International Journal of Impotence Research最新文献

In response to the 2021 Hospital Price Transparency Regulation by The Centers for Medicare & Medicaid Services (CMS), we evaluated hospital-reported price transparency and variability for testosterone (T) testing across the United States (US). Using the Turquoise database, hospitals disclosing free or total T test prices were identified. Hospital characteristics were compared between price reporters and non-reporters. Multivariable regression identified reporting predictors and assessed price variability by test and payer type. Of 6700 hospitals, 51.7% reported at least one T test price. Reporting was more common among larger hospitals (median 100 vs. 75 beds, p < 0.001), non-profits (62.7 vs. 44.3%, p < 0.001), and those with higher compliance scores (4.5 vs. 3, p < 0.001). Regional variation was significant (p < 0.001), but no urban-rural differences were observed (p = 0.71). Median prices were $84.90 (Interquartile range $44.0, $138.0) for total T and $92.27 ($49.17, $144.35) for free T, varying by payer: $79.43 ($40.82, $131.32) for commercial insurance and $98.00 ($54.65, $148.84) for self-pay. On multivariable analysis, hospitals in competitive markets and with more beds tended to have lower prices, while hospital ownership did not significantly affect pricing. Despite the legislation, nearly half of hospitals fail to report prices, driving significant price variation and limiting informed consumer choices.

This study aimed to evaluate the effectiveness of combining a nitric oxide microparticle delivery system (NO-MP) with various FDA-approved PDE5 inhibitors (PDE5i) for improving erectile responses in a rat model of erectile dysfunction (ED) following cavernous nerve injury, similar to the effects of radical prostatectomy. Male Sprague-Dawley rats, 4-5 months old (weighing ~275 g) underwent bilateral cavernous nerve transection. One week post-surgery animals were administered PDE5i via oral gavage (sildenafil 0.05 mg/kg (N = 9), tadalafil 0.005 mg/kg (N = 8), vardenafil 0.01 mg/kg (N = 7), avanafil 0.1 mg/kg (N = 8) or untreated (N = 5) followed by topical application of 250 mg NO-MP to the penile dermis. Erectile responses were assessed by measuring intracorporeal pressure (ICP) and systemic blood pressure (BP) after the application of NO-MP. Compared to NO-MP alone, combination therapy with a PDE5i significantly (P < 0.05) reduced the time to initial erectile response from 63 ± 21.6 min to 8-23 min (vardenafil: 23 ± 2.3, avanafil: 11 ± 8.1, sildenafil: 19.9 ± 9.8, tadalafil: 18 ± 12.8), and increased the frequency of spontaneous erections from 1 ± 0.71 to 1.7-2.7 per hour (vardenafil: 2.1 ± 0.9, avanafil: 2.7 ± 1.1, sildenafil: 1.7 ± 0.6, tadalafil: 2.5 ± 0.8). No significant changes in maximal ICP/BP, duration of erectile response or baseline ICP/BP were observed. These results suggest that combining NO-MP with PDE5i may provide a promising approach for treating ED after radical prostatectomy.

Depression and anxiety are often comorbid with erectile dysfunction and are linked to worse surgical outcomes. We aimed to determine if depression/anxiety increased complication rates in inflatable penile prosthesis (IPP) surgery. All IPP cases by a single surgeon at our institution from 2020-2022 were reviewed. Data was collected on demographics, medical/psychiatric history, intraoperative details, and post-operative outcomes. Univariate, multivariate, and survival analysis were performed to assess relationships between patient factors and complications. 279 IPP cases were performed. Anxiety/depression was significantly associated with post operative complications (p = 0.002) and infection (p = 0.024). Anxiety/depression is independently associated with increased complications in a multivariable logistic regression model including age, BMI, diabetes, primary surgery, smoking status, pelvic surgery, radiation, Peyronie's disease, and correctly holding anticoagulation. Survival analysis showed that anxiety and depression both resulted in faster times to complication and re-operation (all p < 0.05). This is the first study assessing the impact of mental health on IPP outcomes. Urologists should consider mental health when evaluating patients for IPP surgery, and mental health treatment prior to surgery may improve outcomes.

This study examines the impact of withdrawal on women's sexuality and its continued use in Slovenia despite modern contraceptive alternatives. Through in-depth interviews with 45 Slovenian women using withdrawal, findings reveal significant effects on sexual satisfaction, particularly pleasure and orgasm. Many participants reported decreased sexual desire due to pregnancy fears, while concerns about their partner's performance affected arousal. Difficulties in achieving orgasm were common, with some experiencing reduced intensity and frequency. The decision to use withdrawal was often shaped by male preference, limited access to other contraceptive methods, and societal judgment. Some women preferred withdrawal for its perceived naturalness, aligning with a cultural shift toward naturalism, which may reinforce traditional gender roles and sexual norms. Historically, withdrawal was a widely accepted contraceptive method influenced by social norms and a lack of alternatives. The contemporary preference for natural contraception continues despite its risks, demonstrating how cultural beliefs shape reproductive choices. The findings underscore the need for comprehensive contraceptive counselling that acknowledges both personal and societal factors affecting women's decisions. Addressing these influences can help ensure informed choices that enhance both sexual well-being and reproductive autonomy.

Long-term outcomes of penile fracture (PF) include erectile dysfunction (ED) and penile curvature. In this study, we aimed to present the functional and anatomical results of 182 patients who underwent PF repair surgery and to reveal the risk factors for ED and penile curvature in a relatively long follow-up period. Thirty (16.5%) patients suffered from ED and 18 (9.9%) patients had penile curvature, respectively in a median follow-up period of 66 (39-111) months. Presence of bilateral fractures (OR = 7.806; 95% CI = 2.083-29.261; p = 0.002), larger tunical defect size (OR = 1.099; 95% CI = 1.036-1.164; p = 0.002) and longer time between fracture and surgery (OR = 1.095; 95% CI = 1.036-1.157; p = 0.001) were stated as the independent risk factors for ED. Only larger tunical defect size was found as an independent risk factor for penile curvature (OR = 1.14; 95% CI = 1.063-1.221; p < 0.001). The cut-off values for predicting ED were 18.5 mm for tunical defect size, 14.5 h for time between fracture and surgery, and 41 years for age. The cut-off value for tunical defect size was 18.5 mm for penile curvature. Risk of ED increases among patients with extended tunical rupture and delayed surgical repair. Penile curvature manifests less frequently and seems to be associated with the size of the tunical defect.