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1.
Ann R Coll Surg Engl ; 102(2): e36-e38, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31530167

RESUMO

Penile calciphylaxis or calcific uremic arteriolopathy is a rare urological condition often associated with patients undergoing renal dialysis for end-stage renal disease. The majority of cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as an individual entity has brought little attention. The rates of comorbidity and mortality of these patients are often particularly high. Early diagnosis and a multidisciplinary approach are therefore essential. We report a case of penile calciphylaxis in a 59-year-old man with end-stage renal failure on haemodialysis who was successfully managed conservatively.


Assuntos
Angioplastia/métodos , Calciofilaxia/terapia , Tratamento Conservador/métodos , Doenças do Pênis/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Bandagens , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Artéria Femoral/cirurgia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/irrigação sanguínea , Pênis/patologia , Diálise Renal/efeitos adversos , Resultado do Tratamento
2.
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
3.
Radiol Med ; 125(3): 288-295, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823294

RESUMO

PURPOSE: High-flow priapism is an incomplete and painless persistent erection caused by trauma. Its diagnosis is performed thanks to clinic and imaging evaluation with detection of fistula/pseudoaneurysm in the cavernous tissue. This paper aims to retrospectively assess the efficacy and safety of superselective arterial embolization in patients with high-flow priapism. MATERIALS AND METHODS: From January 2008 to March 2017, nine patients with high-flow priapism have been treated in a single center with embolization. The main etiology was trauma in eight subjects. The patients were evaluated with laboratory examinations and clinical and imaging findings (color Doppler ultrasonography and angiography). The mean follow-up time after embolization was 24 months. RESULTS: Eleven procedures were performed in nine patients: two of them required a second treatment session because of recurrence after 1-2 weeks. Embolic agents were microcoils, microparticles (300-500 µm) and Spongostan. Restoration of erectile function was monitored by clinical and color Doppler evaluation during follow-up. CONCLUSIONS: Superselective embolization should be the procedure of choice in patients affected by high-flow priapism; this technique appears to be successful in preserving erectile function. The choice of the embolic agent is crucial, and it should be tailored for each patient.


Assuntos
Embolização Terapêutica/métodos , Pênis/irrigação sanguínea , Priapismo/terapia , Adolescente , Adulto , Angiografia , Criança , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis/lesões , Priapismo/diagnóstico por imagem , Priapismo/etiologia , Recidiva , Fluxo Sanguíneo Regional , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
4.
Urology ; 137: 146-151, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887351

RESUMO

OBJECTIVE: To explore a series of classic bladder exstrophy (CBE) cases referred to the authors' institution where primary closure with penile disassembly epispadias repair was complicated by penile injury. The penile disassembly technique is frequently combined with bladder closure in patients with CBE undergoing the complete primary repair of exstrophy (CPRE). Penile disassembly has been posited as a risk for penile injury by ischemic mechanisms. METHODS: A prospectively-maintained institutional database of 1337 exstrophy-epispadias complex patients was reviewed for CPRE cases referred to the authors' institution, and those with injury to the penis were identified. The location, extent of injury, and subsequent management is reported. RESULTS: One hundred and thirteen male CBE patients were referred after prior CPRE. Twenty-six (20%) were identified with penile loss and reviewed. Eighty-one percent were closed in the neonatal period, and 54% had a pelvic osteotomy. Median follow-up time was 9.9 years (range 0.6-21.3). Of 26 patients with penile loss, 77% had unilateral loss and in 23% had bilateral loss involving the glans and/or one or both corpora cavernosa. Three patients were successfully managed with myocutaneous neophalloplasty. CONCLUSION: Complete penile disassembly during bladder exstrophy closure may lead to penile injury. This major complication questions the continued application of complete penile disassembly in the reconstruction of bladder exstrophy.


