International Journal of Impotence Research最新文献

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.

Penile enlargement procedures have become increasingly popular for aesthetic and psychological reasons. While traditional enlargement techniques, such as fat grafting, hyaluronic acid fillers, and silicone implants, have varying degrees of success, they also present risks such as infection, migration, and resorption. The Hardrock Sandwich Technique (HST) combines bovine pericardial grafts with autologous plasma gel to enhance penile girth and incorporates suspensory ligament release with testicular prosthesis placement for length increase. However, data on the technique's long-term safety, effectiveness, and patient satisfaction remain limited. This study evaluates the safety, effectiveness, and patient satisfaction of HST use in elective penile enlargement surgery. It focuses on postoperative changes in penile dimensions, self-confidence, self-esteem, and complications over a period of at least one year after surgery. This retrospective, single-center study included 456 male patients who underwent the HST between April 2022 and September 2024, with at least one year of follow-up. Penile girth and length were measured preoperatively and on the 1^st day, 3^rd month, and 12^th month after the operation. Patient satisfaction, self-confidence, and self-esteem were assessed using the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory. Postoperative complications were recorded. On the first postoperative day, mean penile girth increased by 43.13% (4.51 ± 2.17 cm, p < 0.001), and penile length increased by 20.78% (2.17 ± 2.53 cm, p < 0.001). A total of 83.40, 71.10, and 75.30% of the patients reported improvements in satisfaction, self-confidence, and self-esteem, respectively, one year after the operation. Postoperative complications included seroma (6.12%), wound dehiscence (2.34%), infection (2.65%), and hematoma (1.40%). One patient had skin necrosis (0.22%), which required the graft to be removed. None of the patients experienced erectile dysfunction or ejaculation issues. The HST is a promising approach for penile augmentation that offers significant improvements in girth, length, and patient satisfaction with minimal complications.