Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.032
Filtrar
1.
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
2.
Nat Commun ; 11(1): 2687, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32483116

RESUMO

Injury of corpus cavernosa results in erectile dysfunction, but its treatment has been very difficult. Here we construct heparin-coated 3D-printed hydrogel scaffolds seeded with hypoxia inducible factor-1α (HIF-1α)-mutated muscle-derived stem cells (MDSCs) to develop bioengineered vascularized corpora. HIF-1α-mutated MDSCs significantly secrete various angiogenic factors in MDSCs regardless of hypoxia or normoxia. The biodegradable scaffolds, along with MDSCs, are implanted into corpus cavernosa defects in a rabbit model to show good histocompatibility with no immunological rejection, support vascularized tissue ingrowth, and promote neovascularisation to repair the defects. Evaluation of morphology, intracavernosal pressure, elasticity and shrinkage of repaired cavernous tissue prove that the bioengineered corpora scaffolds repair the defects and recover penile erectile and ejaculation function successfully. The function recovery restores the reproductive capability of the injured male rabbits. Our work demonstrates that the 3D-printed hydrogels with angiogenic cells hold great promise for penile reconstruction to restore reproductive capability of males.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Pênis/lesões , Transplante de Células-Tronco/métodos , Animais , Sobrevivência Celular , Modelos Animais de Doenças , Disfunção Erétil/diagnóstico por imagem , Disfunção Erétil/fisiopatologia , Disfunção Erétil/cirurgia , Feminino , Heparina , Humanos , Hidrogéis , Imagem por Ressonância Magnética , Masculino , Camundongos , Camundongos Nus , Proteínas Mutantes/genética , Neovascularização Fisiológica , Pênis/irrigação sanguínea , Pênis/fisiopatologia , Gravidez , Impressão Tridimensional , Coelhos , Tecidos Suporte , Transfecção
3.
Oxid Med Cell Longev ; 2020: 7286958, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32215177

RESUMO

Hyperlipidemia is considered one of the most important risk factors for erectile dysfunction (ED). To determine the effect of sodium tanshinone IIA sulfonate (STS) as an antioxidant agent on ED in high-fat diet- (HFD-) induced hyperlipidemia in rats and to investigate if STS administration could improve erectile function via hydrogen sulfide (H2S) production by inhibition of oxidative stress. Hyperlipidemia was induced in Sprague-Dawley rats by feeding HFD for 16 weeks. The rats were randomly divided into 3 groups: control, HFD, and HFD treated with STS (10 mg/kg/day for 12 weeks, intraperitoneal injection). Erectile function including intracavernosal pressure (ICP), H2S production, and antioxidant capacity was assessed. In addition, cavernosal smooth muscle cells (CSMC) isolated from SD rats were pretreated with STS in vitro and exposed to H2O2. Expressions of nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1), activity of antioxidant enzymes, and H2S-generating enzymes within CSMC were examined. ICP was significantly decreased in HFD rats compared with control. In addition, decreased H2S production and expression of cystathionine É£-lyase (CSE) and cystathionine ß-synthase (CBS) associated with increased oxidative stress were observed in the penile tissue of HFD rats. However, all these changes were reversed by 16 weeks after STS administration. STS also increased antioxidant defense as evidenced by increased expression of Nrf2/HO-1 in the penile tissue of HFD rats. In CSMC, pretreatment with STS attenuated the decreased expression of CSE and CBS and H2S production by H2O2. STS exerted similar protective antioxidative effect as shown in the in vivo hyperlipidemia model. The present study demonstrated the redox effect of STS treatment on ED via increased H2S production in HFD-induced hyperlipidemia rat model by increased antioxidant capacity via activation of the Nrf2/HO-1 pathway, which provides STS potential clinical application in the treatment of hyperlipidemia-related ED.


