Trends in treatments for erectile dysfunction in Chile between 2010 and 2020 with special focus on penile prostheses.

OBJECTIVES: Evidence regarding demand trends for erectile dysfunction (ED) treatments are scarce in South America. This study aims to evaluate trends in ED treatments in Chile over a 10-year period (2010- 2020) and estimate the potential number of candidates for penile prosthesis. MATERIALS AND METHODS: Sales trends of pharmacological treatments and penile prosthesis were obtained from market studies. The potential number of candidates for penile prosthesis implantation was calculated by crossing epidemiological data with previously reported ED prevalence, proportion of sexually active men, percentage of men seeking medical assistance for ED, and the proportion of patients who are non-responders to ED oral drug therapies Results: In the 10-year studied period, the Chilean male population older than 50 years increased 34.7%, with an average annual variation (AAV) of 3.4%. For the same period, the sales of oral drug therapies for ED increased by 71.3% (AAV 6.2%), the sales of intracavernosal vasoactive agents (ICVA) decreased by 0.4% (AAV -0.2%), and penile prosthesis sales increased by 113% (AAV 6.7%). We estimated that only 0.05% of sexually active men older than 50 years old with ED who sought medical assistance finally had a penile prosthesis implanted to manage their condition. CONCLUSIONS: Demand for ED oral drug therapies significantly increased in Chile during the last decade, while ICVA remained stable. The annual rate of penile prosthesis implantation increased. However, the gap between the potential penile prosthesis candidates and the actual number of devices implanted is suspected to remain extremely high.

Prótesis penianas: descripción de una serie de implantes con y sin dilatación de cuerpos cavernosos / Penile prostheses: Description of a series of implants with and without dilatation of the corpora cavernosa

INTRODUCCIÓN: El implante de prótesis penianas (PP) es el tratamiento de elección en la disfunción eréctil (DE) refractaria. Tiene una alta tasa de satisfacción (75-100%) y una tasa de complicaciones que varía entre el 2,1-28,8%. La técnica quirúrgica estándar incluye la dilatación de los cuerpos cavernosos (CC) previo a la inserción de los cilindros. Este procedimiento requiere tiempo y es el paso crítico para la ocurrencia de complicaciones. El objetivo de este estudio es describir los resultados de una serie de PP implantadas utilizando las técnicas con y sin dilatación de los CC. MATERIALES Y MÉTODOS: Ciento veinte pacientes con DE refractaria en quienes fue implantada una PP por 2 cirujanos en diferentes centros. Se evaluaron comorbilidades, características operatorias, satisfacción y complicaciones postoperatorias. RESULTADOS: El promedio de edad fue de 61±9,6 años. Las comorbilidades más prevalentes fueron: antecedente de prostatectomía radical, hipertensión arterial y diabetes mellitus. Se instalaron 42 prótesis maleables y 78 hidráulicas. Once pacientes habían tenido previamente una PP. La mediana de tiempo operatorio fue de 70 minutos (35-140). La satisfacción reportada fue de un 95,8%. Diez pacientes presentaron complicaciones. En el grupo en que la cirugía se realizó sin dilatación de los CC (n=80), el tiempo operatorio fue menor que en quienes sí se realizó dilatación de los CC (62,5minutos [35-105] versus 90 minutos [60-140], respectivamente, p < 0,0001). No hubo diferencia en la ocurrencia de complicaciones (p = 0,73) ni en los niveles de satisfacción (p = 0,196) al comparar la técnica con y sin dilatación de los CC. CONCLUSIÓN: En nuestra serie se evidenció un menor tiempo operatorio con la técnica sin dilatación de CC, pero no hubo diferencias en las complicaciones encontradas. Se requiere un estudio prospectivo y aleatorizado para hacer recomendaciones respecto a la dilatación de los CC

