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1.
Urology ; 135: 66-70, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541647

RESUMO

OBJECTIVE: To define age-specific normal Color Doppler Duplex Ultrasound (CDDU) parameters based on a large institutional database of men referred for vascular erectile testing, but found to have normal and sustained rigidity following penile injection of alprostadil. METHODS: A retrospective review of patients who underwent CDDU from January 1, 2005 to December 31, 2014 was conducted. The indications for CDDU assessments included complaint of erectile dysfunction refractory to PDE-5 inhibitors, new-onset penile curvature, or secondary consultation for erectile dysfunction. Pearson correlation test was used to evaluate the association between ordinal age groups with peak systolic velocity (PSV) and resistive index (RI) measurements to determine the effect of age on erectile response. RESULTS: A total of 2043 patients underwent CDDU from January 1, 2005 to December 31, 2014. 259 patients (12.7%) with a mean age 53.7 and a mean BMI of 27.2 were noted to have normal erectile rigidity and normal Doppler parameters (PSV >35 cm/s, RI >0.90). Prolonged erection, defined by need to inject phenylephrine reversal agent at 1-2 hours, occurred in 93% of patients. When age was categorized by decade, a negative correlation coefficient was obtained for previsual sexual stimulation PSV (-0.09, P = .164) and postvisual sexual stimulation PSV (-0.23, P = .005). CONCLUSION: In men with normal vascular erections there appears to be a significant, age-related decline in postvisual sexual stimulation PSV without compromise to cavernous venous occlusion as measured by RI. We have used Doppler parameters in patients without vascular ED to define age-specific normalcy.


Assuntos
Envelhecimento/fisiologia , Disfunção Erétil/diagnóstico , Ereção Peniana/fisiologia , Pênis/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/efeitos dos fármacos , Pênis/irrigação sanguínea , Pênis/fisiologia , Fenilefrina/administração & dosagem , Fenilefrina/antagonistas & inibidores , Inibidores da Fosfodiesterase 5/farmacologia , Inibidores da Fosfodiesterase 5/uso terapêutico , Estudos Retrospectivos , Falha de Tratamento , Agentes Urológicos/uso terapêutico , Adulto Jovem
4.
Urology ; 135: 111-116, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31454660

RESUMO

OBJECTIVE: To explore relationships between dose to periprostatic anatomic structures and erectile dysfunction (ED) outcomes in an institutional cohort treated with prostate brachytherapy. METHODS: The Sexual Health Inventory for Men (SHIM) instrument was administered for stage cT1-T2 prostate cancer patients treated with Pd-103 brachytherapy over a 10-year interval. Dose volume histograms for regional organs at risk and periprostatic regions were calculated with and without expansions to account for contouring uncertainty. Regression tree analysis clustered patients into ED risk groups. RESULTS: We identified 115 men treated with definitive prostate brachytherapy who had 2 years of complete follow-up. On univariate analysis, the subapical region (SAR) caudal to prostate was the only defined region with dose volume histograms parameters significant for potency outcomes. Regression tree analysis separated patients into low ED risk (mean 2-year SHIM 20.03), medium ED risk (15.02), and high ED risk (5.54) groups. Among patients with good baseline function (SHIM ≥ 17), a dose ≥72.75 Gy to 20% of the SAR with 1 cm expansion was most predictive for 2-year potency outcome. On multivariate analysis, regression tree risk group remained significant for predicting potency outcomes even after adjustment for baseline SHIM and age. CONCLUSION: Dose to the SAR immediately caudal to prostate was predictive for potency outcomes in patients with good baseline function. Minimization of dose to this region may improve potency outcomes following prostate brachytherapy.