Assuntos
Antioxidantes/administração & dosagem , Disfunção Erétil/tratamento farmacológico , Hiperlipidemias/tratamento farmacológico , Fenantrenos/administração & dosagem , Animais , Antioxidantes/metabolismo , Células Cultivadas , Dieta Hiperlipídica/efeitos adversos , Disfunção Erétil/etiologia , Peróxido de Hidrogênio/toxicidade , Sulfeto de Hidrogênio/metabolismo , Hiperlipidemias/etiologia , Injeções Intraperitoneais , Masculino , Oxirredução , Estresse Oxidativo/efeitos dos fármacos , Pênis/efeitos dos fármacos , Pênis/metabolismo , Pênis/patologia , Pênis/fisiopatologia , Ratos , Ratos Sprague-Dawley
4.
Rev Med Suisse ; 16(686): 531-538, 2020 Mar 18.
Artigo em Francês | MEDLINE | ID: mdl-32186798

RESUMO

Peyronie's disease (PD) is a relatively unknown cause of sexual dysfunction. Symptoms may include the appearance of an erectile deformity, pain in the penis and erectile dysfunction (ED). The etiology is most often unclear, and medical treatments are limited, although improvement is always possible. However, surgical treatment remains the only option when the disease has stabilized and in the event of significant erectile and sexual disability.


Assuntos
Induração Peniana/fisiopatologia , Disfunção Erétil/complicações , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Ereção Peniana , Induração Peniana/complicações , Pênis/fisiopatologia
5.
Int J Radiat Oncol Biol Phys ; 107(1): 143-151, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32004582

RESUMO

PURPOSE: To study the relationships between absorbed dose to penile base structures and erectile dysfunction (ED) in patients treated with ultrahypofractionated (UHF) radiation therapy (RT) or conventionally fractionated (CF) RT for prostate cancer. METHODS AND MATERIALS: This dose-response study comprises 673 patients (57%) of the 1180 per-protocol patients included in the HYPO-RT-PC trial (median follow-up 5, years), where patients were randomized to CF (39 × 2.0 Gy, 8 weeks) or UHF (7 × 6.1 Gy, 2.5 weeks). No androgen deprivation therapy was allowed. Only patients with erectile function sufficient for intercourse at baseline and complete RT data were included in this study. Erectile function was assessed by physician at regular follow-ups. The main endpoint was severe ED (EDs). The penile bulb (PB) and crus were retrospectively delineated on the treatment planning computed tomography scans. Dose-volume descriptors were derived from EQD2 converted dose matrices (α/ß = 3 Gy). Univariable and multivariable Cox proportional hazard regression and logistic regression were used to find predictors for EDS. RESULTS: No significant difference in EDs was found between CF and UHF. During the follow-up period, EDs occurred in 27% of the patients in both treatment groups. Average (median) PB mean dose, Dmean, was 24.5 (20.2) in CF and 18.7 (13.1) Gy3 in UHF. Age was the only significant predictor for EDs in Cox analyses. All dose-volume variables contributed significantly in univariable logistic regression at 2-year follow-up. Age and near maximum dose (D2%) were significant predictors for EDs in multivariable logistic regression analyses at both 1 and 2 years. CONCLUSIONS: The frequency of EDS was similar in the CF and UHF treatment groups. Age at radiation therapy was the strongest predictor for EDs, followed by dose to PB, and was most evident for younger patients. We propose D2 % <50 Gy3 and Dmean <20 Gy3 to the PB as the primary objectives to be applied in the treatment planning process.


Assuntos
Disfunção Erétil/etiologia , Pênis/fisiopatologia , Pênis/efeitos da radiação , Neoplasias da Próstata/fisiopatologia , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/patologia , Fatores de Tempo
6.
Eur J Pharmacol ; 863: 172675, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31542487

