International Journal of Impotence Research最新文献

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.

The need to enhance the quality of life and functionality of patients with a number of diseases, such as congenital abnormalities, traumas, and gender incongruence, has contributed to a significant development in the field of male genital reconstructive surgery. This article highlights the roots of penile reconstructive surgeries over history, emphasizing innovative achievements that have shaped modern practices. Critical advancements that have improved surgical accuracy and post-operative care are examined, including new imaging modalities, penile prosthesis implantation, and complete phallic reconstruction. In terms of future improvements in genital reconstructive surgery, the combination of tissue engineering and microsurgery offers the potential to further improve the field.

Gender dysphoria is a condition characterized by distress due to a mismatch between a person's gender identity and their assigned gender at birth. This study aimed to compare sexual satisfaction and complication rates in patients undergoing feminizing gender affirming surgery (fem-GAS) using two techniques: standard penile inversion vaginoplasty (PIV) and robotic peritoneal vaginoplasty (RPGAV). We conducted a retrospective analysis data from a prospective registry (2017-2022). All patients had at least two years of hormone therapy. Sexual satisfaction was evaluated one year postoperatively using a custom Likert scale-based questionnaire developed in collaboration with our psychosexologist. We also performed a non-systematic review of the literature on sexual outcomes following LPGAV and RPGAV. We included 19 patients (PIV = 11; RPGAV = 8). Median age at surgery was 32 years. No significant differences were observed between groups regarding preoperative characteristics or complication rates. One Clavien-Dindo grade >3b complication occurred in RPGAV group. Compared to the PIV group, patients in the RPGAV group reported significantly (p = 0.04) higher improvement in "quality of sexual intercourse" (87.5 vs. 27.3%) and "overall sexual satisfaction" (87.5 vs. 27.3%). No significant differences were found in orgasm quality, speed, or erogenous sensitivity. Although literature data on sexual outcomes remain limited, RPGAV may provide better satisfaction, particularly regarding vaginal width, depth, and lubrication, with similar complication rates. Although our study is limited by its small sample size and retrospective design, it represents the first direct comparison between these techniques. Larger prospective studies are needed to confirm these findings.