INTRODUCTION: Penile prosthesis (PP) implantation is the treatment of choice for refractory erectile dysfunction (ED). They show a high satisfaction rate (75%-100%) and a complication rate that varies between 2.1% and 28.8%. The standard surgical technique includes dilatation of the corpora cavernosa (CC) prior to the insertion of the cylinders. This step takes time and is critical for the occurrence of complications. The aim of this study is to describe the results of a series of PP implanted using the techniques with and without dilatation of the CC. MATERIALS AND METHODS: One-hundred and 20 patients with refractory ED in whom a PP was implanted by 2 surgeons in different centers. Comorbidities, operative characteristics, satisfaction and postoperative complications were evaluated. RESULTS: The average age was 61±9.6 years. The most prevalent comorbidities were: history of radical prostatectomy, high-blood pressure and diabetes mellitus. Forty-two malleable and 78 hydraulic prostheses were implanted. Eleven patients had a previous PP. The median operative time was 70 minutes (35-140). The satisfaction reported was 95.8%. Ten patients presented complications. In the group in which the surgery was performed without dilatation of the CC (n=80), the operative time was shorter (62.5 minutes [35-105] versus 90 minutes [60-140] respectively, p < 0.0001). There was no difference in complications (p = 0.73) or levels of satisfaction (p = 0.196) when comparing the technique with and without dilatation of the CC. CONCLUSION: In our series, a shorter operative time was observed with the technique without dilatation of the CC, but there were no differences in complications. A prospective and randomized study is required to make a stronger recommendation regarding to dilatation of the CC

[Penile prostheses: Description of a series of implants with and without dilatation of the corpora cavernosa]. / Prótesis penianas: descripción de una serie de implantes con y sin dilatación de cuerpos cavernosos.

INTRODUCTION: Penile prosthesis (PP) implantation is the treatment of choice for refractory erectile dysfunction (ED). They show a high satisfaction rate (75%-100%) and a complication rate that varies between 2.1% and 28.8%. The standard surgical technique includes dilatation of the corpora cavernosa (CC) prior to the insertion of the cylinders. This step takes time and is critical for the occurrence of complications. The aim of this study is to describe the results of a series of PP implanted using the techniques with and without dilatation of the CC. MATERIALS AND METHODS: One-hundred and 20 patients with refractory ED in whom a PP was implanted by 2 surgeons in different centers. Comorbidities, operative characteristics, satisfaction and postoperative complications were evaluated. RESULTS: The average age was 61±9.6 years. The most prevalent comorbidities were: history of radical prostatectomy, high-blood pressure and diabetes mellitus. Forty-two malleable and 78 hydraulic prostheses were implanted. Eleven patients had a previous PP. The median operative time was 70minutes (35-140). The satisfaction reported was 95.8%. Ten patients presented complications. In the group in which the surgery was performed without dilatation of the CC (n=80), the operative time was shorter (62.5minutes [35-105] versus 90minutes [60-140] respectively, p<0.0001). There was no difference in complications (p=0.73) or levels of satisfaction (p=0.196) when comparing the technique with and without dilatation of the CC. CONCLUSION: In our series, a shorter operative time was observed with the technique without dilatation of the CC, but there were no differences in complications. A prospective and randomized study is required to make a stronger recommendation regarding to dilatation of the CC.

Successful unilateral vasectomy reversal in a lion (Panthera leo).

Background: In 2016, the veterinarian team of Buin Zoo in Chile decided to try to increase the lion population. At that time, the zoo had three lions; two females and one male. The 9-year-old male had been vasectomized 5 years ago at the same institution for birth control. Considering the fact that in humans, vasectomy reversal has excellent reproductive outcomes, a team of human urologists, highly experienced in vasectomy reversal was contacted to perform the procedure. Case description: Surgery was performed on June 16, 2016 under general anesthesia, with the vasectomy site accessed through the previous scar localized in the lower groin. After opening the skin, dartos and tunica vaginalis, we were able to identify the previous vasectomy site. After liberating both vas ends and checking for permeability, a microsurgical anastomosis (magnification 25×) was performed. The surgery took 80 minutes with minimal bleeding, and no surgical complications were observed. After 2 weeks, the lion joined the lionesses and reproductive follow-up was started. Seven months after surgery, one lioness became pregnant, and 4 months later gave birth to two female lion cubs, with no incidents at the zoo. Both cubs were healthy and are still living at the zoo. Conclusion: Vasectomy reversal constitutes a valid perspective to reassume fertility in previous vasectomized lions.

Priapism induced by use of tamsulosin: A case report and review of the literature.