Assuntos
Extrofia Vesical/cirurgia , Epispadia/cirurgia , Complicações Intraoperatórias , Doenças do Pênis , Pênis , Procedimentos Cirúrgicos Urológicos , Atrofia , Criança , Humanos , Recém-Nascido , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Masculino , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Pênis/irrigação sanguínea , Pênis/lesões , Pênis/patologia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Fatores de Risco , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
5.
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
6.
Urologiia ; (5): 112-113, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808643

RESUMO

Blood disorders, in particular chronic myeloid leukemia (CML), are among the rare etiological factors of priapism. A clinical observation of ischemic priapism lasting 18 hours, which developed in patients with previously not diagnosed CML, is presented in the article. The CML was subsequently diagnosed based on the results of blood analyses and bone marrow aspiration. Treatment strategy consisted of immediate aspiration of blood from the cavernous bodies (19G) followed by the intracavernous injection of phenylephrine solution. After resolving priapism, CML therapy was carried out, which allowed to avoid a recurrence of priapism.


Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Fenilefrina/administração & dosagem , Priapismo/terapia , Irrigação Terapêutica , Adulto , Antineoplásicos/uso terapêutico , Medula Óssea/patologia , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Masculino , Pênis/irrigação sanguínea , Fenilefrina/uso terapêutico , Priapismo/etiologia , Recidiva , Resultado do Tratamento
7.
Urologiia ; (5): 119-123, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808645

RESUMO

A clinical observation of the distal segmental thrombosis of the left corpus cavernosum is presented in the article. Efficient treatment was based on the results of contrast MRI, and timely application of long-term doses of antithrombotic drugs was done. It is allowed to avoid short-term formation of such a complication as cavernous fibrosis.


Assuntos
Fibrinolíticos/uso terapêutico , Pênis/diagnóstico por imagem , Priapismo , Trombose/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética , Masculino , Pênis/irrigação sanguínea , Priapismo/etiologia , Trombose/diagnóstico por imagem , Resultado do Tratamento
8.
Undersea Hyperb Med ; 46(5): 695-699, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683369

RESUMO

Successful penile replantations are rarely reported in the literature and are associated with significant complications. We present a case of a patient who auto-amputated his penis. Delayed microvascular replantation was performed approximately 14 hours following injury. He was treated with a phosphodiesterase inhibitor postoperatively, and adjuvant hyperbaric oxygen (HBO2) therapy was started 58 hours after replantation; 20 treatments at 2.4 atmospheres absolute (ATA), twice daily for eight days, followed by once daily for four days. Perfusion of the replanted penis was serially assessed using fluorescent angiography. With some additional surgical procedures including a split- thickness skin graft to the shaft due to skin necrosis he has made a complete recovery with return of normal urinary and sexual function. This unusual case illustrates the potential benefit of HBO2 therapy in preserving viability of a severed body part. Fluorescent angiography may have potential utility in monitoring efficacy of HBO2.


Assuntos
Oxigenação Hiperbárica , Pênis/cirurgia , Complicações Pós-Operatórias/terapia , Reimplante/métodos , Automutilação/cirurgia , Terapia Combinada , Desbridamento , Humanos , Masculino , Necrose , Pênis/irrigação sanguínea , Pênis/patologia , Fotografação , Adulto Jovem
10.
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
11.
Medicine (Baltimore) ; 98(27): e16184, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277124

RESUMO

RATIONALE: Microcoils are a permanent embolic material, and blood vessels that have been embolized by a microcoil remain occluded for a prolonged period of time. The pudendal artery is an important functional vessel for penile erection. Whether simultaneous embolization of the bilateral pudendal artery using microcoils can seriously affect penile erection has not been sufficiently studied. PATIENT CONCERNS: A 47-year-old male patient, after undergoing brain surgery, accidentally pulled out the Foley catheter causing a urethral hemorrhage. The patient was immediately treated using a new larger Foley catheter inserted under urethroscopic guidance and medication. However, massive bleeding occurred on the tenth day after the procedure. DIAGNOSIS: A right internal iliac angiography performed after the bleeding event demonstrated a rupture at the end of the right internal pudendal artery with the contrast agent flowing out directly from the urethra. A super selective internal pudendal angiogram showed a small amount of hemorrhage at the end of the left internal pudendal artery. INTERVENTIONS: The patient underwent interventional treatment. After the bilateral internal iliac angiography was performed, super-selective internal pudendal artery embolization with microcoils was performed. A subsequent bilateral internal pudendal angiogram did not show any abnormality. OUTCOMES: During the follow up period of 2 months, the patient had no complaints of difficulty in urination or sexual dysfunction. LESSONS: Some doctors do not advocate the use of coils as embolic agents in bilateral pudendal artery lesions because of concerns over erectile dysfunction. There is rich vascular circulation in the perineum. Thus, in arterial embolization for the treatment of penile bleeding, regardless of the type of embolic material used, the key is to ensure accurate embolization to maintain good collateral circulation. This principle can help limit the occurrence of sexual dysfunction to the lowest possible levels after such procedures.