Assuntos
Braquiterapia/efeitos adversos , Disfunção Erétil/diagnóstico , Ereção Peniana/efeitos da radiação , Neoplasias da Próstata/radioterapia , Lesões por Radiação/diagnóstico , Idoso , Braquiterapia/métodos , Relação Dose-Resposta à Radiação , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Paládio/administração & dosagem , Paládio/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Prognóstico , Estudos Prospectivos , Próstata/patologia , Próstata/efeitos da radiação , Neoplasias da Próstata/patologia , Lesões por Radiação/etiologia , Radioisótopos/administração & dosagem , Radioisótopos/efeitos adversos , Análise Espaço-Temporal , Fatores de Tempo
7.
Georgian Med News ; (295): 20-24, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31804193

RESUMO

Objective - The search of effective approaches to Peyronie's disease treatment remains an urgent problem. In this study we had evaluated the efficiency of platelet-rich plasma therapy, low-intensity shock wave therapy, local negative-pressure therapy. On a basis of Men's Health Clinic (Kyiv, Ukraine), 23 patients with PD (ICD-10: N48.6) aged from 29 to 47 (mean age of 37.1±4.8) were examined using a questionnaire International Index of Erectile Function, Visual Analogue Scale for pain, cavernous bodies ultrasonography and pharmacodopplerography. The assessment of the reliability of the differences in the mean and relative variables carried out by means of standard methods of variation statistics (assessment of the reliability of the differences in the mean and relative variables was carried out by means of standard methods of variation statistics - Student's t-test, chi-squared test). We identified that 44% of patients had more than 2 induration focuses. In general study cohort, we had found 55 focuses of different square size. After 6-month follow-up observation following combined treatment we had identified significant (p≤0.01) decrease in pain intensity during erection - from moderate to low. There was a significant (p≤0.05) improvement of erectile function, increase of satisfaction with sexual intercourse and overall sexual satisfaction. Significant (p≤0.05) decrease in the end-diastolic blood flow velocity was observed. According to the data of ultrasonic examination, morphological effects of combined therapy were presented as a noticeable regress of fibroplastic process, reduction in the fibroplastic induction focuses by square size and density, penile deviations of less than 30о decreased by 6-12о. Follow-up data had shown a sustained therapy effect for all patients in study cohort. The efficiency of platelet-rich plasma therapy, low-intensity shock wave therapy, local negative-pressure combination has been established as promising.


Assuntos
Induração Peniana , Humanos , Masculino , Ereção Peniana , Induração Peniana/terapia , Pênis , Reprodutibilidade dos Testes , Resultado do Tratamento , Ucrânia
8.
Bratisl Lek Listy ; 120(12): 941-944, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31855055

RESUMO

OBJECTIVES: Erectile dysfunction (ED) is characterised as the inability to achieve or maintain an erection to complete sexual intercourse. ED may be considered as an early complication of diabetes mellitus (DM). The aim of this study was to assess the effect of registered food supplement, natural polyphenolic extract from the French maritime pine bark, Pycnogenol (PYC) on erectile function and lipid profile in ED patients. METHODS: 53 patients with ED were divided into two groups (32 with DM, 21 non-DM) in randomised, blinded and placebo-controlled study. During 3-month intervention with PYC or placebo and one month after the end of the intervention patients were investigated for ED with validated questionnaire International Index of Erectile Function-5 (IIEF-5); lipid profile, glycaemia was analysed in each group. RESULTS: In a randomised, blinded and placebo-controlled study, we found that natural polyphenolic extract, Pycnogenol improved erectile function in DM group by 45 % compared to the NDM group, where the improvement was also significant, but only by 22 %. Total cholesterol, LDL-cholesterol and glucose level was lowered by PYC in patients with DM. Glucose level was not affected by PYC in non-DM. Placebo showed no effect on monitored parameters in both groups. CONCLUSION: Administration of Pycnogenol leads in improvement of erectile function in patients with ED and diabetes (DM group) by 45 %, in NDM group by 22 %, in lowering of total-, LDL-cholesterol by 20 % and 21 % and glycaemia by 22 % in DM (Tab. 2, Fig. 2, Ref. 19).


