Journal of Sexual Medicine最新文献

Background: Remnant cholesterol (RC) is the cholesterol of triglyceride-rich lipoproteins, which has a high degree of atherogenic effect.

Aim: This study investigates the association between RC and low testosterone in male adults in the United States.

Methods: Data were drawn from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 and 2015-2016 cycles, focusing on males aged over 20. RC was measured as the difference between total cholesterol (TC) and the sum of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c). Analyses between RC and low testosterone included logistic regression, subgroup assessment, smooth curve fitting, and mediation analysis.

Outcomes: Low testosterone was defined by a serum testosterone level below 300 ng/dL in male adults.

Results: Out of the 2248 participants, 442 exhibited low testosterone levels. Those deficient in testosterone demonstrated notably higher RC levels (P < 0.001). A direct relationship between RC and low testosterone was evident (OR = 1.02, 95% CI: 1.01-1.03, P < 0.001), and smooth curve fitting revealed a linear trend. Subgroup analysis did not identify any special populations. Moreover, body mass index (BMI) and HOMA-IR was found to partially mediate this relationship.

Clinical implications: Evaluating low testosterone in individuals with high RC levels can be beneficial. Similarly, monitoring lipid profiles, particularly RC levels, in patients with low testosterone might be important for preventing cardiovascular diseases.

Strengths & limitations: This study uses data from NHANES, which is nationally representative and has a large sample size. However, the causal relationship needs further investigation due to the cross-sectional design of this study.

Conclusion: This nationwide study provides initial evidence of a close correlation between RC and the risk of low testosterone.

Background: Although various compartments of the human cardiovascular system have been thoroughly elucidated, the penile fibrovascular assembly remains an exception that has yet to be fully explored; therefore, this gap in our understanding prompts us to conduct further investigations.

Aim: This study revisits the penile-fibro-vascular assembly to determine whether it constitutes an independent vascular compartment within the human body.

Methods: The penile-fibro-vascular assembly was meticulously examined in 23 male human cadavers. The loupe-assisted observation was used to compare the size of bilateral penile arteries, conspicuously addressed at the hilum, and to isolate erection-related vascular channels meticulously with a loupe, as extensively as possible. Additionally, a comprehensive library was analyzed, including 801 cadaveric images, 1001 sets of dual cavernosographies, 11 spongiosographies, 7 Magnetic Resonance Imaging (MRI)/computed tomography (CT) cavernosographies, 61 Doppler's sonographies, and 15 selective internal pudendal arteriographies. Hemodynamic phenomena were observed both intra-corporeally and extra-corporeally in patients who underwent penile venous stripping (n = 501), coil embolization (n = 6), and pudendal arterial stenting (n = 5).

Outcomes: This study confirms the existence of an independent penile fibro-vascular hydraulic environment within the human cardiovascular system.

Results: The human penis contains an independent bi-layered fibrovascular assembly. Anatomical symmetry of bilateral arteries is rare on the arterial side. On the venous drainage side, there is one deep dorsal vein (DDV), two cavernosal veins, and four para-arterial veins, contrary to the conventional understanding of only a single DDV between the tunica albuginea and Buck's fascia. The penile venous drainage blood ultimately returns to pulmonary circulation.

Clinical implications: Penile vascular surgery, particularly penile venous stripping, is shown to be the most physiologically appropriate method for restoring erectile function; contrarily, erection-related arterial stents, or venous embolization do not offer similar benefits.

Strengths and limitations: This study's strength lies in its extensive analysis of a large repository of anatomical, physiological, radiographic imaging, and clinical vascular data; however, its retrospective nature represents a limitation.

Conclusion: This study demonstrates that the penile fibro-vascular assembly functions as an independent vascular system, substantially making it the last vascular compartment to be disclosed in the human body.

Background: Previous observational studies have identified a potential association between walking and the risk of erectile dysfunction (ED); however, the causal relationship between them remains unclear.

Aim: This study aims to explore the causal relationship between walking and ED using Mendelian randomization (MR).

Methods: MR analysis was conducted using genome-wide association study (GWAS) data related to walking pace. The inverse variance weighted (IVW) method was used as the primary MR analysis method. To supplement the IVW results, two additional MR methods were used: MR-Egger and weighted median (WM). Sensitivity analyses were performed to assess heterogeneity and pleiotropy. Furthermore, multivariable MR (MVMR) analysis was employed to evaluate the causal relationship after adjusting for potential confounding factors.

Outcomes: The moderating effects of different walking phenotypes on ED.

Results: According to the IVW method, genetically predicted walking pace was found to have a reverse causal relationship with the risk of ED (OR: 0.24; 95% CI: 0.12-0.51). Similar causal effects were observed using the other two MR methods, with statistical significance found in the WM method and validation through sensitivity analyses. Furthermore, MVMR analysis confirmed that the protective effect of increased walking pace on reducing the risk of ED remained significant even after adjusting for potential confounders.