Assuntos
Embolização Terapêutica/instrumentação , Hemorragia/etiologia , Doenças Uretrais/etiologia , Cateteres de Demora/efeitos adversos , Humanos , Artéria Ilíaca/lesões , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Pênis/lesões , Ruptura/etiologia
12.
Urology ; 131: 223-227, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31163184

RESUMO

Glanular venous malformations are uncommon in pediatric patients. The diagnosis can be easily achieved by observation, even if color Doppler ultrasound is useful for a better characterization. Abdomino-pelvic MRI is necessary to assess the extension of complex lesions and check for associated anomalies. Several therapeutic options are reported in literature. We report 3 paediatric cases successfully treated by surgery with no complications and functional sequelae. Cosmetic results were satisfactory, with minimal surgical scarring. In our opinion, surgery for small glanular venous malformations is indicated within puberty to prevent traumatic bleeding and psychological impact.


Assuntos
Doenças do Pênis/patologia , Doenças do Pênis/cirurgia , Pênis/irrigação sanguínea , Malformações Vasculares/patologia , Malformações Vasculares/cirurgia , Criança , Pré-Escolar , Humanos , Masculino
13.
Int J Radiat Oncol Biol Phys ; 105(2): 400-409, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31175904

RESUMO

PURPOSE: To assess whether BIO 300, a synthetic genistein nanosuspension, improves the therapeutic index in prostate cancer treatment by preventing radiation-induced erectile dysfunction (ED) without reducing tumor radiosensitivity. METHODS AND MATERIALS: Male Sprague-Dawley rats were exposed to 25 Gy of 220-kV prostate-confined x-rays. Animals were randomized to receive sham radiation therapy (RT), RT alone, RT with daily BIO 300 at 2 experimental dosing regimens, or RT with daily genistein. Erectile response was evaluated over time. Penile shaft tissue was harvested for histologic analyses. Murine xenograft studies using prostate cancer cell lines determined the effects of BIO 300 dosing on RT efficacy. RESULTS: Prostate-confined RT significantly decreased apomorphine-induced erectile response (P < .05 vs sham RT). Erection frequency in animals receiving prophylactic treatment with BIO 300 starting 3 days before RT was similar to sham controls after RT. Treatment with synthetic genistein did not mitigate loss in erectile frequency. At week 14, post-RT treatment with BIO 300 resulted in significantly higher quality of erectile function compared with both the RT arm and the RT arm receiving genistein starting 3 days before irradiation (P < .05). In hormone-sensitive and insensitive prostate tumor-bearing mice, BIO 300 administration did not negatively affect radiation-induced tumor growth delay. CONCLUSIONS: BIO 300 prevents radiation-induced ED, measured by erection frequency, erectile function, and erection quality, when administered 3 days before RT and continued daily for up to 14 weeks. Data also suggest that BIO 300 administered starting 2 hours after RT mitigates radiation-induced ED. Data provide strong nonclinical evidence to support clinical translation of BIO 300 for mitigation of ED while maintaining treatment response to RT.


