Journal of Sexual Medicine最新文献

Background: While various treatment modalities exist, penile prosthesis (PP) implantation offers a permanent solution for patients that do not respond to or are not suitable for other treatment options for erectile dysfunction.

Aim: The aim of this study was to establish stretched penile length before surgery as a reliable determining factor of penile length after penile implant surgery.

Methods: For this study, data on penile length before and after PP surgery from three European centers was analyzed. Penile length measurements were conducted preoperatively and postoperatively in different conditions using standardized techniques. Only virgin cases were included and a complete case analysis was performed.

Outcome: The outcome of this study was the comparison of stretched penile length before and the inflated penile length after PP surgery.

Results: Data on penile length before and after PP of 361 patients was analyzed. Preoperative stretched penile length was equal to postoperative inflated penile length in 33% of patients. The absolute mean difference between pre-surgery stretched and postoperative inflated lengths was 1.1 cm. No correlation was found between implanted cylinder length and postoperative penile length. Additionally, the choice of implant type did not significantly affect postoperative penile length outcomes.

Clinical implications: Our findings confirm the reliability of preoperative stretched penile length as a tool for proper patient counseling before PP surgery.

Strengths & limitations: Although our study is overpowered, our results show that preoperative stretched penile length serves as a reliable predictor of postoperative penile length outcomes after PP surgery. By providing clinicians with a tool for patient counseling, our findings contribute to enhancing satisfaction and quality of life outcomes in patients undergoing PP implantation.

Conclusion: Preoperative stretched penile length serves as a reliable predictor of postoperative penile length outcomes after PP surgery.

Background: Radiotherapy is often given with androgen deprivation therapy for prostate cancer which causes a reduction in testosterone levels, which when below castrate levels, can cause the prostate specific antigen (PSA) levels to be artificially low.

Aim: To determine if high-level radiotherapy clinical trials are underestimating biochemical recurrence (BCR) rates due to inadequate measurement of testosterone levels.

Methods: The study plans for clinical trials performed by the Radiation Therapy Oncology Group (RTOG [now NRG]) on clinicaltrials.gov were reviewed for details on testosterone measurement in trials from 1994 to 2023, namely if the testosterone levels were indexed to PSA levels.

Outcomes: PSA being indexed to testosterone levels and other metrics of testosterone measurement, including time of day of measurement, assay used, and mean testosterone measurement.

Results: Five of 21 (24%) trials stipulated that testosterone levels should be indexed to PSA levels. Eleven of 21 (52%) trials made no mention of testosterone. No trial reported testosterone assay or time of day of measurement. Thirteen of 21 (62%) trials did not require regular follow-up testosterone measurements.

Clinical implications: The number of clinical trials indexing or regularly measuring testosterone was surprisingly low, which could cause an underestimation of BCR rates.

Strengths and limitations: Strengths include being the first study, to our knowledge, to analyze the details of testosterone measurement in high-level radiotherapy trials. Limitations include only analyzing RTOG/NRG trials, analyzing unpublished data, and using clinicaltrials.gov rather than official trial protocols to determine details of testosterone measurement.

Conclusion: Indexing of testosterone levels to PSA levels in high-level radiotherapy trials using androgen deprivation therapy was uncommon, possibly rendering data on BCR unreliable, potentially underestimating BCR rates.

Background: Sexual dysfunction (SF) is a prevalent and distressing comorbidity in males with multiple sclerosis (MwMS) and neuromyelitis optica spectrum disorder (MwNMOSD).

Aims: This study aimed to assess the SF in MwMS and MwNMOSD in comparison to male healthy controls (HCs) and identify its associated predictors.

Methods: This case-control study was conducted from February 2023 to January 2024 at the MS clinic of Kashani Hospital, Isfahan, Iran. Participants included 49 MwMS, 27 MwNMOSD, and 40 HCs. Demographic, clinical, and psychological data were collected, and SF was evaluated by the International Index of Erectile Function (IIEF). Linear regression was used to assess relationships between variables.

Outcomes: SF was significantly worse in the MwMS and MwNMOSD compared to the HCs.

Results: SF was significantly lower in MwMS and MwNMOSD compared to HCs. In MwMS, significant independent predictors of SF included partner's education (B = -2.7, P = .003), anxiety (B = -0.6, P = .003), and depression (B = -0.3, P = .026). In MwNMOSD, significant independent predictors of SF were EDSS (B = -5.7, P = .007) and anxiety (B = -1, P = .002).

Clinical implications: Controlling risk factors such as depression and anxiety can improve SF of MwMS to a significant extent.