Clinical implications: Encouraging men to engage in brisk walking could be an effective strategy for reducing the incidence of ED.

Strengths and limitations: This study utilized large-scale GWAS summary data on walking and ED and employed a two-sample, multivariable MR design to minimize confounding factors and reverse causation, enabling the derivation of credible causal effects. It is essential to obtain GWAS data from other populations and replicate this MR analysis to validate the results, as well as conduct further research to explore the underlying mechanisms.

Conclusion: The results of this study suggest that there is an inverse causal relationship between walking pace and ED risk, and brisk walking may be an independent protective factor against ED.

Background: Rigicon is a newer inflatable penile prostheses (IPP) manufacturer that has produced the Infla10 IPP for countries outside the United States (US) since 2019, with Food and Drug Administration studies for approval of Infla10 in the US presently underway.

Aim: This study aims to report the first patient satisfaction, efficacy, and safety from revision data for the newly available Rigicon Infla10 IPP.

Methods: A single surgeon's first 58 patients who underwent Rigicon Infla10 IPP implantation between 2019 and 2023 were included. Most patients (70%) received the Infla10 X (girth expansion) cylinder, and 30% received the Infla10 AX (length and girth expansion) model. Follow-up ranged from 4 to 42 months (median 19 months).

Outcomes: Outcomes measured were intraoperative and postoperative complications as well as patient-reported satisfaction.

Results: Reoperation was required in 5 patients (8.6%). Complication rates were 1.7% urethral erosion (n = 1), 1.7% infection requiring explant (n = 1), and 5% mechanical malfunction due to tubing breakage at pump junction (n = 3). The tubing issue was addressed by the manufacturer, resulting in no additional mechanical concerns. Kaplan-Meier analysis demonstrated rates of cumulative survival of the device at 12, 24, and 36 months were 96.6%, 93.8%, and 78.2%, respectively. Overall, 53 patients (91.4%) were satisfied at 6 months postoperatively and would recommend the procedure. Diminished satisfaction was due to perceived penile shortening in 3 patients (5.1%) and difficulty learning pump cycling in 2 patients (3.4%).

Clinical implications: This single surgeon series demonstrates high rates of patient satisfaction with appropriate early safety from revision.

Strengths and limitations: Limitations include the retrospective nature of this study and short-term follow-up. Additional prospective studies incorporating a larger number of patients are warranted.

Conclusion: While very new in the marketplace, the Infla10 IPP shows promising early satisfaction, efficacy, and safety from revision.

Background: Pelvic arterial (PLA) stenosis is associated with arterial insufficiency of the penis and erectile dysfunction (ED), but the effect of different severities of PLA stenosis on ED remains unclear.

Aim: To investigate how different severities of PLA stenosis affect erectile function.

Methods: We included patients who visited our clinic for ED and underwent computed tomography angiography (CTA) and dynamic duplex sonography (DUS). The erectile hardness score (EHS), simplified International Index of Erectile Function (IIEF-5), DUS and CTA results, and flow index (FI) calculated from the peak systolic velocity (PSV) and PLA stenosis percentages were analyzed. EHS < 3 was defined as significant ED. PLA stenosis was analyzed by the mean PLA (average of the right and left PLA) and unilateral or bilateral stenoses. According to severity, stenosis was classified as mild, moderate, or severe.

Outcomes: Subjective and objective parameters, including the IIEF-5 score, EHS, PSV, and FI, in relation to different severities of PLA stenosis.

Results: The study included 182 patients. Vascular parameters such as the mean PSV, PLA stenosis, and FI correlated with EHS and IIEF-5 scores. Receiver operating characteristic analyses for predicting EHS ≥ 3 showed that all vascular parameters had acceptable discriminatory ability. During the analysis performed using the mean PSA stenosis, EHS decreased in patients with mild and severe mean PLA stenosis, although a PSV drop was noted only in severe cases. The proportion achieving EHS 3 significantly dropped in patients with at least mild mean PLA stenosis. Using unilateral or bilateral PLA stenosis, the EHS significantly dropped in patients with severe unilateral and bilateral PLA stenosis, with PSV decreasing on the affected side in severe unilateral stenosis. However, the mean PSV did not drop despite different unilateral stenosis severities. The proportion achieving EHS 3 significantly dropped among patients with at least moderate unilateral PLA stenosis and bilateral PLA stenosis but not in mild unilateral cases.

Clinical implications: The severity of PLA stenosis is correlated with the risk of ED.

