Penile Circumference Change Research Articles

REMOVED: The Augmenta Implant: A Cadaver Model of a Novel Anatomic Subdermal Implant for Cosmetic Penile Enhancement.

IntroductionThere are limited options for cosmetic penile enhancement and the correction of structural penile deformities.AimWe present the Augmenta, an innovative, technologically advanced subcutaneous elastomer-silicone cosmetic penile implant (CPI), as evaluated by objective structural changes in a cadaveric model.MethodsFive fresh male cadaver pelves were utilized in this preclinical setting. Placement of a subcutaneous elastomer-silicone CPI was performed via a penoscrotal approach. Penile circumference was measured at the base and distal shaft before and after implant placement. Penile length was measured from the pubic bone to the tip of the glans penis before and after implantation of Augmenta.Main Outcome MeasureObjective outcomes included changes in penile circumference and shaft length in both the flaccid and erect state, both before and after CPI placement.ResultsIn 5 cadaver models, implantation of the Augmenta CPI increased flaccid penile shaft base circumference from an average of 8.7 cm to 12.0 cm after implantation (39.1% increase, P < .001). Flaccid distal circumference increased from 7.3 cm to 10.3 cm (41.8% increase, P = .020). During the erect state, penile base circumference increased from an average of 12.5 cm to 13.7 cm (6.3% increase, P = .273), while distal erect circumference changed from an average of 11.3 cm to 12.4 cm (9.7% increase, P = .298). Nonstretched flaccid shaft length increased from an average of 12.1 cm to 14 cm (15.2% increase, P = .073).Clinical ImplicationsThe Augmenta CPI could serve as alternative option for men seeking cosmetic penile enhancement.Strengths and LimitationsLimitations include a small number of cadavers which do not completely reproduce living physiologic function and the use of a single technical approach. However, a consistent and standardized surgical approach reduces operator-dependent outcomes. Another strength is the use of fresh human cadavers that most closely represent live models.ConclusionIn a cadaveric model, the Augmenta CPI demonstrates enhancements in penile girth in both the flaccid and erect state. The unique honeycomb technology, the embedded polyester mesh, and the antimicrobial hydrophilic coating of the Augmenta CPI may provide an advantage to currently available CPIs. Clinical trials will be needed to demonstrate both the safety and feasibility. Clavell-Hernández J, Tatem AJ, Lipshultz LI, et al. The Augmenta Implant: A Cadaver Model of a Novel Anatomic Subdermal Implant for Cosmetic Penile Enhancement. Sex Med 2021;9:100447.

Comparison of arousal and preference assessment outcomes for sex offenders with intellectual disabilities.

We compared outcomes of arousal and preference assessments for five adult male alleged sexual offenders with intellectual disabilities. Arousal assessments involved the use of the penile plethysmograph to measure changes in penile circumference to both deviant (males and females under the age of 18) and nondeviant (males and females over the age of 18) video clips. Paired-stimulus preference assessments were arranged to present still images from the video clips used in the arousal assessments. Results showed correspondence between the assessments for four out of the five participants. Implications are discussed for the use of preference assessment methodology as a less intrusive assessment approach for sexual offender assessments.

Relation Between Erectile Dysfunction and Silent Myocardial Ischemia in Diabetic Patients: A Multidetector Computed Tomographic Coronary Angiographic Study.

IntroductionErectile dysfunction (ED) can precede coronary artery disease. In addition, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and death.AimTo evaluate the presence of SMI in patients with diabetes and ED using multidetector computed tomographic coronary angiography (MDCT-CA).MethodsThis study evaluated patients with diabetes and ED without any history of cardiac symptoms or signs. Erectile function was evaluated with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erectometer. MDCT-CA was used for the detection of coronary artery stenosis.Main Outcome MeasuresSexual Health Inventory for Men score, EHS, maximal penile circumferential change, and coronary artery stenosis by MDCT-CA.ResultsOf 20 patients (mean age = 61.45 ± 10.7 years), MDCT-CA showed coronary artery stenosis in 13 (65%) in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Fifty percent of patients showed at least 50% vessel lumen obstruction of the left anterior descending coronary artery, which was the most commonly affected vessel (55%). Fifteen percent (3 of 20) of patients had greater than 90% stenosis, and two of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age (P = 0.016, r = 0.529) and negatively correlated with EHS (P = .046, r = −0.449). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P = .04).ConclusionMDCT-CA can be a useful tool to identify SMI in diabetic patients with ED, especially in those of advanced age and/or with severe ED.

