Sexual Medicine最新文献

Background: Treatment of patients with erectile dysfunction (ED) was revolutionized by the development and approval of phosphodiesterase type 5 inhibitors (PDE5is), which have been repeatedly shown to be safe and effective in men with this condition. However, some patients do not respond to these agents and others may prefer an alternative therapy.

Aim: The objective of this paper is to evaluate topical therapies for ED used in clinical studies, either as single agents or in combination with a PDE5i, and consequently determine which topical therapies meet the criteria of an 'ideal medication for ED.'

Methods: The PubMed database was searched to identify clinical studies of topical agents that have been evaluated in men with ED. This review was supplemented by a search of presentations at the 2024 annual meetings of the American Urological Association and Sexual Medicine Society of North America.

Results: The literature review and subsequent screening resulted in 39 clinical studies and 5 meeting abstracts for review. The studies demonstrated efficacy for intraurethral and topical alprostadil, topical prostaglandin E₁ ethyl ester, nitric oxide donors, testosterone (in selected patients), and a non-medicated hydro-alcoholic gel. The studies reviewed also demonstrated a significant benefit of adding topical alprostadil to therapy in patients with inadequate responses to PDE5is. An effective topical therapy delivered to its site of action with a rapid onset could improve patients' and partners' satisfaction with and acceptance of treatment. These actions have been demonstrated by a new over-the-counter agent, MED3000, authorized by the United States Food and Drug Administration, and for topical alprostadil, which is available with a prescription in the European Union.

Clinical translation: The availability of safe and effective topical ED therapy is an important addition to current treatment options for men with this condition.

Strengths and limitations: This study provides results from a comprehensive search strategy by including a wide range of search criteria. However, the heterogeneity of studies evaluated creates difficulties in directly comparing results from different studies.

Conclusion: The results of this analysis show that current topical therapies can provide statistically and clinically significant improvements in erectile function in men with ED and may provide an effective alternative to PDE5i in men who require or prefer an alternative therapy.

Background: Patients with erectile dysfunction (ED) are often left with limited nonsurgical options when conventional pharmacotherapies become ineffective. Botulinum neurotoxin serotype A (BoNT-A) intracavernosal injections (ICIs) have been demonstrated in a few clinical studies to be effective and safe in managing ED and may serve as a first- or second-line option.

Aim: To perform a systematic review and meta-analysis on the effectiveness and safety of BoNT-A ICI in managing ED with a focus on human studies.

Methods: A systematic review and meta-analysis of clinical studies was performed in accordance with the PRISMA 2020 statement. Adult men with ED who received BoNT-A were included in the study. The risk of bias assessment of included studies was performed using the JBI assessment checklists.

Outcomes: The effectiveness and safety of BoNT-A ICI. Measures of effectiveness included the increase or change in International Index for Erectile Function (IIEF-EF) score/Sexual Health Inventory for Men (SHIM) score/Erection Hardness Score (EHS) or change in Doppler ultrasound parameters and the percentage of patients achieving the minimal clinically important difference (MCID) score.

Results: The search retrieved 61 articles, and 2 randomized controlled trials (RCTs) and 4 retrospective studies met the inclusion criteria. Three types of BoNT-A were evaluated: onaBoNT-A, aboBoNT-A, and incoBoNT-A. At least 40% of the patients achieved the MCID (2-7 points increase in the IIEF-EF/SHIM score) depending on the severity of ED) at ≥1 month. When directly comparing all 3 BoNT-A, the overall response rate was 77.5%, with no statistically difference between the 3 types. For aboBoNT-A, 500 U appeared to sustain the effectiveness longer compared to 250 U. OnaBoNT-A improved peak systolic velocity on Doppler ultrasound compared with saline. Meta-analysis of the 2 RCTs demonstrated a mean difference of 4.35 (P = .008) in the SHIM score at 12 weeks in favor of onaBoNT-A over normal saline. No systemic side effects have been reported, and the only infrequent local side effect was transient penile pain. Only one case of priapism was reported.

Strengths and limitations: This is the first systematic review summarizing data from human studies on ED and BoNT-A ICI. The inclusion criteria and outcomes of the included studies varied, which limited the number of studies included and parameters assessed in the meta-analysis.

Conclusion: BoNT-A may become an acceptable non-surgical option. However, there is a lack of clinical randomized or observational studies on this topic, and more randomized studies with standardized reporting are required to replicate current results and investigate the long-term benefits of BoNT-A as a monotherapy or adjunct therapy in the management of ED.

Background: Penile fracture (PF) is a urological emergency that can lead to significant complications if not treated promptly and understanding the factors influencing complications and outcomes in PFs is crucial for improving patient management.

Aim: This study aims to evaluate the impact of various factors on postoperative complications and outcomes in patients with PFs based on 10 years of experience at a single center.

