Sexual medicine reviews最新文献

Introduction: Patient medical and surgical history factors, such as prior prostatectomy, may lead surgeons to opt for ectopic reservoir placement rather than the standard reservoir location in the retropubic space (RPS) during inflatable penile prosthesis (IPP) placement.

Objective: To examine the safety and effectiveness of ectopic reservoir placement used with three-piece IPPs in relation to reservoir placement in the RPS.

Methods: A systematic review of MEDLINE/Pubmed and Embase databases was performed for literature between 1970 and 2022. Clinical studies and case reports describing three-piece IPP reservoir placement and clinical outcomes on AMS 700, similar products (such as Coloplast Titan), and three-piece IPPs where the manufacturer is not specified were included.

Results: Seventy articles were identified that reported clinical outcomes on three-piece IPP reservoir placement, which included data on 9565 patients. Of these, 67% of the reservoirs (n = 6413) were placed in ectopic locations. These locations were defined as submuscular (n = 5207), retroperitoneal (n = 405), sub-external oblique (n = 50), peritoneal (n = 42), subcutaneous (n = 10), and did not specify the ectopic location (n = 694). A total of 670 patients had ectopic placement of the AMS 700 reservoirs specifically. Overall, there were no elevated rates in safety outcomes between RPS and ectopic placement. Fourteen studies directly compared safety and/or efficacy outcomes between RPS and ectopic placement and did not report any significant differences between patient groups.

Conclusions: Ectopic reservoir placement of three-piece IPPs, including AMS 700, is comparable in terms of safety, efficacy, and patient satisfaction to RPS reservoir placement. Ectopic reservoir placement of the AMS 700 device is also similarly comparable to ectopically placed reservoirs of other IPPs as reported in the literature. Surgeons should consider ectopic implantation for patients at higher risk of complications associated with reservoir placement into the RPS.

Introduction: Female sexual dysfunction (FSD) remains a silent problem, especially in Arabic-speaking countries and the Middle East and most of the data are from Western countries. Sociocultural determinants haven't been getting the same attention as biological and psychological factors when studying sexual health.

Objectives: To assess the prevalence of FSD in the Arab and Middle Eastern world and understand the sociocultural determinants related.

Methods: On January 13, 2024, we searched electronic databases including Pubmed, Scielo, PsycArticles, Scopus, Cochrane Library and Google Scholar, Middle East Current Psychiatry, and Journal of Middle East Women's Studies, following PRISMA guidelines. Female participants, aged at least 16 years old from Middle East or Arabic-speaking countries, including North Africa, and cross-sectional studies in Arabic, English, and/or French were included. After careful screening of titles, abstracts, and full texts, ineligible articles were excluded.

Results: A total of 19 papers were included in the present review. The most common FSD in each country were as follows: in Egypt, Turkey, Morocco, and Jordan, desire problems. In Iran, orgasm problems, and pain. In Palestine, pain. In Saudi Arabia, arousal. Sociocultural determinants such as language, poor sexual education, poor sexual self-awareness-and of partners-, lack of training, and help-seeking were related to FSD.

Conclusions: FSD is prevalent in Arabic-speaking countries and the Middle East, yet little to no attention is given to this matter. Causes for FSD are mainly cultural, and Arab and Middle Eastern healthcare professionals lack training. Culturally sensitive, evidence-based studies regarding sexual health need to be conducted.

Introduction: Pelvic floor physical therapy (PFPT) and noninvasive modalities can be more safe and available treatments for vaginal laxity (VL) with less risk of postsurgical complications.

Objectives: The purpose of this review is to define the concepts of PFPT and noninvasive modalities, examine the evidence supporting those modalities as a treatment for VL, and evaluate their effectiveness.

Methods: Between 2002 and 2023, clinical studies including women diagnosed with VL were examined in the Web of Science, Cochrane Library, Scopus, and PubMed databases. Exclusion criteria included studies with no outcomes or inadequate data, procedures, suggestions, editorials, book chapters, letters to editors, reviews, meta-analyses, animal research, and articles in languages other than English.

Result: Only seventeen studies have been identified. Four studies have demonstrated the impact of PFPT (low- and medium-energy radiofrequency (RF), ultrasound, low-energy laser treatment, par sacral stimulation, the knack method, and pelvic floor exercises), and thirteen studies have discussed the impact of noninvasive modalities (RF, combined multipolar RF with pulsed electromagnetic, combined RF and pulsed electromagnetic field, high-intensity focused ultrasound, CO2 laser, combining multipolar RF and hybrid fractional laser, microfocused ultrasound, and the VIVEVE surface-cooled RF) on vaginal laxity.