Numerous medications have been associated to the development of priapism as an adverse reaction, the most common are intracavernosal vasoactive agents, antipsychotics and antidepressants. Alpha blockers, in particular tamsulosin which is widely used in different urological conditions, has been associated to priapism in only few case reports. We present the case of a healthy 45-year-old man who medicated himself with two doses of 0.4 mg of tamsulosin due to a renal colic with spontaneous passage of a 3 mm stone. Eight hours after the second tamsulosin dose the patient developed a persistent painful erection not associated to sexual stimulation that lasted for 6 hours. He was admitted to the emergency room, and after history taking and physical evaluation the diagnosis of ischemic priapism was made. The patient denied consumption of any other medication or drug during the last month, blood tests in particular hemogram were normal and no recent history of pelvic trauma was reported. To achieve detumescence, five boluses of 200 mcg of phenylephrine were injected directly in the corpora cavernosa, no further procedures were needed. In the follow-up the patient had no new priapism episodes and he reported no problems with erections in sexual intercourse. Tamsulosin is one of most indicated medications in urological general practice; though priapism has been rarely associated to its consumption the risk of this side effect exists, suggesting that patients should be counselled about it.

Clomiphene citrate treatment for late onset hypogonadism: rise and fall

ABSTRACT Objective: Previous series have demonstrated that Clomiphene Citrate (CC) is an effective treatment to increase Total Testosterone (TT) in Late Onset Hypogonadism (LOH) patients. However, what happens to TT levels after ending CC treatment is still debatable. The objective of this study is to evaluate TT levels 3 months after the discontinuation of CC in patients with LOH who were previously successfully treated with the same drug. Materials and Methods: Twenty-seven patients with LOH that were successfully treated (achieved TT levels >11nmol/l) with CC 50mgs daily for 50 days were prospectively recruited in our Andrological outpatient clinic. CC was then stopped for 3 months and TT levels were measured at the end of this period. Results: Mean TT level before discontinuation of CC was 22.7±8.1nmol/L (mean±SD). Three months after discontinuation, mean TT level significantly decreased in all patients, 10.2±3.9nmol/l (p<0.01). Twenty-one patients (78%) decreased TT levels under 11nmol/L. Six patients (22%) had TT levels that remained within the normal recommended range (≥11nmol/l). No statistical significant differences were observed between both groups. Conclusion: In the short term LOH does not seem to be a reversible condition in most patients after CC treatment. More studies with longer follow-up are needed to evaluate the kinetics of TT in LOH.

Clomiphene citrate treatment for late onset hypogonadism: rise and fall.

OBJECTIVE: Previous series have demonstrated that Clomiphene Citrate (CC) is an effective treatment to increase Total Testosterone (TT) in Late Onset Hypogonadism (LOH) patients. However, what happens to TT levels after ending CC treatment is still debatable. The objective of this study is to evaluate TT levels 3 months after the discontinuation of CC in patients with LOH who were previously successfully treated with the same drug. MATERIALS AND METHODS: Twenty-seven patients with LOH that were successfully treated (achieved TT levels >11nmol/l) with CC 50mgs daily for 50 days were prospectively recruited in our Andrological outpatient clinic. CC was then stopped for 3 months and TT levels were measured at the end of this period. RESULTS: Mean TT level before discontinuation of CC was 22.7±8.1nmol/L (mean±SD). Three months after discontinuation, mean TT level significantly decreased in all pa¬tients, 10.2±3.9nmol/l (p < 0.01). Twenty-one patients (78%) decreased TT levels under 11nmol/L. Six patients (22%) had TT levels that remained within the normal recommended range (≥11nmol/l). No statistical significant differences were observed between both groups. CONCLUSION: In the short term LOH does not seem to be a reversible condition in most patients after CC treatment. More studies with longer follow-up are needed to evaluate the kinetics of TT in LOH.

Evidence for obtaining a second successive semen sample for intrauterine insemination in selected patients: results from 32 consecutive cases.

