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

RESUMO

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


Assuntos
Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Ejaculação/fisiologia , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Humanos , Masculino , Pênis/irrigação sanguínea , Pênis/inervação , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Risco , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Uretra/inervação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
2.
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
3.
Sci Rep ; 10(1): 6618, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32313132

RESUMO

Despite current progress achieved in the surgical technique of radical prostatectomy, post-operative complications such as erectile dysfunction and urinary incontinence persist at high incidence rates. In this paper, we present a methodology for functional intra-operative localization of the cavernous nerve (CN) network for nerve-sparing radical prostatectomy using near-infrared cyanine voltage-sensitive dye (VSD) imaging, which visualizes membrane potential variations in the CN and its branches (CNB) in real time. As a proof-of-concept experiment, we demonstrate a functioning complex nerve network in response to electrical stimulation of the CN, which was clearly differentiated from surrounding tissues in an in vivo rat prostate model. Stimulation of an erection was confirmed by correlative intracavernosal pressure (ICP) monitoring. Within 10 minutes, we performed trans-fascial staining of the CN by direct VSD administration. Our findings suggest the applicability of VSD imaging for real-time, functional imaging guidance during nerve-sparing radical prostatectomy.


Assuntos
Carbocianinas/química , Corantes/química , Sistemas Computacionais , Raios Infravermelhos , Rede Nervosa/diagnóstico por imagem , Pênis/inervação , Pênis/cirurgia , Imagens com Corantes Sensíveis à Voltagem , Animais , Artefatos , Secções Congeladas , Humanos , Masculino , Movimento (Física) , Pênis/diagnóstico por imagem , Ratos Sprague-Dawley , Reprodutibilidade dos Testes
4.
Rev. int. androl. (Internet) ; 18(1): 14-20, ene.-mar. 2020. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-193833

RESUMO

INTRODUCTION AND OBJECTIVES: The aim of this study is to evaluate the effects of castration and subsequent losartan administration on the fibrosis-related parameters in the corpora cavernosa of castrated rats. MATERIAL AND METHODS: Twenty-four male rats were divided into four equal groups. Group 1:sham surgery plus vehicle (0.9% NaCl) (control:con), group 2:sham surgery plus losartan (con+los), group 3: castration plus vehicle (castration:cast) and group 4:castration plus losartan (cast+los). After four weeks of oral losartan treatment, corporal levels of transforming growth factor-beta (TGF-beta), thrombospondin-1 (TSP-1), alpha-actin, beta-actin and fibronectin were investigated by ELISA kits. Changes in the collagen and smooth muscle content were evaluated by histological analysis with Masson trichrome staining. RESULTS: Initial and post-treatment body weights of rats were similar among groups. Castration significantly increased the expression of TGF-beta, TSP-1 and fibronectin and resulted in a significant decrease in alpha-actin levels in the corpora cavernosa. Administration of losartan reduced the levels of TGF-beta, TSP-1 and fibronectin in castrated rats. Alpha actin levels also increased after losartan treatment. Beta-actin levels were not significantly different among 4 groups. The levels of all markers were similar in group 1 and 2. Rate of fibrosis was significantly higher in castrated rats and treatment with losartan reduced this rate. CONCLUSION: Castration increased the expression of fibrosis-related markers in the corpora cavernosa of rats. Administration of losartan significantly attenuated those changes and exerted an antifibrotic effect


