International Journal of Impotence Research最新文献

Vasectomy, a permanent method of preventing the release of sperm, has been widely used as effective birth control, with millions of men undergoing the procedure worldwide each year. Although vasectomy is effective and relatively simple, it is still a subject that receives considerable scrutiny, especially regarding any health effects. Indeed, the relationship between vasectomy and health risks has been a controversial topic. This review includes the examination of the evidence linking vasectomy to oncologic sequelae (i.e. prostate and testicular cancer). In addition, a review of the literature linking vasectomy to sexual dysfunction, cardiovascular disease, primary progressive aphasia/frontotemporal dementia, anti-sperm antibodies, and reproductive hormone changes is also presented. Overall, vasectomy appears safe with no convincing evidence for long term health risks.

We aimed to assess the clinical characteristics of patients presenting for premature ejaculation (PE) as their primary medical complaint over a 15-year time frame. Data from 257 men seeking first medical help for life-long PE between 2008 and 2022 were analysed. Clinical data and serum hormones were collected in each case. At baseline all patients completed the International Index of Erectile Function (IIEF), the Beck Depression Inventory (BDI), and the Premature Ejaculation Diagnostic Tool (PEDT). Descriptive statistics and linear regression analyses were applied. Median (IQR) age at presentation was 32 (26-37) years, and PEDT, BDI and IIEF-Erectile Function (IIEF-EF) scores were 14 (11-17), 7 (1-11) and 19 (10-26), respectively. Of all, 182 (70.9%) patients reported some degree of erectile dysfunction according to IIEF-EF domain scores. Throughout the 15-year time frame, patient's age at presentation significantly decreased over time (beta -0.4, p < 0.001). In details, patient's age at presentation decreased by 1 year every two years of evaluation. Furthermore, depressive symptoms (beta -0.8, p < 0.001) and the severity of PE at presentation as scored with the PEDT (beta -0.5, p < 0.001) linearly decreased overtime. According to a 5-year group subdivision, age at presentation decreased from 2008-2012 to 2013-2017 (p = 0.04) and further decreased between 2018 and 2022 (p = 0.01). Similarly, baseline BDI scores significantly decreased from 2008-2012 to 2018-2022 (all p < 0.001). PE severity at first assessment was stable between 2008-2012 and 2013-2017 but decreased thereafter (p < 0.01). Patients in a steady couple relationship more frequently asked for medical attention for PE between 2018-2022 compared to 2013-2017 and 2008-2012 (72.0% vs. 43.8% vs. 51.6%, p < 0.001). In conclusion we showed that patients' age has decreased over the last 15 years in men with life-long PE. PE severity and depressive symptoms at presentation showed a significant decline overtime. Men in a steady sexual relationship were more likely to seek medical attention for PE in recent years.

Urethroplasty has evolved over last decades, with significant improvements in surgical techniques and graft types. In this narrative review, we aimed to explore the evolution of urethroplasty techniques for bulbar urethral strictures. To do this, the review is structured into three main sections: the Historical Background section highlights the seminal contribution from early pioneers to contemporary techniques, which re-gained momentum in reconstructive urology. Starting with the early techniques in the 19th and 20th centuries, we focused on the pioneering innovations of the 1990s, ultimately leading to the most recent tissue-preserving techniques. The second part presents a literature review comparing different graft types and critically evaluating surgical outcomes from multiple original articles and meta-analysis. Specifically, similar success rates were reported for oral and preputial grafts for the treatment of anterior urethral strictures, while long-term outcomes suggest graft deterioration over time. Furthermore, data on optimal surgical techniques remain limited. Lastly, Future Perspectives address ongoing innovations, including new graft and flap combinations for complex strictures, emphasizing the continuous refinement of less invasive, tissue-preserving techniques.

Improvements in the quality of penile cancer management are difficult due to the rarity of the condition and a limited evidence base for treatment decisions. Penile cancer and some of its highly morbid treatments can cause profound psychosexual and physical effects that negatively impact quality of life. Multidisciplinary interventions are required to equip patients with the support necessary to manage their emotional, physical, work, and lifestyle challenges to optimize health, well-being, and recovery. This paper outlines a model of supported self-management, which is a novel model of care for people with penile cancer to mitigate disease and treatment morbidity.

