International Journal of Impotence Research最新文献

Erectile dysfunction affects around 40% of men and is increasingly prevalent with age and comorbid conditions like cardiovascular disease and depression. Inflatable penile prostheses could be considered one of the definitive treatments for this condition. This systematic review aims to compare the safety and durability of AMS 700® (Boston Scientific), Coloplast Titan® (Coloplast), Rigicon Infla 10® (Rigicon), and Zephyr ZSI 475® (Zephyr) inflatable penile prostheses, focusing on infection rates, removals, and mechanical failures. A systematic review following PRISMA guidelines was conducted. The search identified studies on penile prostheses safety and patient satisfaction. Inclusion criteria were studies on adult males undergoing three-component penile prosthesis implantation for erectile dysfunction reporting data on removal rates, causes, and mechanical failures. Studies on implantation of two-component or malleable penile prosthesis were excluded. After the screening, 30 studies published between 1994 and 2023 were included. The median follow-up duration ranged from 12 to 206 months. Removal rates ranged from 0% to 52.9%, generally below 10%, with infection rates typically under 5%. AMS 700® devices had removal rates from 0.3% to 52.9%, while Coloplast Titan® devices ranged from 0% to 6.2%. Rigicon Infla 10® showed a low mechanical failure rate of 2-3% over short follow-up periods. Zephyr ZSI 475® had high initial mechanical failure rates (25.7%). Mechanical failures varied widely, with AMS® reporting rates from 0 to 37.3%, Coloplast Titan® from 0 to 9.1% but with median shorter follow-up durations. Most inflatable penile prostheses demonstrate good long-term tolerance and durability. While AMS 700® and Coloplast Titan® prostheses are well-established, the low mechanical failure rates of the Rigicon Infla 10®, although promising, need to be confirmed by further studies with a longer follow-up. Preliminary Zephyr® data are inconclusive but highlight the need for further evaluations. Rigorous long-term follow-up and comparative studies are essential to confirm these findings and guide clinical decision-making.

Lengthening corporoplasty is recommended for Peyronie's disease (PD) patients with severe (>60°) or complex curvature and preserved erectile function. This study aimed to evaluate lengthening corporoplasty outcomes using a graft of collagen fleece in Portugal. A multicentric retrospective study included PD patients who underwent the procedure between 2016 and 2024 at four Portuguese hospitals. Among 88 patients, the median age (IQR) was 59.0 (56.0-63.0) years, International Index of Erectile Function-5 (IIEF-5) score 22.5 (22.0-23.0), stretched penile length (SPL) 13.0 (12.0-14.0) cm, and curvature angle 80.0° (78.8-90.0)°. Dorsal curvature was most common (65.9%) and the median surgery duration was 92.5 (80.0-106.3) min. Early postoperative hematoma occurred in 8.0% of cases, and 2.3% had surgical site infections. No surgical reinterventions were needed. After a median follow-up of 31 months, complications included erectile dysfunction (38.6%), residual curvature (19.3%), reduced penile length (9.1%), penile pain (8.0%), and glans hypoesthesia (5.7%). SPL was 13.8 (12.5-15.0) cm immediately postoperative and 14.0 (13.0-15.0) at 1 month. New-onset erectile dysfunction treatments included phosphodiesterase type 5 inhibitors (34.1%), intracavernous alprostadil (1.1%), and penile prosthesis (3.4%). This study demonstrates effective curvature correction but high rates of postoperative erectile dysfunction, often requiring treatment.

Paraffinoma of the penis is a rare but potentially debilitating consequence of subcutaneous mineral-oil injection for penile enlargement. We report a 34-year-old male who presented after failed urethral catheterization with diffuse penile induration and pain during intercourse, following self-injection of paraffin into the preputial region. Clinical assessment and penile ultrasound with color Doppler supported the diagnosis; histology confirmed sclerosing lipogranuloma without malignancy. The patient underwent complete degloving, radical excision of infiltrated tissues, and reconstruction using full-thickness skin grafts harvested from the right biceps and left thigh. Postoperative care included compression dressings and targeted antibiotics, with satisfactory graft take and acceptable cosmetic outcome at 10 and 40 days. Persistent dissatisfaction with penile size highlighted the need for integrated psychological assessment alongside surgical management.