Assuntos
Diabetes Mellitus Tipo 2/complicações , Disfunção Erétil/tratamento farmacológico , Ereção Peniana/efeitos dos fármacos , Polifenóis/farmacologia , Adulto , Complicações do Diabetes , Método Duplo-Cego , Disfunção Erétil/complicações , Humanos , Lipídeos , Masculino , Pessoa de Meia-Idade , Polifenóis/administração & dosagem , Comportamento Sexual/efeitos dos fármacos , Inquéritos e Questionários , Resultado do Tratamento
9.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(11): 1329-1336, 2019 Nov 30.
Artigo em Chinês | MEDLINE | ID: mdl-31852640

RESUMO

OBJECTIVE: To explore the effects of exogenous hydrogen sulfide (H2S) on apoptosis of corpus cavernosum smooth muscle cells (CCSMCs) and erectile dysfunction (ED) in rats with bilateral cavernous nerve injury (BCNI). METHODS: Twentyfour male SD rats were randomly divided into 3 groups (n=8):sham operation group, bilateral cavernous nerve injury group (BCNI group) and H2S intervention group (BCNI+NaHS group). In BCNI and BCNI+NaHS groups, BCNI was induced by clamp injury of the bilateral cavernous nerves, and the rats were subjected to daily intraperitoneal injection of normal saline and 100 µmol/kg NaHS solution for 4 weeks, respectively. After the treatment, the intracavernous pressure (ICP) and mean arterial pressure (MAP), ) of the rats were measured. Western blotting was used to detect the expressions of cystathionine ß synthetase (CBS), cystathionine γ lyase (CSE), α-SMA, collagen-I, caspase-3, Bax and Bcl-2 in the penile cavernous tissue, and the expressions of CBS and CSE were also detected immunohistochemically. The ratio of cavernous smooth muscle to collagen was detected using Masson's Trichrome staining. The apoptosis level of CCSMC was detected by TUNEL + α-SMA immunofluorescence double staining. RESULTS: After 4 weeks of treatment, the rats in BCNI+NaHS group showed a significantly higher ICP/MAP ratio than those in BCNI group (P < 0.05). The results of Masson's Trichrome staining showed that the ratio of cavernous smooth muscle/collagen was significantly higher in BCNI + NaHS group than in BCNI group (P < 0.05). Western blotting showed a significantly higher expression of α-SMA protein but a lower expression of collagen-I protein in BCNI + NaHS group than in BCNI group (P < 0.05). TUNEL+α-SMA immunofluorescence double staining revealed a significantly lower number of apoptotic CCSMCs in BCNI+NaHS group than in BCNI group (P < 0.05). Compared with those in BCNI group, the rats in BCNI+NaHS group had significantly decreased expressions of caspase-3 and Bax proteins (P < 0.05) with significantly enhanced Bcl-2 protein expression and an increased Bcl-2/Bax ratio (P < 0.05). The expressions of CBS and CSE were significantly lower in BCNI group than in the other two groups (P < 0.05). CONCLUSIONS: Exogenous H2S enhance the expression of the classic apoptotic protein Bcl-2 and reduces apoptosis of CCSMC to improve the erectile function in rats with BCNI.


Assuntos
Disfunção Erétil , Animais , Apoptose , Modelos Animais de Doenças , Humanos , Sulfeto de Hidrogênio , Masculino , Miócitos de Músculo Liso , Ereção Peniana , Pênis , Ratos , Ratos Sprague-Dawley
10.
Hinyokika Kiyo ; 65(9): 385-388, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31697882