OBJECTIVE: The goal of this study was to compare the semen parameters of two successive samples obtained within an interval of less than 60 minutes from patients planning to undergo intrauterine insemination (IUI) whose first samples exhibited low semen quality. METHODS: Thirty-two consecutive patients were enrolled in the study. On the day of IUI, the semen analysis of the samples initially presented by all patients met at least two of the following criteria: sperm concentration <5×10(6)/mL, total sperm count <10×10(6), progressive sperm motility (a+b) in the native sample <30%, and total motile sperm count (TMSC) <4×10(6). A successive semen sample was obtained no more than 60 minutes after the first sample. RESULTS: Compared to the first sample, the second exhibited significantly (p<0.05) improved sperm concentration, TMSC, progressive motility, and vitality. Regarding TMSC, the most critical parameter on the day of IUI, 23 patients (71.8%) improved it, while nine (28.2%) displayed poorer outcomes. CONCLUSION: In defined cases, requesting a second successive ejaculate on the day of insemination may result in a high percentage of cases in an improvement of the quality of the sample.

Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial.

PURPOSE: We prospectively evaluated the results of microsurgical spermatic cord denervation in a series of patients with chronic scrotal content pain in a multicenter study, including 1 center in Germany and 3 centers in Chile. MATERIALS AND METHODS: A total of 50 patients with chronic scrotal content pain more than 3 months in duration were prospectively selected for standardized operative microsurgical spermatic cord denervation as pain treatment. In all patients preoperative management included a positive response to a spermatic cord block test with local anesthesia. Pain severity was assessed using an analog visual pain scale (range 0 to 10) for 30 consecutive days. A total of 52 testicular units were operated on using a subinguinal approach. In all cases a surgical microscope was used to identify the arteria testicularis. RESULTS: No intraoperative complications were observed and no testicular units were lost. Two reoperations were performed, including 1 for hematocele and 1 for hydrocele. Six months after surgery 40 patients (80%) were completely pain-free. In 6 patients (12%) intermittent testicular discomfort persisted, which could be managed by acetaminophen on demand. Four patients (8%) had no change in pain severity after surgery. CONCLUSIONS: After proper selection of patients microsurgical spermatic cord denervation seems to be a safe and efficient procedure to treat chronic scrotal content pain. Considering the limitations of the study, a randomized, controlled trial with longer followup is highly warranted.

Necrosis is the dominant cell death pathway in uropathogenic Escherichia coli elicited epididymo-orchitis and is responsible for damage of rat testis.

Male infertility is a frequent medical condition, compromising approximately one in twenty men, with infections of the reproductive tract constituting a major etiological factor. Bacterial epididymo-orchitis results in acute inflammation most often caused by ascending canalicular infections from the urethra via the continuous male excurrent ductal system. Uropathogenic Escherichia coli (UPEC) represent a relevant pathogen in urogenital tract infections. To explore how bacteria can cause damage and cell loss and thus impair fertility, an in vivo epididymo-orchitis model was employed in rats by injecting UPEC strain CFT073 into the vas deference in close proximity to the epididymis. Seven days post infection bacteria were found predominantly in the testicular interstitial space. UPEC infection resulted in severe impairment of spermatogenesis by germ cell loss, damage of testicular somatic cells, a decrease in sperm numbers and a significant increase in TUNEL (+) cells. Activation of caspase-8 (extrinsic apoptotic pathway), caspase-3/-6 (intrinsic apoptotic pathway), caspase-1 (pyroptosis pathway) and the presence of 180 bp DNA fragments, all of which serve as indicators of the classical apoptotic pathway, were not observed in infected testis. Notably, electron microscopical examination revealed degenerative features of Sertoli cells (SC) in UPEC infected testis. Furthermore, the passive release of high mobility group protein B1 (HMGB1), as an indication of necrosis, was observed in vivo in infected testis. Thus, necrosis appears to be the dominant cell death pathway in UPEC infected testis. Substantial necrotic changes seen in Sertoli cells will contribute to impaired spermatogenesis by loss of function in supporting the dependent germ cells.

Combined trifocal and microsurgical testicular sperm extraction is the best technique for testicular sperm retrieval in "low-chance" nonobstructive azoospermia.