Strengths & limitations: The strength of this study lies in its analysis of the effect of PLA stenosis on erectile function from various perspectives, including unilateral, bilateral, and mean stenosis. However, the absence of validation regarding the outcomes of endovascular therapy is a limitation.

Conclusion: Mild mean PLA stenosis and moderate unilateral PLA stenosis are associated with increased risks of ED; however, mild unilateral PLA stenosis does not affect erectile function.

Background: The nature of pelvic floor muscle (PFM) involvement in provoked vestibulodynia (PVD) is poorly understood.

Aim: We aimed to determine if PFM electromyographic (EMG) activity in anticipation of or response to pressure applied to the posterior vaginal fourchette differs between those with and without PVD, and if the magnitude of PFM response is associated with pressure pain sensitivity, psychological or psychosexual function.

Methods: This was an observational case-control study. Forty-two volunteers with PVD and 43 controls with no vulvar pain participated. Five on-line questionnaires were completed, then participants underwent a laboratory-based evaluation of vulvar pain sensitivity. EMG activation of the PFMs, hip adductor, and upper trapezius muscles was measured before, during, and after pressure stimuli (low, moderate) were applied, in random order, to the posterior vaginal fourchette and the posterior thigh (control site).

Outcomes: EMG amplitude of the pubovisceralis (PV), bulbocavernosus (BC), and external anal sphincter (EAS) muscles. Secondary outcomes were EMG activation of the hip adductor brevis and upper trapezius muscles, questionnaire scores reflecting psychological/psychosexual outcomes, pressure pain threshold (PPT) at the vulvar vestibule, pain reported on a tampon test, and heart rate/heart rate variability.

Results: Compared to controls, EMG activation of the PV and EAS, but not the BC, was higher in anticipation of the pressure applied to the vaginal fourchette, was higher in all PFMs while the pressure was applied, and remained higher than baseline after the pressure was removed among those with PVD. EMG response amplitudes were modulated by the intensity of the pressure applied, with the largest responses reaching over 40% MVC in the EAS among those with PVD. PFM EMG amplitudes were associated with greater pain sensitivity and lower sexual function, but not with pain catastrophizing, central sensitization, depression, anxiety, or stress.

Clinical implications: While some anticipatory activation was observed, EMG responses were primarily observed during and after the application of the pressure. Among those with PVD, digital assessment of PFM tone might reflect PFM responses to pain at the vulvar vestibule, and interventions to reduce local pain sensitivity may be an important first step to successful improvements in vaginal function.

Strengths and limitations: This study includes a robust analysis of EMG activation. However, the cross-sectional design precludes the determination of causal relationships.

Conclusions: Those with PVD demonstrate higher PFM responses and a higher prevalence of anticipatory activation in the PV and EAS muscles than controls in response to pressure applied at the vulvar vestibule.

Background: The relationship between impulse control and premature ejaculation (PE), the most common sexual dysfunction in men, is not yet well understood.

Aim: To assess the association between impulse control issues and the severity of PE in men with a lifelong diagnosis of this condition.

Methods: A cross-sectional observational study was designed to evaluate patients who presented to the clinic with complaints of PE between March 2023 and March 2024. The final study sample comprised 40 men with lifelong PE and 40 healthy control subjects.

Outcomes: Impulse control was evaluated with the UPPS Impulsive Behavior Scale and the Barratt Impulsivity Scale-11 (BIS-11), while depression and anxiety levels were measured using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The severity of PE was assessed using the Arabic Index of PE (AIPE).

Results: The mean AIPE score was 15.13 ± 3.33 in the PE group and 32.05 ± 2.06 in the control group (P ˂ 0.001). Compared to the control group, the PE group had significantly higher UPSS Impulsive Behavior Scale scores in all subscales (P ˂ 0.001 for planning, urgency, and lack of perseverance; P = 0. 001 for sensation seeking) and total scores (P ˂ 0.001). The BIS-11 scores were also significantly higher in the PE group compared to the control group for all subscales (P ˂ 0.001 for all). The patients in the PE group also had higher levels of anxiety and depression (P ˂ 0.001 for all).

Clinical implications: A clinician's quantitative assessment of ejaculation time and the severity of PE among men presenting to the clinic with complaints of PE may reveal accompanying comorbid conditions more effectively.

Strength and limitations: The current study is a novel investigation that quantitatively evaluates PE in terms of intravaginal ejaculatory latency time and severity, aiming to identify comorbid conditions. As a limitation, the necessity for patients and their partners to measure the time to ejaculation limited the sample size, making it challenging to generalize the findings.

Conclusion: Our findings suggest that impulse control plays a significant role in lifelong PE. It is important for clinicians to assess impulse control and consider therapeutic interventions for men presenting with PE complaints, particularly in those classified as severe.