RESUMO

We present 2 cases of prolonged ischemic priapism in which corpus cavernosum tissue was obtained using the Winter procedure with an automatic biopsy needle for construction of a percutaneous distal shunt and the relationship with erectile recovery was evaluated. A 24-year-old male was referred to our hospital at 72 hours after onset of priapism. Conservative procedures failed to achieve detumescence. Thus, a Winter procedure, which creates a fistula between the glans penis and corpora cavernosa, was attempted and the patient was successfully treated. Corpus cavernosa biopsy findings showed a nearly normal cavernosal tissue structure. Improvement of erectile function sufficient for sexual intercourse was noted 3 months after the surgery. The second case was in a 51-year-old man suffering from painful priapism that occurred following percutaneous coronary intervention. He was referred to our hospital at 48 hours after onset. Conservative treatment was insufficient, whereas detumescence was obtained with a Winter shunt procedure. Corpora cavernosa biopsy findings revealed extensive fibrosis and erectile function was not improved at 6 months after surgery. Histological evaluation of the corpus cavernosum utilizing the Winter method was found useful for determining post-operative erection recovery in these cases of ischemic priapism.


Assuntos
Priapismo , Coito , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis , Adulto Jovem
11.
Nat Rev Urol ; 16(12): 734-744, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31649327

RESUMO

Penile wounds after traumatic and surgical amputation require reconstruction in the form of autologous tissue transfers. However, currently used techniques are associated with high infection rates, implant erosion and donor site morbidity. The use of tissue-engineered neocorpora provides an alternative treatment option. Contemporary tissue-engineering strategies enable the seeding of a biomaterial scaffold and subsequent implantation to construct a neocorpus. Tissue engineering of penile tissue should focus on two main strategies: first, correcting the volume deficit for structural integrity in order to enable urinary voiding in the standing position and second, achieving erectile function for sexual activity. The functional outcomes of the neocorpus can be addressed by optimizing the use of stem cells and scaffolds, or alternatively, the use of gene therapy. Current research in penile tissue engineering is largely restricted to rodent and rabbit models, but the use of larger animal models should be considered as a better representation of the anatomical and physiological function in humans. The development of a cell-seeded scaffold to achieve and maintain erection continues to be a considerable challenge in humans. However, advances in penile tissue engineering show great promise and, in combination with gene therapy and surgical techniques, have the potential to substantially improve patient outcomes.


Assuntos
Ereção Peniana , Pênis/cirurgia , Engenharia Tecidual , Animais , Células Cultivadas , Modelos Animais de Doenças , Humanos , Masculino , Pênis/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Regeneração , Tecidos Suporte , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
12.
Urologiia ; (4): 80-84, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535810

RESUMO

PURPOSE: To evaluate erectile function in patients with Peyronies disease (PD) who underwent corporoplasty. MATERIALS AND METHODS: A total of 374 patients who underwent corporoplasty by a single surgeon during 1996-2016 were analyzed. In all cases IIEF questionnaire was evaluated pre- and postoperatively. Intracavernous injection test and penile doppler ultrasonography were performed if required. Median follow-up was 9.5 years. Analysis of risk factors for erectile dysfunction (ED) before and after corporoplasty was performed. RESULTS: Prevalence of risk factors for ED in our sample has greatly increased during follow-up. At the last follow-up visit 285 patients were sexually active. Evaluation of patient satisfaction with the quality of erections has shown that 139 patients were fully satisfied (48.8%), 84 patients were somewhat satisfied (29.5%) and 62 patients were not satisfied with their erectile function (21.7%). According to IIEF questionnaire, 105 patients (36.8%) had no ED (> 26 points); 74 patients (26%) had mild ED; 67 patients (23.5%) had mild-to-moderate ED; 21 patients (7.4%) had moderate ED; and 18 patients (6.3%) had severe ED. However, a causal relationship between ED and treatment of Peyronie's disease was found not in all cases. Seven patients had infrequent sexual intercourse (1-2 per month) and 50 patients had no sexual activity. DISCUSSION: At long term after corporoplasty some patients experience ED, though causality between ED and PD treatment couldnt be confirmed in all such cases. It should be noted that we have found an increase in prevalence of independent risk factors for ED during follow-up period. These patients could possibly benefit in terms of quality of life if they underwent penile prosthesis placement during primary surgical treatment for PD. However, some patients had no sexual activity due to causes unrelated to ED. CONCLUSION: Not all patients with PD are satisfied with their sexual functioning after corporoplasty. However, ED after surgical management of PD is not always a consequence of surgery itself.