Methods: In this retrospective study, we analyzed data from 106 patients who underwent surgical treatment for PFs between 2013 and 2023 at our institution. Patient demographics, fracture characteristics, and postoperative outcomes were analyzed. Factors affecting complications including the timing of surgery, defect size were evaluated.

Outcomes: The study revealed that early surgical intervention significantly reduced the risk of complications. Factors such as larger defect size and delayed surgery were associated with higher rates of postoperative complications.

Results: The mean age of the participants was 46.3 ± 13.9 years. The primary causes of PFs were sexual intercourse (62.3%), masturbation (19.8%), forced penile bending (11.3%), rolling over in bed (4.7%), and falling from bed (1.8%). The mean time from trauma to surgery was 10.5 ± 8 hours, with a mean defect size of 12.7 ± 5.5 mm. Postoperative complications included penile curvature, palpable plaques, and painful erections, with rates of 10.4%, 39.6%, and 23.6%, respectively. International Index of Erectile Function (IIEF-5) scores significantly decreased from preoperative (21.36 ± 2.9) to postoperative values at 6 months (19.48 ± 3.7) (P < 0.001). The time from trauma to surgery significantly correlated with the change in IIEF-5 scores between preoperative and postoperative values (P = 0.007, R ² = 0.067). The group experiencing complications exhibited a mean defect size of 14.54 ± 6 mm, whereas the non-complication group had a mean defect size of 11.07 ± 4.5 mm (P < 0.001).

Clinical implications: The findings suggest that timely surgical intervention and careful assessment of defect size are critical in managing PFs and these insights can guide urologists in optimizing treatment strategies and improving patient outcomes.

Strengths and limitations: This study benefits from a substantial sample size and a decade of surgical experience at a single center. However, the study's retrospective design and unknown patient history with erectogenic drugs are limitations.

Conclusion: The timing of surgery significantly impacts IIEF-5 scores, while the size of the defect was associated with other postoperative complications; understanding the factors influencing complications in PFs can improve surgical outcomes.

Background: Sexual dysfunctions (SD) are highly prevalent in Chronic Liver Diseases (CLD). Whether Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) carries a higher risk of SD is unknown as is the role of dietary patterns or quality of Life (QoL).

Aim: to assess (1) prevalence of SD in CLD; (2) whether MASLD is a risk factor for SD; (3) the role of adherence to Mediterranean Diet (MD) or QoL.

Methods: Observational, cross-sectional study, 207 CLD patients (84 females and 123 males), median age 57 years (IQR:46-63); 96 (46.4%) MASLD; and 111 (53.6%) nonMASLD.

Outcomes: SD were assessed through Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF) questionnaires. Adherence to MD was evaluated by the MD Score, QoL by SFHS-12 questionnaire evaluating physical [(ie, Physical Component Summary (PCS)] and mental [(ie, Mental Component Summary (MCS)] health. Multivariate analysis identified predictors of SD.

Results: (1) SD prevalence in CLD was 157/207 (75.8%); 80.9% females were at risk for SD, altered sexual desire/arousal and dyspareunia being the most common complaints, whereas 72.3% males had erectile dysfunction (ED); (2) prevalence of SD was higher in MASLD (89%) than in nonMASLD (64%) (P < 0.001); (3) in females, at univariate analysis, a negative correlation was found between FSFI and age, hypertension, or MASLD; (4) in males, at univariate analysis, IIEF-ED negatively correlated with age, DM2, or MASLD, whereas positively correlated with PCS and MCS; (5) in females, at multivariate analysis BMI (OR = 0.779,CI 95% = 0.640-0.948) and MCS (OR = 0.840,CI 95% = 0.741-0.953) were protective against SD, whereas age (OR = 1.115,CI 95% = 1.040-1.263) and DM2 (OR = 120.894,CI 95% = 1.396-10 741) were predictive of SD; (6) in males, at multivariate analysis, age (OR = 1088,CI 95% = 1032-1.148) and MASLD (OR = 4.075,CI 95% = 1.120-14.828) were risk factors for, whereas PCS (OR = 0,928,CI 95% = 0,865-0,995), and disease duration (OR = 0.393,CI 95% = 0.187-0.822) were protective against SD; 7) MD adherence, while higher in nonMASLD vs MASLD (P = 0.004), was not an independent protective factor against SD.

Clinical implications: SD should not be underestimated in CLD patients, in particular those with MASLD.

Strengths and limitations: Comprehensive study evaluating SD in a large cohort of CLD patients of both sexes, comparing MASLD vs nonMASLD. Due to its cross-sectional design, no conclusions can be drawn about cause and effect.

Conclusions: (1) CLD, in particular MASLD, have a high prevalence of SD which is not affected by MD adherence, whereas QoL seems to play a role; (2) CLD patients should be evaluated for SD, for early diagnosis and treatment.