Evidence That Arousal to Pedophilic Stimuli Can Change: Response to Bailey, Cantor, and Lalumière

We thank Drs. Bailey, Cantor, and Lalumiere for their careful reviews of Muller et al. (2014), hereafter referred to as ‘‘our study’’or‘‘our article.’’Our study reported on the results of a retrospective analysis of a group of men assessed at the Sexual Behaviours Clinic at the Royal Ottawa Mental Health Centre between 1983 and 2011, who fulfilled the following inclusion criteria: DSM-III, IV or IV-TR (American Psychiatric Association, 1980, 1994, 2000) diagnosis of pedophilia, an initial penileplethysmographytest (PPT) indicativeofsexual interest in children, and a second PPT test at least 6 months later. Because we were interested in testing the hypothesis that arousal topedophilic stimulicanchange,weselectedmenwhose PPT at Time 1 showed a greater increase in penile circumference in response to children compared to adults. Of this group, about halfshowedagreaterincreaseinpenilecircumferenceinresponse to adults (as compared to children) at Time 2. In the article, we noted that the men who changed PPT response profiles demonstrated both a decrease of penile circumference change in responsetoaudiotapesdescribingsexual interactionwithchildren and an increase in penile circumference change in response to audiotapes describing sexual interactions between adults. In our article, we suggested that the demonstration of a statistically significant decrease in sexual response toward children (p\.001), combined with a statistically significant increase in sexual response to adults (p\.001), presents a challenge to the claim that pedophilic sexual interest is unchangeable. We note that there was an error that has been formally communicated to the Editor of the Journal of Sexual Medicine, due to the misclassification of three of the men in the study. The removal of these cases and complete re-analysis of the data did not change the results or our conclusions. Bailey, Cantor, and Lalumiere each claimed that the notion of the immutability of pedophilic interest is not challenged by the findings of our study and attempted to offer some non-evidencebased support for their opinions. We are grateful for the opportunity to respond and do so below by reviewing each commentary in alphabetized author order. Bailey began his commentary by equating sexual orientation with sexual arousal,‘‘Because a man’s sexual orientation/ erotic interest is identical to his characteristic sexual response pattern...’’We disagree because sexual orientation is different from sexual arousal. Men who have sex with men are not necessarily gay, and a gay man is still gay even if he loses his sex drive or is unable to get an erection. In our article, we speculated that the reluctance of researchers to accept there is evidence that pedophilic sexual interest can change is due to confusion between sexual orientation and sexual interest. It should be noted that our study was never designed to investigate change insexualorientationandweexplicitlystated in thearticle thatour study does not support any recommendations aimed at changing sexual orientation. Equating orientation with interest confuses interpretation of the issue and may be clinically harmful. Bailey wrote that‘‘...sometimes men do not get sufficient erection during a PPT to be accurately classified.’’ We agree. This is why we selected men who initially produced more changein penile circumference in response tochild stimuli than to adults, as well as only those who demonstrated a change in J. P. Fedoroff (&) S. Curry R. Ranger J. Bradford Forensic Research Unit, University of Ottawa Institute of Mental Health Research, Royal Ottawa Health Care Group, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada e-mail: paul.fedoroff@theroyal.ca

Patterns of Sexual Arousal in Young, Heterosexual Men Who Experience Condom-Associated Erection Problems (CAEP)

Condom-associated erection problems (CAEPs) are reported by a substantial number of young men and are associated with inconsistent and/or incomplete condom use. The underlying mechanisms of CAEP are not well understood, and research examining the possibility that men who report CAEP differ from other men in their sexual responsivity is lacking. This study used psychophysiological methods to examine whether men who report CAEP have a higher threshold for sexual arousal, a stronger need for tactile stimulation, and/or more easily lose their sexual arousal due to neutral distractors or performance-related demands. A total of 142 young, heterosexual men (53% reporting CAEP) were presented with four 3-minute erotic film clips. Three film clips were combined with one of the following manipulations: (i) distraction; (ii) performance demand; or (iii) vibrotactile stimulation. One erotic film clip was presented with no further instructions or manipulations. Average penile circumference changes during the first, second, and third minute (time) of the erotic film stimuli (condition) were submitted to a mixed-model analysis of variance with condition and time as within-subjects factors and group (CAEP/no-CAEP) as between-subjects factor. Significant main effects of condition and time and a significant interaction of group × time were found. No significant interactions involving condition were found. Men who reported CAEP had smaller erectile responses during the first minute, regardless of film condition, than men who reported no CAEP (F(1,141) = 8.64, P < 0.005). The findings suggest that men with and without CAEP differ in the ease with which they become sexually aroused. Men reporting CAEP needed more time and/or more intense stimulation to become aroused. To our knowledge, this study is the first to use psychophysiological methods to assess sexual responsivity in men who report CAEP.

Correlation between erection hardness score and nocturnal penile tumescence measurement.