RESUMO

The aim was to evaluate and characterize H2S-induced relaxation of human corpus cavernosum (HCC) and penile resistance arteries (HPRA) from patients with erectile dysfunction (ED). HCC and HPRA were obtained from men with ED at the time of penile prosthesis insertion. H2S-mediated relaxations were evaluated by exposing these tissues to the stable analogue, NaHS, and to the precursor of H2S, L-cysteine (CYS). The effects of NaHS and CYS were also evaluated on cGMP accumulation in HCC and on acetylcholine- and sildenafil-mediated relaxations in HCC and HPRA. NaHS consistently relaxed HPRA and HCC and more potently than human prostate and bladder. NaHS-induced relaxations in HCC and HPRA were unaffected by the ATP-sensitive K+-channel blocker, glibenclamide or the NO synthase inhibitor, L-NAME, slightly reduced by the Ca2+-activated K+-channel blocker, tetraethylammonium, and markedly inhibited by the soluble guanylyl cyclase inhibitor, ODQ. NaHS caused a cGMP increase in HCC that was inhibited by ODQ. CYS produced relaxations of HCC and HPRA that were sensitive to ODQ and to inhibition of the H2S synthesizing enzymes, cystathionine γ-lyase (CSE) and cystathionine ß-synthase (CBS). CYS also increased cGMP in HCC. In contrast to NaHS, CYS-induced relaxations were prevented by endothelium removal in HPRA. Only in HPRA, treatment with CYS (30 µM) potentiated acetylcholine- and sildenafil-induced relaxations. This effect was prevented by CSE/CBS inhibition and by removing the endothelium. Exogenous and endogenous H2S relaxes HCC and HPRA from ED patients through cGMP accumulation and potentiates vasodilatory capacity of PDE5 inhibition, supporting the therapeutic potential of modulating H2S pathway.


Assuntos
Cisteína/metabolismo , Disfunção Erétil/fisiopatologia , Sulfeto de Hidrogênio/metabolismo , Relaxamento Muscular/efeitos dos fármacos , Pênis/efeitos dos fármacos , Inibidores da Fosfodiesterase 5/farmacologia , Vasodilatação/efeitos dos fármacos , Artérias/efeitos dos fármacos , Artérias/fisiopatologia , GMP Cíclico/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Pênis/fisiopatologia , Citrato de Sildenafila/farmacologia
7.
Andrologia ; 51(10): e13388, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31475740

RESUMO

Studies assessing the efficacy of intralesional verapamil injection in the treatment of Peyronie's disease have yielded mixed results. The purpose of this meta-analysis is to systematise the existing literature on the efficacy of intralesional verapamil injection when used in the treatment of Peyronie's disease. The treatment outcomes of seven different study groups identified by computerised literature search were compared with natural history outcomes and data from control groups of three studies involving placebo saline injection. An exploratory meta-analysis was performed on the data due to differing patient populations, treatment protocols, and inconsistent selection and reporting of outcomes. Intralesional verapamil injection significantly improved sexual function (p < .0005) and penile curvature (p < .005) in individuals with Peyronie's disease. Decreases in pain may be significant after therapy but are questionable. The effect of verapamil on plaque size remains less impressive (p > .05). Intralesional verapamil injection has promise to positively impact a number of clinical outcomes of Peyronie's disease; however, a large, multicentre, randomised, controlled study with reliable protocols is needed to confirm the efficacy of treatment.


Assuntos
Bloqueadores dos Canais de Cálcio/administração & dosagem , Induração Peniana/tratamento farmacológico , Pênis/efeitos dos fármacos , Comportamento Sexual/efeitos dos fármacos , Verapamil/administração & dosagem , Humanos , Injeções Intralesionais , Masculino , Induração Peniana/fisiopatologia , Pênis/fisiopatologia , Comportamento Sexual/fisiologia , Resultado do Tratamento
8.
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
9.
Andrologia ; 51(9): e13365, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31273827

RESUMO

The aim of this study was to evaluate the relationship between penile colour doppler ultrasonography (PCDUS) and complete blood count parameters in patients with erectile dysfunction (ED). The data of the patients who applied to our outpatient clinic with ED (IIEF-5 score <22 or IIEF-EF score <26) between January 2007 and May 2017 were retrospectively analysed. The patients who had available PCDUS results and complete blood count (CBC) values were included in the study. Patients were divided into two groups having normal (n = 530 [68.9%]) or abnormal (n = 240 [31.1%]) PCDUS findings (group 1 versus group 2 respectively). Subsequently, group 2 was divided into three subgroups according to presence of arterial insufficiency (group 2a; n = 85 [11%]), venous insufficiency (group 2b; n = 140 [18.2%]) and both of arterial and venous insufficiency (group 2c; n = 15 [1.9%]), and the four groups were compared in terms of CBC parameters. There was no statistically significant difference between the 4 groups, and between the patients with normal and abnormal PCDUS findings in terms of CBC values. CBC values were not associated with PCDUS findings in patients with ED.


