Difference in Nocturnal Erectile Function Between SRPE Patients and Normal People / 中山大学学报(医学科学版)

ObjectiveTo compare the nocturnal erectile function between SRPE patients and normal people. MethodsFrom July 1st， 2019 to December 15th， 2022， a clinical comparative study was conducted on 29 SRPE patients （experimental group） and 58 volunteers （control group） who visited our urology department. The Rigiscan System was used to monitor sleep monitoring time， the number of nocturnal erections and the rigidity， duration and circumference growth of the penis when the erection reached 60%～79% and 80%～100%， respectively. The patients and volunteers were asked to make written records when they woke up， and then the total number of awakenings and the number of awakenings when the penis erection reached 60% and 80% were compared between the two groups. ResultsAge was eliminated by matching. There was no statistically significant difference in sleep monitoring time， rigidity， circumference growth and duration of the penis when the erection reached 60%～79% and 80%～100%. between the two groups. In terms of sleep， there was a statistically significant difference in the total number of awakenings between the two groups［3（2 ~ 4）vs 0（0 ~ 0），P<0.01］ .And the same was true for the number of awakenings when the penis erection exceeded 60%～79% ［1（0 ~ 1）vs 0（0 ~ 0），P<0.01］and 80%～100% ［2（1 ~ 3）vs 0（0 ~ 0），P<0.01］. ConclusionRigiscan monitoring showed that there was no difference between SRPE patients and normal male in nocturnal penile erection function. Painful awakening usually occurs when the penis erection reaches 60%～79% or 80%～100%， which reveals that SRPE may be caused by abnormal sensation of nocturnal erections or pain sensitivity in some of these patients.

Uretroplastia término terminal y reconstrucción cavernosa temprana en ruptura bilateral de origen traumático / End-to-End Urethroplasty and Early Cavernous Reconstruction in Bilateral Rupture of Traumatic Origin / Uretroplastia término-terminal e reconstrução cavernosa precoce em rotura bilateral de origem traumática

Introducción. La fractura de pene es una emergencia urológica rara, se desconoce la incidencia real dado el subregistro causado por la reducida consulta de los pacientes, resultado del embarazoso contexto. En Estados Unidos alcanza un 38% donde la etiología de índole sexual predomina. En Colombia hay escasos reportes publicados. El diagnóstico de esta entidad es netamente clínico. El objetivo de este trabajo es reportar una evolución satisfactoria en términos de función miccional y eréctil en un paciente sometido a reconstrucción cavernosa y uretral temprana en rotura bilateral de origen traumático mediante una técnica quirúrgica poco convencional, de acuerdo con lo hallado en la literatura. Presentación del caso. Paciente masculino de 30 años, previamente sano, quien consultó al servicio de urgencias por uretrorragia, edema y dolor peneano secundario a trauma contuso del mismo durante relación sexual. El reporte ecográfico mostró disrupción en túnica albugínea del cuerpo esponjoso, hematoma y aparente transección uretral; se realizó exploración quirúrgica 6 horas después, con evidencia de fractura de cuerpos cavernosos, laceración del 40% de la circunferencia, transección completa de la uretra y cuerpo esponjoso. Se realizó rafia de cuerpos cavernosos y uretroplastia término terminal de uretra bulbar, con evolución clínica satisfactoria. Discusión. La reconstrucción quirúrgica en menos de 24 horas en fractura de pene disminuye significativamente la estancia hospitalaria y complicaciones precoces; asimismo, desciende el riesgo de disfunción eréctil, erecciones dolorosas y problemas miccionales. No hay publicaciones que comparen resultados a largo plazo entre los dos abordajes quirúrgicos. Conclusiones. La fractura de pene es una patología poco frecuente con diagnóstico clínico, la cual debe manejarse de manera temprana por cualquier urólogo y, en caso de ser posible, con experiencia reconstructiva y excelentes resultados en la función sexual y miccional.

