintain an erection sufficient for sexual intercourse. The prevalence of ED ranges from 6% to 64% depending on age. Obesity is one of the factors leading to ED, which is widespread in the world. Men with obesity are 30% more likely to develop ED compared with men with normal body weight. AIM: The aim was to identify morphological changes in the cavernous tissue of the penis of patients with obesity using the biological model of laboratory rats as an example. MATERIALS AND METHODS: In vivo modeling of diet-induced obesity was performed. A total of 22 laboratory sexually mature white rats weighing 140-160 g were included in the study. The animals were divided into two groups, the control group (n=10) and experimental group, which included rats with diet-induced obesity (n=12). After 12 weeks, the experiment was completed. All rats underwent: 1) calculation of the Lee index (body mass index in rats); 2) determination of blood glucose level; 3) determination of the level of total cholesterol and triglycerides in the blood; 4) sampling of the penis with fixation in 10% formalin; histological sections 6-8 m thick were stained with hematoxylin and eosin, and frozen sections were prepared with subsequent staining with Sudan 3 to identify adipose cells. RESULTS: In the experimental group, alimentary obesity developed. There were no differences in glucose and total cholesterol levels between two groups. However, a significant difference was found in the serum triglycerides level (1.24+/-0.05 mmol/L in the control group vs. 1.6+/-0.1 mmol/L in the experimental group). In the control group, the average number of adipocytes was 10+/-5 per sample; in the experimental group, their number increased by 3 times (p<0.01). In obese rats, there was an increase not only in the number of adipose cells, but also in their area compared with the control group (17.7+/-7.5 m and 12.9+/-5.3 m, respectively, p<0.01). CONCLUSION: In rats with alimentary obesity, deposition of adipose tissue is observed not only in the visceral and paratesticular regions, but also in the cavernous tissue of the penis, which can negatively affect erectile function.


Assuntos
Disfunção Erétil , Pênis , Tecido Adiposo , Animais , Disfunção Erétil/etiologia , Humanos , Masculino , Obesidade/complicações , Ereção Peniana , Ratos
5.
Hinyokika Kiyo ; 66(11): 411-414, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33271660

RESUMO

Priapism is defined as a full or partial erection for >4 hours without sexual stimulation or orgasm. Ischemic priapism is an emergency disease that urgently requires surgery to reduce pressure in the corpora cavernosa. We encountered a case of severe ischemic priapism that required a proximal shunt. The patient was a 71-year-old man who had been diagnosed with benign prostatic hyperplasia ; hence, oral administration of tamsulosin had been initiated at a local hospital. His penis became gradually rigid and presented with prolonged erection. Then he consulted our hospital. Penile aspiration was impossible, and phenylephrine injection was not effective. He was subsequently transferred to our hospital. He did not have severe pain but had complete erection. We could not correctly evaluate blood gas from the corpora cavernosa and color Doppler ultrasonography showed little blood flow in the corpora cavernosa. We judged that the patient had ischemic priapism. The erection could not be controlled by distal shunt plastic surgery performed using the T shunt and Al-Ghorab methods. Therefore, a proximal shunt plastic surgery as described by Sacher was performed. The surgery was effective, but it caused erectile dysfunction.


Assuntos
Disfunção Erétil , Priapismo , Idoso , Humanos , Masculino , Ereção Peniana , Pênis , Ultrassonografia Doppler em Cores
6.
Wiad Lek ; 73(9 cz. 2): 2049-2055, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148858

RESUMO

OBJECTIVE: 75% of men with coronary artery disease confirmed by coronarography have erectile dysfunction in history, while 75% of patients with a vascular etiology of ED have significant stenoses in penile arterial vascularization. Patients with coronary artery disease have shown a relationship between the range of the lesions in the coronary vessels and erectile dysfunction intensity. This paper aims at attempting to systematize the knowledge of the benefits and drawbacks of nonsurgical endovascular treatment methods for erectile dysfunction with confirmed vascular causes. It analyzes seven studies which assess the results of erectile dysfunction treatment with percutaneous angioplasty. It also mentions the limitations of the cited works and formulates relevant conclusions. CONCLUSION: Conclusions: The analysis shows that endovascular procedures in erection-related arteries are safe in a specially selected group of men. It is necessary to conduct further studies to define an appropriate group of patients who have a chance of benefiting optimally from the endovascular treatment of erectile dysfunction in a long-term follow-up.