BACKGROUND: There is no consensus for the best testicular sperm extraction (TESE) technique in patients with "low-chance" nonobstructive azoospermia (NOA). OBJECTIVE: To determine sperm retrieval rates in an intraindividual comparison using three locations of the testicle with and without the assistance of a microscope (microsurgical TESE [M-TESE]). DESIGN, SETTING, AND PARTICIPANTS: A series of 65 patients with low-chance NOA presenting with low testicular volume (<8 ml) and high serum follicle-stimulating hormone (FSH) (>12.4 IU/l) underwent trifocal-TESE plus M-TESE bilaterally (four biopsies per testis). INTERVENTION: Sperm retrieval was performed as trifocal-TESE (upper, middle, and lower testicular pole) with and without the assistance of a microscope in the middle incision. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The number of evaluated tubules, the mean spermatogenetic scores, and the sperm retrieval rates were evaluated to determine retrieval locations and the use of the microscope. The Friedman and Cochrane Q tests were applied to determine statistical differences. Receiver operating characteristic curves were used for the analysis of serum FSH and testicular volume as preoperative prognostic factors. RESULTS AND LIMITATIONS: The sperm retrieval success of 66.2% using the combined technique, meaning the percentage of patients with at least one tubule containing elongated spermatids, was the highest in the combination of trifocal- and M-TESE (p<0.01), indicating this technique as optimal for patients with low-chance NOA. M-TESE and trifocal-TESE alone were not significantly better. The mean spermatogenetic score giving the number of tubules with elongated spermatids in relation to all tubules was significantly higher in M-TESE versus conventional TESE (p<0.01), indicating the superior quality of the tissue harvested using the microscope. These results are limited by the definition of "success" using "one" spermatid/tubule. Preoperatively, high serum FSH and low testicular volumes did not exclude successful sperm retrieval. CONCLUSIONS: The combination of trifocal- and M-TESE is the best technique to reach high sperm retrieval rates in patients with low-chance NOA.

Tetraethylammonium-sensitive K(+) current in the bovine spermatozoa and its blocking by the venom of the Chilean Latrodectus mactans.

The morphology and size of spermatozoa hinder the study of the functional properties of the spermatozoa plasma membrane. However, some studies have revealed the presence of a number of ion channels in this cell. We set out to measure the endogenous currents and to study the effect of the venom of the Chilean black widow spider (Latrodectus mactans). By patch-clamping bovine spermatozoa our results indicate the presence of an outwardly rectifying current, sensitive to changes in K(+) concentration (30-140 mM) and to tetraethylammonium (TEA, 10-100 mM). The application of the venom (7.5 microg/ml) blocks these K+ currents and then alters the passive properties of the plasma membrane. This leads to the entry of Ca(++), reflected by a change in basal fluorescent units (5+/-2 at 35+/-10 FAU). The Ca(++) influx follows a reduction in the membrane conductance (control 22+/-2; venom 10+/-1 pS), as calcium channels open in accord with voltage dependence.

Are antisperm antibodies really associated with proven chronic inflammatory and infectious diseases of the male reproductive tract?

BACKGROUND: It is debated whether chronic urogenital inflammations and infections may trigger the formation of antisperm antibodies (ASA) in semen. OBJECTIVE: To evaluate the formation of ASA in defined chronic inflammatory and infectious diseases of the male reproductive tract (MRT). DESIGN, SETTING, AND PARTICIPANTS: Three hundred sixty-five patients retrospectively enrolled in a single center were categorized as having National Institutes of Health (NIH) category II chronic prostatitis (n=38), NIH category IIIa chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) (n=59), NIH category IIIb CP/CPPS (n=213), chronic epididymitis (n=34), and chronic urethritis (n=21). Forty-five age-matched men served as controls. MEASUREMENTS: All subjects underwent microbiologic and cytologic analysis for common bacteria, yeasts, and mycoplasma using the four-glass test. Urine samples, ejaculates, and urethral swabs were analyzed with polymerase chain reaction (PCR) for Chlamydia trachomatis and Neisseria gonorrhea. Semen analysis followed World Health Organization (WHO) standards. ASA in seminal plasma were analyzed using the mixed agglutination reaction (MAR) test. RESULTS AND LIMITATIONS: The overall positive detection rate of clinically significant levels (> or = 50% of spermatozoa coated by ASA) of IgG and IgA antibodies was 1.8% and 0.8%, respectively, in the patient group. No clinically significant levels of ASA were detected in the control group, and no statistically significant difference was observed between controls and patients (IgG, p=1.0; IgA, p=1.0). No difference was found between the different inflammatory and infectious diseases and the control group in the detection rate of ASA, even when the cut-point value was lowered to > or = 1% (IgG, p=0.4; IgA, p=0.3). Moreover, in one selected subgroup of patients (n=26) with persistent increased inflammatory parameters (peroxidase-positive leukocytes [PPL] > or = 1 x 10(6)/ml and elastase > or = 230 ng/ml), no significant difference in the levels of ASA was observed compared with the controls (IgG, p=0.1; IgA, p=0.8). CONCLUSION: There is no association between chronic inflammatory or infectious diseases of the MRT and the presence of ASA in semen.