Assuntos
Disfunção Erétil/diagnóstico , Ereção Peniana/fisiologia , Pênis/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adulto , Idoso , Contagem de Células Sanguíneas , Disfunção Erétil/sangue , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Pênis/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
10.
Biomed Res Int ; 2019: 5219048, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312658

RESUMO

Introduction: Glans resurfacing has been suggested as a treatment option for the surgical management of superficial penile cancer (Tis, Ta, T1aG1, T1aG2). In this article we describe in detail the glans resurfacing technique with skin graft for penile cancer in a video presentation and we review the current knowledge of the literature. Material and Methods: The procedure is described in a stepwise fashion. Initially the patient is circumcised. The glans is marked in quadrants and completely stripped by dissecting and removing the epithelium and subepithelium layer of the glans. Deep spongiosal biopsies are taken to exclude invasion. Each quadrant is sent separately for biopsy. The surface of the graft size needed is estimated. A partial thickness skin graft is harvested from the thigh with a dermatome. The skin graft is then fenestrated. The graft is rolled over the glans and quilted with multiple sutures. A silicone 16F Foley catheter and a suprapubic catheter are placed. The penis is dressed with multiple gauzes and compressed with an elastic band. Results: The patient is discharged the next day. The dressing and Foley catheter are removed in 7 days. The patient continues to use the suprapubic catheter for 7 more days. The patient refrains from any sexual activity for 6 weeks and is closely followed. Conclusions: Glans resurfacing is an emerging new appealing surgical technique that is already a recommendation in the EAU guidelines for the treatment of premalignant and superficial penile lesions. The overall satisfaction rate and recovery of the sexual function are acceptable, and it can be considered an ideal procedure to treat superficial penile cancer.


Assuntos
Neoplasias Penianas/cirurgia , Pênis/transplante , Lesões Pré-Cancerosas/cirurgia , Transplante de Pele , Humanos , Masculino , Neoplasias Penianas/fisiopatologia , Pênis/fisiopatologia , Lesões Pré-Cancerosas/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos , Pele/fisiopatologia , Transplantes , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos
12.
BMC Complement Altern Med ; 19(1): 135, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215433

RESUMO

BACKGROUND: Sexual problems are widespread and adversely affect the interpersonal relationships and the quality of life. Currently, synthetic drugs improving sexual function are available, but expenditures for such agents are extremely high. To discover relatively inexpensive, widely available and effective natural drugs, we identified a combined extracts from Lepidium meyenii (maca) root and Allium tuberosum Rottl. (Chinese chive) seed, assessed the effects of this combined extracts on erectile dysfunction, and explored its potential mechanisms. METHODS: The extracts were obtained via supercritical fluid extraction. Male BALB/c mice received doses of extract from single plant or the combined extracts (200 mg/kg) by gastric gavage for 14 d, and Viagra was used as the positive control drug. Sexual behaviour was observed, and concentrations of serum testosterone, nitric oxide (NO), and cyclic guanosine monophosphate (cGMP) in serum as well as in penis were measured. In addition, weights of genital organs were also measured. RESULTS: The combined extracts of maca root and Chinese chive seed (1:1, w/w) had a 45-fold increase in macamide content compared with maca extract. It also led to significantly higher ejaculation frequency (P < 0.05) than single extract from maca root or Chinese chive seed, with no corresponding effect on genital indices. In addition, the NO level in serum (P < 0.01) and penis (P < 0.05) increased notably, as well as the level of cGMP in penis (P < 0.05). CONCLUSIONS: The results indicated that the combined extracts produced better synergistic effects on male sexual function than maca extract or Chinese chive extract alone. These positive effects may involve the upregulation of NO and cGMP concentrations in penis.