Conclusion: This review indicates many knowledge areas that must be attempted in order to understand the influence of nonstrengthening physical therapy and noninvasive methods on vaginal laxity. In addition to the mechanisms behind their impacts. In addition, we strongly recommend that more clinical trials of high methodological and interventional quality are required to investigate the efficacy of various physical therapy approaches, including electrical stimulation, biofeedback exertion, acupressure, manual therapy, neuromodulation, core exercise therapy, hydrotherapy, well-designed ultrasound therapy protocols, and vaginal weight training.

Introduction: Temporomandibular disorders (TMDs) encompass various conditions affecting the temporomandibular joint and surrounding structures, often presenting with pain, limited movement, and functional impairments. TMDs may affect kissing and oral sex, in addition to influencing sexual function, as any other chronic pain condition.

Objective: The study sought to examine the connection between TMDs and sexual function.

Methods: A literature review was conducted, synthesizing evidence from various disciplines, including dentistry, physical therapy, psychology, and sexual medicine. Relevant studies were analyzed to elucidate the multifaceted nature of TMDs and their potential impact on sexual health.

Results: Emerging evidence suggests a complex relationship between TMDs and sexual function, with chronic pain, psychological distress, and physiological factors potentially contributing to sexual dysfunction.

Conclusion: Understanding the interconnectedness of TMDs and sexual function is essential for providing comprehensive care. Further research is needed to assess the association between TMDs and sexual dysfunction, elucidate the underlying mechanisms, and develop targeted interventions that address both TMD symptoms and sexual health concerns.

Introduction: This review explores the interplay between comorbid insomnia and sleep apnea (COMISA) and erectile dysfunction (ED), 2 conditions that significantly impact men's health. COMISA, a recently recognized condition characterized by the coexistence of insomnia and obstructive sleep apnea, has been shown to disrupt sleep architecture and cause intermittent hypoxia. These disturbances are increasingly linked to the exacerbation of ED, a prevalent issue among men. Understanding the connection between COMISA and ED is crucial for developing integrated treatment approaches that address both sleep and sexual health.

Objectives: We aim to explore the epidemiological, physiological, and potential therapeutic intersections of COMISA and ED. This review sets out to develop a better understanding of the relationship between these conditions and to emphasize the need for an integrated diagnostic and therapeutic approach that addresses both sleep and sexual health.

Methods: Through a comprehensive analysis, including a detailed examination of extant studies, we address the hormonal imbalances and alterations in neural pathways that collectively contribute to the complex pathophysiology of ED and how these are particularly susceptible to the concurrent presence of COMISA.

Results: Our analysis indicates that disruptions in sleep architecture and intermittent hypoxia associated with COMISA can exacerbate ED. Hormonal imbalances, endothelial dysfunction, autonomic imbalance, and increased inflammation and oxidative stress are key mechanisms through which COMISA influences ED. These factors collectively impair vascular health, reduce testosterone levels, disrupt neural control of erections, and contribute to the severity of ED.

Conclusions: This review underscores the necessity for an integrated approach to diagnosis and therapy that considers both sleep and sexual health to improve overall outcomes. These insights should foster a deeper understanding of the relationship between COMISA and ED, encourage further research in this area, and potentially lead to the development of innovative treatment strategies to manage these closely intertwined health concerns.

Introduction: The use of hyaluronic acid as a nonsurgical treatment for various conditions within urology has been of great interest in recent literature.

Objectives: In this study, we aimed to provide an updated review and analysis of the current state of hyaluronic acid use in urology, characterize its adverse effects, and briefly discuss future directions of research for hyaluronic acid in urology.

Methods: PubMed searches were run utilizing multiple terms, including "hyaluronic acid," "penile," "augmentation," "Peyronie disease," "premature ejaculation," and "cosmetic urology," among other related iterations. Relevant data extracted included International Index of Erectile Function score, intravaginal ejaculatory latency, glans circumference, penile girth, and plaque size. We also included studies which reported on complications of hyaluronic acid injections. Aggregated analysis was performed on studies with complete pre and post injection data at time closest to 6 months postinjection.

Results: A total of 33 studies met our inclusion criteria. Studies had marked heterogeneity in design, but most reported positive results. A total of 16 studies were included in our analysis. Intravaginal ejaculatory latency, penile girth, glans circumference, and International Index of Erectile Function were all increased on a fixed-effects model. Reduction in plaque size was not significant (P = .069). Complications were rare.