Potassium current in mature bovine spermatozoa.

Ion channels have been assigned a pivotal importance in various sperm functions and are therefore promising targets for contraceptive development. The lack of data on channel functionality and pharmacology has hampered this goal. This is a consequence of technical problems of applying electrophysiological techniques to spermatozoa due to their small size and form. By using a laminin coating to increase adherence of spermatozoa and nystatin in the patch pipette for pore formation, we have adapted the whole-cell recording technique to study currents in mature uncapacitated bovine spermatozoa. Employing these conditions, in the head region, patched spermatozoa could be transferred into the whole-cell configuration. For the first time we document an outward rectifying current in mature bovine spermatozoa was blocked by tetraethyl ammonium (TEA) chloride. The observation of a shift in the reversal potential as a response to changes in the extracellular concentration of K(+) ions allowed us to identify this current as K(+) selective. This result shows that K(+) channels in the head region of mature uncapacitated bovine spermatozoa can be suitably investigated using the whole-cell recording patch-clamp technique.

Relación entre índice de masa corporal, cáncer de próstata, antígeno prostático específico y score de Gleason / Is body mass index related to prostate cancer, PSA and Gleason score?

Objetivo: Evaluar la relación entre índice de masa corporal (IMC), riesgo de cáncer de próstata, antígeno prostático específico (APE) y score de Gleason en 505 pacientes sometidos a biopsia prostática. Pacientes y Métodos: Se realizó un estudio caso control evaluando la relación entre IMC y cáncer de próstata. En los pacientes con cáncer de próstata se evaluó la relación entre IMC (<25, <25<30, <30), APE y score de Gleason. Resultados: Adenocarcinoma de próstata fue diagnosticado en 201 pacientes. Al estratificar el IMC (<25, <25<30, <30) de los pacientes y relacionarlo con la presencia o ausencia de cáncer no se encontró asociación estadísticamente significativa entre los grupos. Se encontró un mayor riesgo de cáncer de próstata en los pacientes de mayor estatura. En los pacientes con cáncer no se encontró asociación estadísticamente significativa entre IMC, APE y score de Gleason. Conclusión: No se encontró asociación entre obesidad y cáncer de próstata. Existe un mayor riesgo de cáncer de próstata a mayor estatura. En los pacientes con diagnóstico de cáncer de próstata no se encontró asociación entre obesidad, APE y score de Gleason.

Objetive: To evaluate the relationship between Body Mass Index (BMI), prostate cancer risk, prostate specific antigen (PSA) and Gleason score in 505 patients who underwent transrectal prostatic biopsy. Patients and Methods: We designed a Case-Control study to evaluate the relationship between BMIand the presence of prostate cancer. In the patients with the diagnosis of prostate cancer we evaluated the relationship between BMI (<25, <25<30, <30), PSA levels and Gleason score. Results: Prostate cancer was diagnosed in 201 patients. BMI (<25, <25<30, <30) was not related to the presence of prostate cancer. Height was associated with an increased risk of prostate cancer. Noassociation was found between BMI, PSA levels and Gleason score in patients with prostate cancer. Conclusions: The results of this study support the hypothesis that BMI is not associated with prostate cancer risk in Chilean population. Height is associated with an increased risk of prostate cancer. Inpatients with prostate cancer no association was found between BMI, PSA levels and Gleason score.