Assuntos
Disfunção Erétil , Induração Peniana , Humanos , Masculino , Satisfação do Paciente , Ereção Peniana , Pênis , Qualidade de Vida
13.
Hinyokika Kiyo ; 65(7): 315-317, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31501399

RESUMO

A 71-year-old man visited a local urologist with the complaint of continuous painful erection for three days. Penile cavernosal blood data showed acidosis and hypoxia. Thus he was diagnosed with ischemic priapism. After penile aspiration and injection of phenylephrine, erection was temporary improved. The blood platelet count was 94.5×104/µl and myeloproliferative disease was suspected. He was referred to our hospital and visited us the following day. Since priapism relapsed, we aspirated corpus cavernosum of the penis and injected phenylephrine which was successful. A bone marrow biopsy and genetic test were performed at the department of hematology and the diagnosis of essential thrombocythemia with JAK2 gene mutation was confirmed. By treatment with hydroxyurea, the blood platelet count decreased without priapism recurrence.


Assuntos
Priapismo , Trombocitemia Essencial , Idoso , Humanos , Masculino , Ereção Peniana , Pênis , Fenilefrina , Priapismo/complicações , Priapismo/diagnóstico , Trombocitemia Essencial/complicações , Trombocitemia Essencial/diagnóstico
14.
Urology ; 133: 249.e1-249.e7, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31476348

RESUMO

OBJECTIVE: To investigate the relationship between the upregulated expression of sphingosine-1-phosphate receptor 1 (S1P1) in the corpus cavernosum and erectile function in spontaneously hypertensive rats (SHRs). METHODS: Twelve-week-old healthy male Wistar-Kyoto rats (WKY) and SHR rats were randomly divided into 4 groups: WKY, SHR, WKY transfection, and SHR transfection (n = 5). A lentiviral vector carrying the S1P1 gene was injected into the corpus cavernosum penis of rats in the transfection groups (1 × 109 TU/mL, 20 µL). After 1 week, the maximum penile intracavernous pressure/mean arterial pressure (ICPmax/MAP), nitric oxide (NO) content, and the expression of eNOS, P-eNOS, ROCK1, ROCK2, and S1P1 in the corpus cavernosum penis of rats in each group were measured. RESULTS: The ICPmax/MAP value was significantly higher in the SHR transfection group than in the SHR group under 3-V and 5-V electrical stimulations (P <.01). The expression of S1P1 and P-eNOS proteins significantly increased (P <.01), while that of ROCK1 and ROCK2 proteins significantly decreased (P <.01) in the SHR transfected group compared with the SHR group. The NO content was significantly higher in the SHR transfection group than in the SHR group (P <.01). CONCLUSION: The upregulated expression of S1P1 in SHR corpus cavernosum penis may improve the SHR erectile function by upregulating the P-eNOS/eNOS ratio and inhibiting the RhoA/Rho kinase signaling pathway.


Assuntos
Ereção Peniana/genética , /genética , Animais , Masculino , Distribuição Aleatória , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY , Transfecção
16.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(4): 636-640, 2019 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-31420614

