International Journal of Impotence Research最新文献

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.

Vasectomy is a highly effective method of permanent contraception for men, offering a minimally invasive and cost-efficient alternative to female sterilization. Over 500,000 vasectomies are performed annually in the U.S., making it the most common non-diagnostic procedure conducted by urologists. Despite this, many residents may not gain adequate training in performing vasectomies in residency, and there are several specific patient populations that warrant additional counseling and care in their approach to a vasectomy. This paper provides a comprehensive review and checklist for the physician detailing necessary steps in the evaluation, counseling, treatment, and management of patients seeking a vasectomy. This includes a focus on special patient scenarios like the young, childless male, the expecting couple, or the individual with intellectual disabilities. Additionally, we review surgical techniques, postoperative care, and reimbursement to ensure a structured, effective approach to vasectomy, while addressing potential challenges that may arise with the goal of optimizing the patient experience and outcomes.

Erectile dysfunction following non-nerve-sparing prostatectomy is prevalent. Although adipose-derived stem cells (ASCs) have shown therapeutic potential for erectile dysfunction, the underlying mechanisms remain unclear. To investigate the therapeutic effects of exogenous stem cells and their recruitment of endogenous stem cells in the context of postprostatectomy erectile dysfunction, we established a bilateral cavernous nerve injury (BCNI) rat model. The rats were divided into the sham surgery, BCNI + PBS, and BCNI+ASCs groups. Intracavernous pressure/mean arterial pressure ratios were compared between groups. In vivo imaging revealed ASC retention in the corpora cavernosa. Penile histomorphology and smooth muscle content were evaluated via Hematoxylin‒eosin and Masson staining. Immunohistochemistry, western blotting, and immunofluorescence were employed to quantify α-SMA, nNOS, caspase-3, vWF, Bax, Bcl-2, and SDF-1 levels and endogenous stem cell recruitment. Compared with the PBS control group, the ASC-treated group presented increased α-SMA, nNOS, and vWF expression and smooth muscle content, as well as reduced caspase-3, Bax, and Bcl-2 levels. Endogenous stem cell recruitment was observed in ASC-treated rats. Our findings demonstrate that exogenous ASCs injection suppresses apoptosis, enhances endothelial function, recruits endogenous stem cells, and alleviates erectile dysfunction in BCNI models. This study elucidates ASC-mediated mechanisms involved in erectile dysfunction recovery, providing insights for clinical translation.

Urethral stricture is a frequent complication following hypospadias repair, often complicated by scarring, anatomical distortion, and poor tissue vascularity. This systematic review and meta-analysis evaluated outcomes of single-stage versus staged urethroplasty for distal urethral strictures after failed hypospadias repair. A total of 20 studies were analyzed. Data were extracted regarding surgical techniques, success rates, complications, and duration of follow-up. Meta-analysis showed a pooled success rate of 78.1% (95% CI: 70.2-84.4%) for single-stage and 76.2% (95% CI: 52.1-90.4%) for staged procedures. The difference in efficacy was not statistically significant. Single-stage repairs were generally associated with shorter treatment durations, while staged approaches were preferred in cases with severe fibrosis or poor tissue quality. Complication rates ranged from 10% to 50%. In staged procedures, the use of buccal mucosa grafts yielded better outcomes compared to skin flaps or other grafts. Significant heterogeneity was observed (I² = 65.2% for single-stage, I² = 90.1% for staged; p < 0.01), likely due to variability in surgical techniques, patient demographics, and follow-up protocols. No publication bias was detected (Egger's test p = 0.398 and 0.388, respectively). Further standardized, prospective studies are necessary to optimize treatment selection and to enhance surgical outcomes.

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.