Assuntos
Procedimentos Endovasculares , Disfunção Erétil , Impotência Vasculogênica , Disfunção Erétil/etiologia , Disfunção Erétil/terapia , Humanos , Impotência Vasculogênica/etiologia , Impotência Vasculogênica/terapia , Masculino , Ereção Peniana , Pênis
7.
Sci Rep ; 10(1): 17595, 2020 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-33077779

RESUMO

Various neurovascular bundle-sparing techniques have been introduced to maximize recovery of erectile function after robot-assisted radical prostatectomy (RARP). The clipless intrafascial neurovascular bundle-sparing technique aims to preserve periprostatic structures and neurovascular bundles as much as possible by avoiding clipping of the vascular pedicles. This study reports 1-year functional and oncologic outcomes and postoperative complications in 105 patients with intact preoperative erectile function who underwent a modified clipless intrafascial neurovascular bundle-sparing RARP. Intact erectile function was defined as score ≥ 21 on the Sexual Health Inventory for Men questionnaire or ability to have sexual intercourse. Median follow-up was 26.5 months (IQR 15.25-48). Postoperative erectile function recovery rates were 71.4%, 81.9%, 88.6%, 92.4%, and 94.3% at 1, 3, 6, 9, and 12 months, respectively. The rate of positive surgical margins was 16.2% overall and 11.8% in patients with stage pT2 disease. The biochemical recurrence rate was 6.7% overall. The modified clipless intrafascial neurovascular bundle-sparing technique is safe and feasible and can achieve excellent recovery of erectile function after RARP. Further large-scale prospective comparative studies are warranted.


Assuntos
Disfunção Erétil/etiologia , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Complicações Pós-Operatórias/etiologia , Próstata/patologia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/patologia , Recuperação de Função Fisiológica , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
8.
Rev Assoc Med Bras (1992) ; 66(9): 1180-1186, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027442

RESUMO

INTRODUCTION: The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process. Unfortunately, there is no standard procedure for CDDU conduction, a fact that results in high result-interpretation variability. OBJECTIVE: The aims of this review are to promote greater standardization during CDDU of the penis and discuss the fundamental principles for its accurate conduction. METHODS: CDDU is initially conducted with the penis in the flaccid state; the whole penis must be assessed (images at B mode) with a high-frequency linear transducer (7.5-18 MHz). Intracavernous injection of vasodilating agents (prostaglandin E1, papaverine, phentolamine) is performed to induce a rigid erection. Serial measurements at different times should be taken during the CDDU session and penile rigidity must be assessed in each evaluation. RESULTS: It is important to monitor the erection response after the vasoactive agent (hardness scale), and scanning during the best-quality erection should be contemplated. Manual self-stimulation, audiovisual sexual stimulation (AVSS), and vasoactive agent re-dosing protocols must be taken into account to reduce the influence of psychogenic factors and to help the patient to get the hardest erection possible. Such measurements contribute to the maximal relaxation of the erectile tissue, so the hemodynamic parameters are not underestimated. CONCLUSIONS: CDDU is a relevant specialized tool to assess patients with erectile dysfunction; therefore, this guideline will help to standardize and establish uniformity in its conduction and interpretation, taking into consideration the complexity and heterogeneity of CDDU evaluations of the penis.


