International Journal of Impotence Research最新文献

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful lesions primarily in apocrine gland-bearing regions, with scrotal involvement in 6% of male patients. Despite its notable prevalence, particularly in Western countries, HS remains frequently under-reported, leading to delays in diagnosis and treatment that exacerbate disease prognosis and significantly diminish patients' quality of life. The complex etiology of HS involves a multifactorial pathogenesis including genetic, anatomical, immunological, and environmental factors, which also contribute to mental health challenges in affected individuals. While medical management is essential, surgical intervention is crucial for managing moderate to severe HS, providing symptomatic relief, infection control, and reduced recurrence rates. This narrative review consolidates current understanding of HS, focusing on its epidemiology, pathophysiology, clinical features, and management strategies. It highlights contemporary surgical techniques ranging from tissue-sparing surgery to wide excision of involved tissue, emphasizing the importance of a multidisciplinary approach that incorporates multimodal therapy and newer biological treatments. Additionally, the review discusses options for surgical reconstruction, particularly techniques such as skin grafts and flaps that are best suited for the male genitalia, addressing the unique challenges in this area. Ultimately, this review aims to enhance awareness and foster improved treatment outcomes for those affected by HS.

Hematoma formation is one of the complications of inflatable penile prosthesis implantation (iPP), possibly indicating surgical evacuation, or resulting in infection and removal of the implant. Gelatin Sponge (Gelfoam®, Pfizer, USA) is sterile compressed sponge, used as a hemostatic agent, directly applied to bleeding surfaces. It is water insoluble, but absorbable within 4-6 weeks with minimal scar formation. In this study, we evaluate the use of Gelfoam® for control of hemostasis and minimizing post-operative bleeding in iPP surgery. Fifty-eight patients were enrolled into one of two groups according to their will, documented in the consent form: the Gelatin Sponge (GS) group (n = 22), and the control group (n = 36). Following cylinder insertion, corporotomies were closed by tying the stay sutures. For the GS group, Gelfoam® was applied to the closed corporotomies, pump space and reservoir track. A closed suction drain was inserted for all cases and monitored post-operatively. Mummy wrap was not used to evaluate Gelfoam® independently. Patients were monitored for drain output and complications. The mean drain output was significantly higher in the control group compared to GS group, both for the first 24 h (156.7 cc ± 91.6 cc vs. 45.9 cc ± 36.9 cc, 70.7% difference, p < 0.0001) and 24-48 h (40.7 cc ± 42.4cc vs. 8.6 cc ± 12.6 cc, 78.8% difference, p < 0.0001). No cases of hematoma formation, infection, foreign body reaction, mass formation or hypersensitivity reaction were encountered in the GS group, compared to two cases of hematoma in the control group, one of which dictated drainage (2/36). The findings herein demonstrate the safety and tolerability of Gelfoam® in iPP surgery, as well as its efficacy in minimizing post-operative bleeding.

Penile augmentation procedures are controversial, primarily because most men seeking these interventions have penile dimensions within the normal range, and due to the associated risks of severe complications. This narrative review explores the effects of foreign body implantations and injections in the penis. Retrospective case series reveal the use of unapproved oil-based substances injected in non-sterile conditions, leading to sclerosing lipogranuloma and requiring complex treatments such as tissue excision and skin transplantation. The prevalence of this practice is unknown. Retrospective reports of foreign body implantation for enhancing sexual pleasure highlight complications such as pain, erosion, inflammation, nodules, skin ulcer, necrosis, penile deformity, gangrene and even death. In contrast, prospective studies on Hyaluronic acid filler injections show that these are better tolerated, however the follow-up period is short. Retrospective series of graft implantation reported improvement in penile girth and patient satisfaction; however, it had a negative impact on penile length. Silicone implants, examined in prospective cohorts carry risks of infection, erosion, seroma and necrosis, resulting in some cases of severe penile deformities and are associated with a removal rate of up to 10%. A multidisciplinary approach is essential for men requesting penile augmentation, and further research is needed to successfully manage patients seeking these procedures.