The Erection Hardness Score (EHS) and the Sexual Health Inventory for men (SHIM) are patient-reported outcome scoring systems for erectile function. It is unclear which is more reliable for predicting the objective erectile function. The aim of this study was to evaluate whether the EHS could predict objective erectile function by measuring the maximal penile circumferential change (MPCC) with an erectometer. The study included 98 patients who visited our clinic from 2005 to 2010. The erectile function was evaluated using the SHIM, EHS, and MPCC. The MPCC was measured with the largest circumferential change of three consecutive occurrences of nocturnal penile tumescence (NPT) determined using the erectometer. We defined erectile dysfunction (ED) as MPCC < 20 mm and carried out multivariate analysis using logistic regression analysis to clarify the predictors for ED, with the variables including age, the SHIM score, and the EHS. We compared the tendency for MPCC ≥ 20 mm when EHS was 3 or more with that when EHS was 2 or less. The median age of the patients was 59.5 years (range 18-83). In logistic regression analysis, the EHS was the only predictor for ED with MPCC < 20 mm. The mean EHS in the MPCC < 20 mm group was 1.64 ± 0.20 (mean ± SEM) and that in the MPCC ≥ 20 mm group was 2.46 ± 0.13 (P = 0.0018). There was a correlation between the EHS and the MPCC (correlation coefficient = 0.33). In comparison with the group having an EHS of 2 or less, that with an EHS of 3 or more tended to have MPCC ≥ 20 mm (P = 0.013). The EHS was correlated with the MPCC. The EHS represents the objective erectile function shown by the measurement of NPT.

Impact of visceral fat ratio on sleep-related erection: a retrospective study of elderly patients.

To investigate the impact of visceral fat accumulation on the preoperative erectile function of elderly patients undergoing radical prostatectomy. A total of 83 patients who underwent radical prostatectomy from August 2005 through August 2013 were included in the present study. Findings at preoperative computed tomography scanning and sleep-related erection were used to determine the objective erectile function. Sleep-related erection was measured with an erectometer during at least three nights, and we assessed the maximum penile circumferential change. The visceral fat ratio was calculated as the ratio of the visceral fat area to the total subcutaneous fat area on computed tomography images, and the influence of these parameters on preoperative erectile function was assessed. In simple linear regression analysis there was a strong correlation between the waist circumference and visceral fat ratio (P < 0.01). A visceral fat ratio of 55% was equivalent to a waist circumference of 85 cm, which is the standard value for central obesity in Japan. Furthermore, the factor that most negatively affected maximum penile circumferential change was the visceral fat ratio. In addition, only a visceral fat ratio of 55% or greater was a significant independent risk factor for declining maximum penile circumferential change in both univariate and multivariate analyses (P = 0.04 and 0.02, respectively). The present study is the first to show the utility of the visceral fat ratio as an index of central obesity and the relationship with sleep-related erection in elderly men.

1314 NEGATIVE IMPACT OF AGING ON THE GANGLIONIC NEURON COUNT AROUND THE HUMAN PROSTATE

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation1 Apr 20111314 NEGATIVE IMPACT OF AGING ON THE GANGLIONIC NEURON COUNT AROUND THE HUMAN PROSTATE Shin-ichi Hisasue, Kohei Hashimoto, Yohei Matsuda, Hisanori Taniguchi, Masahide Kanaya, Satomi Fujii, Satoshi Takahashi, and Taiji Tsukamoto Shin-ichi HisasueShin-ichi Hisasue Sapporo, Japan More articles by this author , Kohei HashimotoKohei Hashimoto Sapporo, Japan More articles by this author , Yohei MatsudaYohei Matsuda Sapporo, Japan More articles by this author , Hisanori TaniguchiHisanori Taniguchi Osaka, Japan More articles by this author , Masahide KanayaMasahide Kanaya Sapporo, Japan More articles by this author , Satomi FujiiSatomi Fujii Kutchan, Japan More articles by this author , Satoshi TakahashiSatoshi Takahashi Sapporo, Japan More articles by this author , and Taiji TsukamotoTaiji Tsukamoto Sapporo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1134AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We recently reported that baseline erectile function greatly influences cavernous nerve quantity and distribution around the prostate (Hisasue et al. J. Urol. 2010). Ganglionic neurons also surrounded the prostate and are believed to be responsible for the axonal regeneration or collateral sprouting of cavernous nerve. We assessed which factor predicts the ganglionic neuron count around the human prostate METHODS We investigated 46 hemispheres of 23 non-nerve sparing radical prostatectomy specimens. We performed immunohistochemical staining with nNOS-antibody, and divided the prostatic hemisphere into six zones to assess the distribution of nNOS-positive ganglionic neurons at the apex, midportion and base of the prostate. Multivariate analysis of quantity of the overall neurons used the variables of patient age (<65 years vs. ≥65 years), specimen weight (≥40g vs. <40g), body mass index (<25 kg/m2, ≥25 kg/m2), and maximum penile circumferential change using erectometer (MPCC; ≥20mm, <20mm). RESULTS Median patient age was 68 years (range 57 to 74). Median MPCC was 25.0mm (range 2.70 to 38.3). Logistic regression analysis revealed that the age was the single significant variable (p=0.046). The ganglionic neuron count was lower in the older (≥65 years) group than in the younger (<65 years) group (p=0.048; Mann-Whitney U-test). The neuron count was significantly different between the two groups in the 4 to 5 o′clock area at the mid-prostate. CONCLUSIONS This is the first study indicating that higher age has a negative impact on the nNOS-positive ganglionic neuron count in human. This result will lead to the rationale why older people show the poor outcome in their recovery of erection following radical prostatectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e525-e526 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shin-ichi Hisasue Sapporo, Japan More articles by this author Kohei Hashimoto Sapporo, Japan More articles by this author Yohei Matsuda Sapporo, Japan More articles by this author Hisanori Taniguchi Osaka, Japan More articles by this author Masahide Kanaya Sapporo, Japan More articles by this author Satomi Fujii Kutchan, Japan More articles by this author Satoshi Takahashi Sapporo, Japan More articles by this author Taiji Tsukamoto Sapporo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Baseline Erectile Function Alters the Cavernous Nerve Quantity and Distribution Around the Prostate