INTRODUCCIÓN Y OBJETIVOS: El objetivo de este estudio es evaluar los efectos de la castración y la posterior administración de losartán en los parámetros relacionados con la fibrosis en los cuerpos cavernosos de ratas castradas. MATERIAL Y MÉTODOS: Veinticuatro ratas macho se dividieron en 4 grupos iguales. Grupo 1: cirugía simulada más vehículo (0,9% NaCl) (control:con); grupo 2: cirugía simulada más losartán (con+los); grupo 3: castración más vehículo (castración:cast) y grupo 4: castración más losartán (cast+los). Después de 4 semanas de tratamiento oral con losartán se analizaron los niveles de factor de crecimiento transformante beta (TGF-beta), trombospondina-1 (TSP-1), alfa-actina, beta-actina y fibronectina mediante kits de ELISA. Cambios en el colágeno y el contenido de músculo liso se evaluaron mediante análisis histológico con tinción con tricrómico de Masson. RESULTADOS: Los pesos corporales iniciales y posteriores al tratamiento de las ratas fueron similares entre los grupos. La castración aumentó considerablemente la expresión de TGF-beta, TSP-1 y fibronectina, y dio como resultado una disminución importante de los niveles de alfa-actina en los cuerpos cavernosos. La administración de losartán redujo los niveles de TGF-beta, TSP-1 y fibronectina en ratas castradas. Los niveles de alfa-actina también aumentaron después del tratamiento con losartán. Los niveles de beta-actina no fueron muy diferentes entre los 4 grupos. Los niveles de todos los marcadores fueron similares en los grupos 1 y 2. La tasa de fibrosis fue mucho mayor en las ratas castradas y el tratamiento con losartán redujo esta tasa. CONCLUSIÓN: La castración aumentó la expresión de marcadores relacionados con la fibrosis en los cuerpos cavernosos de las ratas. La administración de losartán atenuó considerablemente esos cambios y ejerció un efecto antifibrótico


Assuntos
Animais , Masculino , Ratos , Disfunção Erétil/tratamento farmacológico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Losartan/administração & dosagem , Fibrose/prevenção & controle , Disfunção Erétil/sangue , Pênis/lesões , Pênis/inervação , Pênis/patologia , Ratos Wistar
6.
J Sex Med ; 17(4): 603-613, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31953029

RESUMO

INTRODUCTION: The projection of the human male urogenital system onto the paracentral lobule has not previously been mapped comprehensively. AIM: To map specific urogenital structures onto the primary somatosensory cortex toward a better understanding of sexual response in men. METHODS: Using functional magnetic resonance imaging, we mapped primary somatosensory cortical responses to self-stimulation of the penis shaft, glans, testicles, scrotum, rectum, urethra, prostate, perineum, and nipple. We further compared neural response with erotic and prosaic touch of the penile shaft. MAIN OUTCOME MEASURE: We identified the primary mapping site of urogenital structures on the paracentral lobule and identified networks involved in perceiving touch as erotic. RESULTS: We mapped sites on the primary somatosensory cortex to which components of the urogenital structures project in men. Evidence is provided that penile cutaneous projection is different from deep penile projection. Similar to a prior report in women, we show that the nipple projects to the same somatosensory cortical region as the genitals. Evidence of differential representation of erotic and nonerotic genital self-stimulation is also provided, the former activating sensory networks other than the primary sensory cortex, indicating a role of "top-down" activity in erotic response. CLINICAL IMPLICATIONS: We map primary sites of projection of urogenital structures to the primary somatosensory cortex and differentiate cortical sites of erotic from nonerotic genital self-stimulation. STRENGTH & LIMITATIONS: To our knowledge, this is the first comprehensive mapping onto the primary somatosensory cortex of the projection of the components of the urogenital system in men and the difference in cortical activation in response to erotic vs nonerotic self-stimulation. The nipple was found to project to the same cortical region as the genitals. Evidence is provided that superficial and deep penile stimulation project differentially to the cortex, suggesting that sensory innervation of the penis is provided by more than the (pudendal) dorsal nerve. CONCLUSION: This study reconciles prior apparently conflicting findings and offers a comprehensive mapping of male genital components to the paracentral lobule. We provide evidence of differential projection of light touch vs pressure applied to the penile shaft, suggesting differential innervation of its superficial, vs deep structure. Similar to the response in women, we found nipple projection to genital areas of the paracentral lobule. We also provide evidence of differential representation of erotic and nonerotic genital self-stimulation, the former activating sensory networks other than the primary sensory cortex, indicating a role of top-down activity in erotic response. Allen K, Wise N, Frangos E, et al. Male Urogenital System Mapped Onto the Sensory Cortex: Functional Magnetic Resonance Imaging Evidence. J Sex Med 2020;17:603-613.


