International Journal of Impotence Research最新文献

Erectile dysfunction (ED) is a common condition in men; however, evidence of its association with mortality is limited. We examined the association between ED and long-term all-cause and cardiovascular (CV) mortality in a nationally representative cohort of adult men. This prospective cohort study included data from men aged 20 years and older from the 2001-2004 National Health and Nutrition Examination Survey linked to National Death Index records through December 31, 2019. ED was defined as reporting sometimes or never being able to achieve or maintain an erection adequate for satisfactory intercourse. Primary outcomes were the associations of ED with all-cause and  CV mortality, evaluated using survey-weighted Cox proportional hazards regression models. Among 4 110 men followed for a median of 16.3 years, 1 226 deaths (419 CV deaths) occurred. In fully adjusted models, ED was independently associated with an increased risk of all-cause (HR, 1.45; 95% CI, 1.20-1.75) and CV (HR, 1.57; 95% CI, 1.12-2.19) mortality. The magnitude of these associations was similar to those observed for other CV risk factors such as diabetes mellitus, hypertension, and stroke. These findings suggest the need to broaden clinical perspectives on ED beyond sexual health to recognize its significance as a marker of mortality risk.

Sleep-related painful erections (SRPE) and stuttering priapism (SP) are two rare disorders of penile erection. The aim of this article is to highlight the key similarities and differences between each condition and their management. We performed a literature review on the PubMed and Medline databases with a particular focus on the pathophysiology, risk factors, investigations and management of SRPE and SP. The main presenting feature in both SRPE and SP is sleep disruption due to brief episodes of painful erections that are typically self-limiting. SP is considered a subtype of ischaemic priapism and sickle cell disease is an important risk factor. These patients can develop major priapic episodes which require emergency management. The pathophysiology in SRPE is less well-defined and episodes only occur during sleep, detumesce quicker than in SP and do not progress to ischaemic priapism. Treatment aims are to prevent recurrence, but no established guidelines exist and the limited data is mainly from case studies. Management options in SP include hormonal analogues and α-agonists but in SRPE, baclofen has demonstrated the most consistent results. Our review suggests that SRPE and SP are two distinct conditions and further research is required to develop optimal management strategies for each disease process.

Simultaneous stress urinary incontinence (SUI) and erectile dysfunction (ED) are commonly caused by prostate surgery. Penile prosthesis is the gold standard for erectile dysfunction refractory to conservative therapies, fixed male sling and artificial urinary sphincter are recommended in mild and moderate/severe stress urinary incontinence respectively. The implantation of these devices can be simultaneous or delayed. This systematic review analyzes articles on simultaneous implantation of penile prosthesis and anti-incontinence devices. We search on Pubmed/Medline and Scopus: "penile prosthesis" AND "artificial urinary sphincter", "male sling", "Mini-Juppette", "ATOMS", "ProACT", "urethral bulking", "Advance", "Virtue". We have included 21 studies, mostly retrospective. The size of study cohorts is relatively small (2-65 patients) and the main cause of stress urinary incontinence and erectile dysfunction was radical prostatectomy. The average operating time appeared longer (57-218 min), although without evidence of intraoperative complications and an average hospital stay of 1-3 days. The average follow up of the studies ranged from 1 month to 94 months. Studies expressed different outcomes measurements, that could not allow a cumulative analysis. The overall continence outcomes were encouraging, with social continence rates (no more than 1 pad/day) ranging from 72 to 100%. The overall satisfaction for the inflatable penile prosthesis was high (84-100%). The postoperative complication rate did not show an augmented risk for double implants. All studies did not report any technical or surgical implant obstacles in synchronous versus metachronous implantation.