Assuntos
Pênis , Disfunção Erétil , Hemodinâmica , Humanos , Masculino , Ereção Peniana , Ultrassonografia Doppler em Cores
9.
Urologiia ; (4): 144-150, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897029

RESUMO

Despite significant advances in andrology, the problem of penile cavernous fibrosis remains not fully understood. Many studies on the epidemiology of erectile dysfunction have been published, but consensus on the place and role of this pathology in the structure of sexual disorders has not yet been reached. The data obtained at different time intervals and in different geographical areas are strikingly different. Also, the role of organic disorders in the penis, including fibroplastic changes, in certain etiological factors has not been determined. In addition, the relationship between etiological factors and morphological changes in penile tissues is disputed due to the small amount of data obtained from the pathohistological study of human penis biopsies. This review is devoted to the systematization of epidemiological data and etiological factors of cavernous fibrosis, the definition of the relationship between them, the analysis of clinical and experimental studies, which study the relationship between the degree of severity of damaging agents and the formation of typical fibrogenic reactions.


Assuntos
Disfunção Erétil , Induração Peniana , Fibrose , Humanos , Masculino , Morfogênese , Ereção Peniana , Pênis
11.
J Sex Med ; 17(9): 1687-1693, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32736945

RESUMO

OBJECTIVES: Here we examine the association between shift work sleep disorder (SWSD) and erectile dysfunction (ED) in shift workers. METHODS: Men presenting to a single andrology clinic between January 2014 and July 2017 completed validated questionnaires: International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and the nonvalidated SWSD Questionnaire. Men were also asked about shift work schedule, comorbidities, phosphodiesterase 5 (PDE5) inhibitor use, and testosterone use. Serum total testosterone values were determined for each visit. Linear regression was performed controlling for testosterone use, testosterone levels, PDE5 inhibitor use, age, and comorbidities to determine the effect of SWSD on ED as assessed using the IIEF. RESULTS: Of the 754 men completing questionnaires, 204 reported nonstandard shift work (begins before 7 am or after 6 pm, regularly extends out of that frame, or rotates frequently) and 48 were found to have SWSD using a screening questionnaire. Nonstandard shift work alone did not result in worse IIEF-EF scores (P = .31), but those who worked nonstandard shifts and had SWSD demonstrated IIEF-EF scores 2.8 points lower than men without SWSD (P < .01). When assessing for the type of shift work performed, men who worked night shifts had IIEF-EF scores 7.6 points lower than men who worked during the day or evening (P < .01). Testosterone use improved IIEF-EF scores for men with SWSD by 2.9 points, ameliorating the effect of SWSD on ED. However, baseline testosterone levels were not associated with worse erectile function in this cohort. CONCLUSION: Men with SWSD have worse erectile function, with men who work night shifts having even poorer erectile function. These findings suggest that circadian rhythm disturbance may significantly impact erectile function. While testosterone therapy may partly reverse the effects of SWSD, shift work is a potential risk factor for ED and should be assessed for as part of the evaluation of men with ED. Rodriguez KM, Kohn TP, Kohn JR, et al. Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function. J Sex Med 2020;17:1687-1693.


Assuntos
Disfunção Erétil , Jornada de Trabalho em Turnos , Transtornos do Sono do Ritmo Circadiano , Disfunção Erétil/etiologia , Humanos , Masculino , Ereção Peniana , Jornada de Trabalho em Turnos/efeitos adversos , Testosterona
12.
J Sex Med ; 17(10): 2108-2112, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32773345