Assuntos
Mapeamento Encefálico/métodos , Genitália/fisiologia , Imagem por Ressonância Magnética , Pênis/fisiologia , Adulto , Literatura Erótica/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/inervação , Escroto/fisiologia , Adulto Jovem
7.
J Pak Med Assoc ; 70(Suppl 1)(2): S65-S69, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31981339

RESUMO

Pelvic fractures represents high energy trauma with associated other organ injuries including intra-abdominal injuries, haemorrhage and extremity injuries. Anatomical location of genitourinary structures makes them vulnerable to injury with pelvic fracture. Incidence of sexual dysfunction varies in literature with 5% incidence of dysfunction in patients without urethral injury and 42% with urethral injuries. Hence in pelvic fracture, erectile dysfunction may be due to neurogenic, vascular, corporal and psychogenic injury. In this narrative review of targeted English literature from all level of evidences, which is written and supervised by experienced specialized orthopaedic, trauma and urology surgeons who were among the pioneers of conducting pelvis fracture management workshops in the country, we aim to describe the mechanism that can lead to erectile dysfunction after pelvic fracture, assessment principles, decision-making and preoperative planning and indications of operative managements.


Assuntos
Disfunção Erétil/terapia , Fraturas Ósseas/terapia , Ossos Pélvicos/lesões , Pênis/irrigação sanguínea , Pênis/inervação , Uretra/lesões , Alprostadil/uso terapêutico , Disfunção Erétil/diagnóstico , Disfunção Erétil/etiologia , Fraturas Ósseas/complicações , Humanos , Masculino , Traumatismos dos Nervos Periféricos/complicações , Traumatismos dos Nervos Periféricos/diagnóstico , Inibidores da Fosfodiesterase 5/uso terapêutico , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Uretra/diagnóstico por imagem , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/diagnóstico , Vasodilatadores/uso terapêutico
8.
Differentiation ; 111: 22-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31654825

RESUMO

Development of the human prepuce was studied over the course of 9-17 weeks of gestation in 30 specimens. Scanning electron microscopy revealed subtle surface features that were associated with preputial development, namely the appearance of epidermal aggregates that appeared to be associated with formation of the preputial fold. Transverse and sagittal sections revealed that the epidermis of the glans is considerably thicker than that of the penile shaft. We described a novel morphogenetic mechanism of formation of the preputial lamina, namely the splitting of the thick epidermis of the glans into the preputial lamina and the epidermis via the intrusion of mesenchyme containing red blood cells and CD31-positive blood vessels. This process begins at 10-11 weeks of gestation in the proximal aspect of the glans and extends distally. The process is likely to be androgen-dependent and mediated via androgen receptors strategically localized to the morphogenetic process, but signaling through estrogen receptor may play a role. Estrogen receptor alpha (ESR1) has a very limited expression in the developing human glans and prepuce, while estrogen receptor beta (ESR2) is expressed more broadly in the developing preputial lamina, epidermis and urethra. Examination of the ontogeny of innervation of the glans penis and prepuce reveals the presence of the dorsal nerve of the penis as early as 9 weeks of gestation. Nerve fibers enter the glans penis proximally and extend distally over several weeks to eventually reach the distal aspect of the glans and prepuce by 14-16 weeks of gestation.


Assuntos
Morfogênese , Pênis/crescimento & desenvolvimento , Receptores Androgênicos/metabolismo , Receptores Estrogênicos/metabolismo , Uretra/crescimento & desenvolvimento , Humanos , Masculino , Microscopia Eletrônica de Varredura , Pênis/inervação , Pênis/metabolismo , Pênis/ultraestrutura , Uretra/inervação , Uretra/metabolismo , Uretra/ultraestrutura
9.
Niger J Clin Pract ; 22(12): 1737-1741, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793482