Erectile dysfunction is a major postoperative complication following radical prostatectomy. Various treatments for post- radical prostatectomy erectile dysfunction including nonsurgical phosphodiesterase-5 inhibitors, intraurethral alprostadil, intracavernosal injections and penile implant prosthesis, often yield suboptimal results. In this prospective single-center case series, we examine the efficacy and outcomes of Himplant^®, a subcutaneous silicone penile implant, placement in four patients with post-radical prostatectomy erectile dysfunction who experienced limited benefits with phosphodiesterase-5 inhibitors. Patient data including demographics, prostate cancer diagnoses, erectile dysfunction characteristics, previous treatments, and outcomes were collected. Himplant^® placement was performed in a standardized manner through a high scrotal incision in all cases. Follow-up evaluations were conducted to assess the effectiveness of the procedure and any associated complications. Patients were contacted and asked 15 questions regarding satisfaction and erectile function with the responses recorded. This study presents findings of high patient satisfaction, increases in flaccid penile length and girth, no incidence of adverse events, and improved erectile function following Himplant^® placement post-radical prostatectomy. Accordingly, we suggest Himplant^® placement in patients who are frustrated by their penile appearance and suffering from erectile dysfunction after radical prostatectomy. Further multicenter studies are warranted to validate these findings and assess long-term outcomes and patient-reported satisfaction.

Glansectomy with or without a neoglans reconstruction is commonly performed for invasive penile cancer confined to the glans penis. The aim of penile-preserving procedures is to maintain sexual and urinary function without compromising oncological outcomes. A systematic review was performed to evaluate the functional outcomes following glansectomy. Overall, 14 studies which included 327 glansectomy procedures were analysed. At a mean follow-up of 40.7 (range, 13-52) months, the recurrence rate was 9.1% (0-25%) and the disease-specific survival rate was 87.5-100%. Partial graft loss and meatal stenosis occurred in 6.1% (0-17.6%) and 8.1% (0-14.3%) respectively. 91.1% (50-100%) had preserved erectile function and 62.5% (33.3-100%) were sexually active. 75.6% (66.7-100%) of patients were voiding whilst standing up and 83.7% (63.6-91.2%) had maintained glans sensation. Satisfaction with the overall appearance was achieved in 86.3% (68.2-100%). The reporting of functional outcomes was heterogenous with a limitation that there are no standardised guidelines on the assessment of functional outcomes following glansectomy. Further research should focus on identifying appropriate tools for reporting functional outcomes following glansectomy and standardising reporting.

This cross-sectional study aimed to validate the male version of the Orgasmometer in Mandarin and to examine whether Chinese men with premature ejaculation (PE) experience reduced orgasmic intensity. From September 2020 to January 2023, a group of 230 men with PE (mean age=28.2 ± 4.8) and 107 men without sexual dysfunction (mean age= 35.1 ± 6.7), who were seeking help from the Department of Infertility and Sexual Medicine, underwent a detailed assessment from the andrologist and completed a questionnaire that included the Mandarin Orgasmometer (Orgasmometer-m), the Premature Ejaculation Diagnostic Tool (PEDT), and the erectile function domain of the International Index of Erectile Function (IIEF-6). Orgasmometer-m scores were 5.0 (4.0) in the PE group and 8.0 (3.0) in the non-PE group; PEDT scores were 14.8 ± 2.5 and 3.3 ± 2.4, and IIEF-6 scores were 27.9 ± 1.6 and 29.1 ± 1.2, respectively (p < 0.001). The Orgasmometer demonstrated good discriminative validity, with an area under the curve (AUC) of 0.8296 (95% CI: 0.7873-0.8719, p < 0.0001). A score of ≤6 was identified as the optimal cutoff for distinguishing low from high orgasm intensity, yielding 66.1% sensitivity and 86.9% specificity. These findings support the reliability of the Orgasmometer-m and suggest that men with PE report diminished orgasmic experiences.