This single-institution, pre- post-intervention, retrospective study (2019-2021) compared the effect of dorsal penile nerve and ring block of 20 cc bupivacaine (0.25%) with and without dexmedetomidine (70 µg) + dexamethasone (4 mg) on pain scores, and both intra- and postoperative analgesia after primary inflatable penile prosthesis implantation. Dorsal penile nerve and ring block were completed with 10 cc of solution each, immediately before first incision. Anesthesia was not instructed to adjust their anesthetic plan for surgery. The primary outcomes were 11-point '0-10' numerical rating scale pain scores at 0, 2, 6, 12, 18, and 24 h postoperatively and cumulative narcotic use in those time windows. Secondary outcomes included intraoperative narcotic use, intraoperative hypotension (MAP < 60 for >5 min or requiring intervention), and intraoperative bradycardia (HR < 50 for >1 min). 98 patients met inclusion criteria. 32 were in the bupivacaine-only block (pre-intervention) group and 66 were in the bupivacaine, dexmedetomidine, dexamethasone combination block (post-intervention) group. Pain scores at all time points were significantly lower in the post-intervention than in the pre-intervention group (1.1 vs 3.8 p < 0.001, 1.6 vs 3.9 p < 0.001, 3.1 vs 4.9 p = 0.0047, 2.4 vs 4.3 p = 0.0011, 2.9 vs 5.3 p = 0.0047, 2.3 vs 4.4 p < 0.001). Cumulative postoperative narcotic requirement was lower for the post-intervention group (46.8 vs 65.5 mg oral morphine equivalents, p = 0.0067). Secondary outcomes (hypotension and bradycardia) were noted in 16 post-intervention cases, each mild and brief. Intraoperative penile block with bupivacaine and adjuvant dexmedetomidine and dexamethasone can safely improve immediate post-operative analgesia and decrease opioid consumption in the first 24 h.

Fungal infections after inflatable penile prosthesis (IPP) surgery are uncommon but clinically significant due to their association with prosthesis loss and reoperation. While antifungal prophylaxis has been proposed as a preventive strategy, supporting evidence remains limited and inconsistent. At our institution, perioperative antifungal agents have never been part of the IPP protocol. Among 1772 cases performed without antifungal use, we encountered a single fungal infection caused by Meyerozyma guilliermondii, which matched the operating surgeon's otitis externa isolate. Following this event, we implemented routine use of surgical hoods that fully cover the ears and scalp for all scrubbed personnel. Since then, over 1535 IPP procedures have been performed without a single fungal infection. Based on this experience and a review of relevant literature, we propose that surgical hoods that fully cover the ears and scalp may offer a simple, cost-effective, and underutilized means of reducing fungal contamination during urologic prosthetic surgery.

TGF-β1 plays a fundamental role in the pathogenesis of Peyronie's disease, driving the excessive extracellular matrix accumulation and fibroblast activation characteristic of fibrosis. As in many fibrotic disorders, its action via Smad transcription factors presents a key therapeutic target. Given the notable deficiency in proven effective conservative treatments for Peyronie's disease, particularly in its acute phase, this study aimed to investigate the efficacy of baicalein, a flavonoid known to inhibit the TGF-β1/Smad signaling pathway, thereby offering a promising therapeutic strategy. We established a rat model of Peyronie's disease on 30 male Wistar albino rats using a single intratunical injection of a combined solution containing 0.1 mL recombinant TGF-β1 protein (0.01 μg/μL) and 0.1 mL sodium tetradecyl sulfate (0.01 μg/μL, 3%), and administered baicalein intralesionally at low (0.8 μg/L, 50 μL), moderate (1.6 μg/L, 50 μL), and high (3.2 μg/L, 50 μL) doses. There were no significant differences among the groups in terms of animal weights or degrees of curvature before and after treatment. Our comprehensive analysis of blindly performed histopathological and immunohistochemical parameters, including tunica albuginea thickness, fibrosis severity, and smooth muscle content, demonstrated that intralesional baicalein suppressed fibrosis formation in corporeal bodies (p = 0.002) in a dose-dependent manner, preserved crucial cavernosal smooth muscle tissue (p = 0.005), and effectively prevented pathological increases in tunica albuginea thickness (p = 0.002). Importantly, systemic toxicity was not detected in any of the subjects. As the first study to investigate intralesional baicalein for Peyronie's disease, our findings positively contribute to the literature and underscore its potential as a safe, accessible, and highly effective agent. Further in vitro and in vivo research is warranted to fully explore baicalein's capacity to address current treatment gaps in this challenging condition.

