Journal of Sexual Medicine最新文献

Background: Dehydrated human amnion/chorion membrane (dHACM) has shown potential in enhancing neurovascular recovery and functional outcomes in robot-assisted radical prostatectomy (RARP).

Aim: To evaluate the effects of dHACM on continence recovery, sexual function, and oncological outcomes in patients undergoing RARP.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, analyzing data from PubMed, Cochrane, and EMBASE. Six retrospective studies comparing RARP with and without dHACM were included. Odds ratios (OR) and standardized mean differences (SMD) were calculated using a random-effects model.

Outcomes: The primary outcomes were continence and potency recovery, and secondary outcomes included biochemical recurrence (BCR).

Results: The meta-analysis included 4072 patients (1699 experimental and 2373 control). dHACM significantly improved early continence recovery (SMD 1.78, 95% CI 1.26-2.34) at <3, 3, and 6 months postoperatively (OR 1.95, 95% CI 1.13-3.36; OR 2.17, 95% CI 1.52-3.09; and OR 1.70, 95% CI 1.10-2.63, respectively). Time to potency recovery was shorter (SMD -0.55, 95% CI -0.67 to -0.43), with significant improvements at <3, 3, 6, and 9 months (OR 1.67, 95% CI 1.25-2.23; OR 1.27, 95% CI 1.06-1.53; OR 1.41, 95% CI 1.15-1.72; and OR 1.51, 95% CI 1.16-1.97, respectively). There were no significant differences in BCR (OR 0.85, 95% CI 0.54-1.35).

Clinical implications: dHACM offers potential as an adjunct to enhance functional recovery following RARP without compromising oncologic safety, but further high-quality studies are needed.

Strengths & limitations: Strengths include a comprehensive analysis of early functional outcomes and low heterogeneity in early potency and continence data. Limitations include reliance on retrospective studies and lack of randomized controlled trials.

Conclusion: dHACM may accelerate continence and sexual function recovery in early period after RARP while maintaining oncological outcomes, but further randomized studies are necessary to confirm these findings.

Background: Urinary tract infections (UTIs) significantly impact quality of life and can also lead to changes in sexual function.

Aim: This study aims to assess the symptoms associated with recurrent urinary tract infections (rUTIs) and their influence on both quality of life and sexual activity.

Methods: A case-control study was conducted, involving 383 patients with rUTIs and 161 healthy controls. The Acute Cystitis Symptom Score (ACSS) and Female Sexual Function Index (FSFI) questionnaires were utilized, with all surveys completed online through Google Forms.

Outcomes: The ACSS and FSFI were collected using online surveys designed through Google Forms.

Results: A higher prevalence of constipation was observed in the rUTI group compared to controls (37.6% vs 31.7%). rUTIs caused moderate to severe interference with work activities in 55.5% of cases, while 59% reported interference with social life. Sexual life assessment revealed that all FSFI domains were significantly affected in patients with rUTIs. Sexual desire was rated as low or very low in 61.9% of rUTI cases compared to 48.1% of controls (P < .001). Additionally, 35.3% of rUTI patients reported low or very low confidence in becoming sexually aroused, compared to 7.5% of controls (P < .001). Difficulty reaching orgasm was reported by 29.6% of rUTI patients versus 20.7% of controls (P < .001). Pain or discomfort following vaginal penetration was reported more than half the time by 43.9% of rUTI patients, compared to 19.6% of controls (P < .001). Dissatisfaction with sexual intercourse was noted in 53.6% of rUTI patients versus 15.8% of controls (P < .001).

Clinical implications: The assessment of sexual health should be integrated into the management of patients with rUTIs. Interventions targeting UTI management must also address strategies to improve sexual function and satisfaction.

Strengths and limitations: This study provides insight into the impact of rUTIs on sexual function across both pre- and post-menopausal women, allowing for an evaluation of how sexual perceptions evolve with age. However, the study's limitations include the lack of assessment of sexual practices, which may influence the risk of rUTIs and affect FSFI results.

Conclusions: Women with rUTIs report significantly lower sexual satisfaction and higher rates of sexual dysfunction. It is essential to evaluate the sexual function of patients with rUTIs, and management strategies must consider ways to improve sexual health as part of the overall treatment plan.

