International Journal of Impotence Research最新文献

The Peyronie's Disease Questionnaire (PDQ) has been instrumental in providing standardized, patient-centered evaluation of Peyronie's disease. However, the evolving understanding of sexual health and diversity invites a re-examination of this tool's underlying assumptions. This Perspective discusses the PDQ's current framework, its contributions, and its limitations, particularly in capturing the heterogeneity of patients' sexual experiences. Drawing from the developmental pathways of other sexual health instruments, we reflect on the importance of inclusivity in questionnaire design and the potential benefits of future revisions or alternative tools that better reflect contemporary clinical and sociocultural realities.

Testosterone replacement therapy (TRT) remains controversial in men with a history of prostate cancer due to historical concerns regarding oncologic safety. This scoping review aimed to systematically map existing evidence on the safety and efficacy of TRT in men following definitive treatment for prostate cancer. A systematic search of PubMed, CENTRAL, and Embase identified 447 records, from which 12 studies met inclusion criteria. Most were retrospective cohort studies, with sample sizes ranging from 10 to 152 men. TRT was not associated with an increased risk of biochemical recurrence or cancer progression in any included study. Reported PSA kinetics remained within expected post-treatment parameters, and several studies showed lower recurrence rates in TRT groups compared to controls. TRT consistently increased total and/or free testosterone and improved hypogonadal symptoms. However, the evidence base is limited by retrospective designs, small sample sizes, heterogeneous outcome reporting, and a lack of long-term data. Despite these limitations, findings suggest TRT may be cautiously considered in selected men with stable disease and confirmed hypogonadism. High-quality prospective studies are needed to clarify safety in diverse and high-risk populations and inform future clinical guidelines.

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.