Humans have long used various substances to enhance sexual pleasure and performance, often at the expense of their overall health. This review investigates the sexual-related effects of recreational drugs, including amphetamines, 3,4-methylenedioxymethamphetamine (MDMA), mephedrone, gamma-hydroxybutyrate (GHB), and ketamine. By examining anecdotal evidence, self-reports, and limited scientific data, this study aims to clarify the current understanding of these drugs' effects on sexual function. Amphetamines, potent central nervous system stimulants, are associated with increased sexual desire and arousal, delayed ejaculation and prolonged sexual sessions, and heightened orgasm intensity. However, their use is also linked to compulsive sexual behavior, erectile dysfunction with chronic use, and a high risk of dependency. MDMA, known for its empathogenic properties, enhances intimacy, physical sensuality, and sexual desire while intensifying orgasm. Nevertheless, it can impair erectile and ejaculatory function, with prolonged use leading to chronic sexual dysfunction. Mephedrone, a synthetic cathinone with stimulant effects similar to amphetamines, increases sexual desire and reduces inhibitions, though specific evidence regarding its sexual-related impacts remains limited. GHB, with its combined stimulant and depressant properties, is often used to enhance sexual experiences. Its effects include increased arousal, intensified orgasm, lowered inhibitions, and greater sexual openness. However, its use carries a substantial risk of dependency. Finally, ketamine, a dissociative anesthetic used recreationally for its euphoric effects, shows minimal associations with sexual function, with limited evidence pointing to reduced inhibitions. Chronic use is linked to urinary and sexual dysfunction. Across all substances, unsafe sexual behaviors and a heightened risk of STI/HIV transmission emerge as major negative consequences, underscoring the broader health risks associated with sexualized drug use. This review highlights the need for greater awareness of both the perceived benefits and risks of sexualized associated with sexualized drug use. It underscores the necessity for rigorous, controlled research to better understand the effects of these substances on sexual function and calls for the development of legitimate treatment options for sexual dysfunction, which are often inadequately addressed through illicit drug use.

The diagnosis of female genital cutting/mutilation (FGC/M) in children is complex, as findings may be subtle or mimic normal vulval variation. England and Wales safeguarding guidance advises referral of any signs of FGC/M, regardless of the observer's background. We hypothesised that most children referred to a specialist clinic for concerns about vulval appearance would not have undergone FGC/M, reflecting gaps in anatomical knowledge and limitations of current guidance. A retrospective review of electronic medical records for all children (0-17years) seen from October 2014 to March 2025 was undertaken. The primary outcome was the proportion of appearance-related referrals. Secondary endpoints included confirmed finding of FGC/M, family history of FGC/M, vulval findings, and whose concerns triggered the referral. Among 291 referrals, 129/291 (44.3%) were confirmed to have undergone FGC/M. Forty-two cases (42/291 (14.4%)) were triggered for appearance concerns (median age 4 y IQR 2-11). FGC/M was verified in just one of these 42 children (1/42 (2.4%)). There was a family history of FGC/M in 14/42 (33.3%). Thirty-four (34/42 (81.0%)) had typical anatomy and six (6/42 (14.3%)) had common paediatric vulval conditions. Non-clinicians generated 26/42 referrals (61.9%). Updated guidance is needed to balance vigilance in safeguarding with a more nuanced, informed and child-centered approach.

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.