Background: Shockwave therapy is an optional adjuvant treatment for vascular erectile dysfunction (ED). There is variability in treatment protocols and challenges with patients adherence to the weekly protocol, which is the most commonly used.

Aim: This study aimed to evaluate the noninferiority of a monthly shockwave therapy protocol compared to the weekly protocol for treating vascular ED.

Methods: A randomized, open-label, control active, multicenter clinical trial was conducted. A total of 184 men diagnosed with vascular ED, without comorbid conditions associated with secondary dysfunction or active treatment for ED, were included across 5 clinics in Mexico and Colombia. Patients were randomized to receive either 6 sessions of weekly or monthly shockwave therapy, applying the same parameters for both groups.

Outcomes: The primary outcome was the change in the International Index of Erectile Function-Erectile Function Domain (IIEF-EF) Questionnaire score at 24 weeks after treatment, assessed using a noninferiority approach. Secondary outcomes included clinical improvement, erection hardness, and self-esteem (SEAR Questionnaire) at posttreatment, 12 weeks, and 24 weeks of follow-up.

Results: At 24-week posttreatment, the average change in IIEF-EF was 1.93 (± 6.55; 95% CI 0.49-3.38) in the weekly group and 4.30 (± 6.78; 95% CI 2.69-5.9) in the monthly group, demonstrating noninferiority of the monthly protocol (difference -2.36; 95% CI -4.4 to -0.2; noninferiority P < .0001). At the end of treatment, clinical improvement was achieved by 55.2% of participants in the monthly protocol and 30.9% in the weekly (P = .042). No significant differences were found in other outcomes.

Clinical implications: A 6-session monthly shockwave therapy regimen could improve erectile function in men with ED.

Strengths and limitations: This is the largest clinical trial to date evaluating shockwave therapy regimens for ED. The principal limitations were the absence of objective vascular assessment of the changes produced by shockwaves, and the absence of a placebo control group.

Conclusion: A monthly protocol of 6 shockwave therapy sessions is noninferior to a weekly protocol up to 6 months after therapy, in men with vascular ED.

Background: Three common strategies exist for managing the inflatable penile prosthesis reservoir during revision surgery: the original reservoir can be (a) removed, (b) deactivated and left in situ, sometimes referred to as "drain and retain" (DR), or (c) validated and reconnected to new cylinders, which we have termed "reservoir recycling" (RR).

Aim: To compare the efficacy and safety of the RR approach to penile prosthesis revision against DR and the recommended approach of complete device removal and replacement.

Methods: A retrospective chart review of our single-surgeon inflatable penile prosthesis database between 2007 and 2022 was performed, identifying revision surgeries. Cases were stratified by reservoir management technique. Patients who had undergone at least 1 follow-up visit and had complete documentation regarding reservoir handling were included. Reservoir-related complications necessitating surgical intervention such as infection and device failure were compared between the 3 groups using a chi-square test. Mean follow-up duration, time to revision, and operative time were also assessed.

Outcomes: The primary outcome was the incidence of reservoir-related complications requiring surgical intervention and secondary outcomes included time to revision surgery and operative time.

Results: Among 140 patients meeting inclusion criteria, 62 underwent full reservoir replacement (FR), 48 DR, and 30 RR. Compared to FR, DR and RR groups had similar mean time to revision and intraoperative time. Follow-up duration was similarly limited for all 3 groups at a median of approximately 4.5 months. There were no postoperative infections in the RR cohort. However, when compared to the DR and FR groups, this did not reach significance (P = .398). There was no difference in mechanical failure rate between the 3 groups (P = .059). Nonmechanical failure was also similar between all 3 groups (P = .165).

Clinical implications: These results suggest that RR exhibits comparable outcomes to DR and FR, making it a viable option during select penile prosthesis revision surgeries, potentially decreasing morbidity without compromising outcomes.

Strengths and limitations: This is the first study to evaluate outcomes after RR. Limitations include small sample size, limited follow-up, and single-surgeon experience.