Assuntos
Disfunção Erétil/prevenção & controle , Genisteína/uso terapêutico , Nanopartículas/uso terapêutico , Ereção Peniana/efeitos dos fármacos , Lesões Experimentais por Radiação/complicações , Protetores contra Radiação/uso terapêutico , Animais , Pressão Sanguínea , Modelos Animais de Doenças , Drogas em Investigação/uso terapêutico , Disfunção Erétil/etiologia , Fibrose , Masculino , Camundongos , Camundongos Nus , Ereção Peniana/efeitos da radiação , Pênis/irrigação sanguínea , Pênis/patologia , Próstata/efeitos da radiação , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional , Suspensões/uso terapêutico , Transplante Heterólogo
14.
Int Rev Psychiatry ; 31(2): 126-140, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31074664

RESUMO

Penile plethysmography (PPG) is the primary physiologic assessment method used to gauge sexual responses in adult men. Depending on the country or jurisdiction of assessment, stimuli used to elicit arousal can include videos, still images, and audio materials. It can depict a variety consenting and non-consenting sexual scenarios as well as neutral, non-sexual scenarios. Models in visual stimuli can be clothed, semi-clothed, or nude. Variation in stimuli modality and the type of sexual interest being tested can have a large impact on PPG outcomes. This paper reviews research on types of PPG stimuli, the different sexual interests being assessed, reliability and validity, and the impact of anonymizing models depicted in assessment materials. Innovations in stimuli development in three labs located in Canada, the United States, and the Czech Republic are also discussed. The work done in these three labs and the broader range of research on assessment stimuli are presented to highlight the need for a unified, multi-site, standardized approach to assess problematic sexual interests and their change in response to treatment.


Assuntos
Nível de Alerta/fisiologia , Transtornos Parafílicos/diagnóstico , Fotografação , Comportamento Sexual/psicologia , Gravação de Videoteipe , Adulto , Canadá , República Tcheca , Humanos , Masculino , Transtornos Parafílicos/psicologia , Pênis/irrigação sanguínea , Pletismografia/normas , Comportamento Sexual/fisiologia , Estados Unidos
15.
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
16.
Int Rev Psychiatry ; 31(2): 114-125, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30938553

RESUMO

This article provides a comparison and comprehensive analysis of varied approaches to the assessment of sexual interest and behaviours at different international sexual behaviour assessment labs. The assessment protocols are described for four sexual behaviour laboratories: the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic in Canada; the Medical University of South Carolina's Sexual Behaviours Clinic and Laboratory in the US; the Laboratory of Evolutionary Sexology and Psychopathology in the Czech Republic; and the Laboratory of Forensic Sexology in Russia. An overview of examinee demographics and types of cases assessed is provided for each lab. Assessment protocols, including psychometric measures and objective measures of sexual interest and arousal, such as penile plethysmography or eye-tracking, are also reviewed. The differences across labs may lead to interesting and productive cross-cultural investigations and studies about the efficacy of specific assessment methods.


Assuntos
Comparação Transcultural , Internacionalidade , Transtornos Parafílicos/diagnóstico , Pletismografia , Comportamento Sexual/psicologia , República Tcheca , Psiquiatria Legal/legislação & jurisprudência , Humanos , Masculino , América do Norte , Transtornos Parafílicos/psicologia , Pênis/irrigação sanguínea , Psicometria , Federação Russa
17.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936333

RESUMO

We present a case of intractable acute ischaemic priapism occurring secondary to newly commenced olanzapine. It demonstrates rapid intervention in a stepwise approach aiming to restore penile flaccidity in order to prevent chronic damage to the corpora cavernosa. After an unsuccessful conservative approach, our patient underwent two formal distal penile shunt procedures with no effective penile detumescence. Subsequently, bilateral proximal penile shunts were performed comprising a right corpus cavernosum to corpus spongiosum anastomosis and a left saphenous vein to left corpus cavernosum anastomosis. The patient remained an inpatient for observation, and detumescence was gradually achieved over several days after this procedure. However, follow-up revealed erectile dysfunction, and it was explained to the patient that he was unlikely to achieve further erections and that a penile implant was the only realistic option.