Introduction. Penile fracture is a rare urological emergency, the real incidence is unknown given the underreporting caused by the reduced consultation of patients, resulting from the embarrassing context. In the United States it reaches 38%, where sexual etiology predominates. In Colombia there are few published reports. The diagnosis of this entity is purely clinical. The aim of this work is to report a satisfactory evolution in terms of voiding and erectile function in a patient who underwent early cavernous and urethral reconstruction in bilateral rupture of traumatic origin by means of an unconventional surgical technique, in accordance with what has been found in the literature. Case Presentation. A 30-year-old male patient, previously healthy, consulted the emergency department for urethrorrhagia, edema and penile pain secondary to blunt trauma to the penis during sexual intercourse. The ultrasound report showed disruption in the tunica albuginea of the corpus spongiosum, hematoma and apparent urethral transection; surgical exploration was performed 6 hours later, with evidence of fracture of the corpora cavernosa, laceration of 40% of the circumference, complete transection of the urethra and corpus spongiosum. Sutures to the corpora cavernosa and end-to-end urethroplasty of the bulbar urethra were performed, with satisfactory clinical evolution. Discussion. Surgical reconstruction in less than 24 hours in penile fractures significantly reduces hospital stay and early complications; it also reduces the risk of erectile dysfunction, painful erections and voiding problems. There are no publications comparing long-term results between the two surgical approaches. Conclusions. Penile fracture is a rare pathology with clinical diagnosis, which should be managed early by any urologist and, if possible, with reconstructive experience and excellent results in sexual and voiding function.

Introdução. A fratura peniana é uma emergência urológica rara, a real incidência é desconhecida dada a subnotificação causada pela reduzida consulta de pacientes, resultado do contexto constrangedor. Nos Estados Unidos chega a 38% onde predomina a etiologia de natureza sexual. Na Colômbia há poucos relatórios publicados. O diagnóstico desta entidade é puramente clínico. O objetivo deste trabalho é relatar uma evolução satisfatória da função miccional e erétil em um paciente submetido à reconstrução cavernosa e uretral precoce em ruptura bilateral de origem traumática por meio de técnica cirúrgica não convencional, de acordo com o que foi encontrado na literatura. Apresentação do caso. Paciente do sexo masculino, 30 anos, previamente saudável, procurou o pronto-socorro por uretrorragia, edema e dor peniana secundária a trauma contuso durante a relação sexual. O relatório do ultrassom mostrou ruptura na túnica albugínea do corpo esponjoso, hematoma e transecção uretral aparente; a exploração cirúrgica foi realizada 6 horas depois, com evidência de fratura dos corpos cavernosos, laceração de 40% da circunferência, transecção completa da uretra e corpo esponjoso. Foram realizadas ráfia dos corpos cavernosos e uretroplastia término-terminal da uretra bulbar, com evolução clínica satisfatória. Discussão. A reconstrução cirúrgica em menos de 24 horas nas fraturas penianas reduz significativamente o tempo de internação e as complicações precoces. Da mesma forma, diminui o risco de disfunção erétil, ereções dolorosas e problemas de micção. Não há publicações comparando os resultados a longo prazo entre as duas abordagens cirúrgicas. Conclusões. A fratura peniana é uma patologia rara com diagnóstico clínico, que deve ser tratada precocemente por qualquer urologista e, se possível, com experiência reconstrutiva e excelentes resultados na função sexual e miccional.

Effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function in patients with prostate cancer / 中国基层医药

Objective:To investigate the effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function in patients with prostate cancer.Methods:Fifty-six patients with stable prostate cancer who received treatment in Deqing People's Hospital between March 2015 and March 2018 were included in this study. They were randomly divided into observation and control groups ( n = 28/group). The observation group was subjected to modified radical prostatectomy via an extraperitoneal approach. The control group underwent standard laparoscopic surgery. Clinical efficacy and the effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function were compared between the two groups. Results:Amount of blood loss and postoperative drainage were (125.39 ± 11.12) mL and (65.39 ± 10.12) mL in the observation group, and (224.79 ± 14.01) mL and (104.79 ± 15.01) mL in the control group. There were no significant differences in amount of blood loss and postoperative drainage between the two groups ( t = 18.83, 15.67, both P < 0.05). At 1, 3 and 6 months after surgery, the percentage of patients who had urinary control recovery in the observation group was 53.57% (15/28), 78.57% (22/28), 98.21% (27/28), respectively, which were significantly higher than those in the control group [21.43% (6/28), 35.71% (10/28), 67.86% (19/28), χ2 = 4.12, 7.21, 5.01, all P < 0.05]. At 1, 3 and 6 months after surgery, the score of erectile function recovery in the observation group was (15.98 ± 0.28) points, (15.99 ± 0.72) points, and (18.91 ± 0.48) points, which were significantly higher than those in the control group [(17.11 ± 0.34) points, (13.11 ± 0.48) points, (13.41 ± 0.39) points, t = 3.01, 12.89, 15.78, all P < 0.05]. Conclusion:Modified radical prostatectomy via an extraperitoneal approach can improve postoperative urinary control and sexual dysfunction.