Conclusion: There was no difference in reservoir-related complications when comparing the 3 methods. These preliminary results suggest that reservoir recycling may provide a safe and effective reservoir-handling alternative in inflatable penile prosthesis revision surgery.

Background: Sexual function during pregnancy and the postpartum period is a complex component of maternal and couple health, and it's deeply influenced by an intricate interplay of physiological, psychological, childbirth, and relational factors.

Aim: This review seeks to explore the nuanced dynamics of sexual function during pregnancy and the postpartum period, shedding light on both the challenges and opportunities for enhancing maternal and couple sexual well-being.

Methods: Drawing on a combination of existing scientific literature and extensive clinical experience, this expert opinion delves into the physiological transformations, psychological adjustments, and shifts in relational dynamics that accompany pregnancy and postpartum. It sheds light on the sexual experiences of partners and underscores the necessity of a holistic understanding of sexual health in this context.

Outcomes: The review offers an enhanced perspective on sexual function during pregnancy and postpartum and aims to contribute to a deeper and more nuanced understanding that can inform both clinical practice and future research.

Results: The results highlight that pregnancy and postpartum phases influence sexual function, with fluctuations in sexual desire and activity resulting from changes in physiological, psychological, and relational factors. Women experience a decline in sexual function, particularly during the third trimester, with factors, such as hormonal changes, body image concerns, and partner dynamics shaping sexual experiences across pregnancy and postpartum stages.

Clinical implications: A thorough understanding of sexual function throughout pregnancy and postpartum is critical for enhancing maternal and couple health and it creates pathways to more effective and compassionate care.

Strengths and limitations: The strengths of this review include the integration of scientific literature with clinical experience to provide a holistic view of sexual function. However, the limitations are the reliance on cross-sectional studies and the scarcity of data on couple sexual functioning.

Conclusion: Understanding the interplay of physiological and anatomical changes, psychological factors, and partner dynamics is crucial in addressing sexual function during pregnancy and the postpartum period.

Background: Penile constriction devices offer a noninvasive approach to enhance the sexual experience and as the variety of penile constriction devices increases, it is crucial to assess patient preferences and device effectiveness to provide insights into their clinical utility.

Aim: We aimed to compare the preferences for and effectiveness of two medical-grade penile constriction devices: Eddie by Giddy and FirmTech.

Methods: Between May and July of 2023, males were recruited via social media and prospectively enrolled into an Institutional Review Board-approved, randomized, questionnaire-based study. Upon enrollment, the participants completed the Sexual Health Inventory for Men and Androgen Deficiency in Aging Males questionnaires. Participants were randomized to which device they received first. They used the device twice either during masturbation or intercourse in a two-week timeframe. Once utilized, the participants completed a 17-question, Likert scale, device satisfaction questionnaire, in which lower numbers indicated positive responses. The process was repeated with the second device. T-test and Chi-Square Analysis were run for statistical analysis.

Outcomes: The primary outcomes of this study were patient-reported device satisfaction and efficacy and the secondary outcome was the device preference for patients with and without erectile dysfunction.

Results: Fifty men were enrolled and 49 completed the study. The average age was 40 years old. Of the participants, 80% recommend the FirmTech device compared to 53% who recommend the Eddie by Giddy device (P = 0.0026). The FirmTech device was overall easier to put on both flaccid and erect (P = 0.0308 and 0.0002), was more comfortable, had better stretch, and was easier to adjust (P = 0.087, <0.0001, and 0.0119, respectively). The FirmTech device had a better overall impression amongst the participants (P = 0.0249). Eddie by Giddy was felt to improve erectile firmness more in those with ED than in those without (P = 0.0178).

Clinical implications: This study adds to the current literature on penile constriction devices that better guide providers as they counsel patients on these devices to enhance sexual function.

Strengths and limitations: The strength of this study is that this is a prospective randomized crossover study. The limitations of this study are that this is a single center study based on patient reported outcomes.

Conclusion: The FirmTech device performed better than the Eddie by Giddy with respect to overall impression of the device, likelihood of using the device in the future, and recommending the device to a friend, while the Eddie by Giddy device performed better at improving erectile firmness.

Clinical trial registration number: NCT05853822.