Assuntos
Cebolinha-Francesa/química , Disfunção Erétil/tratamento farmacológico , Lepidium/química , Extratos Vegetais/administração & dosagem , Animais , Disfunção Erétil/sangue , Disfunção Erétil/fisiopatologia , Feminino , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Ereção Peniana/efeitos dos fármacos , Pênis/efeitos dos fármacos , Pênis/fisiopatologia , Qualidade de Vida , Sementes/química , Comportamento Sexual Animal , Testosterona/sangue
13.
Int J Impot Res ; 31(3): 155-161, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036957

RESUMO

This introductory manuscript aims to familiarize the concept of the ability of certain forces or energies applied on the penis. This concept is described and discussed in more detail for three optional applicative energies; shock wave energy via mechano-transduction, ultrasound energy via its theoretical unique effect on the cellular membrane, specifically cyclic separation of the two phospholipid layers, creating biochemical, functional and structural tissue changes. Radio frequency energy via its heating effect is proven to induce immediate changes on collagen strucures and on realignment of collagen fibers, as well as induction of local vasodilation. Applying any of these energies on the erectile tissue may potentially affect biochemical processes, which through different mechanisms lead to a beneficial clinical effect on erectile function.


Assuntos
Disfunção Erétil/terapia , Terapia por Radiofrequência , Terapia por Ultrassom , Animais , Modelos Animais de Doenças , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Ereção Peniana , Pênis/fisiopatologia
14.
Andrologia ; 51(8): e13297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31033009

RESUMO

The penile duplex ultrasound (PDU) has been used as a diagnostic tool in erectile dysfunction (ED) management. It is currently recommended that peak systolic velocity (PSV) and end-diastolic flow (EDF) should be recorded on both the right and left cavernosal arteries. However, the clinical utility of bilateral recordings is unknown. Our primary objective is to assess the clinical utility of bilateral recordings in ED treatment with sildenafil. A total of 77 patients were included. All patients had a standardised PDU and also completed the IIEF-5 and started on-demand treatment with sildenafil at 100 mg at baseline. The IIEF-5 and EDITS were completed at the 6-month follow-up. The Spearman test was used to assess correlation. Receiver operating characteristic (ROC) curves were drawn, and the area under the curve (AUC) was calculated. Improvement, cure and satisfaction were high (77.9%, 64.9% and 67.5%, respectively), and the median IIEF-5 and EDITS were 25(22; 25) and 81.81(63.63; 88.63) respectively. The lowest PSV had the highest positive correlation with IIEF-5 and EDITS (p = 0.436 and 0.379, respectively), and it could predict improvement, cure and satisfaction with a fair-to-good accuracy (AUC = 0.837, 0.750 and 0.749 respectively). The present study shows bilateral penile blood-flow assessment is important, and attention should be focused on the lowest bilateral PSV.


Assuntos
Disfunção Erétil/diagnóstico por imagem , Pênis/irrigação sanguínea , Citrato de Sildenafila/administração & dosagem , Ultrassonografia Doppler Dupla , Agentes Urológicos/administração & dosagem , Idoso , Artérias/diagnóstico por imagem , Artérias/efeitos dos fármacos , Artérias/fisiopatologia , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Velocidade do Fluxo Sanguíneo/fisiologia , Relação Dose-Resposta a Droga , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/fisiopatologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Pênis/diagnóstico por imagem , Pênis/fisiopatologia , Fluxo Sanguíneo Regional/efeitos dos fármacos , Fluxo Sanguíneo Regional/fisiologia , Resultado do Tratamento
15.
Urology ; 129: 106-112, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30954611