Assuntos
Antipsicóticos/efeitos adversos , Olanzapina/efeitos adversos , Pênis/cirurgia , Priapismo/induzido quimicamente , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Antipsicóticos/administração & dosagem , Humanos , Masculino , Olanzapina/administração & dosagem , Pênis/irrigação sanguínea , Pênis/efeitos dos fármacos , Priapismo/fisiopatologia , Priapismo/cirurgia , Prisioneiros , Resultado do Tratamento
18.
J Am Coll Cardiol ; 73(12): 1386-1394, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30846336

RESUMO

BACKGROUND: Fluorine-18 sodium fluoride (NaF), a bone-seeking radiopharmaceutical used to detect osseous metastases, localizes in regions of microcalcification in atherosclerosis. OBJECTIVES: To determine if atherosclerosis of penile arteries plays a role in erectile dysfunction (ED), this study analyzed NaF images in prostate cancer patients. METHODS: NaF positron emission tomography-computed tomography bone scans were evaluated in 437 prostate cancer patients (age 66.6 ± 8.7 years). Their urologic histories were reviewed for prevalent ED (diagnosed before the scan date) or incident ED (no ED at first scan, but developed during 1-year follow-up); patients with no ED (neither before the scan nor during follow-up) were included as a control group. A semicircular region of interest was set on the dorsal one-half of the penis (to avoid residual excreted activity in the urethra) on 5 contiguous slices at the base of the penis on positron emission tomography-computed tomography coronal reconstructions, and the average standardized uptake value (SUVmax) was described as NaF uptake. RESULTS: Of 437 patients, 336 (76.9%) had prevalent ED, 60 incident ED (13.7%), and 41 had no ED (9.4%). SUVmax in patients with prevalent (median 1.88; interquartile range [IQR]: 1.67 to 2.16) or incident (median 1.86; IQR: 1.72 to 2.08) ED was significantly higher than no ED (median 1.42; IQR: 1.25 to 1.54) patients (p < 0.001). After adjustment for other risk factors, the odds ratio of prevalent or incident ED was 25.2 (95% confidence interval: 9.5 to 67.0) for every 0.5-U increment in SUVmax with receptor operating characteristic area of 0.91 (95% confidence interval: 0.88 to 0.94). CONCLUSIONS: NaF uptake in penile vessels suggests that atherosclerosis is associated with ED in prostate cancer patients. The importance of NaF uptake needs to be tested in noncancer subjects and cause-effect relationship needs to be established.


Assuntos
Disfunção Erétil/diagnóstico por imagem , Radioisótopos de Flúor , Pênis/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Fluoreto de Sódio , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Estudos Retrospectivos
19.
Rev. int. androl. (Internet) ; 17(1): 1-7, ene.-mar. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-182208

RESUMO

Introduction: Diagnostic tests for vascular erectile dysfunction (ED) depend on cavernous smooth muscles (CSM) relaxation following an intracorporal injection (ICI). Enhanced sympathetic tone, which is not uncommon during performance of these tests, can bias its results. Also, CSM diseases can cause veno-occlusive diseases (VOD) ED. Corpus cavernosum electromyography (CC-EMG) potentials’ amplitudes represent the integrated sympathetic activity of healthy CSM. Stem-cells and gene-therapy are potential therapeutic options for impaired CSM. Objective: To utilize CC-EMG, as a new diagnostic technique that can confirm the integrity of CSM, and to identify patients with impaired CSM activity, among those diagnosed as vascular ED per Color Duplex Doppler Ultrasonography (CDDU). Patient and methods: Group 1 included 24 patients with ED and negative response to ICI. Group 2 included 10 men without ED. Patients included in group 1 had penile CDDU examination and all participants had spontaneous CC-EMG recordings. Results: According to CDDU parameters, group 1 was sub-grouped as nine arterial, ten VOD and five mixed type. CC-EMG potentials' amplitudes ranged 223-320, 179-237, 103-250 and 83-200μV for group 2 and arterial, mixed and VOD subgroups respectively. The widest ranges of potentials’ amplitudes were recorded in the subgroups of patients with an element of VOD. Four patients with ED, within these subgroups, had CC-EMG potentials’ amplitudes ranged 200-250μV that exceeded/approached the lowest value recorded from men in group 2. Conclusion: CC-EMG recordings elicited marked differences of CSM activity among patients diagnosed with an element of VOD ED per CDDU. This finding highlighted the need to utilize CC-EMG to assess the integrity of CSM. Identifying patients with impaired CSM activity may modify the chosen methods for therapeutic interventions