RESUMO

Background: Neonates feel pain. There is a concern among practitioners that pain of injecting analgesics to neonates prior to circumcision could as well be the same as the pain of the procedure. This has made many reluctant to offer effective analgesia for circumcision. If eutectic mixture of local anesthetics (EMLA) provides analgesia comparable to dorsal penile nerve block (DPNB), it will obviate needle prick and encourage analgesia use in neonatal circumcision. Aim: To determine how the analgesic efficacy of EMLA compares with that of DPNB in neonatal plastibell circumcision. Methods: A prospective study of 110 male neonates for plastibell circumcision randomized into two groups: A and B, of 55 each, received EMLA or DPNB as analgesia prior to circumcision, respectively. The pulse rates and SpO2 were recorded with pulse oximeter pre-procedural and at four stages of the procedure (adhesiolysis, dorsal slit, tying, and excision) for each neonate. Also the modification of neonatal infant pain scale (NIPS) was recorded during the procedure. Results: There were differential changes in SpO2 (lower absolute mean values) and pulse rate (higher absolute mean values) for neonates who received EMLA when compared with DPNB before the procedure. These differences were significant with SpO2 at adhesiolysis (91.0% and 95.0%), dorsal slitting (90.9% and 94.7%), and excision stages (93.4% and 95.3), respectively (P < 0.05). They were also significant with the pulse rates at adhesiolysis (167.9 and 158.6), dorsal slitting (174.3 and 161.7), and tying stages (182.2 and 169.0), respectively (P values = 0.013, 0.015, and 0.044, respectively). This shows DPNB is better than EMLA. However, the difference was not significant at the tying stage with SpO2 and at excision stage with PR (P > 0.05). Conclusion: EMLA produces analgesic effect. However, it does not provide effective analgesia for plastibell circumcision in neonates. DPNB provides a better analgesia than EMLA for neonatal plastibell circumcision.


Assuntos
Anestésicos Locais/uso terapêutico , Circuncisão Masculina , Lidocaína/uso terapêutico , Bloqueio Nervoso , Dor/prevenção & controle , Pênis/inervação , Prilocaína/uso terapêutico , Anestesia Local , Humanos , Lactente , Recém-Nascido , Combinação Lidocaína e Prilocaína , Masculino , Dor/etiologia , Manejo da Dor/métodos , Medição da Dor , Estudos Prospectivos , Resultado do Tratamento
10.
Acta Cir Bras ; 34(9): e201900901, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800678

RESUMO

PURPOSE: To evaluate the effects of tadalafil (TD) in preventing histological alterations of the corpus cavernosum caused by isolated lesions of cavernous nerve (ILCN) and artery (ILCA) in rats. METHODS: Fifty male Wistar rats were randomly assigned in five groups: G1: control; G2: bilateral ILCN; G3: bilateral ILCA; G4: ILCN+TD; G5: ILCA+TD. The cavernous bodies were submitted to histomorphometry, immunohistochemistry and biochemical analysis. RESULTS: Nerve density was significantly higher in G2 and G4 compared to control (22.62±2.84 and 19.53±3.47 vs. 15.72±1.82; respectively, p<0.05). Smooth muscle density was significantly lower in G2 and G3 in comparison to G1 (12.87±1.90 and 18.93±1.51 vs. 21.78±1.81, respectively; p<0.05). A significant decrease in the sinusoidal lumen area was observed in G2 compared to controls (5.01±1.62 vs. 9.88±3.66, respectively; p<0.05) and the blood vessel density was increased in G2 and G3 (29.32±4.13 e 20.80±2.47 vs. 10.13±2.71, p<0.05). Collagen density was higher in G3 compared to G1 (93.76±15.81 vs. 64.59±19.25; p<0.05). CONCLUSIONS: Histomorphometric alterations caused by ILCN were more intense than those produced by vascular injury, but the collagen analyses showed more fibrosis in animals with ILCA. TD was effective in preventing the majority of the alterations induced by the periprostatic bundle injury.