Surgical therapy of Peyronie's disease is the gold standard for correction of the associated penile curvature. In patients with co-existing erectile dysfunction, not responding to medical/conservative treatment, penile prosthesis implantation is indicated and recommended. Severe residual curvature in these cases can be addressed by plaque incision and grafting. The novel collagen fleece TachoSil^® (Corza Medical, MA, USA) has emerged as a reliable and robust graft for this purpose, with favorable results. Hatzichristodoulou was the first to publish his new technique of plaque incision and grafting with TachoSil^® for residual curvature correction during penile prosthesis implantation in 2018 (PICS Technique). Since then, this technique was adopted and used by various surgeons. In the current narrative review all publications using this novel graft after plaque incision for residual curvature correction will be presented and respective results discussed. Moreover, the surgical technique will be highlighted in detail. The TachoSil^® has self-adhesive properties which make it unique and the ideal graft for this indication. Results of the studies on this topic, that are available so far, are excellent. The technique is safe. However, data from more patients and even more long-term follow-up results of patients treated with this technique and graft are requested.

Penoscrotal decompression (PSD) has emerged as a promising surgical intervention for refractory ischaemic priapism, involving proximal corporotomies and the drainage of ischaemic blood. Initial outcomes have shown high success rates in achieving detumescence, low recurrence rates, and relatively good preservation of erectile function. This meta-analysis aims to comprehensively evaluate PSD's effectiveness across three key metrics: detumescence, prevention of recurrence, and erectile function preservation. A systematic review and meta-analysis, following PRISMA guidelines, identified 9 publications that met the inclusion criteria. They encompassed five case reports, two abstracts, and two observational cohort studies, with data on 62 patients who presented with refractory ischaemic priapism. Notably, around half (46.7%) of the patients had conventional distal shunts prior to PSD. Overall following PSD, detumescence was achieved in 89.3% (CI 95%, 0.78-0.95). Post-PSD recurrence of ischaemic priapism occurred in 12.7% (95% CI, 0.06-0.24). Erectile function was preserved in 54.8% of the patients who had follow-up (95% CI, 0.40-0.68). These findings inform us that PSD proves to be a viable and effective surgical option for refractory ischaemic priapism with a key feature being better sexual function preservation outcomes compared to shunting procedures. Given the paucity of data, further larger scale prospective studies of robust designs are still necessary to better establish PSD's role within the treatment algorithm for refractory ischaemic priapism.

This retrospective study examines 58 transgender women who presented with cosmetic concerns following gender-affirming vaginoplasty between January 2020 and April 2023. The cohort's mean age was 36.8 years (±9.8), with a mean BMI of 29.5 kg/m² (±7.1). Most patients were Black or African American (41.4%) or White (31.4%), and 43.0% had wound healing comorbidities. Of the total cohort, 62.1% (36/58) underwent penile inversion vaginoplasty (PIV), 31.0% (18/58) robotic-assisted vaginoplasty with peritoneal flaps, and 6.9% (4/58) shallow-depth vaginoplasty. A total of 36.2% (21/58) patients reported cosmetic concerns, most frequently labial (20.7%), clitoral (12.1%), hypergranulation tissue (8.6%), mons pubis fullness (5.2%), and introital scarring (5.2%). Management included expectant care, in-office procedures (e.g., silver nitrate for hypergranulation), and surgical revision. Surgical revision was performed in 80.9% of patients, with all reporting post-operative cosmetic satisfaction. A guide to surgical revision is discussed for each cosmetic concern subgroup. A tiered approach involving expectant management, in-office interventions, and surgical revision can effectively address these issues and enhance patient satisfaction.

Pelvic physical therapy is an evidence-based, first-line treatment for many pelvic floor disorders and sexual dysfunction. Studies have shown that pelvic physical therapy programs can both improve pelvic floor dysfunctions and sexual function. This article aims to provide an overview of the current state of the art regarding pelvic physical therapy for male sexual dysfunction to inform healthcare providers who treat men with sexual dysfunction better. A literature review was performed in Google Scholar, PubMed, and Science Direct to find review articles, research articles, and case studies about the effect of pelvic physical therapy treatments for male sexual dysfunction. Twenty-six articles were found about various pelvic physical therapy interventions. Besides this overview of the literature, an overview of interventions used in clinical practice is also provided. This narrative review supports the potential efficacy of pelvic physical therapy in addressing male sexual dysfunction. Pelvic physical therapy approaches that comprise exercise modalities, electrotherapy approaches, manipulative techniques, lifestyle changes, behavioral suggestions, and pain management strategies, should be suggested for potential benefits in improving erectile function, premature ejaculation, and sexual dysfunction-associated chronic pelvic pain. More research is needed to examine the effect of pelvic physical therapy on hypoactive sexual desire and delayed ejaculation.