Strengths and limitations: Despite limitations like the cross-sectional design and exclusion of certain variables, our study identifies significant associations between sexual dysfunction and various risk factors in MwMS and MwNMOSD, emphasizing the need for future longitudinal research.

Conclusion: MwMS and MwNMOSD exhibited worse SF than HCs. Multiple factors have been identified as independent predictors of SF within these patient groups.

Background: Inflatable penile prosthesis (IPP) insertion is recommended for the treatment of patients with Peyronie's disease (PD) and significant erectile dysfunction (ED); adjunctive procedures can be used for residual curvature after IPP placement.

Aim: To assess the management of penile curvature correction in PD patients undergoing IPP procedures within a large multinational, multicenter cohort.

Methods: A retrospective analysis was conducted on PD patients treated with IPP by 11 experienced prosthetic surgeons. Demographic, intraoperative, and postoperative data were analyzed to assess the improvement in penile curvature following IPP, including adjunctive correction techniques such as manual modeling, tunica albuginea plication, and grafting.

Outcomes: Curvature correction achieved after IPP placement and adjunctive procedures.

Results: For 499 PD patients treated with IPP, median age was 62.0 [30.0, 91.0] years with mean follow-up of 16.5 (SD = 12.9) months. The mean preoperative curvature was 39.4° (SD = 17.8°), with dorsal curvature being most common. Among our cohort, 17.6% had IPP-only placement, while the majority of 82.4% patients underwent IPP along with adjunctive correction procedures. Specifically, manual modeling (with/without the "scratch" technique) was used in 74.7% of cases, tunica albuginea plication in 4.8%, grafting in 2%, and combined grafting and modeling in 0.8%. Patients who underwent grafting generally had fewer preoperative comorbidities and more severe preoperative curvatures of 60.0° [45.0°, 70.0°]. Grafting also provided the highest median curvature correction of 55.0° [48.8°, 73.8°], (P < .001). Plication achieved a median curvature correction of 40.0° [28.8°, 41.2°], whereas modeling resulted in a median curvature reduction of 26.0° [20.0°, 39.5°], (P < .001).

Clinical implications: We observed that grafting, though less frequently used, provided more curvature correction in severe PD cases undergoing IPP.

Strengths and limitations: Large cohort size and multinational participation are strengths, though retrospective design and general variability in surgical techniques are limitations.

Conclusion: Adjunctive techniques, including grafting, plication, and modeling provide options for tailoring curvature correction to disease severity and patient characteristics. Future prospective studies are needed to standardize and evaluate the comparative outcomes of these techniques.

Background: 95% of men with spinal cord injuries exhibit difficulties with sexual function, including erectile dysfunction, anejaculation, retrograde ejaculation, poor ejaculatory force, and poor sperm quality.

Aim: The primary goal is to determine if well-established interventions, such as spinal cord epidural stimulation, are a feasible treatment for sexual dysfunction and if locomotor recovery training can be used to improve ejaculatory function in a rodent model of spinal cord injury (SCI).

Methods: Male Wistar rats underwent thoracic laminectomies (shams), spinal cord transections, or moderate spinal cord contusion injuries. In urethane-anesthetized rodents, terminal spinal cord epidural stimulation was performed to target the mid-lumbar level spinal generator for ejaculation (SGE) in animals with transection spinal cord injuries at 3-, 14-, or 70-days post-injury and in animals with sham surgeries and spinal cord contusions at 70 days post-injury. The impact of locomotor training frequency was examined in two groups of rats with spinal cord contusion, which underwent 1-hr of assisted plantar stepping on a treadmill, training two or five times weekly for 6 weeks. Terminal experiments in all groups were followed by measures of sperm concentration and post-mortem testicular weight and morphology.

Outcomes: Spinal cord epidural stimulation consistently induced the expulsion phase of ejaculation, and occasionally the emission phase of ejaculation in rats with chronic SCI.

Results: All animals were most responsive to spinal cord epidural stimulation combined with manual stimulation to induce ejaculation, with chronic injury resulting in the most consistent responses. Locomotor training improved response rates to spinal cord epidural stimulation, with intermittent training resulting in the most consistent induction of both the emission and expulsion phases of ejaculation. Sperm concentration was impacted by injury completeness and time-post injury, which was lowest in the chronic complete transection group of rats. Locomotor training resulted in an overall increase in sperm concentration, with 2 days per week of training resulting in a significant improvement of sperm motility.

Clinical implications: Spinal cord epidural stimulation combined with locomotor training is a feasible intervention for individuals with SCI who seek to regain sexual function.