RESUMO

OBJECTIVE: To compare the patient's satisfaction and long-term results of 2 penile plication procedures in patients with penile curvature. METHODS: This retrospective study included 387 patients with congenital penile curvature (n = 260) and Peyronie's disease (n = 127) who underwent surgical correction of penile curvature with penile plication procedures. Of the patients, 202 underwent plication of tunica albuginea with the Lue's 16-dot technique, while 185 underwent highly superficial excision of tunica albuginea with the modified Nesbit corporoplasty. Surgical outcomes and patient's satisfaction were compared between the 2 techniques in all patients. RESULTS: The mean duration of surgery was significantly shorter in the 16-dot plication technique (48.1 ±â€¯7.5 minutes), compared with the modified Nesbit corporoplasty (63 ±â€¯16.9 minutes) (P = .001). Complete penile straightening was achieved in 87.6% of the patients who underwent 16-dot plication technique and in 89.7% of the patients who underwent modified Nesbit plication, revealing no difference (P = .514). The rates of penile sensory loss (P = .001) and de-novo erectile dysfunction (P = .016) were significantly higher in the modified Nesbit corporoplasty than in the 16-dot plication technique, but rate of suture related complications was significantly higher in the 16-dot plication technique than in the modified Nesbit corporoplasty (P = .001). The patients with congenital penile curvature had significantly less ratio of postoperative penile length loss and de-novo erectile dysfunction than Peyronie's disease patients. CONCLUSION: Overall, both surgical techniques have very high success and satisfaction rates with very low complication rates. However, the types of complications are significantly different between the 2 surgical procedures. Therefore, patients with penile curvature should be informed about outcomes of penile plication procedures, and surgical method should be preferred based on patient's preference and surgeon's experience.


Assuntos
Satisfação do Paciente , Ereção Peniana/fisiologia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Técnicas de Sutura , Suturas , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Induração Peniana/diagnóstico , Induração Peniana/fisiopatologia , Induração Peniana/cirurgia , Pênis/diagnóstico por imagem , Pênis/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Ultrassonografia Doppler , Adulto Jovem
16.
J Urol ; 202(3): 599-610, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30916626

RESUMO

PURPOSE: Current penile traction therapy devices have significant limitations, including the need to use them for 3 to 8 hours per day. Given these issues, the novel RestoreX® penile traction therapy device was developed in cooperation with Mayo Clinic. MATERIALS AND METHODS: We performed a randomized, controlled, single-blind, intent to treat trial (ClinicalTrials.gov NCT03389854) in men with Peyronie's disease who were assigned to the penile traction therapy device for 30 to 90 minutes per day or to no therapy for 3 months. Study inclusion criteria were curvature 30 degrees or greater with no study exclusions due to complex curvature, hourglass deformity, prior Peyronie's disease therapy or surgery, or calcification. The primary outcome was safety and secondary outcomes were penile length and curvature, and questionnaire responses. RESULTS: A total of 110 men were randomized 3:1 to the penile traction therapy group or the control group. The cohorts were well matched with a mean age of 58.4 years, a 49.7-month Peyronie's disease history and 59.3 degree curvature. Overall penile traction therapy was well tolerated with only transient and mild adverse events reported. At 3 months men undergoing penile traction therapy demonstrated significant improvements over controls in penile length (1.5 vs 0 cm, p <0.001), curvature (-11.7 vs 1.3 degrees, p <0.01) and erectile function (4.3 vs -0.7, p = 0.01) according to the International Index of Erectile Function-Erectile Function among men with erectile dysfunction. Overall 77% of the men on penile traction therapy experienced improved curvature (mean -17.2 degrees in 28.2% of responders) while 94% achieved increased length (1.6 cm in 10.9%). Counter bending and the white line indicator improved efficacy, validating key device innovations. Of men who had previously used other penile traction therapy devices 100% preferred the RestoreX device. CONCLUSIONS: Penile traction therapy with the RestoreX device for 30 to 90 minutes per day was safe, and resulted in significant and clinically meaningful improvements in penile curvature and length in men with Peyronie's disease, and in erectile function in men with erectile dysfunction and Peyronie's disease with no significant adverse events. To our knowledge these data represent the only reported improvements for any device used less than 3 to 8 hours per day.