Assuntos
Pênis/irrigação sanguínea , Pênis/inervação , Traumatismos dos Nervos Periféricos/prevenção & controle , Inibidores da Fosfodiesterase 5/farmacologia , Substâncias Protetoras/farmacologia , Tadalafila/farmacologia , Animais , Colágeno/análise , Colágeno/efeitos dos fármacos , Tecido Elástico/anatomia & histologia , Tecido Elástico/efeitos dos fármacos , Disfunção Erétil/prevenção & controle , Imuno-Histoquímica , Masculino , Pênis/efeitos dos fármacos , Pênis/patologia , Prostatectomia/efeitos adversos , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes
11.
Am J Hypertens ; 32(12): 1206-1213, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31584631

RESUMO

BACKGROUND: This study was designed to evaluate whether overconsumption of NaCl, a well-known risk factor for hypertension, leads to erectile dysfunction in rodents. METHODS: Male Wistar rats received regular chow (control group) or 4% NaCl chow for 24 weeks and were subjected to blood pressure measurement and apomorphine-induced erection. Moreover, cavernosal strips from both the control and 4% NaCl groups were evaluated in organ baths. RESULTS: Animals subjected to 4% NaCl chow did not develop hypertension but presented a significant reduction in the total number of erections following apomorphine administration as compared with the control group. The addition of high KCl or phenylephrine resulted in similar contractile responses in the corpus cavernosal strips from both the control and 4% NaCl groups. However, electrical field stimulation-induced contraction was significantly enhanced in cavernosal strips from animals exposed to 4% NaCl. Incubation of Y-27632, but not of atropine and Nω-nitro-l-arginine methyl ester (L-NAME), entirely prevented the potentiation of the contractile responses evoked by electrical stimulation. The enhanced contractile responses evoked by electrical stimulation found in the high-salt group were also avoided in the absence of extracellular calcium. Concentration-response curves of CaCl2 revealed augmented contractility in response to extracellular calcium in cavernosal strips from the 4% NaCl-treated rats, compared with control samples. CONCLUSIONS: A high-salt diet alone rendered the animals less responsive to apomorphine-induced penile erection and enhanced neurally mediated contractile responses in the corpus cavernosum, a clear indication that overconsumption of sodium can lead to erectile dysfunction even without the development of hypertension.


Assuntos
Apomorfina/farmacologia , Disfunção Erétil/etiologia , Contração Muscular/efeitos dos fármacos , Músculo Liso/inervação , Ereção Peniana/efeitos dos fármacos , Pênis/inervação , Cloreto de Sódio na Dieta/toxicidade , Animais , Sinalização do Cálcio , Estimulação Elétrica , Disfunção Erétil/metabolismo , Disfunção Erétil/fisiopatologia , Masculino , Ratos Wistar , Quinases Associadas a rho/metabolismo
12.
Theranostics ; 9(22): 6354-6368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31588222

RESUMO

Erectile dysfunction (ED) is an important kind of postoperative complication of pelvic surgery that affects patients' quality of life. Transplantation of mesenchymal stem cells (MSC) has been found to alleviate ED caused by cavernous nerve injury (CNI) in rats. However, little is known about whether induced pluripotent stem cell-derived mesenchymal stem cells (iMSC) have a therapeutic effect on CNI ED. We established an ED model on rats and evaluated the effect of iMSC on it. Methods: Eight-week-old male Sprague-Dawley rats were assigned to four groups and received following operation: sham operation (sham group); bilateral CNI and phosphate-buffered saline (PBS) injections (PBS group); bilateral CNI and adipose-derived mesenchymal stem cells transplantation (adMSC group); or bilateral CNI and iMSC injection (iMSC group). After therapy, the cavernous nerve was stimulated by electricity and the intracavernous pressure (IAP)/mean arterial blood pressure (MAP) was measured. The endothelial and smooth muscle tissue in the penis was assessed histologically with Masson's trichrome stain. Immunofluorescence/immunohistochemical stains were applied for the detection of nNOS, vWF, eNOS, SMA, Desmin, S100ß, and caspase-3. Nude rats CNI ED model was established for the evaluation of iMSC longevity and differentiation capacity. The paracrine factors were assessed by real-time PCR. Results: Transplantation of iMSC significantly restored the IAP/MAP in this CNI ED model and showed long-term effects. It could rescue the expression of vWF, eNOS, SMA, and Desmin, which indicated the alleviation of endothelial and smooth muscle tissues of the penis. iMSC therapy also could increase the expression of nNOS in the cavernosum and S100ß in the major pelvic ganglia (MPG) which contributed to the erectile function. Moreover, the level of BAX and caspase-3 were reduced and Bcl-2 was increased, which indicated the anti-apoptosis effects of iMSC. The iMSC showed little transdifferentiation and exerted their function by activating the secretome of the host. Conclusion: Transplantation of iMSC significantly improved ED induced by CNI. The iMSC may exert their effects via paracrine factors and may be a promising therapeutic candidate for treating CNI ED in the future.