Lessons learned after 20 years' experience with penile fracture

ABSTRACT Objective: To report our experience over the past 20 years in the diagnosis and surgical treatment of penile fracture (PF). Materials and methods: Between January 1997 and January 2017, patients with clinical diagnosis of PF were admitted to our facility and retrospectively assessed. Medical records were reviewed for clinical presentation, etiology and operative findings. Postoperative complications, sexual and urinary function were evaluated. Results: Sexual trauma was the main etiological factor, responsible for 255 cases (88.5%): 110 (43.1%) occurred with the "doggy style" position, 103 (40.3%) with "man on top" position, 31 (12.1%) with the "woman on top" position and 11 (4.3%) in other sexual positions. The most common findings in the clinical presentation were hematoma, in all cases and detumescence in 238 (82.6%). Unilateral corpus cavernosum injuries were found in 199 (69%) patients and bilateral in 89 (31%) patients. Urethral injuries were observed in 54 (18.7%) cases. Nine (14.7%) patients developed erectile dysfunction and eight (13.1%) had penile curvature. Only two (3.7%) patients had complications after urethral reconstruction. Conclusions: PF has typical clinical presentation and no need for additional tests in most cases. Hematoma and immediate penile detumescence are the most common clinical findings. Sexual activity was the most common cause. The 'doggy style' and 'man-on-top' was the most common positions and generally associated with more severe lesions. Concomitant urethral injury should be considered in cases of highenergy trauma. Surgical reconstruction produces satisfactory results, however, it can lead to complications, such as erectile dysfunction and penile curvature.

Objective measurements of the penile angulation are significantly different than self-estimated magnitude among patients with penile curvature

ABSTRACT Introduction: The study was aimed to assess the presence of actual differences between the objective and the perceived magnitude of a curvature between patients affected by Peyronie's disease (PD) and congenital penile curvature (CPC). Materials and Methods: Wee analysed a cohort of 88 consecutive patients seeking medi- cal help for either CPC or PD. All patients were invited to provide a self-made drawing of their penis in erection in order to obtain self-provided description of the deformity. An objective measurement of the deformity was also performed drawing two intersecting lines through the center of the distal and proximal straight section of the penile shaft. Results: Our findings showed significant differences between patient self-estimation and the objective measurements of the penile angulation performed by trained experts, with only 32% of patients correctly assessing their own curvature. Overall, patients tended to overestimate (56%) their degree of curvature, but the results are different in patients with PD than those with CPC. In the 60 men (68%) who did not accurately assess their curvature, PD patients generally overestimated their curvature versus CPC patients (67% vs 16%). On the contrary CPC patients underestimated their curvature compared to PD (42% vs. 4%). Conclusion: In order to improve patients' satisfaction rates, the surgeon needs to take into consideration the patient's perception of the deformity when planning the type of surgical correction.

Beneficial Effect of Berberis amurensis Rupr. on Penile Erection / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate whether the methanol extract of Berberis amurensis Rupr. (BAR) augments penile erection using in vitro and in vivo experiments.</p><p><b>METHODS</b>The ex vivo study used corpus cavernosum strips prepared from adult male New Zealand White rabbits. In in vivo studies for intracavernous pressure (ICP), blood pressure, mean arterial pressure (MAP), and increase of peak ICP were continuously monitored during electrical stimulation of Sprague-Dawley rats.</p><p><b>RESULTS</b>Preconstricted with phenylephrine (PE) in isolated endotheliumintact rabbit corus cavernosum, BAR relaxed penile smooth muscle in a dose-dependent manner, which was inhibited by pretreatment with NG-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, and H-[1,2,4]-oxadiazole-[4,3-α]-quinoxalin-1-one, a soluble guanylyl cclase inhibitor. BAR significantly relaxed penile smooth muscles dose-dependently in ex vivo, and this was inhibited by pretreatment with L-NAME H-[1,2,4]-oxadiazole-[4,3-α]-quinoxalin-1-one. BAR-induced relaxation was significantly attenuated by pretreatment with tetraethylammonium (TEA, P<0.01), a nonselective K channel blocker, 4-aminopyridine (4-AP, P<0.01), a voltage-dependent K channel blocker, and charybdotoxin (P<0.01), a large and intermediate conductance Ca sensitive-K channel blocker, respectively. BAR induced an increase in peak ICP, ICP/MAP ratio and area under the curve dose dependently.</p><p><b>CONCLUSION</b>BAR augments penile erection via the nitric oxide/cyclic guanosine monophosphate system and Ca sensitive-K (BK and IK) channels in the corpus cavernosum.</p>

Value of non-sexual penile erection for penile rehabilitation in men with erectile dysfunction / 中华男科学杂志