RESUMO

OBJECTIVE: To investigate and analyze the complications of penile augmentation with acellular dermal matrix (ADM) and following management. METHODS: This was a retrospective review of all patients who received penile augmentation with ADM between June 2016 and January 2019. The patients were evaluated with outpatient physical examination. Related complications and following management were summarized and analyzed. RESULTS: Between June 2016 and January 2019, ADM was used as filling material on 78 patients (mean age: 31.14 years, range: 21-66 years), who were successfully received penile augmentation surgery. In the follow-up three months, the penile circumference was increased by 1.1 cm (0.5-2.1 cm) on average. The mean follow-up time was 12.20 months. In this study, there were 47 (60.26%, 47/78) patients with erectile discomfort, 91.49% (43/47) of whom manifested as erectile traction. There were 12 (15.38%, 12/78) patients with delayed healing, improved by daily regular dressing change. There were 10 (12.82%, 10/78) patients with unobvious augmentation effect. There were 9 (11.54%, 9/78) patients with stamp-like changes of ADM. There were 8 (10.26%, 8/78) patients with wound hematoma and 7 (8.97%, 7/78) patients with foreskin edema, relieved by compression with wrap. There were 4 (5.13%, 4/78) patients with wound infection and 3 (3.85%, 3/78) patients with skin necrosis of the dorsal side, which could be treated with ADM removal and repair surgery with bipedicle scrotal flap. And there were 2 (2.56%, 2/78) patients suffering psychological influence. Finally, most patients with various complications recovered successfully, however 7 patients (8.97%, 7/78) underwent ADM removal surgery. CONCLUSION: Using ADM as filling material could achieve positive effect in penile augmentation but the complications are common and cannot be neglected. Standardized surgical methods, rigorous postoperative care, and adequate notification with patients can effectively reduce the complications of penile augmentation with ADM. To treat properly and timely for complications can obtain satisfactory results.


Assuntos
Derme Acelular , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis , Estudos Retrospectivos , Retalhos Cirúrgicos , Adulto Jovem
17.
Int Braz J Urol ; 45(5): 1033-1042, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408283

RESUMO

Cinnamomum cassia (Cinnamon) is a well-known traditional medicine with therapeutic benefits for centuries. We evaluated the effects of cinnamon essential oil (CEO) and its main component cinnamaldehyde (CA) on human corpus cavernosum (HCC) and rat CC. The essential oil of cinnamon was analyzed for the confirmation of the oil profile. HCC specimens from patients undergoing penile prosthesis surgery (age 48-69 years) were utilized for functional studies. In addition, erectile responses in anesthetized control and diabetic rats were evaluated in vivo after intracavernosal injection of CEO and CA, and rat CC strips were placed in organ baths. After precontraction with phenylephrine (10µM), relaxant responses to CEO and CA were investigated. CA (96.9%) was found as the major component. The maximum relaxation responses to CEO and CA were 96.4±3.5% and 96.0±5.0% in HCC and 97.5±5.5% and 96.8±4.8% in rat CC, respectively. There was no difference between control and diabetic rats in relaxation responses to CEO and CA. The relaxant responses obtained with essential oil and CA were not attenuated in the presence of nitric oxide synthase (NOS) inhibitor, and soluble guanylate cyclase inhibitor (sGS) in CC. In vivo, erectile responses in diabetic rats were lower than in control rats, which was restored after intracavernosal injection of CEO and CA. CEO and CA improved erectile function and relaxation of isolated strips of rat CC and HCC by a NO/cGMP-independent mechanism. Further investigations are warranted to fully elucidate the restorative effects of CEO and CA on diabetic erectile dysfunction.


Assuntos
Acroleína/análogos & derivados , Cinnamomum zeylanicum/química , Relaxamento Muscular/efeitos dos fármacos , Óleos Voláteis/farmacologia , Pênis/efeitos dos fármacos , Acroleína/farmacologia , Idoso , Análise de Variância , Animais , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Relaxamento Muscular/fisiologia , Ereção Peniana/efeitos dos fármacos , Ereção Peniana/fisiologia , Pênis/fisiopatologia , Fenilefrina/farmacologia , Inibidores da Fosfodiesterase 5/farmacologia , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Citrato de Sildenafila/farmacologia , Vasoconstritores/farmacologia
18.
Curr Urol Rep ; 20(10): 58, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31468204