RESUMO

BACKGROUND: In the last decade, many novel minimally invasive surgical techniques within benign prostatic hyperplasia (BPH) surgery were developed to reduce postoperative complications that often discourage patients from pursuing BPH surgery. AIM: To assess perspective of future and past international BPH surgery patients regarding their postoperative complications, namely erectile and ejaculatory function. METHODS: A survey was distributed randomly to 2 groups of BPH patients: one with 149 patients having undergone surgery in the last 2 years (group A), and the other cohort of 151 men seriously considering BPH surgery in the next year (group B). This survey consisted of 20 questions that assessed patients' motivating factors for undergoing elective BPH surgery and their perspectives regarding the potential postoperative complications attributed to BPH surgery. OUTCOMES: The perspective of future and past international BPH surgical patients towards the preservation of their erectile and ejaculatory functions was assessed with the help of a survey. RESULTS: Results indicated that in general BPH surgery patients considered the maintenance of erectile (95%, n = 284) and ejaculatory function (92%, n = 276) to be important preoperative considerations, regardless of their age. Patients aged 50-59 years were most concerned with the permanent impact on sexual function and patients aged >60 years were most concerned with urinary incontinence. In patients aged >70 years, 66% (n = 43) and 62% (n = 40) of the respondents indicated that maintaining erectile and ejaculatory function was important, respectively. CLINICAL IMPLICATIONS: Patient-centered care needs to be implemented in order to address the importance that past and future BPH surgery patients hold toward the maintenance of their postoperative sexual function. STRENGTHS & LIMITATIONS: In the group of patients having previously undergone BPH surgery, the possibility of recall bias should be taken into account when interpreting the study's findings. However, maintaining sexual function was also important for the group of patients seriously considering surgery in the next year suggesting that these considerations are not solely due to recall bias. Additionally, the results were limited by the small sample size of participants in groups A (n = 149) and B (n = 151). CONCLUSION: It was found that past and future BPH surgery patients attribute a significant importance toward the maintenance of their sexual function. Although novel approaches with better sexual outcomes such as Rezum and UroLift for prostates <80 mL, and Aquablation for any size prostate are available, more research is needed to investigate their long-term effects on sexual function before they can be recommended to patients. Bouhadana D, Nguyen D-D, Zorn KC, et al. Patient Perspectives on Benign Prostatic Hyperplasia Surgery: A Focus on Sexual Health. J Sex Med 2020;17:2108-2112.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Saúde Sexual , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Hiperplasia Prostática/cirurgia , Resultado do Tratamento
13.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 678-683, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773800

RESUMO

OBJECTIVE: To evaluate decision regret among patients receiving penile girth enhancement with acellular dermal matrix (PGE with ADM) and to investigate the potential indicators for decisional regret so as to facilitate the decision-making process for this special group. METHODS: In the study, 78 patients receiving PGE with ADM from Jun. 2016 to Jan. 2019 at Peking University People's Hospital and cooperative hospitals were eligible. Penile girth was taken by only one surgeon 1 week before surgery. Hospital anxiety and depression scale (HAD), international index of erectile function (IIEF) and a 10 cm long visual analogue scale named visualized penile image (VPI) were applied to measure psychological burden, erectile function and satisfaction with penile image respectively at the same time. All the patients were followed up for 3 months. Decision regret scale (DRS) was adopted for measuring decisional regret. Multivariate analysis of variance was applied to investigate the potential indicators for regret. Data analysis process was conducted with SPSS (version 24.0; SPSS, Chicago, IL, USA). RESULTS: Mean penile girth recorded before intervention was (8.29±0.30) cm and increased to (9.46±0.29) cm post surgery (t=76.28, P < 0.01). As for both subscales of HAD measuring psychological burden, a signi-ficant reduction in the mean score was seen, that is, 2.8±1.3 (t=19.28, P < 0.05) for anxiety and 3.0±1.2 (t=20.67, P < 0.05) for depression, respectively. The average score of VPI increased by 3.7±1.1 (t=30.63, P < 0.05). There was no significant change in the average score of IIEF measuring erectile satisfaction (t=1.60, P=0.11). Twenty-nine (38.2%) patients expressed regret to some degree, and the mean DRS score was 23.4±14.8. The scores of DRS correlated negatively with scores of visualized penis image (r=-0.348, P < 0.01), and positively with scores of anxiety (r=0.760, P < 0.01) and depression subscale (r=0.471, P < 0.01). The scores of DRS was irrelevant to those of IIEF (r=0.02, P=0.867). The patients with high annual income (> 120 000 yuan) and education level above undergraduate were more prone to experience decision regret after intervention (P < 0.01). CONCLUSION: PGE with ADM did augment penile girth and lower psychological burden, the regret rate of which was acceptably low among the patients. High income and good education might indicate more post-operative regret. Additional decision-making aids should be offered to patients with high income and education level above high school.


