International Journal of Impotence Research最新文献

Post-vasectomy pain syndrome (PVPS) is a chronic and potentially debilitating condition affecting a subset of men undergoing vasectomy. Despite its impact on quality of life, PVPS remains underrecognized, and management strategies are often inconsistent due to limited high-quality evidence. This review aims to synthesize current evidence on the prevention, diagnosis, and management of PVPS and to provide clinically relevant recommendations. PVPS etiology appears multifactorial, involving immunological, mechanical, and neuropathic mechanisms. Diagnosis is clinical, with adjunctive imaging and nerve blocks providing diagnostic and prognostic value. Initial management is conservative, including NSAIDs, neuropathic agents, and pelvic floor therapy. In refractory cases, microsurgical spermatic cord denervation, vasectomy reversal, or epididymectomy may be considered. Psychosocial factors are important and require multidisciplinary care. PVPS demands a nuanced, stepwise approach. Prevention through informed consent and careful surgical technique is key. Further research is needed to standardize diagnostic criteria and validate treatment pathways to optimize patient outcomes.

Hypoactive Sexual Desire Dysfunction (HSDD) in women has a complex origin, and addressing modifiable factors can lead to the best outcomes. One contributing factor is sexual boredom, particularly in women in monogamous relationships and we decided to evaluate sexual novelty as a therapeutic strategy in such women using prospective randomized study design. These women were recruited following screening using a Decreased Sexual Desire Screener (DSDS). Participants' baseline sexual boredom was assessed using the Sexual Boredom Scale (SBS). Reasons for sexual boredom were identified, and customized novelty packages were developed accordingly. The participants were divided into two groups: Group A received psychotherapy alone (n = 196), while Group B (n = 202) received psychotherapy along with a customized sexual novelty package. Sexual desire levels were measured and compared at baseline and after a six-month intervention using the Elements of Desire Questionnaire (EDQ). The groups were similar in age, duration of monogamy, SBS scores, and baseline EDQ scores. Post-intervention results showed that the improvement in EDQ scores for the sexual novelty group was double that of the psychotherapy group (1.8 ± 0.3 vs 0.9 ± 0.1, p < 0.0001). Moreover, multiple regression models showed that lower age of the participant (p = 0.0253) and a longer period of monogamy (p = 0.0268) adversely affected sexual desire.

Recent studies have explored peripheral electrical stimulation (pES) as a potential treatment for erectile dysfunction (ED). This systematic review and meta-analysis evaluate the efficacy of pES in ED patients. A systematic search was conducted across PubMed, Scopus, ScienceDirect, and Web of Science to identify randomized controlled trials (RCTs) published between 2015 and 2025. Studies comparing pES to sham procedures, standard therapies, or no treatment were included. Eligible studies assessed objective or subjective erectile function outcomes, primarily using the International Index of Erectile Function (IIEF-5). A meta-analysis was performed using a random-effects model. Only three RCTs (n = 82) met inclusion criteria. pES was associated with a significant mean increase in IIEF-5 scores versus controls, with a pooled mean difference of 5.04 points (95% CI, 4.04-6.04). However, heterogeneity was high (I² = 86%, p < 0.001) and a significant difference in terms of pES protocols was noted. No adverse effects were reported. Hypothetical mechanisms of pES in ED have been discussed. pES shows potential as a novel, non-invasive ED treatment targeting multiple physiological pathways. The low certainty of evidence, limited number of RCTs, and study heterogeneity highlight the need for further research.

Delayed ejaculation (DE) and anejaculation (AE) pose significant clinical challenges in andrology and sexual medicine, with no universally effective or standardized treatments currently available. In clinical practice, management strategies are primarily empirical. Drawing inspiration from the physiological mechanisms underlying nocturnal emissions, we propose a novel therapeutic approach for non-organic DE and AE. This method aims to facilitate ejaculation by enhancing seminal vesicle fluid secretion, thereby increasing prostatic urethral pressure during sexual activity. To this end, we administered Yangjing Capsules, a traditional Chinese herbal formulation with kidney-tonifying properties, to promote seminal vesicles secretory function. Preliminary clinical findings demonstrated an efficacy rate of 83.3% in the treatment group, compared to 40% in the control group treated with ephedrine tablets (RR = 2.083; 95% CI:1.331-3.626; P = 0.0016). We anticipate that this strategy may offer a novel option for the clinical management of non-organic DE and AE and provide new insights into therapeutic development in this field.