RESUMO

PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) and sexual health have common links. Medical and surgical treatments for LUTS can significantly affect various domains of sexual health including erectile function, ejaculatory function, and libido. This review summarizes recent findings. RECENT FINDINGS: Current literature demonstrates a strong association between LUTS, sexual health, and metabolic syndrome. The role of miRNA is also being investigated. Combination medical therapy with phosphodiesterase 5 inhibitors (PDE5-I) shows promise but needs further investigation. Newer surgical therapies for benign prostatic hyperplasia (BPH) aim to preserve sexual function without sacrificing efficacy and durability. Although we are beginning to acknowledge the link between LUTS and sexual health, a better understanding of the underlying biochemistry is needed. Only then can more effective therapies be developed. Further prospective studies should focus on the long-term durability and safety of treatments for both conditions.


Assuntos
Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/terapia , Síndrome Metabólica/complicações , Saúde Sexual , Ejaculação , Humanos , Libido , Masculino , Síndrome Metabólica/cirurgia , Ereção Peniana , Inibidores da Fosfodiesterase 5/uso terapêutico , Estudos Prospectivos , Hiperplasia Prostática/complicações
19.
Radiol Med ; 124(12): 1270-1280, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31302847

RESUMO

In an emergency department, penile traumas are uncommon and a prompt diagnosis is necessary. Penile injury may result from penetrating and non-penetrating trauma. Non-penetrating injuries can produce cavernosal hematomas or fractures: if not treated promptly, these lesions can result in fibrosis or erectile dysfunction. Penile traumatic lesions need a clinical approach first, but a radiological study is often required: ultrasonography with color and spectral Doppler study is usually the first approach. In some cases, magnetic resonance imaging may be performed to better recognize even small discontinuity of the tunica albuginea. Radiologists have to be aware of the various radiological patterns of penile traumatic lesions, in order to establish a prompt and correct diagnosis.


Assuntos
Pênis/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Cicatriz/etiologia , Serviço Hospitalar de Emergência , Disfunção Erétil/etiologia , Fibrose/etiologia , Hematoma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Ereção Peniana , Pênis/anatomia & histologia , Priapismo/etiologia , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Ultrassonografia Doppler em Cores , Uretra/diagnóstico por imagem , Uretra/lesões , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações
20.
Urology ; 132: 156-160, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31306669

RESUMO

OBJECTIVE: To confirm the distribution of functional nerves involved in erectile function at the posterior of the prostate base, intraoperative nerve stimulation was performed during robot-assisted radical prostatectomy (RARP) METHODS: Several points at the posterior of the prostate and the posterolateral typical neurovascular bundle (NVB) were electrically stimulated at the level of the prostate base during RARP in patients with clinically localized prostate cancer. The prostate pedicle (PP), medial side of the PP (MPP), Denonvilliers' fascia (DF), and typical NVB were stimulated using bipolar electrodes. The changes in pressure at the middle of the urethra were measured using an inserted balloon-catheter to detect the increase in cavernosal pressure. RESULTS: Although the study included only 12 patients, each stimulation of the PP, MPP, and NVB induced evident urethral pressure responses in all patients. The median amplitude of the pressure responses was 5.49 (IQR 3.11-8.42), 6.00 (IQR 3.70-8.30), and 3.22 (IQR 2.48-7.19) cm H2O at the PP, MPP, and NVB, respectively. The amplitude of responses at the PP and MPP was not small compared with the responses at the typical NVB. Stimulations at the DF induced unstable weak urethral response alone or no response in all patients. CONCLUSION: We showed that electrostimulation of the PP and MPP increases the cavernosal pressure similar to the typical NVB stimulation. These findings indicate that maximal preservation of the tissues at the posterior area of the prostate base can contribute to optimal recovery of postoperative erectile function after nerve-sparing RARP.


Assuntos
Estimulação Elétrica , Ereção Peniana/fisiologia , Próstata/inervação , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Humanos , Período Intraoperatório , Masculino
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