Assuntos
Disfunção Erétil/terapia , Células-Tronco Pluripotentes Induzidas/citologia , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/citologia , Pênis/inervação , Animais , Transdiferenciação Celular , Células Cultivadas , Modelos Animais de Doenças , Disfunção Erétil/fisiopatologia , Vesículas Extracelulares , Humanos , Masculino , Células-Tronco Mesenquimais/fisiologia , Músculo Liso/fisiologia , Músculo Liso/fisiopatologia , Óxido Nítrico Sintase Tipo I/metabolismo , Pênis/lesões , Pênis/fisiologia , Traumatismos dos Nervos Periféricos , Ratos Sprague-Dawley , Subunidade beta da Proteína Ligante de Cálcio S100/metabolismo
14.
Urology ; 134: 228-231, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560912

RESUMO

Pudendal nerve decompression surgery has not been studied or reported for the treatment of penile numbness in the absence of pain. Herein, we report a case of a male patient with chronic numbness of the penis and erectile dysfunction in the absence of pelvic pain who was found to have pudendal nerve entrapment. This patient was treated with surgical decompression of the pudendal nerves that resulted in the return of genital sensation and erections. Thus, we propose that pudendal nerve entrapment may be considered as a cause of penile numbness and that pudendal nerve decompression surgery in these patients may be effective.


Assuntos
Disfunção Erétil/etiologia , Hipestesia/etiologia , Pênis/inervação , Neuralgia do Pudendo/diagnóstico , Adulto , Constipação Intestinal/etiologia , Descompressão Cirúrgica , Incontinência Fecal/etiologia , Humanos , Masculino , Exame Neurológico , Neuralgia do Pudendo/complicações , Neuralgia do Pudendo/cirurgia , Incontinência Urinária/etiologia
15.
Am J Physiol Regul Integr Comp Physiol ; 317(5): R673-R683, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31483153

RESUMO

In men with a spinal cord injury (SCI), erectile function, ejaculation, and fertility are severely impaired. The present study utilized a telemetric pressure transducer implanted into the corpus cavernosum of the penis to examine sexual function during awake mating behavior in a rat contusion model with a range of Infinite Horizon Impactor forces distributed between 150 and 215 kdyn. The mating behavior paradigm included examination of the counts, average pressure, and average duration for mounts, intromissions, and ejaculations. Male Wistar rats were mated with receptive females in 30-min sessions preinjury (sexual acclimation) and once per week for 6 wk beginning after a 2-wk recovery period post-SCI. All SCI animals had significant deficits in sexual function in the parameters measured. These deficiencies were more prevalent in a subset having less than 20% white matter sparing, likely a reflection of the extent of bilateral spino-bulbo-spinal sexual circuitry disruption at the lesion epicenter. The resulting discoordination of the autonomic and somatic reflex control of erection and ejaculation recorded using telemetry devices in an awake, behaving animal model provides an effective means of gauging sexual function deficits after SCI and could have utility for quantifying recovery after a therapeutic intervention.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Disfunção Erétil/diagnóstico , Ereção Peniana , Pênis/inervação , Comportamento Sexual Animal , Traumatismos da Medula Espinal/complicações , Telemetria , Animais , Doença Crônica , Modelos Animais de Doenças , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Masculino , Pressão , Ratos Wistar , Traumatismos da Medula Espinal/fisiopatologia , Telemetria/instrumentação , Fatores de Tempo , Transdutores de Pressão
16.
Ann Plast Surg ; 83(3): 326-333, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31268946

