International Journal of Impotence Research最新文献

Phosphodiesterase type 5 inhibitors (PDE5i) are among the first line treatment options in men with erectile dysfunction (ED). On-demand sildenafil has proved to be an effective PDE5i but with lower spontaneity scores compared to daily tadalafil treatment. We aimed to investigate the impact of on-demand sildenafil compared to bedtime use on efficacy and spontaneity scores in men with ED. We retrospectively analysed data from a cohort of men with mild/moderate ED treated for three months with on-demand sildenafil 50 mg oral suspension formulation (OSF) (group 1, n = 40), bedtime sildenafil 50 mg OSF (group 2, n = 40) and bedtime sildenafil 37.5 mg OSF (group 3, n = 40). After three months patients were evaluated with the International Index of Erectile Function-5 items (IIEF-5) and the Psychological and Interpersonal Relationship Scales-Short Form (PAIRS-SF) questionnaires. Propensity score matching was used to adjust for baseline confounders. The IIEF-5 and PAIRS-SF scores were compared between groups at follow-up with the repeated measures ANOVA test. Linear regression analyses tested the associations between study variables and spontaneity scores. After matching, median patient's age and ED duration were 56 (50-61) years and 18 (10-20) months, respectively. Compared to baseline, IIEF-5 scores significantly improved after sildenafil OSF treatment, irrespective of the therapeutic approach (all p < 0.01 vs. baseline). The PAIRS-SF spontaneity score was significantly better in group 2 [15 (13-16), p < 0.01] and group 3 [14 (14-16), p < 0.01] compared to the on-demand use [13 (12-13)]. Fewer time concerns were reported for bedtime use than on-demand sildenafil. Sildenafil OSF bedtime use was found to be an independent predictor for better spontaneity and fewer time concerns scores (all p < 0.001). Bedtime sildenafil OSF showed similar efficacy but better spontaneity scores than on-demand use. Bedtime sildenafil is a valuable option for men with ED prioritizing efficacy and sexual spontaneity.

We aimed to depict the age-specific distribution of total Testosterone (tT) levels among young men presenting to a single academic centre with uro-andrological complaints. Overall, tT levels from 2593 men aged 20-44 years were analyzed. Men were grouped into 'infertile men' and 'men with sexual dysfunction (SD)' according to their primary complaints. Data was also collected from 71 same-ethnicity age-comparable fertile controls. Linear regression fitted the relationship between tT and increasing age. Distribution of tT was determined for each 5-year age-group, both for the overall population and the subgroups. tT quantiles were reported for each sample sub-group and age-group. Of 2664 men, 1913 (71.81%) were classified as infertile, 680 (25.52%) with SD and 71 as fertile men (2.67%), respectively. tT levels depicted a reduction of 0.14 nmol/L per year between 20 and 44 years of age (p < 0.001) within the overall study population. Significant reduction was also observed for the population stratified by urological complaints (all p < 0.05). This is the first study to describe tT levels as a function of baseline clinical status in a large same-ethnicity cohort of young men, uniformly assessed using a standardized laboratory method.

Congenital penile curvature is a rare condition identified by an abnormal penile curvature present from birth. Surgical intervention is currently the most effective treatment and is generally deferred until after puberty; however, early correction is recommended by some due to its impact on psychosexual development. This systematic review aims to evaluate the literature on surgical techniques for congenital penile curvature correction, focusing on their efficacy, safety, and patient-reported outcomes. Conducted in accordance with PRISMA guidelines and registered with PROSPERO (ID: CRD42024526737), the review includes 59 studies meeting inclusion criteria. The findings indicate that numerous surgical techniques have been documented over the past decades, predominantly focusing on shortening procedures such as Nesbit, Yachia, tunica albuginea plication, and Essed-Schröder. These historically utilized methods remain effective for correcting congenital penile curvature, but they may result in side effects like penile shortening and erectile dysfunction. The review emphasizes the necessity for well-designed studies to better compare the benefits of various surgical techniques.

The implantation of a three-piece inflatable penile prosthesis (IPP) has been shown to be a safe and successful treatment with a high satisfaction rate among individuals with erectile dysfunction. This narrative review aims to explore ways to improve the functional outcomes of IPP implantation. We conducted an English-language narrative review using all relevant articles sourced from PubMed. Over the years, modifications in IPP surgery have focused on increasing the longevity of prostheses and improving functional outcomes. These modifications include advancements in surgical methods, implant types, intracorporeal tubing length, the use of rear tip extenders, and reservoir placement. IPP implantation continues to significantly improve quality of life, making it essential for surgeons to stay updated on the latest developments and research to ensure the best outcomes for their patients. Optimal functional outcomes are achieved by an experienced surgical team and the use of a safe, rapid, minimally invasive surgical technique with the latest technology and equipment.