Conclusion: Literature on hyaluronic acid for urologic issues demonstrates promising results; however, the quality of studies was variable. Our analysis of these studies largely corroborates these findings; however, the results are limited by the data available. Hyaluronic acid may be promising, but we highly implore standardization of study regimens in randomized controlled trials.

Introduction: Iontophoresis therapy (IPT) is a noninvasive technique that uses electrical impulses to deliver charged molecules into the skin for controlled and targeted drug delivery. IPT has been explored as a noninvasive treatment option for Peyronie's disease (PD), but the current literature in this regard is still scarce.

Objective: We aimed to systematically review the current literature on the application of IPT in the management of PD to provide a comprehensive evaluation and holistic outlook on the subject.

Method: A comprehensive search strategy was implemented in the following databases to retrieve research articles: PubMed (MEDLINE), Scopus, and Web of Science. Google Scholar was also manually searched. The search results were imported into Rayyan reference management for assessment based on the predefined inclusion criteria. The quality of the articles was evaluated by the proper JBI checklist (ie, per the study design), and the JBI grades of recommendation were used for grading the evidence.

Results: A systematic search yielded 451 publications, 11 of which met the criteria to be included in this systematic review. The results demonstrated that IPT, usually with verapamil and dexamethasone, has shown promising results in treating PD. These methods can reduce pain, plaque size, and penile curvature while improving sexual function and quality of life with no serious adverse events. However, most studies had moderate to low quality, indicating a weak recommendation for a certain health management strategy.

Conclusion: Based on the extant literature, there is currently insufficient evidence to support the use of IPT for the management of PD. Placing it in the forefront of research can facilitate the management choices for PD even further, given its therapeutic potential.

Introduction: Erectile dysfunction (ED), affecting around 52% of men aged 40-70, is a significant marker of overall health and a potential warning sign of multiple conditions like cardiovascular diseases (CVDs), diabetes, and mental health disorders. Recognizing and addressing ED through a holistic approach involving nutrition, physical activity, sleep, and stress management can improve both erectile and overall health outcomes.

Aims: To provide a narrative review of the available literature on the relationship between ED and overall health, elaborate on the possible mechanisms explaining this association, and discuss the effects of lifestyle on ED.

Methods: A search of the medical literature was carried out in PubMed and Medline, focusing on original research and systematic reviews of original research on ED and overall health.

Results: Due to shared pathophysiological mechanisms like endothelial dysfunction, ED is a significant indicator of overall health, particularly related to CVD and diabetes mellitus. Multiple studies have shown that ED frequently precedes cardiovascular events and is associated with increased cardiovascular risk, especially in younger men and those with diabetes. It also has a profound, bidirectional relationship with mental health conditions like depression and anxiety, creating a vicious cycle where each exacerbates the other. The four health pillars of nutrition, physical activity, sleep, and stress management play significant roles in erectile function and overall sexual health.

Conclusion: ED is not just a condition affecting sexual function but a critical indicator of broader health issues. By adopting an integrative approach that combines nutrition, physical activity, sleep, and stress management, healthcare providers can offer holistic and effective management strategies for this condition.

Introduction: Testosterone deficiency is a clinical disorder due to either failure of the testes to produce testosterone or failure of the hypothalamus or pituitary to produce sufficient gonadotropins. Previous formulations of oral testosterone therapy, particularly methyltestosterone, have been associated with adverse liver effects. Many different routes of testosterone delivery have been developed, each with their own administrative benefits and challenges. Newer formulations of oral testosterone undecanoate (TU) provide a convenient administration option, although their use has been limited by hepatotoxicity concerns based on older methyltestosterone data, and prescribing physicians may still be concerned about adverse liver effects.

Objectives: In this review, we discuss the history of oral testosterone development, clarify the mechanism of action of oral TU, and describe the relevant liver safety findings.

Methods: Relevant literature was allocated to present a review on the history of oral TU development and the mechanism of action of oral TU. We pooled data from individual studies of oral TU products to present a safety summary.

Results: Overall, safety results from studies of the newer formulations of oral TU showed that increased liver function test values are not generally associated with oral TU formulations and that no clinically significant liver toxicities were noted in clinical trials of oral TU.

Conclusion: Continued research into the safety of oral TU will contribute to a better understanding of the potential risks in patients receiving this therapy, an outcome that highlights the importance of providing patient education and reassurance regarding oral TU safety.