RESUMO

BACKGROUND: Modern approaches to erectile dysfunction (ED) often entail the use of multimodal medical therapy and surgery; however, with recent advances in microsurgery, new options may exist for patients suffering from ED. This comprehensive review of the literature serves to reevaluate anatomical and physiological principles that mediate erection to improve understanding for reconstructive surgeons hoping to offer new interventions. METHODS: A search strategy for this review was agreed upon by all authors. Articles were divided into 2 categories - primary and secondary. Primary articles were defined as those in which the anatomy of the pelvis and/or perineum was the primary focus of the article, whereas secondary did not directly focus on anatomic considerations. Select historical texts and textbook chapters were also included to provide well established and critical anatomical evidence for this review. RESULTS: Several approaches may be used to restore nerve function to treat neurogenic and vasculogenic ED. Somatic sensory loss can be treated by either direct neurorrhaphy or neuroplasty in the location of disruption. Microvascular techniques also exist to improve flow or to repair small vessels injured in the pelvis. Classical approaches to impotence include vein stripping to reduce venous outflow or direct vascularization to improve inflow. CONCLUSIONS: Postradical prostatectomy ED has been demonstrated to improve with microsurgical interventions. In the coming years, innovation will continue and collaboration between plastic surgeons and urologists will allow us to tackle this common and difficult problem.


Assuntos
Disfunção Erétil/cirurgia , Pênis/inervação , Pênis/cirurgia , Humanos , Masculino , Microcirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
17.
Urology ; 131: 136-143, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31202856

RESUMO

OBJECTIVE: To determine if combined administration of LIMK2 and JNK inhibitors in a rat model of erectile dysfunction induced by cavernosal nerve (CN) injury could restore erectile function by suppressing both cavernosal apoptosis and fibrosis via rectification of molecular pathways related to the structural alterations. METHODS: Sixty 12-week-old male Sprague-Dawley rats were categorized into 4 groups: (1) Sham-surgery (Sham) group, (2) CN-crush-injury (CNCI), (3) CNCI group (CNCI+L+1.0J) treated with a combination of 10.0 mg/kg LIMK2-inhibitors and low-dose (1.0 mg/kg) JNK-inhibitors, and (4) CNCI group (CNCI+L+10.0J) treated with a combination of 10.0 mg/kg LIMK2-inhibitors and a high dose (10.0 mg/kg) of JNK-inhibitors. Ten days after surgery, erectile response, histological-studies, and Western-blot was investigated. RESULTS: The CNCI group showed a reduced maximal ICP/MAP or AUC/MAP, decreased immunohistochemical-staining of α-SMA, decreased SM/collagen ratio, increased phospho-cJun-positive apoptotic cells, increased phospho-LIMK2-positive fibroblasts, increased cJun-phosphorylation, increased LIMK2/Cofilin-phosphorylation, decreased Bcl-2/Bax ratio, and increased protein-expression of fibronectin, compared to the Sham group. Both the CNCI+L+1.0J and CNCI+L+10.0J groups showed improvements in erectile-responses, content of cavernosal α-SMA, number of phospho-cJun-positive apoptotic cells, Bcl-2/Bax ratio and cJun phosphorylation. Their improvements in the CNCI+L+10.0J group showed a tendency to be greater than those in the CNCI+L+1.0J group. Also, in the 2 treatment groups, rectification of SM/collagen ratio, number of phospho-LIMK2-positive fibroblasts, LIMK2/Cofilin-phosphorylation, and protein-expression of fibronectin was observed. CONCLUSION: This study suggests that combined inhibition of JNK and LIMK2 may improve erectile function by suppressing cavernosal apoptosis and fibrosis via restoration of cJun/Bcl-2/Bax and LIMK2/Cofilin pathways at 10 days after CN injury.