Erectile function is a complex neurovascular process influenced by multiple physiological systems, including autonomic regulation, vascular integrity, and endocrine balance. Sleep-related erections (SRE), which occurs predominantly during rapid eye movement sleep (REM), plays a critical role in maintaining erectile physiology by ensuring periodic oxygenation of penile tissue and preventing fibrosis. Sleep fragmentation, particularly disruption of REM sleep, has been increasingly recognized as a contributing factor to erectile dysfunction (ED), with mechanisms involving heightened sympathetic activity, impaired parasympathetic vasodilation, and neuroendocrine dysregulation. Sleep disorders, such as obstructive sleep apnea and chronic sleep deprivation are associated with reduced SRE frequency, increased oxidative stress, and decreased nitric oxide bioavailability, all of which contribute to endothelial dysfunction and erectile impairment. Ageing exacerbates these issues by further reducing SRE occurrence and increasing the prevalence of sleep disturbances. Therapeutic strategies aimed at optimizing sleep architecture and its quality, including pharmacological, hormonal, and neuromodulatory interventions, may provide promising avenues for mitigating ED and promoting healthy ageing. This review highlights the interplay between sleep physiology, erectile function, and therapeutic implications, underscoring the importance of sleep optimization in ED management.

Sexual health during pregnancy remains an under addressed aspect of prenatal care, despite its significant impact on women's well-being. This study examined sexual activity, perceptions, satisfaction, and counseling patterns among women with high-risk and low-risk pregnancies in a culturally diverse population. The study was conducted at a single medical center in northern Israel between March and October 2024. A total of 198 pregnant women participated (response rate 91.9%), of whom 126 (63.6%) were classified as high-risk based on conditions such as diabetes or gestational diabetes (36.5%), prior preterm birth or cervical shortening (27.8%), two or more cesarean deliveries (18.3%), fetal abnormalities (7.9%), polyhydramnios (10.3%), hypertension (7.1%), hypercoagulability (5.6%), and twin pregnancies (4.0%). Maternal characteristics were generally comparable, although high-risk women were surveyed at an earlier gestational age than low-risk women (32.49 ± 4.69 vs. 35.36 ± 4.36 weeks, p < 0.001) and had a higher number of clinic visits (median 3 vs. 0, p < 0.001). Most participants in both groups reported decreased sexual activity during pregnancy (65.6 vs. 64.8%, p = 0.941), with no significant differences in sexual desire, partner's perceived desire, or sexual satisfaction (very satisfied: 50.4 vs. 54.9%, p = 0.814). A substantial proportion of patients (44.7% high-risk, 42.9% low-risk, p = 0.383) expressed a desire to receive information from a physician about sexual intercourse and desire, however, only 21.4% reported receiving such counseling from their physician, and embarrassment regarding these discussions was low (16.8 vs. 18.6%). Beliefs about the safety of intercourse were mostly similar, though a higher proportion of high-risk women strongly disagreed that intercourse should be avoided in high-risk pregnancies (17.1 vs. 8.5%, p = 0.043). Obstetric outcomes demonstrated lower gestational age at birth among high-risk pregnancies (38.00 ± 2.21 vs. 39.29 ± 1.25 weeks, p < 0.001), while birthweight and mode of delivery were comparable between groups. These findings indicate similar patterns of sexual function, perceptions, and satisfaction across pregnancy risk groups but reveal a substantial gap in physician-initiated counseling. Integrating routine, proactive discussions about sexual health into prenatal care may enhance patient understanding, reassurance, and overall well-being.