Erectile dysfunction (ED) is a common male disease. Some related studies show that the prevalence of ED is nearly 52% in men aged 40 to 70 years and is increasing among younger males. Hypoxia is now considered to be an independent risk factor for ED and the mechanisms of hypoxia inducing ED are varied and complicated. Recently, an idea in penile rehabilitation has attracted much attention, which aims at improving erectile function by increasing oxygen supply to the cavernosum and reducing tissue fibrosis and apoptosis. The approaches to achieve non-sexual penile erection by increasing oxygen supply to the cavernosum, such as behavior therapy, medication, vacuum constriction device, and intracavernous injection, can simulate normal sexual erection and help patients with penile rehabilitation. This review focuses on the strategies for non-sexual penile erection in penile rehabilitation.

Dexmedetomidine Prevent Penile Erection after General Anesthesia Induction and Bladder Irritation during Recovery / 医学研究杂志

Objective To observe the preventive effect of dexmedetomidine on penile erection(PE) after general anesthesia induction and urinary bladder irritation during recovery(UBIR) with urethral catheterization in male patients.Methods A total of 1000 male patients with ASA grade Ⅰ ～ Ⅱ were randomly divided into control group(group C) and dexmedetomidine group (group D,n =500).Dexmedetomidine (1 μg/kg) was intravenous pumped in group D and saline was given in group C 15 minutes before anesthesia induction.Both groups started catheterization within 10 minutes after endotracheal intubation.The incidence and grade of PE before infusion(To),before induction(T1),before catheterization(T2) and during catheterization (T3) were observed.The degree and extent of UBIR were observed and recorded.Results The incidence and grade of PE at T3 time-point in group C were highest (Compared with T2 and other time-points,P ＜ 0.05),but there was no statistically differences in incidence and grade of PE in group D between at T3 and T2time points (P ＞ 0.05).The incidence of PE at T2 and T3 time-points were 4.0％ and 5.6％ in group D,which was significantly lower than those in group C (15.4％,77.8％,P＜0.05).The incidence of PE at grade 1,2 and3 was 4.4％,1.0％ and0.2％ respectively in group D,which was significantly lower than those in group C (62.6％,11.4％,3.8％,P ＜ 0.05).The incidence of UBIR was significantly lower (28.4％ vs 63.0％,P ＜ 0.05),among which the incidence of UBIR at grade 1,2 and 3 were 15.6％,10.4％ and 2.4％,which was significantly lower in group D than those in group C (22.0％,21.0％,20.0％,P ＜ 0.05).Conclusion 1μg/kg dexmedetomidine pumped before anesthesia induction could prevent the occurrence of PE during catheterization and UBIR,which can improve patients' comfort.

The Effect of Alcohol Administration on the Corpus Cavernosum

PURPOSE: We studied the effects of alcohol administration on the corpus cavernosum (CC) using an animal model. MATERIALS AND METHODS: CC sections and the aortic ring of rabbits were used in an organ bath study. After acute alcohol administration, changes in blood alcohol concentration and electrical stimulation induced intracavernosal pressure/mean arterial pressure (ICP/MAP) percentage were compared in rats. Cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) levels in the CC were measured using immunoassays. After chronic alcohol administration, ICP/MAP percentage, cAMP and cGMP were compared in rats. Histological changes were examined using the Masson trichrome stain and the Sircol collagen assay. Endothelial nitric oxide synthase (eNOS) expression was examined using immunohistochemistry and Western blotting. RESULTS: Alcohol relaxed the CC in a dose-dependent manner, and the relaxation response was suppressed when pretreated with propranolol, indomethacin, glibenclamide, and 4-aminopyridine. In rats with acute alcohol exposure, the cAMP level in the CC was significantly greater than was observed in the control group (p<0.05). In rats with chronic alcohol exposure, however, changes in cAMP and cGMP levels were insignificant, and the CC showed markedly smaller areas of smooth muscle, greater amounts of dense collagen (p<0.05). Immunohistochemical analysis of eNOS showed a less intense response, and western blotting showed that eNOS expression was significantly lower in this group (p<0.05). CONCLUSIONS: Acute alcohol administration activated the cAMP pathway with positive effects on erectile function. In contrast, chronic alcohol administration changed the ultrastructures of the CC and suppressed eNOS expression, thereby leading to erectile dysfunction.

A Randomized, Placebo-Controlled, Double-Blind, Multi-Center Therapeutic Confirmatory Study to Evaluate the Safety and Efficacy of Avanafil in Korean Patients with Erectile Dysfunction

A multi-center, randomized, double-blind, placebo-controlled study was conducted with 158 subjects who were randomized to placebo or avanafil 50, 100, and 200 mg on demand for 8 weeks to evaluate the safety, tolerability, and efficacy of avanafil in the treatment of erectile dysfunction (ED) in Korean men. The primary outcome was the erectile function (EF) domain score of the International Index of Erectile Function (IIEF) questionnaire. Secondary outcomes included changes in the scores of IIEF questions 3 and 4 (IIEF Q3, Q4) from baseline, changes in all domain scores in the IIEF from baseline, Sexual Encounter Profile questions 2–5 (SEP2–5), the Global Efficacy Assessment Question (GEAQ), and the number of subjects whose EF domain score at the 8th week visit was ≥ 26. After 8 weeks of treatment, the dose groups except avanafil 50 mg scored significantly higher on the IIEF-EF domain from baseline than the placebo group. The changes from baseline in the avanafil group in IIEF Q3 (all doses) and Q4 (200 mg alone) were higher than the placebo group. The differences between avanafil and placebo groups were significant in SEP2 (100 and 200 mg) and SEP3–5 (200 mg). The differences in the GEAQ “Yes” response were also significant in the avanafil 100 and 200 mg groups. Regarding the ratio of normal EF at the end of the study, avanafil 200 mg differed significantly from the placebo. Most treatment-associated adverse events were mild and resolved spontaneously. This is a clinical trial study and was registered at www.ClinicalTrials.gov (Identifier: NCT02477436).

Implantation of AMS 700 LGX penile prosthesis preserves penile length without the need for penile lengthening procedures / 亚洲男科学杂志(英文版)

Implantation of an inflatable penile prosthesis (IPP) is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS 700 LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS 700 LGX. This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February 2009 to April 2012. Stretched flaccid penile length, penile length at 50% and 100% of stiffness (P50 and P100) and International Index of Erectile Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores, were measured at 6 and 12 months postsurgery. Of 45 patients who underwent AMS 700 LGX implantation (median age 61 years) and completed 6 months follow-up, 36 (80%) completed the study. A significant difference in stretched flaccid penile length was seen between 6 and 12 months (P = 0.033). P100 was also significantly increased at 6 and 12 months, with a mean 10% increase (1.3 ± 0.4 cm) from baseline to 12 months. Differences in mean IIEF scores at 6 and 12 months were significant for the desired domain (P = 0.0001) and for overall satisfaction (P = 0.002); however, mean EDITS scores at 6 and 12 months were not significantly improved. AMS 700 LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation.

Clinical Management of Priapism: A Review

Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow), non-ischemic (high-flow), and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.

Un nuevo enfoque terapéutico para la disfunción eréctil: las ondas de choque de baja intensidad / A new therapeutic approach for erectile dysfunction: Low intensity shockwaves / Um novo enfoque terapêutico para a disfunção eréctil: as ondas de choque de baixa intensidade

La disfunción eréctil es la incapacidad de lograr o mantener una erección del pene para la penetración vaginal y el desempeño sexual satisfactorio; se la considera el segundo problema más frecuente de disfunción sexual en hombres, después de la eyaculación precoz, con una prevalencia aproximada del 30%. La mayoría de los casos de disfunción eréctil tienen origen orgánico, principalmente por enfermedades vasculares, pero también está asociada a factores psicológicos, neurológicos u hormonales, o a alteraciones estructurales. La terapia farmacológica con inhibidores de la 5-fosfodiesterasa ha tenido eficacia clínica, pero hay pacientes que no responden a ella. Por tal razón se recurrió a las ondas de choque de baja intensidad que mejoran la vascularización y el flujo sanguíneo del pene con lo que se logran erecciones que permiten mejorar la calidad de la vida sexual. En esta revisión se incluyen diferentes estudios que demuestran la efectividad de este tratamiento.

Erectile dysfunction is the inability to achieve or sustain a penile erection for vaginal penetration and satisfactory sexual performance. It is the second most frequent problem of sexual dysfunction in men, after premature ejaculation, with an approximate prevalence rate of 30%. Most cases of erectile dysfunction have an organic origin, mostly vascular diseases, but it is also associated with psychological, neurological, and hormonal factors, or with structural alterations of the penis. Therapy with 5-phosphodiesterase inhibitors has been clinically effective, but some patients do not respond to it. Lowintensity shock waves may improve penile vascularity and blood flow, leading to better erections, and improvement of the quality of sexual performance. In this review several studies are included that show the effectiveness of this treatment for erectile dysfunction.