We aimed to summarize in a systematic review the current evidence on the effectiveness of electrical stimulation in the treatment of erectile dysfunction. Following the PRISMA guidelines, we performed a literature search for randomized controlled trials using Medline, CINAHL, Embase, and Web of Science, and searched unpublished studies and trial registrations. We used Cochrane's risk-of-bias assessment tool and GRADE system to assess the certainty of evidence. From 3 586 potentially relevant records, we included three trials. Overall, 82 men with erectile dysfunction (20-65 years old), assessed using the IIEF-5 questionnaire, were randomized. Transcutaneous electrical stimulation was compared to placebo (Mean difference-MD:4.60, 95% Confidence interval-CI 0.28-8.92, n = 22), aerobic exercise (MD:6.50, 95%CI 5.10-7.90, n = 30), and used in association with pelvic floor muscle training with biofeedback and compared to the same procedure without electrical stimulation (MD:4.80, 95% CI 1.29-8.31, n = 30). We were unable to combine studies for meta-analysis due to clinical heterogeneity. This review was limited by the quality of existing evidence. The certainty of the evidence was very low due to risk of bias and small sample sizes. There is inconclusive evidence of the effectiveness of electrical stimulation in the treatment of erectile dysfunction.

Phalloplasty aims to construct a functional and aesthetic phallus in transgender and gender diverse and cisgender patients with absence or loss of penile tissue. Sensation is a critical outcome in postoperative quality of life, impacting placement of erectile devices, sexual function, and overall well-being. Despite this, there is currently a lack of consensus on strategies to optimize sensation in phalloplasty. A comprehensive search of Medline and Embase databases was conducted with keywords related to phallic sensation in penile reconstruction. 237 abstracts were identified, and 28 articles, with 178 patients, met inclusion for final analysis. Studies consistently demonstrate improved sensation with neurorrhaphy; however, significant heterogeneity exists in the reported number of nerve coaptations and coaptation techniques as well as donor and recipient nerve selection. Reported sensory outcomes are mostly limited to presence or absence of sensation (tactile and/or erogenous or unspecified) and/or orgasmic ability. The lack of granularity in reported outcomes makes it challenging to draw robust evidence-based conclusions regarding optimal surgical techniques for maximizing sensory outcomes. Additionally, there is minimal discussion of approaches beyond solely performing nerve coaptations. Based on literature review, histomorphometric data, and our experience in phalloplasty and peripheral nerve surgery, we present a comprehensive approach to optimizing sensory outcomes in phalloplasty based on four key factors: nerve topography, selecting optimal nerve coaptations, considering the impact of sensory end-organ receptors, and integration of sensory re-education protocols targeting cortical plasticity and sexual rehabilitation.

This review critically examines Post-Finasteride Syndrome (PFS), a condition eventually reported by men who have used finasteride for androgenetic alopecia or benign prostatic enlargement and experienced persistent adverse effects after discontinuation. We explore the clinical manifestations, including sexual dysfunction, neuropsychiatric symptoms, and physical changes, that collectively challenge both diagnosis and management. This review evaluates the evidence for PFS, discusses potential mechanisms including neurobiological alterations, genetic predispositions, and addresses the controversies surrounding its existence and recognition by the medical community. Emphasis is placed on the role of patient education and the need for thorough risk assessment before prescribing finasteride. Although contrasting data from literature, men treated with finasteride could develop a plethora of non-neglectable physical and psychological symptoms identifying PFS. A multidisciplinary approach to research, policy-making, and patient advocacy is essential to better understand, diagnose, and manage PFS, underlining the necessity for greater awareness and scientific inquiry into this contentious and impactful syndrome.

Penile cancer (PeCa) is rare but aggressive and life changing. Penile-preserving surgery (PPS) allows length preservation for sexual activity and normal voiding. Intraoperative frozen section examination (FSE) of resection margins helps to decide on how much penile tissue is excised. Oncological outcomes and diagnostic accuracy of FSE to date, however, are not well documented. The objective of this systematic review was to evaluate the efficacy of FSE in the treatment of PeCa and its impact on oncological outcomes. A systematic review was conducted with reference to the PRISMA statement. Studies published from 2009 to 2024 were identified through a search conducted between 1975 and 2024. The search yielded 7 studies involving 574 patients. Intraoperative FSE had a high percentage of accuracy, with a mean accuracy of 95.4% and a range of 92.9-99.4%. The mean values of sensitivity, specificity, positive predictive value, and negative predictive values were 71.4%, 99.9%, 98.8%, and 96.5%, respectively. Functional outcomes with PPS were encouraging, especially in terms of sexual function. The average local recurrence rate was 7.9%. There is a paucity of data on PeCa FSE in the literature. However, it appears that FSE is accurate and can be helpful in guiding surgeons intraoperatively when performing PPS.