Assuntos
Derme Acelular , Emoções , Humanos , Masculino , Satisfação do Paciente , Ereção Peniana , Pênis , Procedimentos Cirúrgicos Reconstrutivos
17.
Vasc Endovascular Surg ; 54(8): 707-711, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32840461

RESUMO

INTRODUCTION: Erectile dysfunction (ED) affects more than 150 million men worldwide, with deleterious effects on quality of life. ED is known to be associated with ischemic heart disease but the impact of ED in patients with peripheral arterial disease (PAD) is unknown. We assessed the prevalence and severity of ED in patients with PVD. METHODS: Following ethical approval, sequential male patients diagnosed with PAD over a 1-year period following diagnosis of intermittent claudication. The patient demographics and comorbidities were recorded, with the International Index of Erectile Function (IIEF-5) questionnaire used to grade severity of ED. Computed tomographic angiography and severity of stenosis in the proximal vessels and internal pudendal arteries were correlated using a modified Bollinger Matrix scoring system. RESULTS: 60 patients were recruited, most (77.2%) reported erectile dysfunction (52.5% severe, 22.5% moderate). Patients with severe ED were more likely to have 2 or more comorbidities (P = .009). 86.7% with severe ED had bilateral internal pudendal artery stenosis with a mean modified Bollinger score of 17.6. 35.5% of moderate ED patients had bilateral internal pudendal stenosis with a mean Bollinger score of 11.75. There was significant difference in overall scores between moderate and severe erectile dysfunction (p< 0.05), thus indicating a potential link between ED severity and extent of vessel stenosis. CONCLUSION: There is a substantial burden of clinically significant ED among patients with PAD. This study suggests ED should be discussed with all PAD patients and ED may precede a PAD diagnosis. There is scope for endovascular revascularization as a treatment option for ED secondary to arterial insufficiency.


Assuntos
Impotência Vasculogênica/epidemiologia , Ereção Peniana , Doença Arterial Periférica/epidemiologia , Idoso , Angiografia por Tomografia Computadorizada , Estudos Transversais , Procedimentos Endovasculares/instrumentação , Inglaterra/epidemiologia , Humanos , Impotência Vasculogênica/diagnóstico por imagem , Impotência Vasculogênica/fisiopatologia , Impotência Vasculogênica/terapia , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/terapia , Projetos Piloto , Prevalência , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Stents
18.
Cochrane Database Syst Rev ; 8: CD013641, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32813279