A disfunção eréctil é a incapacidade de conseguir ou manter uma ereção do pénis para a penetração vaginal e o desempenho sexual satisfatório; se a considera o segundo problema mais frequente de disfunção sexual em homens, depois da ejaculação precoce, com uma prevalência aproximada de 30%. A maioria dos casos de disfunção eréctil têm origem orgânica, principalmente por doenças vasculares, mas também está associada a fatores psicológicos, neurológicos ou hormonais, ou a alterações estruturais. A terapia farmacológica com inibidores da 5-fosfodiesterasa teve eficácia clínica, mas há pacientes que não respondem a ela. Por tal razão se recorreu às ondas de choque de baixa intensidade que melhoram a vascularização e o fluxo sanguíneo do pénis com o que se conseguem ereções que permitem melhorar a qualidade da vida sexual. Nesta revisão se incluem diferentes estudos que demonstram a efetividade deste tratamento.

Atividade física e disfunção erétil: uma revisão sistemática / Physical activity and erectile dysfunction: a systematic review

Entendida como a incapacidade constante ou recorrente de alcançar ou manter uma ereção satisfatória, a disfunção erétil (DE) tem causas multifatoriais. A prática de atividade física pode ser utilizada como uma medida preventiva para a DE. Nesse sentido, o principal objetivo do presente estudo foi analisar a literatura científica, publicada nos últimos dez anos (2004 a 2014), sobre a relação entre atividade física, DE e os fatores associados em homens a partir de 17 anos e em estudos de corte transversal, ensaios clínicos randomizados e estudos de coorte. A análise dos artigos foi feita por meio de uma revisão sistemática de artigos publicados nas bases de dados Bireme, ScienceDirect, PubMed/Medline, na biblioteca eletrônica SciELO e no Portal de Periódicos da Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) em português, inglês e espanhol. Identificou-se 230 estudos, sendo que apenas 19 preencheram os critérios de inclusão. Todos publicados em inglês. Em todos os estudos analisados, foi diagnosticada a presença de DE. No que diz respeito à atividade física, em 17 estudos, ela esteve significantemente associada à menor ocorrência de DE, tanto nos estudos com delineamento transversal quanto nos quase-experimentais e ensaios clínicos randomizados. A DE pareceu estar associada a diferentes fatores relacionados ao estilo de vida do homem, nomeadamente, nível de escolaridade, doenças crônicas não transmissíveis, índice de massa corporal e também à idade.

Defined as the constant or recurrent inability to attain or maintain a satisfactory erection, erectile dysfunction (ED) has multifactorial causes. Regular physical activity can be used as a preventive tool for ED. In this sense, the main objective of this study was to analyze the scientific literature, published in the last ten years (2004-2014), about the relationship between physical activity, ED and the associated factors among men older than 17 years in cross-sectional, randomized clinical trials and cohort studies. A systematic review was done in articles published in the databases Bireme, ScienceDirect, and PubMed/Medline, in the electronic library SciELO and in the Portal of Journal of Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) written in Portuguese, English and Spanish. Two hundred and thirty studies were identified, and only 19 met the inclusion criteria. All of them were published in English. In all the studies, ED was diagnosed. Concerning physical activity, in 17 studies, it was significantly associated with a lower incidence of ED, both for studies with cross-sectional design, for the quasi-experimental studies and for the randomized clinical trials. ED appeared to be associated with different factors related to lifestyle of men, particularly, education level, non-communicable chronic diseases, body mass index and age.

Retrospective study for the combined effects of Ibuprofen and Cimetidine on the inhibition of penile erection postoperative penis / 中国基层医药

Objective Explore the combined effects of Ibuprofen and Cimetidine on the inhibition of penile erection postoperative penis after circumcision.Methods Reviewed 557 circumcision cases,patients were divided into 3 groups according to the drugs:Diethylstilbestrol group(D group),Ketoconazole group(K group)and the group combined Ibuprofen with Cimetidine(F&C group).D group(n =156)were treated by Diethylstilbestrol for 5 days from the day of operation.K group(n =188)were treated by Ketoconazole for 5 days from the day of operation.F&C group (n =213) were treated by Ibuprofen and Cimetidine for 5 days from the day of operation.6 postoperative indices were compared for evaluating the effects of different drugs on the inhibition of penile erection postoperative penis,including the incidences of secondary hemorrhage,drug adverse reaction,morning erection,the pain frequency,pain degree and holding time of duration of nocturnal penile erection.Results The 4 indices of D group were 6.4％,96.8％,(4.8 ± 2.18) times,(13.6 ± 6.39) minutes,including the incidences rate of secondary hemorrhage and morning erection,the pain frequency and holding time of duration of nocturnal penile erection.These 4 indices of K group and F&C group were 1.6％,91.0％,(4.2 ± 2.21) times,(10.5 ± 5.35) minutes and 1.4％,89.7％,(4.1 ± 2.20) times,(10.4 ± 5.67) minutes.These 4 indices of F&C group were significant less or lower than D group(P ＜ 0.05),but were no significant differences than K group(P ＞ 0.05).It is listed in lighting the penile pain degree,D group,K group,F&C group(P ＜0.05).While the difference of adverse drug reaction rates had no statistically significant among 3 groups (P ＞ 0.05).Conclusion Though the adverse drug reaction rate of the medication combined Ibuprofen with Cimetidine is similar to Ketoconazole and Diethylstilbestrol, most of adverse drug reactions of the former in routine dose were stomach discomforts that could be lower risk than drug hepatitis,and there is no altercation or dispute on transnormal drug dose.The combined effects of Ibuprofen and Cimetidine in routine dose is very similar to Ketoconazole on the inhibition of penile erection postoperative penis,and is signifcantly better than Diethylstilbestrol.The medication combined Ibuprofen with Cimetidine is the best efficacity in the relief of pain among 3 kinds of medication,which is worth popularizing and applying.

Efficacy of Long-Term Daily Dosage of Alfuzosin 10 mg upon Sexual Function of Benign Prostatic Hypertrophy Patients: Two-Year Prospective Observational Study

PURPOSE: To identify sexual function improvement associated with alfuzosin (10 mg daily for 2 years). MATERIALS AND METHODS: We enrolled 30 men with lower urinary tract symptom (LUTS) who visited Gyeongsang National University Hospital between 2010 and 2012. At first visit, urinalysis, prostate specific antigen, transrectal ultrasound, and uroflowmetry were performed. The nternational Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculation Function Domain (MSHQ-EjFD) questionnaires were administered, and the subjects answered the same questionnaires at 1 month, 6 months, 1 year, and 2 years of follow-up. RESULTS: Twelve men completed of the entire study. After administration of alfuzosin, the median IPSS at first visit, 1 month, 6 months, 1 year, and 2 years was 18.00 (interquatile range [IQR]: 14.00~29.75), 20.00 (IQR: 11.50~30.00), 15.50 (IQR: 8.50~25.25), 14.50 (IQR: 9.25~19.50), and 11.50 (IQR: 5.00~17.75), respectively, which showed an improvement. The median QoL at the same times was 4.50 (IQR: 4.00~5.00), 4.50 (IQR: 4.00~5.00), 3.00 (IQR: 2.00~4.00), 3.50 (IQR: 2.25~4.00), and 3.00 (IQR: 1.00~3.00), respectively, and also showed improvement. Likewise, the median IIEF was 36.50 (IQR: 24.50~46.75), 37.50 (IQR: 26.75~47.25), 45.50 (IQR: 35.00~59.75), 48.50 (IQR: 34.75~62.75), and 47.50 (IQR: 43.25~61.00), while the median MSHQ-EjFD was 19.00 (IQR: 12.0~24.75), 19.50 (IQR: 13.50~27.75), 23.00 (IQR: 19.25~32.25), 26.50 (IQR: 18.25~34.50), 27.00 (IQR: 21.50~32.50), respectively, with both showing improvement. CONCLUSIONS: After administration of alfuzosin (10 mg daily for 2 years), the IPSS, QoL, IIEF, and MSHQ-EjFD all improved significantly. This means long-term administration of 10 mg of alfuzosin daily would be effective not only for LUTS but also erectile function and ejaculation.

Clinical Neuroanatomy and Neurotransmitter-Mediated Regulation of Penile Erection / 대한배뇨장애요실금학회지

Erectile dysfunction (ED) has an adverse impact on men's quality of life. Penile erection, which is regulated by nerves that are innervated into the erectile tissue, can be affected by functional or anatomical trauma of the perineal region, including specific structures of the penis, causing ED. Penile erection is neurologically controlled by the autonomic nervous system. Therefore, it is of utmost importance to understand the neurogenic structure of the erectile tissue and the types of neurotransmitters involved in the penile erection process. Here, we highlight the basic clinical anatomy and erectile function of the penis. Understanding the clinical connotation of the relationship between penile erectile structure and function may provide fresh insights for identifying the main mechanisms involved in ED and help develop surgical techniques for the treatment of ED.

The influence of PKRP plus titanium laser lithotripsy on PSA and sexual function in prostate hyperplasia patients complicated with bladder stones / 中国基层医药

Objective To explore the influence of transurethral plasmakinetic resection of the prostate (PKRP) plus titanium laser lithotripsy on prostate-specific antigen(PSA) and sexual function in prostate hyperplasia patients complicated with bladder stones.Methods 62 patients with prostate hyperplasia and bladder stones were randomly divided into the observation group (n =31 cases) and the control group (n =31 cases).The patients in the observation group were operated through PKRP plus titanium laser lithotripsy,while the patients in the control group were operated through transurethral prostatectomy (TURP) plus pneumatic lithotripsy.Serum PSA was detected before and after operation.Sexual function was evaluated six months after operation.Results The IIEF-5 score in two groups were all decreased after operation.Postoperative IIEF-5 score of the observation group had no significant difference compared with that before operation(t =0.3896,P ＞ 0.05).Postoperative IIEF-5 score of the control group had significant difference compared with that before operation (t =4.2820,P ＜ 0.05).The difference between the two groups was significant (t =3.7473,P ＜ 0.05).Serum PSA in two groups were all significantly decreased 1 month after operation(t =2.0423,15.3077,P ＜ 0.01).It in the observation group was lower than that in the control group(t =13.2142,P ＜ 0.05).Conclusion PKRP plus titanium laser lithotripsy can decrease serum PSA and improve sexual function in prostate hyperplasia patients complicated with bladder stones.

Transient Distal Penile Corporoglanular Shunt as an Adjunct to Aspiration and Irrigation Procedures in the Treatment of Early Ischemic Priapism

PURPOSE: Ischemic priapism, a compartment syndrome, requires urgent treatment in order to nourish the corpora cavernosa. As the first step, aspiration of blood and irrigation of the cavernosal bodies is performed to prevent fibrotic activity and secure erectile capability. During aspiration, there are risks of cardiovascular side effects of adrenergic agonists. We aimed to evaluate a transient distal penile corporoglanular shunt technique in place of aspiration and irrigation techniques for treatment of early ischemic priapism. MATERIALS AND METHODS: A transient distal penile shunt was applied to 15 patients with early ischemic priapism between January 2011 and May 2012. Priapism duration, history, causes, pain, and any prior management of priapism were assessed in all patients. A complete blood count and penile Doppler ultrasonography were performed, which showed attenuated blood flow in the cavernosal artery. A sterile closed system blood collection set, which has two needles and tubing, was used for the transient distal penile shunt. RESULTS: Ten of 15 patients with early ischemic priapism were successfully treated with this transient shunt technique. No additional procedures were needed after the resolution of rigidity in the 10 successfully treated patients. CONCLUSIONS: The transient nature of this technique is an advantage over aspiration and irrigation in the treatment of early ischemic priapism. Our results indicate that the technique can be offered for patients with an ischemic priapism episode of no more than 7 hours.

Effects and Mechanism of Action of a Tribulus terrestris Extract on Penile Erection

PURPOSE: Tribulus terrestris has been used as an aphrodisiac. However, little is known about the effects and mechanism of action of T. terrestris on penile erection. Therefore, the effect of a T. terrestris extract and the mechanism of action of the extract on relaxation of the corpus cavernosum (CC) were investigated. The erectogenic effects of an oral preparation of the extract were also assessed. MATERIALS AND METHODS: The relaxation effects and mechanism of action of the T. terrestris extract on rabbit CC were investigated in an organ bath. The intracavernous pressure (ICP) was calculated after oral administration of the extract for 1 month to evaluate whether the relaxation response of the CC shown in the organ bath occurred in vivo. Additionally, cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) were measured in the CC by immunoassay. Smooth muscle relaxation was expressed as the percentage decrease in precontraction induced by phenylephrine. The ICP was also assessed in rats after oral administration of the extract for 1 month, and changes in concentrations of cGMP and cAMP were monitored. RESULTS: Concentration-dependent relaxation effects of the extract on the CC were detected in the organ bath study. Relaxation of the CC by the T. terrestris extract was inhibited in both an endothelium-removed group and an L-arginen methyl ester pretreatment group. The ICP measured after oral administration of the T. terrestris extract for 1 month was higher than that measured in the control group, and a significant increase in cAMP was observed in the T. terrestris extract group. CONCLUSIONS: The T. terrestris extract induced concentration-dependent relaxation of the CC in an organ bath. The mechanism included a reaction involving the nitric oxide/nitric oxide synthase pathway and endothelium of the CC. Moreover, in an in vivo study, the T. terrestris extract showed a significant concentration-dependent increase in ICP. Accordingly, the T. terrestris extract may improve erectile function.