Assuntos
Disfunção Erétil/terapia , Satisfação do Paciente , Induração Peniana/terapia , Tração/instrumentação , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Ereção Peniana/psicologia , Induração Peniana/complicações , Induração Peniana/fisiopatologia , Induração Peniana/psicologia , Pênis/patologia , Pênis/fisiopatologia , Método Simples-Cego , Fatores de Tempo , Tração/efeitos adversos , Tração/métodos , Resultado do Tratamento
17.
Int J Impot Res ; 31(2): 61-64, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30837719

RESUMO

Erectile dysfunction (ED) is a common side effect to radical prostatectomies, even with nerve-sparing procedures. To ameliorate the problem so-called "penile rehabilitation" programs have been developed. The most widely used method of this is subscribing sildenafil or other PDE5-inhibitors to patients following surgery. This is based on a theory that these drugs may increase penile oxygenation and provide antiapoptotic factors (primarily NO and cGMP), thus protecting the penile tissue in a period with reduced nerve function following the surgery. Preclinical studies have confirmed the potential of sildenafil in this context and early human trials have suggested that a steady ingestion of sildenafil might protect the structural integrity of the penis. However, subsequent well-designed trials have not been able to confirm the initial findings. This fits well with sildenafil's mechanism of action because it does not actually induce erections or the production of either nitric oxide or cGMP. Rather, the drug enhances effects of an erectile response induced by neurotransmitters from the cavernous nerves. Therefore, sildenafil should no longer be offered as a sole means of penile rehabilitation. Rather, more research is needed, and clinicians need to apply a broader concept of sexual rehabilitation in postprostatectomy ED.


Assuntos
Disfunção Erétil/tratamento farmacológico , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Citrato de Sildenafila/uso terapêutico , Disfunção Erétil/etiologia , Humanos , Masculino , Ereção Peniana/efeitos dos fármacos , Pênis/efeitos dos fármacos , Pênis/fisiopatologia , Próstata/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica
18.
J Ultrasound Med ; 38(10): 2739-2748, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30839126

RESUMO

OBJECTIVES: The aim of this study was to analyze the diagnostic accuracy of different criteria of pharmaco-penile duplex sonography in venous erectile dysfunction (ED). METHODS: The following parameters were measured after an intracavernous injection test in patients with ED from May 2016 to February 2017 at our hospital: diameter, peak systolic velocity, end-diastolic velocity, and resistance index of the cavernous artery; diameter and peak velocity (if leak occurred) of the deep dorsal vein. Three ultrasonographic diagnostic criteria of venous ED were applied. Criterion A: continuous blood flow signals in the deep dorsal vein, peak velocity greater than 3 cm/s, peak systolic velocity greater than 30 cm/s, end-diastolic velocity greater than 5 cm/s; Criterion B: resistance index less than 0.89 and other parameters corresponding with Criterion A; Criterion C: resistance index less than 0.80 and other parameters corresponding with Criterion A. The diagnostic results of each criterion were compared with the cavernosographic results. RESULTS: Thirty-six patients were diagnosed as venous ED by cavernosography in 54 ED cases. The diagnostic specificity, sensitivity, and accuracy of Criterion A were 70.6%, 91.7%, and 84.9%, respectively. Those of Criterion B were 82.4%, 69.4%, and 73.6%, while the results for Criterion C were 94.1%, 33.3%, and 52.8%, respectively. Criterion A had the highest diagnostic accuracy, the largest area under the receiver operating characteristic curve (area = 0.811), and the highest consistency (kappa = 0.642) with the cavernosographic results in the 3 criteria. The difference was statistically significant (P < .05). CONCLUSIONS: Among the 3 commonly used ultrasonographic criteria, Criterion A is most appropriate in the diagnosis of venous ED.


Assuntos
Disfunção Erétil/diagnóstico por imagem , Disfunção Erétil/fisiopatologia , Pênis/irrigação sanguínea , Pênis/diagnóstico por imagem , Ultrassonografia Doppler Dupla/métodos , Adolescente , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/fisiopatologia , Estudos Prospectivos , Fluxo Sanguíneo Regional/fisiologia , Reprodutibilidade dos Testes , Adulto Jovem
19.
Curr Urol Rep ; 20(4): 18, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30895471

RESUMO

PURPOSE OF REVIEW: To provide an evidence based discussion of preoperative, intraoperative, and postoperative factors that lead to successful outcomes in penile prosthesis surgery. RECENT FINDINGS: In the preoperative period, careful patient selection, appropriate counseling, thorough evaluation, and sufficient time for physical and emotional adaptation to an inflatable penile prosthesis are the key. During surgery, the entire device should be explanted whenever possible. A drain and retain strategy for the reservoir is a safe alternative in situation where the reservoir is not easily removable. The mechanical cleansing of lavage is more important than chemical sterilization. Postoperative instructions should be made clear and nursing phone calls may reduce the number of ER visits. Careful preoperative counseling, attention to intraoperative details, and vigilance in the postoperative period are necessary for a successful outcome with penile prosthesis revision surgery.