Surgical site infections remain a devastating complication of inflatable penile prosthesis (IPP) implantation. We evaluated a novel surgical protocol combining chlorhexidine-alcohol skin preparation with fibrin sealant-mediated hemostasis and no drain placement, hypothesizing that it would reduce infection and hematoma rates. Between January 2020 and December 2023, 103 men underwent primary IPP placement with a protocol of 2% chlorhexidine gluconate/70% isopropyl alcohol (ChloraPrep®) skin antisepsis and intraoperative application of Evicel® fibrin sealant to corporotomy suture lines, subcutaneous tissues, and pump pocket. This group was compared with 115 historical controls who received povidone iodine skin preparation only and routine surgical drains between January 2015 to December 2019. The primary endpoint was IPP infection at 12 months; secondary endpoints included hematoma rate, operative time, length of stay, and patient satisfaction. No infections occurred in the study cohort (0/103), compared to 3.5% (4/115) of controls (p < 0.001). Hematoma incidence was 1.0% (1/103) versus 5.2% (6/115) in controls (p = 0.03). Mean operative time (52.4 ± 13.8 min vs. 58 ± 18 min, p = 0.12) was similar between groups, while same-day discharge rates were higher in the study cohort (94.7 vs. 88.0%, p = 0.03). Combining chlorhexidine-alcohol skin antisepsis with fibrin sealant hemostasis and eliminating drains is a viable option to reduce infections and hematomas in IPP surgery.

Hyaluronic acid (HA) fillers are widely used in aesthetic medicine due to their biocompatibility and reversibility with hyaluronidase. However, their use in penile augmentation (PA) remains limited, and knowledge of hyaluronidase application in this context is sparse. This case series presents four patients with residual HA from previous penile girth enhancement (PGE), successfully managed using hyaluronidase. These cases illustrate its utility in correcting asymmetries, managing adverse effects, and preparing the site for reinjection. Although underutilized in urologic practice, hyaluronidase represents an effective adjunct in the refinement and maintenance of HA-based PGE.

Recurrent ischemic priapism is a common complication in males with sickle cell disease (SCD), strongly associated with chronic intravascular hemolysis. Hemolysis elevates circulating free heme levels, which are metabolized by heme oxygenase (HO) into carbon monoxide (CO). CO activates soluble guanylate cyclase (sGC), increasing cyclic GMP (cGMP) and promoting smooth muscle relaxation. This study hypothesizes that excess extracellular heme contributes to the pathophysiology of priapism by impairing corpus cavernosum contractility through the HO-CO-sGC-cGMP pathway. The aim of this study was to investigate the effects of heme on contractile mechanisms in the mouse corpus cavernosum and assess the involvement of this signaling pathway. A total of 114 male C57BL/6 mice (3-4 months old) were used. Mice corpus cavernosum was dissected free and mounted in 7-mL organ baths containing Krebs solution. Contractions were induced by phenylephrine (1 nM-300 µM), KCl (1-300 mM), or electrical field stimulation (EFS; 2-32 Hz). Tissues were pre-incubated with heme (100 µM) or vehicle (0.1% DMSO), with or without the HO inhibitor 1 J or the sGC inhibitor ODQ (10 µM, 30 min). Additional groups were pre-treated with the heme oxygenase (HO) inhibitor 1 J (10 µM) or the sGC inhibitor ODQ (10 µM) prior to heme exposure. Pre-incubation with heme significantly reduced EFS-induced contractions across all tested frequencies (e.g., 32 Hz: control 1.20 ± 0.17 mN vs. heme 0.67 ± 0.12 mN; P = 0.02; n = 6). Similarly, phenylephrine-induced contraction was attenuated by heme, with a decrease in Emax (control 0.90 ± 0.08 mN vs. heme 0.57 ± 0.11 mN; P = 0.03; n = 7), without changes in pEC₅₀. KCl-induced contractions were also affected, with reduced potency (pEC₅₀: control 1.18 ± 0.06 vs. heme 1.90 ± 0.11; P = 0.04; n = 6), though Emax remained unchanged. The inhibitory effects of heme were abolished by 1 J or ODQ in all protocols, indicating that the HO-CO-sGC-cGMP pathway mediates these responses. In conclusion, heme impairs contractile responses of the corpus cavernosum through activation of the HO-CO-sGC-cGMP signaling cascade. These findings identify a novel mechanism potentially contributing to priapism in SCD and support further investigation of this pathway as a therapeutic target.