International Journal of Impotence Research最新文献

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.

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.