International Journal of Impotence Research最新文献

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.

Priapism, a prevalent complication in sickle cell disease (SCD) patients, manifests as prolonged and painful erections unrelated to sexual arousal. The detailed mechanisms contributing to this condition, especially regarding sympathetic function in the corpus cavernosum that maintains penile flaccidity, remain to be elucidated. In this study, it was hypothesized that the pathways of the sympathetic nervous system would be down-regulated, thereby contributing to the development of ischemic priapism in sickle cell disease. This study aimed to investigate the contractions induced by stimulation of sympathetic terminals and the expression of tyrosine hydroxylase in the corpora cavernosa of Berkeley SCD mice. C57BL/6 mice (wild-type, WT) and Berkeley SCD mice were used. A total of 22 mice were used in this study, with 11 allocated to the WT group and 11 to the SCD group. Mice corpus cavernosum was dissected free and mounted in 7-mL organ baths containing Krebs solution. Noradrenergic contractions were obtained using electrical-field stimulation (4-32 Hz) in corpus cavernosum strips from WT and SCD mice. Measurements of tyrosine hydroxylase phosphorylated at Ser-31 and total tyrosine hydroxylase protein expressions in cavernosal tissues were also measured by western blot. The neurogenic contractions were significantly lower (P < 0.05) in the SCD group compared to WT group at all tested frequencies. The protein expression of both total tyrosine hydroxylase and tyrosine hydroxylase phosphorylated at Ser-31 was significantly decreased by approximately 46.28% (P = 0.01) and 55.32% (P = 0.03) in cavernosal tissues from the SCD group compared to the control group, respectively. In conclusion, sympathetic hypoactivity characterized by the downregulation of tyrosine hydroxylase contributes to the hypocontractility of the corpus cavernosum in Berkeley SCD mice. This suggests an impairment in the mechanism responsible for maintaining penile flaccidity, potentially predisposing to erections without sexual stimulation, similar to those observed in ischemic priapism. Pharmacological treatments aiming to restore sympathetic tone in the penis might hold promise for addressing ischemic priapism in SCD.

Inflatable penile prosthesis (IPP) implantations are commonly performed in hospital settings which accommodate an overnight stay and are increasingly being performed as day procedures in outpatient settings with same-day discharge. This study sought to investigate the safety and feasibility of day surgery insertion of an IPP. Surgical parameters and incidence of postoperative complications including infection, hospital admission, emergency room visitation, and additional analgesia were investigated. This prospective study included all adult patients undergoing day surgery insertion of an IPP at an ambulatory surgical center classified as ASA 1-3, between February 2023 and April 2024. All procedures were performed via infrapubic approach under spinal anesthesia or deep sedation with local anesthesia. 52 patients were enrolled with a mean age of 62.5 ± 3.1 [43-79] years. All procedures were performed successfully with no intra-operative complications. The mean surgery duration was 65.2 ± 17.9 [35-130] minutes. The mean recovery time was 115.9 ± 58.2 [50-323] minutes. No patients required hospital admission or had acquired a post-operative infection. One patient required emergency room visitation, which was unrelated to the surgery. 5.9% (n = 3) of patients required additional postoperative analgesia. Our results demonstrate the safety and feasibility of performing an IPP implantation in an outpatient setting.

This study aimed to review the current knowledge on priapism in the paediatric and adolescent population through a review of the current literature. Priapism is defined as a prolonged and persistent penile erection lasting over 4 h, unassociated with a sexual stimulus or persisting after ejaculation and orgasm. It has an incidence of 0.3-1.5 per 100,000 per annum in males of all ages, and comprises 3 main types: ischaemic, non-ischaemic and stuttering. The most common cause of priapism in children is sickle cell disease, and these individuals usually have the ischaemic type of priapism, which is a true urological emergency. We discuss in this article the management pathways for children and young adults, with the main emphasis being on accurate diagnosis and emergent management. Erectile dysfunction is the main consequence of delayed management.

In recent decades, the assessment of male sexual function has been a subject of enduring interest. The use of the RigiScan®, a conventional diagnostic tool designed to differentiate between psychological and organic causes of erectile dysfunction (ED), has decreased due to several disadvantages. In this study, patient perspectives on the merits and drawbacks of the RigiScan®, as well as preferences for a future diagnostic device, were explored. Patients at St. Antonius Hospital and Leiden University Medical Center who underwent RigiScan® examinations were surveyed. A pretested questionnaire was used to gather data on their experiences, satisfaction levels, and suggestions for improvement. Among the 120 distributed questionnaires, a 39.2% response rate was achieved. The process of applying the RigiScan® around the penis was reported to have an average difficulty rating of 4.6 ± 2.5 (range: 1-9) points. While 74.5% of the participants were able to keep the device on all night, 25.5% of the participants experienced difficulties. Sleep quality was assessed at 5.5 ± 2.6 (range: 0-9) points. The participants reported an average pain rating of 4.7 ± 2.8 (range: 0-9) points. Despite these challenges, 69.6% of the participants reported that the device met their expectations, while 30.4% of the participants were dissatisfied. The key areas for improvement included device size (33.7%), user-friendliness (25.5%), sound (9.2%), hygiene (7.1%), and pain (6.1%). This study revealed that patients who underwent a nocturnal erectile function assessment with the RigiScan® device preferred a more patient-friendly and less intrusive diagnostic device. Further research is needed to determine whether a new sensor possessing these improved characteristics can increase patient satisfaction.