We clarified the distribution of neuronal nitric oxide synthase positive nerve fibers around the prostate and factors contributing to fiber quantity. We investigated 46 hemispheres of 23 nonnerve sparing radical prostatectomy specimens from patients with available preoperative International Index of Erectile Function and maximum penile circumferential change data. We performed immunohistochemical staining with neuronal nitric oxide synthase antibody, and divided the prostatic hemisphere into 6 zones to assess the distribution of neuronal nitric oxide synthase positive nerve fibers at the apex, midportion and base of the prostate. Multivariate analysis of the quantity of overall neuronal nitric oxide synthase positive nerve fibers used the variables of specimen weight, patient age, body mass index, International Index of Erectile Function and maximum penile circumferential change. A maximum penile circumferential change of 20 mm or less was considered objective erectile dysfunction. Median patient age was 68 years (range 57 to 74). Median International Index of Erectile Function-erectile function domain score was 12 (range 0 to 24) and median maximum penile circumferential change was 25.0 mm (range 2.70 to 38.3). Of the neuronal nitric oxide synthase positive nerve fibers 65% were distributed in a 3 to 5 o'clock sextant (p <0.001). Logistic regression analysis revealed that maximum penile circumferential change was the single significant variable (p = 0.019). The fiber count was greater in the objective erectile dysfunction group (median 1,500, range 382 to 2,760) than in the nonerectile dysfunction group (median 649, range 156 to 2,916) (p = 0.009). The fiber count was significantly different between the 2 groups in the 3 to 6 o'clock area, especially at the apex. Baseline erectile function greatly impacts cavernous nerve quantity and distribution. Cavernous nerve preservation in the neurovascular bundle, especially at the apex, is still essential for patients with erectile dysfunction.

Genital and heart rate response to erotic stimulation in men with and without premature ejaculation

This study compared genital and penile response patterns in men with and without premature ejaculation (PE) so as to identify the potential anomalous psychosomatic relationships among men with PE. Genital and heart rate response profiles of 25 men with PE were compared with those of 13 age-matched sexually functional counterparts during visual sexual stimulation presented in combination with vibrotactile penile stimulation. Although no differences were found between men with PE and controls on maximum penile circumference change, overall penile response was significantly lower in the PE group and PE men who ejaculated during the session exhibited shorter latencies to maximum circumference change. Furthermore, significant differences were found between groups in patterns of heart rate. These findings indicate differences in physiological responses between men with PE and sexually functional counterparts during erectile tumescence and progression toward ejaculation. Such differences might be explained by 'premature' sympathetic activation during the sexual response cycle in men with PE, thereby diminishing parasympathetically controlled penile response and triggering sympathetically mediated seminal emission prematurely.

701 THE IMPACT OF ERECTILE FUNCTION ON THE CAVERNOUS NERVE QUANTITY IN THE RADICAL PROSTATECTOMY SPECIMEN

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research I1 Apr 2010701 THE IMPACT OF ERECTILE FUNCTION ON THE CAVERNOUS NERVE QUANTITY IN THE RADICAL PROSTATECTOMY SPECIMEN Shin-ichi Hisasue, