International Journal of Impotence Research最新文献

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.

After its first introduction in 1982, studies have shown that performing inflatable penile prosthesis (IPP) under local anesthesia (LA) is not only feasible but additionally provides postoperative analgesia. In our retrospective review of 1334 first-time IPP under LA between 2014 and 2024, mean injected volume of anesthetic drug was 36.5 mL. Additional conscious sedation was required in 433 patients (31.7%), and none underwent conversion to regional or general anesthesia intraoperatively. Notably, all ectopic reservoir placement (n = 184) required additional conscious sedation. Mild local anesthesia systemic toxicity (LAST) was reported in 82 cases (6.2%) which was managed with conservative treatment. In 2 patients who experienced moderate LAST, IV benzodiazepine neutralized the neurologic symptoms. Two stages of an injection was done with 1:1 mixture of 1% lidocaine and 0.75% ropivacaine through a 10 mL syringe with a 25 G 1.5-inch needle. LA also seems to provide better postoperative pain control by continuation of analgesia beyond normal half-life of the injected drugs. It also gives valuable prompts for individualized pain management post operatively. Finally, it may help detection of an intraoperative complication by utilizing sudden pain as a safety marker.

Neurovascular bundle mobilization (NVBm) requires experience to avoid injury of the dorsal nerves and arteries of the penis. This work described Shaeer's Hydro-Inflation Technique for Neurovascular Bundle Mobilization (S-NVBm), whereby infiltration of the neurovascular bundle with saline is performed to increase safety and speed of NVBm. S-NVBm was performed in 50 cases: 21 cases of corporal rotation for congenital curvature, and 29 cases of penile prosthesis implantation with slitting of the tunica albuginea for correction of Peyronie's disease deformity (S-NVBm group). A matching group was operated upon with "classic" NVBm, without hydro-inflation (C-NVBm group, n = 32). In S-NVBm cases, hydro-inflation of Buck's fascia was performed prior to NVBm using 80% saline and 20% xylocaine (without adrenaline). The mixture was injected into Buck's fascia with the blunt nozzle of a 20 ml syringe, superficially applied to the surface. Average duration for NVBm in the S-NVBm group was 3.5 min ± 1.4 (range 1.2-7), compared to a duration of 7.3 ± 2 (range 4-11.2) in the C-NVBm group (p < 0.001); a 51.8% difference. No arterial injury was witnessed with S-NVBm group, compared to 1 case of minor unilateral arterial injury in the C-NVBm group. Sensitivity score was 10.2% higher in the S-NVBm group (mean 4.7 ± 0.5, range 3-5) compared to a mean of 4.3 ± 1 (range 2-5) in the C-NVBm group (p < 0.001). Biosthesiometry detected a mild sensory deficit in 1/50 cases of the S-NVBm group (2%) compared to 3/32 in the C-NVBm group (9.4%). Average post-operative pain score was 46% lower (2.5 ± 1.4, range 1-6) in the S-NVBm group compared to 4.6 ± 1.3 (range 2-7) in the C-NVBm group(p < 0.001). The findings herein demonstrate that Hydro-Inflation technique allows mobilization of the neurovascular bundle in a shorter time, with less post-operative pain, and with a lower risk for sensory deficit.

Urethral complications following urethral lengthening in transgender men, such as strictures and fistulas, are common and frequently necessitate secondary surgical interventions. These surgeries vary significantly in their techniques and are evaluated with considerable heterogeneity, making a synthesized presentation of their outcomes valuable for guiding clinical management. This systematic review included 14 studies selected through a database search (Medline, Embase, Web of Science) that reported urethral complications after urethral lengthening. Among the 595 patients considered, 76% underwent phalloplasty and 24% underwent metoidioplasty. Our findings highlight that staged urethroplasty techniques demonstrated the lowest recurrence rates (0-25%), particularly in the management of long strictures in the pendulous urethra. In contrast, one-stage urethroplasties-especially those performed without augmentation-were associated with high recurrence rates, reaching approximately 50%, even when buccal mucosa grafts were used for augmentation. Patient-reported outcomes were documented in only one-third of the included studies, underscoring the limited functional evaluation of urethroplasty outcomes following phalloplasty. The considerable variability in urethroplasty techniques, types of genital reconstruction, and reporting standards highlights the need for more comprehensive and standardized outcome assessments. Future studies will be essential in advancing our understanding and optimizing the management of these complex cases.

This systematic review aimed to evaluate the current evidence on the etiology, frequency, and management of glans necrosis (GN). A comprehensive search was conducted in Medline (via PubMed), Web of Science, and Embase (via Scopus) for studies on GN as a penile procedure complication. This study involved articles in English published between May 1967 and January 2025. Articles reporting GN following penile procedures were included, whereas those describing GN due to metabolic causes or non-surgical interventions were excluded. Nine of 321 identified articles met the inclusion criteria, enrolling 34 GN cases among 2582 patients. The etiologies were penile prosthesis implantation (n = 24), grafting procedures for Peyronie's disease (n = 2), penile brachytherapy for penile cancer (n = 4), and penile paraffinoma removal (n = 4). None of the studies reported conservative management. Surgical interventions included prosthesis removal (n = 6), prosthesis replacement combined with glans resurfacing (n = 1), debridement (n = 17), glans reconstruction (n = 1), scrotal skin free grafting (n = 4), and partial penectomy (n = 4). Therefore, although GN is rare, its consequences can be severe. Immediate surgical intervention is warranted for effective management.