RESUMO

BACKGROUND: Robotic-assisted laparoscopic prostatectomy (RALP) is widely used to surgically treat clinically localized prostate cancer. It is typically performed using an approach (standard RALP) that mimics open retropubic prostatectomy by dissecting the so-called space of Retzius anterior to the bladder. An alternative, Retzius-sparing (or posterior approach) RALP (RS-RALP) has been described, which is reported to have better continence outcomes but may be associated with a higher risk of incomplete resection and positive surgical margins (PSM). OBJECTIVES: To assess the effects of RS-RALP compared to standard RALP for the treatment of clinically localized prostate cancer. SEARCH METHODS: We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceedings, up to June 2020. We applied no restrictions on publication language or status. SELECTION CRITERIA: We included trials where participants were randomized to RS-RALP or standard RALP for clinically localized prostate cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently classified and abstracted data from the included studies. Primary outcomes were: urinary continence recovery within one week after catheter removal, at three months after surgery, and serious adverse events. Secondary outcomes were: urinary continence recovery six and 12 months after surgery, potency recovery 12 months after surgery, positive surgical margins (PSM), biochemical recurrence-free survival (BCRFS), and urinary and sexual function quality of life. We performed statistical analyses using a random-effects model. We rated the certainty of evidence using the GRADE approach. MAIN RESULTS: Our search identified six records of five unique randomized controlled trials, of which two were published studies, one was in press, and two were abstract proceedings. There were 571 randomized participants, of whom 502 completed the trials. Mean age of participants was 64.6 years and mean prostate-specific antigen was 6.9 ng/mL. About 54.2% of participants had cT1c disease, 38.6% had cT2a-b disease, and 7.1 % had cT2c disease. Primary outcomes RS-RALP probably improves continence within one week after catheter removal (risk ratio (RR) 1.74, 95% confidence interval (CI) 1.41 to 2.14; I2 = 0%; studies = 4; participants = 410; moderate-certainty evidence). Assuming 335 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 248 more men per 1000 (137 more to 382 more) reporting continence recovery. RS-RALP may increase continence at three months after surgery compared to standard RALP (RR 1.33, 95% CI 1.06 to 1.68; I2 = 86%; studies = 5; participants = 526; low-certainty evidence). Assuming 750 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 224 more men per 1000 (41 more to 462 more) reporting continence recovery. We are very uncertain about the effects of RS-RALP on serious adverse events compared to standard RALP (RR 1.40, 95% CI 0.47 to 4.17; studies = 2; participants = 230; very low-certainty evidence). Secondary outcomes There is probably little to no difference in continence recovery at 12 months after surgery (RR 1.01, 95% CI 0.97 to 1.04; I2 = 0%; studies = 2; participants = 222; moderate-certainty evidence). Assuming 982 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 10 more men per 1000 (29 fewer to 39 more) reporting continence recovery.  We are very uncertain about the effect of RS-RALP on potency recovery 12 months after surgery (RR 0.98, 95% CI 0.54 to 1.80; studies = 1; participants = 55; very low-certainty evidence).  RS-RALP may increase PSMs (RR 1.95, 95% CI 1.19 to 3.20; I2 = 0%; studies = 3; participants = 308; low-certainty evidence) indicating a higher risk for prostate cancer recurrence. Assuming 129 per 1000 men undergoing standard RALP have positive margins, this corresponds to 123 more men per 1000 (25 more to 284 more) with PSMs. We are very uncertain about the effect of RS-RALP on BCRFS compared to standard RALP (hazard ratio (HR) 0.45, 95% CI 0.13 to 1.60; I2 = 32%; studies = 2; participants = 218; very low-certainty evidence). AUTHORS' CONCLUSIONS: Findings of this review indicate that RS-RALP may result in better continence outcomes than standard RALP up to six months after surgery. Continence outcomes at 12 months may be similar. Downsides of RS-RALP may be higher positive margin rates. We are very uncertain about the effect on BCRFS and potency outcomes. Longer-term oncologic and functional outcomes are lacking, and no preplanned subgroup analyses could be performed to explore the observed heterogeneity. Surgeons should discuss these trade-offs and the limitations of the evidence with their patients when considering this approach.


Assuntos
Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/prevenção & controle , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Incontinência Urinária/prevenção & controle , Idoso , Humanos , Calicreínas/sangue , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Ereção Peniana , Complicações Pós-Operatórias/epidemiologia , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/epidemiologia
19.
J Sex Med ; 17(8): 1416-1422, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32631763

