International Journal of Impotence Research最新文献

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.

The artificial urinary sphincter is the standard surgical treatment for persistent stress urinary incontinence in male patients when conservative methods fail, with the perineal approach being the most commonly used. However, the penoscrotal approach, which requires only a single incision, offers advantages such as shorter operation times and ease of execution, though concerns about lower dry rates and higher complication risks remain. This retrospective cohort study analyzed outcomes of 156 patients who underwent artificial urinary sphincter implantation via the penoscrotal approach between 2014 and 2024, excluding revision and double prosthesis cases. The mean patient age was 72.5 ± 6.8 years, a median cuff size of 4 cm (3.5-6), a mean operation time of 28.3 ± 8.7 min and a median follow-up of 27.6 (2.6-109.7) months. The most common immediate postoperative complication was urinary retention (5.8%). At six months, 65.4% of patients were completely dry, and 82.7% were socially continent. Revision was required in 32.1% of cases, aligning with literature-reported rates. This study suggests that the penoscrotal approach is a viable alternative to the perineal method, offering potential benefits in operative efficiency while maintaining comparable outcomes to the classic perineal approach.

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.