Assuntos
Disfunção Erétil/cirurgia , Prótese de Pênis , Pênis/cirurgia , Implantação de Prótese/métodos , Remoção de Dispositivo , Humanos , Masculino , Prótese de Pênis/efeitos adversos , Pênis/fisiopatologia , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos , Reoperação
20.
J Sex Med ; 16(3): 383-393, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30846112

RESUMO

BACKGROUND: Previous studies have documented improvement in erectile function after bilateral cavernous nerve injury (BCNI) in rats with the use of pioglitazone. Our group determined this improvement to be mediated by the insulin-like growth factor-1 (IGF-1) pathway. AIM: To eliminate the systemic effects of pioglitazone and evaluate the local delivery of IGF-1 by polymeric microspheres after BCNI in the rat. METHODS: Male Sprague-Dawley rats aged 10-12 weeks were assigned at random to 3 groups: sham operation with phosphate buffered saline (PBS)-loaded microspheres (sham group), crush injury with PBS-loaded microspheres (crush group), and crush injury with IGF-1-loaded microspheres (IGF-1 group). Poly(lactic-co-glycolic) acid microspheres were injected underneath the major pelvic ganglion (MPG). IGF-1 was released at approximately 30 ng/mL/day per MPG per rat. OUTCOMES: Functional results were demonstrated by maximal intracavernosal pressure (ICP) normalized to mean arterial pressure (MAP). Protein-level analysis data of IGF-1 receptor (IGF-1R), extracellular signal-regulated kinase (ERK)-1/2, and neuronal nitric oxide synthase (nNOS) were obtained using Western blot analysis and immunohistochemistry for both the cavernosal tissue and the MPG and cavernous nerve (CN). RESULTS: At 2 weeks after nerve injury, animals treated with IGF-1 demonstrated improved erectile functional recovery (ICP/MAP) at all voltages compared with BCNI (2.5V, P = .001; 5V, P < .001; 7.5V, P < .001). Western blot results revealed that up-regulation of the IGF-1R and ERK-1/2 in both the nervous and erectile tissue was associated with improved erectile function recovery. There were no significant between-group differences in nNOS protein levels in cavernosal tissue, but there was an up-regulation of nNOS in the MPG and CN. Immunohistochemistry confirmed these trends. CLINICAL TRANSLATION: Local up-regulation of the IGF-1R in the neurovascular bed at the time of nerve injury may help men preserve erectile function after pelvic surgery, such as radical prostatectomy, eliminating the need for systemic therapy. STRENGTHS & LIMITATIONS: This study demonstrates that local drug delivery to the MPG and CN can affect the CN tissue downstream, but did not investigate the potential effects of up-regulation of the growth factor receptors on prostate cancer tissue. CONCLUSION: Stimulating the IGF-1R at the level of the CN has the potential to mitigate erectile dysfunction in men after radical prostatectomy, but further research is needed to evaluate the safety of this growth factor in the setting of prostate cancer. Haney NM, Talwar S, Akula PK, et al. Insulin-Like Growth Factor-1-Loaded Polymeric Poly(Lactic-Co-Glycolic) Acid Microspheres Improved Erectile Function in a Rat Model of Bilateral Cavernous Nerve Injury. J Sex Med 2019;16:383-393.


Assuntos
Disfunção Erétil/tratamento farmacológico , Fator de Crescimento Insulin-Like I/administração & dosagem , Ereção Peniana/efeitos dos fármacos , Animais , Modelos Animais de Doenças , Disfunção Erétil/fisiopatologia , Plexo Hipogástrico/metabolismo , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Microesferas , Óxido Nítrico Sintase Tipo I/metabolismo , Pênis/fisiopatologia , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica , Traumatismos do Sistema Nervoso/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA