International Journal of Impotence Research最新文献

Sleep Related Painful Erections (SRPE) are parasomnias exclusive to Rapid Eye Movement (REM) sleep, causing sleep disturbances, daytime fatigue, and impaired quality of life. Due to a lack of standardized management, we developed a diagnostic and treatment pathway for this rare condition at our institution. Patients diagnosed with SRPE from 2017-2024 by strict criteria were recruited into our novel pathway. This included a comprehensive diagnostic panel to exclude potential confounding causes of penile pain through history, clinical examination, laboratory tests and imaging studies. Once SRPE is diagnosed a stepwise approach of initiating Baclofen (10 mg daily at night), followed by polysomnography (PSG) (to explore sleep architecture and implement sleep medication and/or treat obstructive sleep apnoea accordingly) and pelvic floor physiotherapy (PFP) (to target pelvic floor hypertonicity). Symptoms were evaluated using a dedicated questionnaire during clinic follow-up. Patients achieving a symptom-free period of >6 months were discharged. Twenty patients with SRPE (mean age 46.2 ± 11.6 years) were included. The mean delay to referral was 3.5 ± 3.1 years, with a mean of 3.3 ± 2.1 SRPE episodes per night (range 1-7) lasting 33 ± 23.7 minutes. 85% of patients completed most of the pathway. Baclofen was administered to 17 patients (10-80 mg at night), 17 underwent PSG, and 9 had PFP assessment. Baclofen benefited 70.6% of patients: 35.3% managed with Baclofen alone, 52.9% required additional sleep medication, and Baclofen was replaced by Etilefrine (5-15 mg at night) in 11.8%. PSG findings included fragmented sleep (76.5%), REM sleep abnormality (47.1%), and mild sleep apnoea (41.2%). Among those assessed for PFP, 66.6% had abnormal pelvic floor muscle tone and initiated PFP. After 3.5 ± 1.9 years of follow-up, 45% were successfully discharged and 55% are still on follow-up and experienced symptom improvement. This multimodal pathway offers a promising framework for managing SRPE.

Sickle cell disease is one of the most common autosomal recessive genetic disorders with 23% and over 70% of men with this condition, experiencing episodes of ischaemic priapism and stuttering priapism, respectively, with potentially severe consequences. The effective prevention of sickle cell disease induced ischaemic priapism and stuttering priapism requires a multidisciplinary and multimodal approach. A search of the English literature was performed utilising Pubmed® and Google Scholar to identify publications on contemporary and novel treatment options, with their associated treatment outcomes if available, that are utilised to prevent stuttering priapism episodes and hence a fulminant ischaemic priapism. This narrative review focuses on three main aspects which include firstly, patient education and lifestyle modifications. Secondly, strategies aimed at preventing stuttering priapism episodes with traditional treatments such as alpha-adrenergic agonists and hormone manipulation strategies among others. Finally, we review treatments utilised to treat the underlying sickle cell disease with contemporary options such as hydroxyurea to more novel therapies such as crizanlizumab and voxelotor. The role of potentially curative techniques such as gene therapy and stem cell transplantation are also reviewed and summarised.

The seminal vesicles (SVs) have long been recognized for their role in male fertility, yet their contribution to male sexual function is often underestimated. In recent decades, studies have gradually unveiled an association between SVs and various male sexual dysfunctions (SDs), including diminished libido, erectile dysfunction, premature ejaculation, delayed ejaculation, and orgasmic disorder. We conducted a comprehensive literature search of publications up until April 2024 in PubMed, Google Scholar, and CNKI, focusing on original studies, case reports, and reviews addressing the relationship between SVs and male SDs. The aim was to explore the pathophysiological mechanisms, clinical evaluation, and management of this relationship, providing urologists and andrologists with new insights into diagnosing and treating complex male SDs. Current research suggests that SVs may play a role in male sexual function, but the evidence remains limited. Future large-scale, rigorously designed studies are needed to further validate this relationship.

Ischaemic priapism is a urological emergency characterised by a prolonged, painful erection unrelated to sexual stimulation. While several aetiological factors contribute to this condition, the pharmacological causes have gained significant attention in recent years. This narrative review aims to comprehensively assess ischaemic priapism, specifically focusing on its pharmacological aetiology. We propose an approach and assessment strategy to the numerous factors associated with pharmacologically induced ischaemic priapism. By enhancing our understanding of the pharmacological causes of this condition, healthcare professionals can improve patient management and reduce the long-term complications associated with ischaemic priapism.

The aim of this meta-analysis was to determine the relationship between erectile dysfunction (ED) and serum homocysteine (Hcy) levels. A comprehensive search was performed using databases such as Web of Science, PubMed, and the Cochrane Library to identify suitable studies published by July 2023. The statistical analysis involved calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs) using STATA software. Twelve studies with 1766 ED patients and 2340 non-ED control participants were included in this meta-analysis. The pooled results indicated that the Hcy levels of ED patients were obviously greater than those of control participants (SMD (95% CI) = 0.97 (0.51,1.43), p < 0.001). Subgroup analysis revealed a greater SMD in ED patients aged>40 years, overweight status, those with a mild-moderate International Index of Erectile function (IIEF) score, and those living in Mediterranean countries, (1.18 (0.61, 1.75), p < 0.001; 1.27 (0.72, 1.82), p < 0.001;1.63 (1.04, 2.22), p < 0.001; 1.18 (0.61, 1.75), p < 0.001, respectively). Our meta-analysis indicated that subjects with ED exhibit higher levels of serum Hcy. However, due to the existence of publication bias, more rigorous and large-sample studies are needed.