RESUMO

BACKGROUND: Penile duplex Doppler ultrasound (PDDU) is a minimally invasive tool to evaluate erectile hemodynamics in patients with erectile dysfunction (ED). Despite decades of use, there is still a large variability in PDDU protocols, and a high rate of false diagnosis is reported. AIM: Review of PDDU methodology in the published literature addressing protocol heterogeneity, technical and interpretation challenges. METHODS: A PubMed literature search was performed using the search terms "penile doppler ultrasound", "penile duplex ultrasound" or "penile ultrasound", and "Erectile dysfunction". Studies were analyzed for the presence of the following elements in reporting of the PDDU protocol: (i) intracavernosal vasoactive agents used, (ii) use of a redosing protocol, (iii) means of rigidity assessment, (iv) report of at-home best-quality erection, (v) normative criteria for peak systolic velocity (PSV) and end-diastolic velocity (EDV), and (vi) use of time-based hemodynamics assessment. Inclusion criteria were studies available in English, from 2005 onwards, and with full text. Exclusion criteria were review, descriptive or short communication articles, animal studies, and studies in populations other than those with ED. OUTCOMES: A critical review of the heterogeneity in published literature was performed to guide a structured discussion of methodological challenges and to create a list of recommendations. RESULTS: Significant heterogeneity was seen in key methodological aspects. Fifty percent of studies reported the use of prostaglandin E1 only, and 12% of studies did not mention the agent used. Redosing as part of the PDDU protocol was mentioned in only 26% of studies. The majority (56%) did not mention any form of rigidity assessment. The most frequently used grading system was the Erection Hardness Score (14%). Overall, most studies (59%) used a timed-base protocol for hemodynamic assessment. No clear consensus was defined for normative criteria for PSV and EDV, 39% defining a normal PSV as ≥30 cm/s, and 57% using EDV values ≤5 cm/sec as normal. CLINICAL IMPLICATIONS: The absence of standardization has led to inadequate reporting of key factors which has rendered data interpretation and comparison between studies challenging. STRENGTHS AND LIMITATIONS: Our strengths include an extensive review of literature, with a structured analysis of the impact of each methodological pitfall. Our main limitation is the fact that protocol reporting, and not its application, was assessed. CONCLUSION: Despite its widespread use, analysis of the literature on PDDU use in the ED population shows marked protocol heterogeneity, rendering data interpretation a problem. Nascimento B, Miranda EP, Terrier JE, et al. A Critical Analysis of Methodology Pitfalls in Duplex Doppler Ultrasound in the Evaluation of Patients With Erectile Dysfunction: Technical and Interpretation Deficiencies. J Sex Med 2020;17:1416-1422.


Assuntos
Disfunção Erétil , Disfunção Erétil/diagnóstico por imagem , Humanos , Masculino , Ereção Peniana , Pênis/diagnóstico por imagem , Ultrassonografia Doppler , Ultrassonografia Doppler Dupla
20.
Zhonghua Yi Xue Za Zhi ; 100(26): 2049-2053, 2020 Jul 14.
Artigo em Chinês | MEDLINE | ID: mdl-32654452

RESUMO

Objective: To investigate the effect of blocking penile blood drainage at the root of the rat penis on cell retention, penile erectile function, and histopathological changes when erectile dysfunction (ED) is treated by intracavernous injection (ICI) of stem cells. Methods: Thirty male SD rats were randomly divided into sham operation group (n=6), ED model group (n=6), treatment group A (blockade group, n=9) and treatment group B (non-blockade group, n=9). Twenty-four hours after the model was established, group A and group B were treated by ICI of 1 × 10(6) adipose-derived stem cells (ADSCs). Before ICI, the penile blood drainage in group A was temporarily blocked with a rubber tourniquet at the root of the penis which was removed 5 minutes after the injection. The dynamic changes of the local fluorescent signal of the penis and the expression of the fluorescent signal in the lung were detected after ICI. The maximum intracavernous pressure/mean arterial pressure (ICPmax/MAP) was measured to evaluatethe erectile function, and histopathological changes of the penis were observed after 28 days. Results: At different time points (0, 10 and 60 min), the intensity of the bioluminescent signal (×10(6)·p·s(-1)·sr·cm(-2)) in group A had a similar trend when compared with that in group B, and the differences were not statistically significant (8.76±1.17 vs 8.16±1.12, 6.45±1.47 vs 6.72±0.69, 3.77±0.30 vs 3.36±1.06, all P>0.05). A large number of ADSCs could be found in the lungs in both treatment groups after 60 min of ICI. There was no statistically significant difference in erectile function (0.44±0.11 vs 0.43±0.07) and histopathological change (0.08±0.02 vs 0.08±0.03) regardless of the occlusion of blood drainage at the root of the penis (all P>0.05). Conclusion: Temporarily blocking of penile blood drainage has no obvious advantage in improving cell retention and efficacy when ADSCs are used to treat ED of rat models.


Assuntos
Disfunção Erétil , Tecido Adiposo , Animais , Modelos Animais de Doenças , Drenagem , Humanos , Masculino , Ereção Peniana , Pênis , Ratos , Ratos Sprague-Dawley
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA