Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.140
K. Khalaf Alla, R. Calopedos, J. Mehr, R. Wang
Corporal tissue ingrowth into previously implanted cylinder is a rare but possible issue encountered during penile prosthesis (PP) revision surgery. To prevent cylinder aneurysms, a middle layer of woven and expandable polypropylene-like material was incorporated into the implant design in 1987. While the outer silicone layer usually prevents its contact with tissue, in cases of ruptured cylinders, there is a risk of cavernous ingrowth into the exposed woven layer. Collagen deposition within the inflammatory tongue of tissue can lead to significant difficulty in implant removal. Having a degree of suspicion about this phenomenon is important, especially as an implant may remain somewhat functional if the inner silicone layer remains intact. If encountered, its recognition is paramount in triggering operative countermeasures. To our knowledge, this is the only contemporary and second case series describing this phenomenon in English literature. To highlight the existence of this difficult phenomenon in revision surgery and demonstrate our approach. We report 3 patients over the past 3 years who underwent complex penile revision surgery. All had AMS penile implantation 10–15 years prior and presented with inability to inflate device. Each case began routinely through a vertical penoscrotal incision; however, the stuck cylinders were unable to be removed through the traditional corporotomy. Penoscrotal incision and corporotomy were extended until the location of ingrowth was identified. A combination of sharp and blunt dissection was required to liberate the cylinder from the surrounding corporal tissue. Care was taken to maintain a plane just outside the ruptured cylinder to prevent more proximal or distal injury to the tunica albuginea. Once liberated and new device implanted, corpora are closed in the usual fashion without the need for elaborate tunica albuginea reconstruction. All 3 patients had successful revision of impacted cylinder from the corpora through extension of the vertical penoscrotal incision. No secondary distal incision was necessary in these cases. Patients were followed for 6–12 months in which time all prosthesis remained functional and no deviation from the usual post-operative course was encountered. Implanters should not shy away from maximizing exposure if ingrowth is suspected. The vertical penoscrotal incision was a versatile approach that could be easily extended and should be considered for suspected complex revision surgery. Furthermore, this phenomenon also adds credence to early revision surgery in the cases of device malfunction from suspected cylinder rupture. Despite the difficulty this issue poses, corporal tissue readily integrates into porous synthetic materials. This ability may be useful in future device development in the tissue engineering space. No.
{"title":"(154) Corporal Tissue Ingrowth: A Rare but Operable Challenge in Revision Surgery for Inflatable Penile Prosthesis","authors":"K. Khalaf Alla, R. Calopedos, J. Mehr, R. Wang","doi":"10.1093/jsxmed/qdae002.140","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.140","url":null,"abstract":"\u0000 \u0000 \u0000 Corporal tissue ingrowth into previously implanted cylinder is a rare but possible issue encountered during penile prosthesis (PP) revision surgery. To prevent cylinder aneurysms, a middle layer of woven and expandable polypropylene-like material was incorporated into the implant design in 1987. While the outer silicone layer usually prevents its contact with tissue, in cases of ruptured cylinders, there is a risk of cavernous ingrowth into the exposed woven layer. Collagen deposition within the inflammatory tongue of tissue can lead to significant difficulty in implant removal. Having a degree of suspicion about this phenomenon is important, especially as an implant may remain somewhat functional if the inner silicone layer remains intact. If encountered, its recognition is paramount in triggering operative countermeasures. To our knowledge, this is the only contemporary and second case series describing this phenomenon in English literature.\u0000 \u0000 \u0000 \u0000 To highlight the existence of this difficult phenomenon in revision surgery and demonstrate our approach.\u0000 \u0000 \u0000 \u0000 We report 3 patients over the past 3 years who underwent complex penile revision surgery. All had AMS penile implantation 10–15 years prior and presented with inability to inflate device. Each case began routinely through a vertical penoscrotal incision; however, the stuck cylinders were unable to be removed through the traditional corporotomy. Penoscrotal incision and corporotomy were extended until the location of ingrowth was identified. A combination of sharp and blunt dissection was required to liberate the cylinder from the surrounding corporal tissue. Care was taken to maintain a plane just outside the ruptured cylinder to prevent more proximal or distal injury to the tunica albuginea. Once liberated and new device implanted, corpora are closed in the usual fashion without the need for elaborate tunica albuginea reconstruction.\u0000 \u0000 \u0000 \u0000 All 3 patients had successful revision of impacted cylinder from the corpora through extension of the vertical penoscrotal incision. No secondary distal incision was necessary in these cases. Patients were followed for 6–12 months in which time all prosthesis remained functional and no deviation from the usual post-operative course was encountered.\u0000 \u0000 \u0000 \u0000 Implanters should not shy away from maximizing exposure if ingrowth is suspected. The vertical penoscrotal incision was a versatile approach that could be easily extended and should be considered for suspected complex revision surgery. Furthermore, this phenomenon also adds credence to early revision surgery in the cases of device malfunction from suspected cylinder rupture. Despite the difficulty this issue poses, corporal tissue readily integrates into porous synthetic materials. This ability may be useful in future device development in the tissue engineering space.\u0000 \u0000 \u0000 \u0000 No.\u0000 \u0000 \u0000 \u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"106 44","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140088629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.198
Y. Huang, X. Li, J. Yao, W. Liu, M. Lu, Y. Xie
The elderly males undergo degenerative fertility and testicular endocrine function that jeopardize the reproductive health and well-being. However, the mechanisms underlying reproductive aging are unclear. This study aims to investigate the phenotypes and transcriptomes of seven regions of the male mouse reproductive tract: the testis, efferent ductules, initial segment, caput, corpus and cauda epididymidis, and vas deferens, in adult (3 months) and aged (21 months) mice. Quantitative PCR, immunohistochemistry, immunofluorescent staining, and enzyme-linked immunosorbent assay were performed for the analysis of gene expression in mice, human tissues, and semen samples. Aged male mice showed both systematic and reproductive changes, and remarkable histological changes were detected in the testis and proximal epididymis. Transcriptomes of the male reproductive tract were mapped, and a series of region-specific genes were identified and validated in mouse and/or human tissues, including Protamine 1 (Prm2), ADAM metallopeptidase domain 28 (Adam28), Ribonuclease A family member 13 (Rnase13), WAP four-disulfide core domain 13 (Wfdc13), and Wfdc9. Meanwhile, age-related transcriptome changes of different regions of the male reproductive tract were characterized. Notably, increased immune response was functionally related to the male reproductive aging, especially the T cell activation. An immune response-associated factor, phospholipase A2 group IID (Pla2g2d), was identified as a potential biomarker for reproductive aging in mice. And the PLA2G2D level in human seminal plasma surged at approximately 35 years of age. Furthermore, we highlighted Protein tyrosine phosphatase receptor type C (Ptprc), Lymphocyte protein tyrosine kinase (Lck), Microtubule associated protein tau (Mapt), and Interferon induced protein with tetratricopeptide repeats 3 (Ifit3) as critical molecules in the aging of initial segment, caput, caput, and cauda epididymidis, respectively. This study provides an RNA-seq resource for the male reproductive system during aging in mice, and is expected to improve our understanding of male reproductive aging and infertility. No.
{"title":"(221) Anatomical Transcriptome Atlas of the Male Mouse Reproductive System During Aging","authors":"Y. Huang, X. Li, J. Yao, W. Liu, M. Lu, Y. Xie","doi":"10.1093/jsxmed/qdae002.198","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.198","url":null,"abstract":"\u0000 \u0000 \u0000 The elderly males undergo degenerative fertility and testicular endocrine function that jeopardize the reproductive health and well-being. However, the mechanisms underlying reproductive aging are unclear.\u0000 \u0000 \u0000 \u0000 This study aims to investigate the phenotypes and transcriptomes of seven regions of the male mouse reproductive tract: the testis, efferent ductules, initial segment, caput, corpus and cauda epididymidis, and vas deferens, in adult (3 months) and aged (21 months) mice.\u0000 \u0000 \u0000 \u0000 Quantitative PCR, immunohistochemistry, immunofluorescent staining, and enzyme-linked immunosorbent assay were performed for the analysis of gene expression in mice, human tissues, and semen samples. Aged male mice showed both systematic and reproductive changes, and remarkable histological changes were detected in the testis and proximal epididymis. Transcriptomes of the male reproductive tract were mapped, and a series of region-specific genes were identified and validated in mouse and/or human tissues, including Protamine 1 (Prm2), ADAM metallopeptidase domain 28 (Adam28), Ribonuclease A family member 13 (Rnase13), WAP four-disulfide core domain 13 (Wfdc13), and Wfdc9. Meanwhile, age-related transcriptome changes of different regions of the male reproductive tract were characterized.\u0000 \u0000 \u0000 \u0000 Notably, increased immune response was functionally related to the male reproductive aging, especially the T cell activation. An immune response-associated factor, phospholipase A2 group IID (Pla2g2d), was identified as a potential biomarker for reproductive aging in mice. And the PLA2G2D level in human seminal plasma surged at approximately 35 years of age. Furthermore, we highlighted Protein tyrosine phosphatase receptor type C (Ptprc), Lymphocyte protein tyrosine kinase (Lck), Microtubule associated protein tau (Mapt), and Interferon induced protein with tetratricopeptide repeats 3 (Ifit3) as critical molecules in the aging of initial segment, caput, caput, and cauda epididymidis, respectively.\u0000 \u0000 \u0000 \u0000 This study provides an RNA-seq resource for the male reproductive system during aging in mice, and is expected to improve our understanding of male reproductive aging and infertility.\u0000 \u0000 \u0000 \u0000 No.\u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140089215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.224
C. Ho, H. M. Tan
The Asian Men’s Health Report 2 is a follow up to the first Asian Men’s Health Report in 2013 with updated data and new aspects delved into. To report on the state of men’s health in Asia Key databases that contained information on the health status of men from Asian countries were used. When limited data were available, findings from independent studies were sought to supplement the data. A general trend towards a more aging Asian population can be seen from the population pyramid for Asia in 1950, 2015 and 2050. Men have a lower life expectancy at birth than women in all Asian countries. Men have lower healthy life expectancy compared to women in all Asian countries except Kuwait and Qatar. Ischemic heart disease, stroke and chronic obstructive pulmonary disease are the top three causes of death and DALY among both Asian men and women. More women die due to communicable diseases compared to men. Death due to road traffic injuries are more common in men than women There are rooms for improvement for men’s health in Asia. Health care practitioners and policy makers should take up the lead. No.
{"title":"(261) Asian Men’s Health Report 2","authors":"C. Ho, H. M. Tan","doi":"10.1093/jsxmed/qdae002.224","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.224","url":null,"abstract":"\u0000 \u0000 \u0000 The Asian Men’s Health Report 2 is a follow up to the first Asian Men’s Health Report in 2013 with updated data and new aspects delved into.\u0000 \u0000 \u0000 \u0000 To report on the state of men’s health in Asia\u0000 \u0000 \u0000 \u0000 Key databases that contained information on the health status of men from Asian countries were used. When limited data were available, findings from independent studies were sought to supplement the data.\u0000 \u0000 \u0000 \u0000 A general trend towards a more aging Asian population can be seen from the population pyramid for Asia in 1950, 2015 and 2050. Men have a lower life expectancy at birth than women in all Asian countries. Men have lower healthy life expectancy compared to women in all Asian countries except Kuwait and Qatar. Ischemic heart disease, stroke and chronic obstructive pulmonary disease are the top three causes of death and DALY among both Asian men and women. More women die due to communicable diseases compared to men. Death due to road traffic injuries are more common in men than women\u0000 \u0000 \u0000 \u0000 There are rooms for improvement for men’s health in Asia. Health care practitioners and policy makers should take up the lead.\u0000 \u0000 \u0000 \u0000 No.\u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"325 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.127
M. Shirai, M. Sano, Y. Anno, K. Ishikawa, A. Taniguchi, A. Kure, Y. Uesaka, T. Nozaki, S. Fukuhara, A. Iwasa, K. Kobayashi, J. Kato, A. Tsujimura
Phosphodiesterase 5 inhibitors (PDE5i) are the first-line treatment for erectile dysfunction (ED), but there is in approximately 30% of ineffective patients or contraindicated in patients taking nitrate medications. Although vacuum erection device (VED) is the second line in ED guidelines, they have long been unavailable in Japan, due to the withdrawal of their manufacturers. A new VED, Vigor 2020, has now been manufactured and received medical approval by the Pharmaceuticals and Medical Devices Agency (PMDA) in Japan. It is very important to be able to sexual intercourse with VED, recommended in the ED guidelines. We conducted a retrospective observational study of patients with Vigor 2020 in clinical practice. We analyzed male patients aged 20 years or older who presented to an outpatient clinic with ED and were treated with Vigor 2020 as a second-line treatment, because PDE5i was ineffective or contraindicated. Sexual and ejaculatory function were assessed using questionnaires [Erection Hardness Score (EHS), International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire for assessing ejaculatory dysfunction (MSHQ-EjD), the numerical rating scale (NRS)]. There were 34 participants who could be evaluated before and after the use of Vigor 2020, with a mean age of 57.85 (27–86) years. Significant improvement in EHS and IIEF total score were observed with the use of Vigor 2020 in all participants. There was a significant improvement in MSHQ-EjD and NRS for participants who had an EHS of 3 or higher after the use of Vigor 2020. But no significant improvement in MSHQ-EjD and NRS for participants who had an EHS of 2 or lower after the use of Vigor 2020. The participants experienced no significant adverse events. Vigor 2020 may be one treatment tool for ED, as defined in the ED guidelines. There is not only significant improvement of erection with Vigor 2020 but also improvement of ejaculation in cases of significant erectile efficacy. No.
{"title":"(139) Efficacy of a New Vacuum Erection Device (Vigor 2020) for Erectile Dysfunction in a Retrospective Study in Japan","authors":"M. Shirai, M. Sano, Y. Anno, K. Ishikawa, A. Taniguchi, A. Kure, Y. Uesaka, T. Nozaki, S. Fukuhara, A. Iwasa, K. Kobayashi, J. Kato, A. Tsujimura","doi":"10.1093/jsxmed/qdae002.127","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.127","url":null,"abstract":"\u0000 \u0000 \u0000 Phosphodiesterase 5 inhibitors (PDE5i) are the first-line treatment for erectile dysfunction (ED), but there is in approximately 30% of ineffective patients or contraindicated in patients taking nitrate medications. Although vacuum erection device (VED) is the second line in ED guidelines, they have long been unavailable in Japan, due to the withdrawal of their manufacturers.\u0000 \u0000 \u0000 \u0000 A new VED, Vigor 2020, has now been manufactured and received medical approval by the Pharmaceuticals and Medical Devices Agency (PMDA) in Japan. It is very important to be able to sexual intercourse with VED, recommended in the ED guidelines. We conducted a retrospective observational study of patients with Vigor 2020 in clinical practice.\u0000 \u0000 \u0000 \u0000 We analyzed male patients aged 20 years or older who presented to an outpatient clinic with ED and were treated with Vigor 2020 as a second-line treatment, because PDE5i was ineffective or contraindicated. Sexual and ejaculatory function were assessed using questionnaires [Erection Hardness Score (EHS), International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire for assessing ejaculatory dysfunction (MSHQ-EjD), the numerical rating scale (NRS)].\u0000 \u0000 \u0000 \u0000 There were 34 participants who could be evaluated before and after the use of Vigor 2020, with a mean age of 57.85 (27–86) years. Significant improvement in EHS and IIEF total score were observed with the use of Vigor 2020 in all participants. There was a significant improvement in MSHQ-EjD and NRS for participants who had an EHS of 3 or higher after the use of Vigor 2020. But no significant improvement in MSHQ-EjD and NRS for participants who had an EHS of 2 or lower after the use of Vigor 2020. The participants experienced no significant adverse events.\u0000 \u0000 \u0000 \u0000 Vigor 2020 may be one treatment tool for ED, as defined in the ED guidelines. There is not only significant improvement of erection with Vigor 2020 but also improvement of ejaculation in cases of significant erectile efficacy.\u0000 \u0000 \u0000 \u0000 No.\u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"69 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.151
K. Khalaf Alla, S. Howell, R. Wang
Peyronie's disease, a condition characterized by penile curvature, approximately affects 9% of men. Surgical interventions are often employed to address this bothersome condition, and these can include techniques such as plication of the tunica albuginea, incision, or excision of the plaque with grafting procedures, and penile prosthesis implantation. The recommended treatment options vary depending on the specific constellation of symptoms and underlying conditions experienced by the patient. We present a case of severe ventral curvature and penile shortening due to urethral tethering, resulting in residual curvature even after undergoing plaque excision and grafting. The patient is a 65-year-old gentleman with a history of metastatic renal cell carcinoma, deep vein thrombosis status post inferior vena cava filter placement as well as anticoagulation with apixaban, and diabetes mellitus who presented with a complaint of progressive penile curvature over his past 12 months. His secondary complaints included difficulty and pain with intercourse. He noted a 90-degree ventral erection. He denies any history of penile trauma, surgery, or pelvic radiation, though he did report chest radiation for his metastatic kidney cancer. Penile doppler noted a large ventral mid penile plaque measuring 9.5x7.7x5 mm. Due to the severe, bothersome curvature, the patient was recommended excision and grafting (Tutoplast). Intraoperatively, a 2.5 cm x 3.0 cm plaque was excised and a Tutoplast pericardial allograft was used to cover the corporal defect. However, due to urethral tethering the patient still had residual curvature. We opted to perform a dorsal tunica albuginea plication using the Lue 16 dot technique. Penile plication remains a tool in the armamentarium of the reconstructive urologist and andrologist for penile curvature arising from Peyronie’s disease. However, in the setting of severe curvature, the penile length loss arising from plication alone can be prohibitive. Therefore incision, or excision with grafting has been implemented with significant sparing of penile length. On the other hand, there is a limit to which length can be maintained and occasionally the tethering of the corpus spongiosum can result in residual curvature. Contralateral tunical plication is therefore an option to be performed concomitantly with grafting procedures. This combination is uncommon but has been reported. In our approach, the patient’s severe curvature was improved with ventral plaque excision and grafting. However, his residual curvature at this stage was able to be corrected with minimal effect on his penile length by applying a dorsal plication technique with minimal additional risk. During the follow-up after the surgery, the patient reported a smooth recovery without any complications. There was no residual curvature, and the patient was able to achieve normal erections sufficient for intercourse without the need for additional measures.
{"title":"(166) Surgical Excision and Grafting with Simultaneous Dorsal Plication for Ventral Plaque Accompanied by Urethral Tethering","authors":"K. Khalaf Alla, S. Howell, R. Wang","doi":"10.1093/jsxmed/qdae002.151","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.151","url":null,"abstract":"\u0000 \u0000 \u0000 Peyronie's disease, a condition characterized by penile curvature, approximately affects 9% of men. Surgical interventions are often employed to address this bothersome condition, and these can include techniques such as plication of the tunica albuginea, incision, or excision of the plaque with grafting procedures, and penile prosthesis implantation. The recommended treatment options vary depending on the specific constellation of symptoms and underlying conditions experienced by the patient.\u0000 \u0000 \u0000 \u0000 We present a case of severe ventral curvature and penile shortening due to urethral tethering, resulting in residual curvature even after undergoing plaque excision and grafting.\u0000 \u0000 \u0000 \u0000 The patient is a 65-year-old gentleman with a history of metastatic renal cell carcinoma, deep vein thrombosis status post inferior vena cava filter placement as well as anticoagulation with apixaban, and diabetes mellitus who presented with a complaint of progressive penile curvature over his past 12 months. His secondary complaints included difficulty and pain with intercourse. He noted a 90-degree ventral erection. He denies any history of penile trauma, surgery, or pelvic radiation, though he did report chest radiation for his metastatic kidney cancer. Penile doppler noted a large ventral mid penile plaque measuring 9.5x7.7x5 mm. Due to the severe, bothersome curvature, the patient was recommended excision and grafting (Tutoplast). Intraoperatively, a 2.5 cm x 3.0 cm plaque was excised and a Tutoplast pericardial allograft was used to cover the corporal defect. However, due to urethral tethering the patient still had residual curvature. We opted to perform a dorsal tunica albuginea plication using the Lue 16 dot technique.\u0000 \u0000 \u0000 \u0000 Penile plication remains a tool in the armamentarium of the reconstructive urologist and andrologist for penile curvature arising from Peyronie’s disease. However, in the setting of severe curvature, the penile length loss arising from plication alone can be prohibitive. Therefore incision, or excision with grafting has been implemented with significant sparing of penile length. On the other hand, there is a limit to which length can be maintained and occasionally the tethering of the corpus spongiosum can result in residual curvature. Contralateral tunical plication is therefore an option to be performed concomitantly with grafting procedures. This combination is uncommon but has been reported. In our approach, the patient’s severe curvature was improved with ventral plaque excision and grafting. However, his residual curvature at this stage was able to be corrected with minimal effect on his penile length by applying a dorsal plication technique with minimal additional risk. During the follow-up after the surgery, the patient reported a smooth recovery without any complications. There was no residual curvature, and the patient was able to achieve normal erections sufficient for intercourse without the need for additional measures.","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"162 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.233
J. Feghali
Severe corporeal fibrosis presents significant challenges in penile implant insertion. LISWT studies in rats and humans have suggested its ability to rejuvenate cavernous bodies through various mechanisms and growth factors. This prompted our evaluation of LISWT's effectiveness in facilitating prosthesis implantation in patients with penile fibrosis, which are typically considered difficult cases. A 34-year-old male smoker with a history of sickle cell disease, bilateral hip replacements, and splenectomy due to sickle cell crisis sought penile prosthesis implantation. He presented with severe erectile dysfunction and corporeal fibrosis following two ischemic priapism episodes caused by sickle cell disease, which were treated with distal shunts 4 and 1 years prior, respectively (Fig. 1). After obtaining consent, the patient underwent four cycles of LISWT, spaced one month apart. Each cycle consisted of four weekly sessions using the PiezoWave2 device from Richard WOLF with settings of 0.16mj/mm2 energy flux density, 6Hz frequency, and 10mm wave focus penetration depth. In each session, the patient received a total of 6000 shocks, distributed between the perineum, dorsum penis, and the lateral aspect of the penis. A month post-LISWT, the patient's Erection Hardness Score (EHS) improved from 0 to 1 following an intracavernous injection of 20 mcg of alprostadil (Fig. 2). Subsequently, he underwent a malleable penile implant procedure through the penoscrotal approach. Cavernosal dilation was successful up to 10mm using a Hegar dilator, with bilateral corporal measurements of 8cm proximally and 9cm distally. A Tactra malleable penile prosthesis (9.5mm girth and 17cm length) from Boston Scientific was implanted without complications (Fig. 3.A.B) In cases of severe corporeal fibrosis, pre-treatment with LISWT may aid in the dilation of the corpora during penile prosthesis implantation, potentially reducing complications. Randomized studies are warranted to validate this indication No.
{"title":"(270) LISWT Before Penile Prosthesis Implantation Might Facilitate Dilation of Fibrotic Corpora","authors":"J. Feghali","doi":"10.1093/jsxmed/qdae002.233","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.233","url":null,"abstract":"\u0000 \u0000 \u0000 Severe corporeal fibrosis presents significant challenges in penile implant insertion. LISWT studies in rats and humans have suggested its ability to rejuvenate cavernous bodies through various mechanisms and growth factors.\u0000 \u0000 \u0000 \u0000 This prompted our evaluation of LISWT's effectiveness in facilitating prosthesis implantation in patients with penile fibrosis, which are typically considered difficult cases.\u0000 \u0000 \u0000 \u0000 A 34-year-old male smoker with a history of sickle cell disease, bilateral hip replacements, and splenectomy due to sickle cell crisis sought penile prosthesis implantation. He presented with severe erectile dysfunction and corporeal fibrosis following two ischemic priapism episodes caused by sickle cell disease, which were treated with distal shunts 4 and 1 years prior, respectively (Fig. 1). After obtaining consent, the patient underwent four cycles of LISWT, spaced one month apart. Each cycle consisted of four weekly sessions using the PiezoWave2 device from Richard WOLF with settings of 0.16mj/mm2 energy flux density, 6Hz frequency, and 10mm wave focus penetration depth. In each session, the patient received a total of 6000 shocks, distributed between the perineum, dorsum penis, and the lateral aspect of the penis.\u0000 \u0000 \u0000 \u0000 A month post-LISWT, the patient's Erection Hardness Score (EHS) improved from 0 to 1 following an intracavernous injection of 20 mcg of alprostadil (Fig. 2). Subsequently, he underwent a malleable penile implant procedure through the penoscrotal approach. Cavernosal dilation was successful up to 10mm using a Hegar dilator, with bilateral corporal measurements of 8cm proximally and 9cm distally. A Tactra malleable penile prosthesis (9.5mm girth and 17cm length) from Boston Scientific was implanted without complications (Fig. 3.A.B)\u0000 \u0000 \u0000 \u0000 In cases of severe corporeal fibrosis, pre-treatment with LISWT may aid in the dilation of the corpora during penile prosthesis implantation, potentially reducing complications. Randomized studies are warranted to validate this indication\u0000 \u0000 \u0000 \u0000 No.\u0000 \u0000 \u0000 \u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140082999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.143
E. Allaire, M. Pedini, M. Maman-Maharazou, H. Sussman, J. Floresco, P. Hauet, R. Virag
Introduction. Primary erectile dysfunction (PED) due to cavernovenous leakage (CVL), a disease in which blood entering corpora cavernosa escapes too early because of abnormal venous network, may affect as many as 1 to 2% of men under 30 with failure of erections to develop or maintain. When resistant to PDE5Is, it is a devastating condition leaving men with no possibility of sexual intercourse with penetration, and usually absence of diagnosis and specific treatment. Evaluate symptoms and results of a new method of treatment combining open surgery and embolization simultaneously during the same procedure, in patients with PED and CVL resistant to PDE5Is. 81 consecutive patients with severe PED with CVL diagnosed by pharmacologically-challenge penile duplex sonography (PC-PDS) were operated-on. Leaks were imaged by caverno-computed tomography. Patients with other cause of ED were excluded, all had refused a penile implant, signed an informed consent, had a control PC-PDS three months after surgery, and were clinically evaluated during follow-up. A retrospective analysis was performed on prospectively collected data. Comparisons of variables before and after surgery used a paired t-test. Mean age at PED onset reported by patients was 19.0±4.6 years, range 13–30. Mean age at surgery was 34.5±9.2 years, range 18–70. Mean ED duration before surgery was 15.4±10.1 years (range 1–40). All patients had clinical signs of organic ED (no phase of erection improvement in the past six months, erectile dysfunction during masturbation (Erection Hardness Score (EHS)<3 and/or erection instability). CVL could be suspected in all patients based on reported erection instability during masturbation, and in 86.4%, based on variation of EHS according to body position during masturbations. At three-month evaluation, mean pharmacologic EHS had increased from 2.59±.77 before surgery, to 3.45±.63 (p<.0001). The mean pharmacologic EHS increase was 0.83±.92. All CVL hemodynamic parameters at PC-PDS had decreased compared to pre-surgery: mean End Diastolic Velocity (from 9.9±9.22 to 6.77±7.34 cm/s, p<.023), mean leakage speed on Deep Dorsal Vein (from 10.87±12.48 to .69±2.77 cm/s, p<.0001), mean speed on any superficial vein (from 10.96±10.08 to 4.77±6.90 cm/s, p<.0001). Patients unable to perform penetrations despite intracavernous injection of Prostaglandin E1 20 micg plus Papaverine 40 mg (pharmacological EHS<3) decreased from 64.2 to 13.5% (Chi-square test: p<.001). At the end of the 26.0±21.9-month follow-up, IIEF-5 score had increased from 8.9±5.3 to 16.1±5.8 (p<.013), clinical EHS during sexual intercourse from 1.97±.67 to 3.31±.71 (p<.0001), penetration success rate from 18.3±28.2 to 64.2±40.1%, morning EHSfrom 1.11±1.40 to 2.12±1.49 (p<.0002), masturbation EHS from 2.14±.84 to 3.07±.77 (p<.002) before and after surgery, respectively. 38.3% did not take any medication for erection. Simultaneous open surgery and embolization is a conser
{"title":"(157) Primary Erectile Dysfunction Caused by Cavernovenous Leakage: Clinical Presentation and New Surgical Treatment in 81 Consecutive Patients with Severe Erectile Dysfunction","authors":"E. Allaire, M. Pedini, M. Maman-Maharazou, H. Sussman, J. Floresco, P. Hauet, R. Virag","doi":"10.1093/jsxmed/qdae002.143","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.143","url":null,"abstract":"\u0000 \u0000 \u0000 Introduction. Primary erectile dysfunction (PED) due to cavernovenous leakage (CVL), a disease in which blood entering corpora cavernosa escapes too early because of abnormal venous network, may affect as many as 1 to 2% of men under 30 with failure of erections to develop or maintain. When resistant to PDE5Is, it is a devastating condition leaving men with no possibility of sexual intercourse with penetration, and usually absence of diagnosis and specific treatment.\u0000 \u0000 \u0000 \u0000 Evaluate symptoms and results of a new method of treatment combining open surgery and embolization simultaneously during the same procedure, in patients with PED and CVL resistant to PDE5Is.\u0000 \u0000 \u0000 \u0000 81 consecutive patients with severe PED with CVL diagnosed by pharmacologically-challenge penile duplex sonography (PC-PDS) were operated-on. Leaks were imaged by caverno-computed tomography. Patients with other cause of ED were excluded, all had refused a penile implant, signed an informed consent, had a control PC-PDS three months after surgery, and were clinically evaluated during follow-up. A retrospective analysis was performed on prospectively collected data. Comparisons of variables before and after surgery used a paired t-test.\u0000 \u0000 \u0000 \u0000 Mean age at PED onset reported by patients was 19.0±4.6 years, range 13–30. Mean age at surgery was 34.5±9.2 years, range 18–70. Mean ED duration before surgery was 15.4±10.1 years (range 1–40). All patients had clinical signs of organic ED (no phase of erection improvement in the past six months, erectile dysfunction during masturbation (Erection Hardness Score (EHS)<3 and/or erection instability). CVL could be suspected in all patients based on reported erection instability during masturbation, and in 86.4%, based on variation of EHS according to body position during masturbations. At three-month evaluation, mean pharmacologic EHS had increased from 2.59±.77 before surgery, to 3.45±.63 (p<.0001). The mean pharmacologic EHS increase was 0.83±.92. All CVL hemodynamic parameters at PC-PDS had decreased compared to pre-surgery: mean End Diastolic Velocity (from 9.9±9.22 to 6.77±7.34 cm/s, p<.023), mean leakage speed on Deep Dorsal Vein (from 10.87±12.48 to .69±2.77 cm/s, p<.0001), mean speed on any superficial vein (from 10.96±10.08 to 4.77±6.90 cm/s, p<.0001). Patients unable to perform penetrations despite intracavernous injection of Prostaglandin E1 20 micg plus Papaverine 40 mg (pharmacological EHS<3) decreased from 64.2 to 13.5% (Chi-square test: p<.001). At the end of the 26.0±21.9-month follow-up, IIEF-5 score had increased from 8.9±5.3 to 16.1±5.8 (p<.013), clinical EHS during sexual intercourse from 1.97±.67 to 3.31±.71 (p<.0001), penetration success rate from 18.3±28.2 to 64.2±40.1%, morning EHSfrom 1.11±1.40 to 2.12±1.49 (p<.0002), masturbation EHS from 2.14±.84 to 3.07±.77 (p<.002) before and after surgery, respectively. 38.3% did not take any medication for erection.\u0000 \u0000 \u0000 \u0000 Simultaneous open surgery and embolization is a conser","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140083398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.062
K. Almekaty, M. Ragab, A. Rashed, A. Gaith, A. Hagras, A. Ghoneim, A. Abdelraheem, M. Zahran
Lifelong premature ejaculation (PE) is considered one of the commonest sexual disorder affecting men with an estimated prevalence of 2–5%. [1,2] Many definitions have been proposed for lifelong PE, the most accepted is the ISSM’s which consider PE “ejaculation which always or nearly always occurs prior to or within about 1 minute of vaginal penetration from first sexual experiences (lifelong premature ejaculation) + Negative personal consequences such as distress, bother, frustration, and/or the avoidance of sexual intimacy”.[3] However, there is no doubt that lifelong PE negatively affects the quality of life of the patient and his partner. [2] Proper assessment of this problem in an objective validated way has always been a challenge. [4] Treatment also varied from behavioral techniques, SSRIs and local anaesthetics with very variable outcome, unsatisfactory for many patients. [5] New lines have been always evolving trying to address this resistant category of patients such as injection of the glans penis with filler [6] or neurectomy of the dorsal nerve of the penis. [7] Herein; we assess a new line of treatment for lifelong PE which theoretically can inhibit the stereotyped rhythmic contractions of the bulbospongiosus muscle during the reflex of ejaculation using botulinum-A toxin; in a prospective, randomized, placebo-controlled study. This study aimed to assess a new line of treatment for lifelong premature ejaculation (PE) which is botulinum-A toxin injection into the bulbospongiosus muscle. It was conducted at the Andrology Unit of Tanta University in Egypt between November 2020 and November 2022. Patients with lifelong PE were considered for this study. Those suffering from PE secondary to erectile dysfunction, genital infection or psychic stress were excluded. Patients have been asked to stop any medical treatment that could affect their sexual function eg PDE5i and medications for lifelong PE; for at least 1 month before injection as well as 6 months thereafter. Sixty patients with lifelong PE have been prospectively enrolled and randomized into 2 groups; the test group (group A) was injected with 100 U botulinum-A toxin at 10 U/ml and the control group (group B) which was injected with the same volume of saline into the bulbospongiosus muscle. Injection was done in lithotomy position, using a fanning technique, under US guidance using the superficial probe to localize the site of injection. Fifty-seven patients of 60 completed the follow up protocol. Fifty-seven patients of 60 completed the follow up protocol. The IELT, PEP score and female satisfaction showed no statistically significant difference between both groups at the 1, 3 and 6 months post intervention. However, in the treatment group, the median (IQR) PEP score increased significantly after 1 and 3 months with a mean difference of 1.6 and 95 % CI of (0.7–2.5), P=0.001 and 0.9 and 95% CI of (1.07–1.69), P=0.02 respectively. Whereas insignificant cha
终生早泄（PE）被认为是影响男性的最常见性障碍之一，估计发病率为 2-5%。[1,2]对于终生早泄，人们提出了许多定义，其中最广为接受的是 ISSM 的定义，即早泄 "总是或几乎总是在首次性经历插入阴道前或插入阴道后约 1 分钟内发生射精（终生早泄）+消极的个人后果，如痛苦、烦恼、沮丧和/或避免性亲密关系"。[2]以客观有效的方式对这一问题进行适当评估一直是一项挑战。[4]治疗方法也多种多样，包括行为技术、SSRIs 和局部麻醉剂，但疗效参差不齐，许多患者都不满意。[5]新的治疗方法一直在不断发展，试图解决这类患者的抵触情绪，如在阴茎龟头注射填充物[6]或阴茎背神经切除术。[7]在此，我们通过一项前瞻性、随机、安慰剂对照研究，评估了一种治疗终身性阴茎海绵体肌炎的新方法，该方法理论上可以使用肉毒杆菌毒素抑制射精反射过程中球海绵体肌的刻板节律性收缩。 这项研究旨在评估一种治疗终身早泄（PE）的新方法，即向球海绵体肌注射肉毒杆菌毒素。 研究于 2020 年 11 月至 2022 年 11 月期间在埃及坦塔大学的 Andrology Unit 展开。本研究考虑终生勃起功能障碍患者。因勃起功能障碍、生殖器感染或精神压力而继发的阴茎海绵体肌炎患者不在研究范围内。要求患者在注射前至少 1 个月和注射后 6 个月内停止任何可能影响其性功能的药物治疗，如 PDE5i 和治疗终身 PE 的药物。前瞻性地招募了 60 名终身 PE 患者，并将其随机分为两组：试验组（A 组）注射 10 U/ml 的 100 U 肉毒杆菌毒素，对照组（B 组）在球海绵体肌内注射相同容量的生理盐水。注射时采取截石位，使用扇形技术，在 US 引导下使用浅表探针定位注射部位。60 名患者中有 57 名完成了随访方案。 60 名患者中有 57 名完成了随访。干预后 1 个月、3 个月和 6 个月，两组患者的 IELT、PEP 评分和女性满意度在统计学上无显著差异。然而，在治疗组中，PEP 评分的中位数（IQR）在 1 个月和 3 个月后显著增加，平均值分别为 1.6 和 95 % CI (0.7-2.5)，P=0.001；0.9 和 95 % CI (1.07-1.69)，P=0.02。而对照组在 6 个月时的变化不明显，平均差异为 0.13。在 BS 肌肉注射 A 型肉毒杆菌似乎是安全的，但与安慰剂相比，在治疗终生无 PE 症方面未能证明其疗效。
{"title":"(067) The Outcome of Bulbospongiosus Muscle Injection with Botulinum-A Toxin for Treatment of Lifelong Premature Ejaculation; A Randomized Controlled Trial","authors":"K. Almekaty, M. Ragab, A. Rashed, A. Gaith, A. Hagras, A. Ghoneim, A. Abdelraheem, M. Zahran","doi":"10.1093/jsxmed/qdae002.062","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.062","url":null,"abstract":"\u0000 \u0000 \u0000 Lifelong premature ejaculation (PE) is considered one of the commonest sexual disorder affecting men with an estimated prevalence of 2–5%. [1,2] Many definitions have been proposed for lifelong PE, the most accepted is the ISSM’s which consider PE “ejaculation which always or nearly always occurs prior to or within about 1 minute of vaginal penetration from first sexual experiences (lifelong premature ejaculation) + Negative personal consequences such as distress, bother, frustration, and/or the avoidance of sexual intimacy”.[3] However, there is no doubt that lifelong PE negatively affects the quality of life of the patient and his partner. [2] Proper assessment of this problem in an objective validated way has always been a challenge. [4] Treatment also varied from behavioral techniques, SSRIs and local anaesthetics with very variable outcome, unsatisfactory for many patients. [5] New lines have been always evolving trying to address this resistant category of patients such as injection of the glans penis with filler [6] or neurectomy of the dorsal nerve of the penis. [7] Herein; we assess a new line of treatment for lifelong PE which theoretically can inhibit the stereotyped rhythmic contractions of the bulbospongiosus muscle during the reflex of ejaculation using botulinum-A toxin; in a prospective, randomized, placebo-controlled study.\u0000 \u0000 \u0000 \u0000 This study aimed to assess a new line of treatment for lifelong premature ejaculation (PE) which is botulinum-A toxin injection into the bulbospongiosus muscle.\u0000 \u0000 \u0000 \u0000 It was conducted at the Andrology Unit of Tanta University in Egypt between November 2020 and November 2022. Patients with lifelong PE were considered for this study. Those suffering from PE secondary to erectile dysfunction, genital infection or psychic stress were excluded. Patients have been asked to stop any medical treatment that could affect their sexual function eg PDE5i and medications for lifelong PE; for at least 1 month before injection as well as 6 months thereafter. Sixty patients with lifelong PE have been prospectively enrolled and randomized into 2 groups; the test group (group A) was injected with 100 U botulinum-A toxin at 10 U/ml and the control group (group B) which was injected with the same volume of saline into the bulbospongiosus muscle. Injection was done in lithotomy position, using a fanning technique, under US guidance using the superficial probe to localize the site of injection. Fifty-seven patients of 60 completed the follow up protocol.\u0000 \u0000 \u0000 \u0000 Fifty-seven patients of 60 completed the follow up protocol. The IELT, PEP score and female satisfaction showed no statistically significant difference between both groups at the 1, 3 and 6 months post intervention. However, in the treatment group, the median (IQR) PEP score increased significantly after 1 and 3 months with a mean difference of 1.6 and 95 % CI of (0.7–2.5), P=0.001 and 0.9 and 95% CI of (1.07–1.69), P=0.02 respectively. Whereas insignificant cha","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"123 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.156
S. Kalidoss, P. Barreto Guimaraes, D. Nusbaum, O. Raheem, E. Kocjancic
Management of Peyronie’s disease is challenging for patients and can present with deformed penile angulation, pain, and reduction in erectile function. This video demonstrates the usage of cadaveric fascia lata grafting to rectify severe ventral penile curvature symptomatic of advanced Peyronie’s disease. We outline a surgical technique to use fascia lata allografting for the correction of excessive ventral penile curvature caused by Peyronie’s disease if non-surgical treatments are insufficient. A 65 year-old African-American male patient with severe Peyronie’s disease and a history of hypertension presented with a ventral penile curvature of 110 degrees at the proximal third of the shaft. Consequently, he was unable to engage in penetrative sexual intercourse. An artificial hydraulic erection confirmed the curvature, and the areas of fibrotic plaque were palpated. A degloving incision was made proximal to the glans, and a 6 cm segment of Buck’s fascia was elevated ventrally. The neurovascular bundle and urethra were separated from the corporae. A second hydraulic erection was induced, exposing a 6 cm by 3.5 cm rectangular tunical defect which was marked for excision. Bovie electrocautery was utilized to excise the fibrotic section of tunica albuginea. A rectangular section of Biosure human cadaveric fascia lata graft was soaked in saline solution and trimmed to 6 cm by 4 cm. The graft was sutured to the excised region of the tunica albuginea with 4–0 Maxon in a watertight fashion with a running stitch. A final hydraulic erection confirmed the mitigation of the penile curvature, and Buck’s fascia and the shaft skin were re-approximated to the subcoronal skin with 3–0 Vycril suture. This grafting procedure resulted in a near complete resolution of the ventral penile curvature with no complications. The patient was admitted overnight for observation and discharged POD 1 with a 3-layer dressing and mesh underwear. The postoperative penile length increased to 17.5cm from 16cm preoperatively as a result of the grafting and mitigation of the penile curvature. Fascia lata allografts are robust and easily obtainable, which is ideal for the corporal reconstruction of fibrotic tunica albuginea in patients with Peyronie’s disease. This procedure demonstrates the utility of cadaveric fascia lata as an alternative surgical grafting material for the surgical correction of penile curvature associated with severe Peyronie’s disease. No.
{"title":"(171) Tunical Incision and Grafting for Severe Peyronie’s Disease Using Human Fascia Lata: Surgical Technique","authors":"S. Kalidoss, P. Barreto Guimaraes, D. Nusbaum, O. Raheem, E. Kocjancic","doi":"10.1093/jsxmed/qdae002.156","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.156","url":null,"abstract":"\u0000 \u0000 \u0000 Management of Peyronie’s disease is challenging for patients and can present with deformed penile angulation, pain, and reduction in erectile function. This video demonstrates the usage of cadaveric fascia lata grafting to rectify severe ventral penile curvature symptomatic of advanced Peyronie’s disease.\u0000 \u0000 \u0000 \u0000 We outline a surgical technique to use fascia lata allografting for the correction of excessive ventral penile curvature caused by Peyronie’s disease if non-surgical treatments are insufficient.\u0000 \u0000 \u0000 \u0000 A 65 year-old African-American male patient with severe Peyronie’s disease and a history of hypertension presented with a ventral penile curvature of 110 degrees at the proximal third of the shaft. Consequently, he was unable to engage in penetrative sexual intercourse. An artificial hydraulic erection confirmed the curvature, and the areas of fibrotic plaque were palpated. A degloving incision was made proximal to the glans, and a 6 cm segment of Buck’s fascia was elevated ventrally. The neurovascular bundle and urethra were separated from the corporae. A second hydraulic erection was induced, exposing a 6 cm by 3.5 cm rectangular tunical defect which was marked for excision. Bovie electrocautery was utilized to excise the fibrotic section of tunica albuginea. A rectangular section of Biosure human cadaveric fascia lata graft was soaked in saline solution and trimmed to 6 cm by 4 cm. The graft was sutured to the excised region of the tunica albuginea with 4–0 Maxon in a watertight fashion with a running stitch. A final hydraulic erection confirmed the mitigation of the penile curvature, and Buck’s fascia and the shaft skin were re-approximated to the subcoronal skin with 3–0 Vycril suture.\u0000 \u0000 \u0000 \u0000 This grafting procedure resulted in a near complete resolution of the ventral penile curvature with no complications. The patient was admitted overnight for observation and discharged POD 1 with a 3-layer dressing and mesh underwear. The postoperative penile length increased to 17.5cm from 16cm preoperatively as a result of the grafting and mitigation of the penile curvature.\u0000 \u0000 \u0000 \u0000 Fascia lata allografts are robust and easily obtainable, which is ideal for the corporal reconstruction of fibrotic tunica albuginea in patients with Peyronie’s disease. This procedure demonstrates the utility of cadaveric fascia lata as an alternative surgical grafting material for the surgical correction of penile curvature associated with severe Peyronie’s disease.\u0000 \u0000 \u0000 \u0000 No.\u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"30 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140276998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1093/jsxmed/qdae002.131
S. Balasubramanian, C. Fox, V. Ramanathan
Sexuality is expressed through an individual’s sexual behaviours. Distinguishing “problematic” or atypical sexual behaviours from “typical” sexual behaviours depends on sociocultural conceptions of the norm. Perceptions of problematic sexual behaviour evolve in response to societal change. These perceptions influence and reflect the attitudes and vales of health practitioners. The attitudes and values of health practitioners directly affects clients with problematic sexual behaviours. Therapy approaches are not value-free. Practitioners are influenced by sociocultural norms which create and reinforce stereotypes. These social forces are especially pronounced in the context of problematic sexual behaviours. The nosological classification of sexual “disorders” risks pathologizing normal variants of sexual behaviours. Despite this, research examining health practitioner attitudes and values toward problematic sexual behaviours is scant. Existing measures of attitudes either focus on a broad range of sexual behaviours or on sexual health overall. We therefore sought to understand the themes underlying health practitioner attitudes and values toward problematic sexual behaviours. To assess the themes influencing health practitioner attitudes and values towards problematic sexual behaviours. An inductive qualitative approach provided the framework using in-depth, semi-structured interviews. An interview schedule was based on deductive domains gleaned from a review research exploring health practitioner attitudes and values toward problematic sexual behaviour, and the research team’s experience of the field. A case vignette of a distressed person reporting a problematic sexual behaviour was created to trigger discussion. A diverse range of health practitioners working with people reporting problematic sexual behaviours was recruited. This included five medical doctors (general practice, psychiatry, sexual health) and two sexual health nurses. A coding matrix was generated based on a priori review of the literature and a posteriori review of the interviews. Thematic analysis of interview transcripts was performed using the software program NVivo. Five themes emerged from the interviews. Two deductive themes were identified: methods of inquiry about sexual behaviours; discrepancies in defining problematic sexual behaviours. Myriad frameworks underpin a practitioner’s exploration of sexual behaviour issues. Interviewees also could not operationalise a consistent definition of the “problem”. Three inductive themes emerged: managing judgement in consultations; reflections on practitioner knowledge; the tension between fantasies and problematic sexual behaviours. Interviewees referred to “non-judgemental care” as essential in addressing sexual behaviour problems. There was consistent reference to a “limited understanding” of problematic sexual behaviours. A need to differentiate thoughts (fantasies) from actions (behaviours) for ris
{"title":"(145) Health Practitioner Attitudes and Values Towards Problematic Sexual Behaviours","authors":"S. Balasubramanian, C. Fox, V. Ramanathan","doi":"10.1093/jsxmed/qdae002.131","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae002.131","url":null,"abstract":"\u0000 \u0000 \u0000 Sexuality is expressed through an individual’s sexual behaviours. Distinguishing “problematic” or atypical sexual behaviours from “typical” sexual behaviours depends on sociocultural conceptions of the norm. Perceptions of problematic sexual behaviour evolve in response to societal change. These perceptions influence and reflect the attitudes and vales of health practitioners. The attitudes and values of health practitioners directly affects clients with problematic sexual behaviours. Therapy approaches are not value-free. Practitioners are influenced by sociocultural norms which create and reinforce stereotypes. These social forces are especially pronounced in the context of problematic sexual behaviours. The nosological classification of sexual “disorders” risks pathologizing normal variants of sexual behaviours. Despite this, research examining health practitioner attitudes and values toward problematic sexual behaviours is scant. Existing measures of attitudes either focus on a broad range of sexual behaviours or on sexual health overall. We therefore sought to understand the themes underlying health practitioner attitudes and values toward problematic sexual behaviours.\u0000 \u0000 \u0000 \u0000 To assess the themes influencing health practitioner attitudes and values towards problematic sexual behaviours.\u0000 \u0000 \u0000 \u0000 An inductive qualitative approach provided the framework using in-depth, semi-structured interviews. An interview schedule was based on deductive domains gleaned from a review research exploring health practitioner attitudes and values toward problematic sexual behaviour, and the research team’s experience of the field. A case vignette of a distressed person reporting a problematic sexual behaviour was created to trigger discussion. A diverse range of health practitioners working with people reporting problematic sexual behaviours was recruited. This included five medical doctors (general practice, psychiatry, sexual health) and two sexual health nurses. A coding matrix was generated based on a priori review of the literature and a posteriori review of the interviews. Thematic analysis of interview transcripts was performed using the software program NVivo.\u0000 \u0000 \u0000 \u0000 Five themes emerged from the interviews. Two deductive themes were identified: methods of inquiry about sexual behaviours; discrepancies in defining problematic sexual behaviours. Myriad frameworks underpin a practitioner’s exploration of sexual behaviour issues. Interviewees also could not operationalise a consistent definition of the “problem”. Three inductive themes emerged: managing judgement in consultations; reflections on practitioner knowledge; the tension between fantasies and problematic sexual behaviours. Interviewees referred to “non-judgemental care” as essential in addressing sexual behaviour problems. There was consistent reference to a “limited understanding” of problematic sexual behaviours. A need to differentiate thoughts (fantasies) from actions (behaviours) for ris","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"23 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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