Assuntos
Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/etiologia , Proteínas Quinases JNK Ativadas por Mitógeno/antagonistas & inibidores , Quinases Lim/antagonistas & inibidores , Pênis/lesões , Pênis/inervação , Traumatismos dos Nervos Periféricos/complicações , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Animais , Modelos Animais de Doenças , Combinação de Medicamentos , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
18.
Nanomedicine ; 20: 102033, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31173931

RESUMO

Erectile dysfunction (ED) is a significant medical condition, with high impact on patient quality of life. Current treatments are minimally effective in prostatectomy, diabetic and aging patients due to injury to the cavernous nerve (CN); loss of innervation causes extensive smooth muscle (SM) apoptosis, increased collagen and ED. Sonic hedgehog (SHH) is a critical regulator of penile SM. We developed a self-assembling peptide amphiphile (PA) nanofiber hydrogel for extended release of SHH protein to the penis after CN injury, to suppress SM apoptosis. In this study we optimize the animal model, SHH concentration, duration of suppression, and location of delivery, to maximize SM preservation. SHH treatment suppressed apoptosis and preserved SM 48%. Increased SHH duration preserved SM 100%. Simultaneous penis/CN delivery increased SM 127%. Optimization of SHH PA delivery is essential for clinical translation to ED patients, and the PA vehicle has wide applicability as an in vivo delivery tool.


Assuntos
Sistemas de Liberação de Medicamentos , Proteínas Hedgehog/administração & dosagem , Hidrogéis/química , Nanofibras/química , Pênis/inervação , Pênis/patologia , Animais , Apoptose/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Humanos , Masculino , Pênis/lesões , Peptídeos/administração & dosagem , Peptídeos/farmacologia , Ratos , Ratos Sprague-Dawley , Tensoativos/administração & dosagem
19.
Eur Urol ; 76(2): 189-196, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30955973

RESUMO

BACKGROUND: Radical prostatectomy (RP) is recommended for the treatment of men with clinically localised prostate cancer. However, RP is associated with a high incidence of erectile dysfunction (ED), which can impact the quality of life (QoL) significantly. OBJECTIVE: To evaluate the effectiveness of end-to-side nerve grafting surgery to restore erectile function and improve sexual QoL in men with ED after RP. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of a single-centre experience of nerve grafting in men with ED following RP was performed. Seventeen men had surgery between March 2015 and October 2017 in Melbourne, Australia, which fulfilled study inclusion and exclusion criteria. INTERVENTION: Microsurgical bilateral end-to-side nerve grafts from a selective fascicular neurotomy of the femoral nerve to the penile corpora cavernosa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Results were serially measured utilising the International Index of Erectile Function (IIEF-5) and the sexual domain of Expanded Prostate Cancer Index Composite (EPIC-26). The proportion and 95% confidence interval (CI) of men recovering sexual function following nerve grafting were determined. RESULTS AND LIMITATIONS: All patients had ED following their RP. Median age at nerve grafting was 64yr (interquartile range [IQR] 60-66yr). Median time between nerve- and non-nerve-sparing RP, and nerve grafting was 2.4 (IQR 2.1-3.1) and 2.2 (IQR 1.7-5.1)yr, respectively. Median follow-up was 18 (IQR 15-24) mo. At 12mo after nerve grafting, 71% (95% CI 44-90%) of patients had erectile function recovery sufficient for satisfactory sexual intercourse, and 94% (95% CI 71-99%) and 82% (95% CI 57-96%) had clinically significant improvements in sexual function and reduced bother, respectively. There were two minor wound infections. Limitations include the retrospective study design. CONCLUSIONS: End-to-side nerve grafting restored erectile function in 71% of men with ED following RP, supporting previous findings. Of the men, 94% had clinically relevant improvements in sexual QoL. We recommend multicentre implementation of post-RP nerve grafting into clinical practice with appropriate data collection to confirm its efficacy and feasibility. PATIENT SUMMARY: We provide confirmatory evidence that end-to-side nerve grafting surgery restored erectile function and improved sexual quality of life in, respectively, 71% and 94% of men with erectile dysfunction following radical prostatectomy.


Assuntos
Vias Autônomas/cirurgia , Disfunção Erétil/cirurgia , Nervo Femoral/cirurgia , Prostatectomia/efeitos adversos , Qualidade de Vida , Nervo Sural/transplante , Idoso , Coito , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis/inervação , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante Autólogo/métodos
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