Introduced in the late 1990s, nerve grafting, particularly with sural and genitofemoral nerves, aims to enhance erectile function recovery when neurovascular bundles cannot be preserved following radical prostatectomy. Over the past three decades, researchers have conducted numerous animal and clinical studies to explore the application and clinical effectiveness of this method, with the hope of benefiting patients suffering from erectile dysfunction after radical prostatectomy. Animal studies have demonstrated the potential of various grafting materials, including autologous nerve and vein grafts, and bioengineered grafts, in promoting nerve regeneration and erectile function recovery. Clinical studies, especially those focusing on sural and genitofemoral nerve grafts, have shown mixed results with varied success rates due to methodological weaknesses and small sample sizes. This review thoroughly incorporates current data, explores emerging nerve grafting methods, demonstrates the complexity of nerve grafting outcomes, and emphasizes the necessity for continuous research, including multi-institutional randomized controlled trials, to establish standardized protocols and optimize patient selection for nerve grafting in the management of erectile dysfunction after radical prostatectomy.

The high prevalence of erectile dysfunction (ED) underscores the critical importance of interventions and preventive measures targeting potential risk factors, among which obesity stands out. Relative fat mass (RFM) emerges as a superior indicator for quantifying body fat compared to traditional metrics like body mass index (BMI) or waist circumference (WC). However, research on the relationship between RFM and ED is extremely limited. A total of 3627 participants from the National Health and Nutrition Examination Survey 2001-2004 were eligible for analysis. The RFM is calculated using the following formula: RFM = 64-(20×height/WC). Weighted multivariable logistic regression models were utilized to assess the correlation between RFM and ED, supplemented by smooth curve fitting to further explore the linear association. When all potential covariates adjusted, continuous RFM demonstrated a positive association with ED prevalence (odds ratio (OR): 1.11, 95% confidence interval (CI): 1.05-1.18, P = 0.002). When RFM was categorized into tertiles (T1-T3), participants in T3 group exhibited a significantly higher likelihood of ED (OR: 2.19, 95% CI: 1.19, 4.05, P = 0.020) compared to those in T1. Subgroup analyses revealed a stronger correlation among participants aged over 60 years, obese individuals, and those with hypertension, while weaker correlations were observed among those with diabetes and cardiovascular disease (CVD). After sensitivity analysis for severe ED, the aforementioned regression analysis results remained statistically significant. The final ROC analysis demonstrated that the predictive ability of RFM was superior to that of BMI and WC, with an AUC (95% CI) of 0.639 (0.619-0.659). Elevated RFM demonstrated a linear correlation with increased incidence of ED and exhibited strong predictive capability for ED, underscoring the importance of obesity intervention for ED. Future studies with larger clinical samples are necessary to confirm our findings and expand the application value of RFM in assessing ED risk.

Female orgasmic experience and intensity depend on several biological, anatomical, cultural, psychological and relational factors, yet studies have not explored how receptiveness to different stimulations (clitoral, vaginal, or both) affects subjectively perceived orgasmic intensity. Using data from sexually active, heterosexual women in two Italian nationwide surveys from 2021 and 2023, we evaluated orgasmic experience, sexual and psychological well-being using validated psychometric tools (FSFI, Orgasmometer, GAD-7, PHQ-9), also considering several socio-demographic factors, aiming to identify changes in terms of subjectively perceived orgasmic intensity according to different stimulations. The two surveys (Sex@COVID study, from April 7^th to May 4^th, 2020, n = 6821; and the FATHER Study, from May 12^th to June 12^th, 2023, n = 1845) were hosted on a dedicated website and were advertised through social media, radio broadcast, and interviews on national newspapers. Among 1,799 women meeting inclusion criteria, 40.7% primarily experienced clitorally activated orgasms (CAO, n = 733), 18% vaginally activated orgasms (VAO, n = 324), and 41.2% both types (Clitorally and Vaginally Activated Orgasms, CaVAO, n = 742). Significant psycho-sexological differences between the two studies were observed, with additional evidence suggesting the impact of lockdown and social distancing on sexual outcomes. Women experiencing CaVAO attained the highest FSFI and Orgasmometer scores, followed by those with VAO, and lastly, those with CAO (p < 0.001 for both). Regression analysis confirmed the same trend for Orgasmometer scores (R² = 0.247, p < 0.001), also highlighting the relevance of sexual dysfunction (according to FSFI, β = -1.34 ± 0.08, p < 0.001) for orgasmic intensity. Lastly, women preferring masturbation to partnered sexual activity had lower orgasmic intensity (β = -0.41 ± 0.07, p < 0.001). Age, psychological status and relationship status had no significant effect on the model. Despite some limitations, this is the first study addressing the association between receptiveness to different stimulations and orgasmic intensity on a large sample using validated psychometric instruments.