Introducción: Las pruebas diagnósticas para la disfunción eréctil (DE) vascular dependen de la relajación de los músculos cavernosos lisos (MCL) después de una inyección intracorporal (IIC). El tono simpático mejorado, que es frecuente durante la realización de estas pruebas, puede sesgar los resultados. Además, las enfermedades de los MCL pueden provocar DE con enfermedades venooclusivas (EVO). Las amplitudes de los potenciales de la electromiografía de los cuerpos cavernosos (CC-EMG) representan la actividad simpática integrada de los MCL sanos. Las células madre y la terapia génica son opciones terapéuticas potenciales para los MCL con discapacidad. Objetivo: Utilizar CC-EMG como una nueva técnica de diagnóstico que pueda confirmar la integridad de los MCL e identificar a los pacientes con actividad de MCL deteriorada entre los diagnosticados con DE vascular por ecografía Doppler color dúplex (CDDU, por sus siglas en inglés). Paciente y métodos: El grupo 1 incluyó a 24 pacientes con DE con una respuesta negativa a la IIC. El grupo 2 incluía a 10 varones sin DE. En los pacientes incluidos en el grupo 1 se realizó CDDU en el pene y todos los participantes presentaron grabaciones de la CC-EMG espontáneas. Resultados: De acuerdo con los parámetros CDDU, el grupo 1 se dividió en subgrupos, como 9 arteriales, 10 VOD y 5 tipos mixtos. Las amplitudes de los potenciales de la CC-EMG variaron entre 223-320, 179-237, 103-250 y 83-200μV para el grupo 2 y los subgrupos arteriales, mixtos y VOD, respectivamente. Los amplios rangos de amplitudes de los potenciales se registraron en los subgrupos de pacientes con un elemento de VOD. Cuatro pacientes dentro de estos subgrupos tenían amplitudes de potencial de la CC-EMG de 200-250μV que excedían/acercaban el valor más bajo para varones en el grupo 2. Conclusión: Las grabaciones de la CC-EMG provocaron marcadas diferencias de actividad de los MCL entre los pacientes diagnosticados con un elemento de VOD DE por CDDU. Este hallazgo destacó la necesidad de utilizar CC-EMG para evaluar la integridad de los MCL. La identificación de pacientes con actividad de CSM afectada puede modificar los métodos elegidos para las intervenciones terapéuticas


Assuntos
Humanos , Masculino , Disfunção Erétil/fisiopatologia , Doenças do Pênis/diagnóstico por imagem , Pênis/irrigação sanguínea , Eletromiografia/métodos , Ultrassonografia Doppler Dupla/métodos , Doenças Vasculares Periféricas/diagnóstico por imagem
20.
Khirurgiia (Mosk) ; (1): 43-49, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30789607

RESUMO

AIM: To analyze experimentally the outcomes of xenotransplantation (cadaveric artery, decellularized cadaveric artery) for tunica albuginea defects repair. MATERIAL AND METHODS: The study included 60 chinchilla rabbits. Rabbits underwent local replacement of tunica albuginea. Animals were divided into 2 groups (group 1 - human cadaveric artery, group 2 - decellularized cadaveric artery). The result was considered after 7, 14 and 30 days postoperatively. RESULTS: Tendency to stasis, sludge-phenomenon and ultimately development of fibrosis of transplantation area were histologically observed in group 1 after 30 days. In group 2 luminal surface of decellularized artery was smoothed, fibrin and blood elements were absent. In group 1 mean level of C-reactive protein was 3.86±0.43, 1.17±0.2 and 0.73±0.16 mg/L after 7, 14 and 30 days respectively. In group 2 the same values were 0.33±0.03, 0.23±0.03 and 0.11±0.02 mg/L. Differences were significant (t =-46.28, t = -25.95, t = -14.84; p<0.0001).


Assuntos
Artérias/transplante , Pênis/cirurgia , Transplante Heterólogo , Ferimentos e Lesões/cirurgia , Animais , Cadáver , Tecido Conjuntivo/lesões , Tecido Conjuntivo/cirurgia , Humanos , Masculino , Músculo Liso/lesões , Músculo Liso/cirurgia , Pênis/irrigação sanguínea , Pênis/patologia , Coelhos , Transplante Heterólogo/efeitos adversos , Transplante Heterólogo/métodos
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