Strengths and limitations: Although we have anecdotal reports of non-targeted L3 spinal cord epidural stimulation inducing ejaculation in humans having spinal cord injuries, the current outcomes may be underestimated as stimulation was carried out in anesthetized animals.

Conclusion: Spinal cord epidural stimulation to target the SGE is a feasible intervention for sexual dysfunction following SCI.

Background: Historically, β-blockers have been associated with erectile dysfunction (ED). Nebivolol, a third-generation β-blocker, may have had no negative effect on erectile function because of its vasodilating properties. However, the evidence level was considered either as low or very low.

Aim: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of nebivolol on erectile function.

Methods: All published RCTs were searched through PubMed, Cochrane Library, Web of Science, and Embase until October 2023. Review Manager version 5.3.0 was used for statistical analysis. Sensitivity analyses were performed by excluding each study using Stata 17 software.

Outcomes: The primary outcome was the International Index of Erectile Function (IIEF)-5 score. We excluded publication types, including letters, reviews, and meta-analyses.

Results: We identified four RCTs in this meta-analysis. All included studies compared the effects of nebivolol vs metoprolol on erectile function. Eight parallel groups with 397 individuals reported IIEF-5 scores. A random-effect model revealed that the IIEF-5 score was significantly higher in the nebivolol group (MD 1.81, 95%CI 0.95-2.68, P < .0001, I2 = 99%). We conducted a sensitivity analysis by removing each individual study and observed that there was no significantly different result. Furthermore, we conducted a prespecified subgroup analysis based on the dosage of metoprolol, patients with ED at the time of enrollment, and disease type. Subgroup analysis revealed that heterogeneity significantly decreased, and the result of the IIEF-5 score was stable and consistent.

Clinical implications: Our results provides stronger evidence that nebivolol significantly reduced the risk of ED occurrence or progression.

Strengths and limitations: Our meta-analysis included high-quality RCTs and conducted a predetermined subgroup analysis. However, the main limitations are the limited number of included studies and their heterogeneity.

Conclusion: Our meta-analysis provided stronger evidence that nebivolol significantly reduced the risk of ED occurrence or progression compared with metoprolol, irrespective of whether the patient had ED or not. This meta-analysis could serve as an important reference for future studies in this field.

Background: Existing research is very limited in providing nationally representative data on the relationship between sexual activity and depression in U.S. female adults aged 20-59 years, particularly with regard to marital status differences.

Objectives: Our specific objective was to explore the relationship between sexual activity and depression in adult women in the United States.

Methods: We conducted a study utilizing depression and sexuality data from the U.S. National Health and Nutrition Examination Survey (NHANES) for women aged 20-59 years between 2007 and 2016. Subsequently, we used survey-weighted logistic regression models to examine the relationship between low-frequency sexual activity and the risk of depression. To further explore the effects of different stratification factors on the relationship between low-frequency sexual activity and depression, we conducted subgroup analyses based on age, race, marital status, poverty-to-income ratio (PIR), education level, BMI, hypertension, diabetes mellitus, smoking, trouble sleeping, and urine Leakage. In addition, sensitivity analysis and smoothed curve fitting were performed to ensure the reliability of the results.

Main outcome measure: Sexual activity was assessed by sexual frequency, ≤11 sexual encounters in a 12-month period were categorized as low-frequency sexual activity; depression was diagnosed by the Patient Health Questionnaire (PHQ-9, ≥10 scores).

Results: From the 2007 to 2016 NHANES, a total of 6061 participants were enrolled in the study. Of these participants, 1869 (30.84%) reported a sexual frequency of 0-11 times/year categorized as low-frequency sexual activity. After adjustment for the full covariates, the risk of depression was found to be higher in low-frequency sexual activity participants (sexual frequency ≤ 11) compared to normal-frequency sexual activity participants (sexual frequency > 11) (OR = 1.37, 95 % CI: 1.08, 1.73; P = 0.010), this association varied according to marital status.

Clinical implications: Our findings have important clinical implications and suggest that clinicians should pay attention to the mental health of female patients with low-frequency sexual activity and screen depressed patients for sexual activity.

Strengths & limitations: Our study is the large, nationally representative study to assess the relationship between low-frequency sexual activity and depression in women aged 20 to 59 years. However, the cross-sectional study design was unable to demonstrate a causal relationship between low-frequency sexual activity and depression.

Conclusion: In conclusion, our study demonstrates a significant association between low frequency of sexual activity and risk of depression in a population of women aged 20 -59 years in the U.S, which may be bidirectional.