Prosthetic urology: past, present, and future / 亚洲男科学杂志(英文版)

The global population is collectively getting older, and age is directly correlated with erectile dysfunction (ED). With the advent of effective oral agents and wide availability of the Internet, a larger portion of the population is becoming aware of the different treatment options for men with ED. The penile prosthesis is a definitive and effective treatment for ED which has been available for just over half a century.

Role of Penile Prosthesis in Priapism: A Review

Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.

Modifying Risk Factors in the Management of Erectile Dysfunction: A Review

Erectile dysfunction (ED) is prevalent among men and its presence is often an indicator of systemic disease. Risk factors for ED include cardiovascular disease, hypertension, diabetes mellitus (DM), tobacco use, hyperlipidemia, hypogonadism, lower urinary tract symptoms, metabolic syndrome, and depression. Addressing the modifiable risk factors frequently improves a patient's overall health and increases lifespan. The literature suggests that smoking cessation, treatment of hyperlipidemia, and increasing physical activity will improve erectile function in many patients. How the treatment of DM, depression, and hypogonadism impacts erectile function is less clear. Clinicians need to be aware that certain antihypertensive agents can adversely impact erectile function. The treatment of men with ED needs to address the underlying risk factors to ameliorate the disease process.

Premature ejaculation: current and future treatments / 亚洲男科学杂志(英文版)

Premature ejaculation (PE) is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration (FDA). Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.

Evaluation of corporal fibrosis in cadaveric pericardium and vein grafts for tunica albuginea substitution in rats / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the degree of corporal fibrosis in rats with cadaveric pericardium or vein as grafting materials for tunica albuginea substitution.</p><p><b>MATERIALS AND METHODS</b>Thirty male Sprague-Dawley rats (300 g approximately 325 g) were divided at random into 3 groups of 10 animals each: group 1 was the sham-operated controls and groups 2 and 3 underwent wedge excision of tunica albuginea and replacement with cadaveric pericardium and vein grafts, respectively. Four months later, rats were sacrificed and the penis removed to assess the degree of fibrosis using RT-PCR technique for TGF-bgr1 mRNA expression. The tissues were fixed in 10% formalin, paraffin-embedded and stained with Masson's trichrome and Verhoff's van Giesen for collagen and elastic fibers.</p><p><b>RESULTS</b>Four months after grafting, there was minimal fibrosis surrounding the patch in the vein graft rats and moderate fibrosis in the pericardial graft rats. The degree of penile fibrosis in the pericardial graft rats was significantly higher than that in the controls (P<0.01), but in the vein graft rats it was not significantly different from that of the controls (P>0.05).</p><p><b>CONCLUSION</b>The degree of penile fibrosis of cadaveric pericardial graft was significantly higher than that of the control group, while in the vein graft group it was comparable to the latter. The authors believe that the vein graft may be a more ideal substance to be used as the tunica albuginea substitute than the pericardial graft in the surgical treatment of Peyronie'S disease.</p>

The Role of Chronic Endothelin Antagonism for Preserving Erectile Function in Experimental Diabetic Rats / 대한남성과학회지

PURPOSE: This study was designed to investigate the role of chronic endothelin receptor antagonism to preserve erectile function in diabetic rats. MATERIALS AND METHODS: Forty adult male Sprague-Dawley rats (250-350 gm) were divided into 4 groups: Group 1, non-diabetic control rats (n=5); Group 2, non-diabetic rats fed 10 mg/kg of RO-485695, a combined endothelin receptor antagonist (n=5); Group 3, diabetic control (n=15); Group 4, diabetic rats fed 10 mg/kg of RO-485695 (n=15). Streptozotocin, 65 mg/kg, was used for development of diabetes mellitus. Body weight and blood glucose levels were measured every 2 weeks and drug feeding was done by oral gavage. Twelve weeks after induction of diabetes and RO-485695 treatment, erectile function was determined by measurement of intracavernosal pressure (ICP) and maximal arterial pressure (MAP) after electrical stimulation of the cavernosal nerve. RT-PCR analysis for detection of mRNA of endothelin-1, endothelin receptor A (ET-A), and endothelin receptor B (ET-B), and Western blot analysis and immunohistochemical evaluation of the eNOS protein were performed. RESULTS: Body weight and blood glucose levels were not influenced by 10 mg/kg of RO-485695. Erectile function after 5 volts stimulation was significantly decreased in the diabetic rat (group 3 & 4) compared with the non-diabetic rat (group 1 & 2) (64.3+/-9.6 vs 41.9+/-14.8 mmHg), but increased in group 4 compared with group 3 (44.3+/-16.9 vs 36.6+/-10.1 mmHg). The mRNA expression of endothelin-1 was up-regulated significantly in group 3 & 4 when compared with group 1 & 2. However this endothelin expression was down-regulated in group 4 compared with group 3. The mRNA expression of ET-A among 4 groups was not significantly different. ET-B band in rat cavernosal tissue could not be observed in any group under these conditions. eNOS protein expression was increased in group 4 compared with group 3. CONCLUSIONS: Chronic endothelin receptor antagonism in the experimental diabetic rat model has been demonstrated to preserve cavernosal erectile function, suggesting a possible therapeutic role for endothelin receptor antagonists in diabetic erectile dysfunction.

Expression and Localization of Peripheral Dopamine D1 and D2 Receptors in Rat and Human Seminal Vesicle / 대한남성과학회지

PURPOSE: Dopamine, an established neurotransmitter in the central nervous system, is recognized for its role in penile erection and ejaculation in rats. However, its complete mechanism of action in the genitourinary tract is unknown. The objective of this study was to investigate the existence and expression of peripheral dopamine D1 and D2 receptor mRNAs and also the corresponding proteins in rat and human seminal vesicles. Concurrently, immunohistochemical staining was carried out for localizing peripheral dopamine D1 and D2 receptor proteins in rat and human seminal vesicles. MATERIALS AND METHODS: The seminal vesicle tissues of male Sprague-Dawley rats and human radical prostatectomy specimens were used for the extraction of total RNA and proteins, and for the preparation of slide sections. The hypothalamus tissues of rat brain served as a control for dopamine D1 and D2 receptors. The presence and the expression of peripheral dopamine D1 and D2 receptor mRNAs in rat and human seminal vesicle tissues was performed by reverse transcription-polymerase chain reactions (RT-PCR). At the same time the detection of corresponding proteins of D1 and D2 receptor was also investigated by using Western blotting technique. The anatomical localizations of dopamine D1 and D2 receptor proteins in rat and human seminal vesicle were identified by immunohistochemical staining using an antipeptide polyclonal rabbit antibody. RESULTS: Dopamine D1 and D2 receptor genes expression were detected in both human and rat seminal vesicle tissues. Western blot analyses demonstrated that peripheral dopamine D1 and D2 receptor proteins exist in both human and rat seminal vesicle tissues. Immunohistochemical localization of peripheral dopamine D1 and D2 receptor proteins were demonstrated in smooth muscle layer of human and rat seminal vesicle. CONCLUSIONS: The results of this study demonstrate that peripheral dopamine D1 and D2 receptors are present in the seminal vesicle tissue of both rats and humans. These results suggest that seminal emission may be mediated in part by stimulation of peripheral dopamine receptors located in the seminal vesicles.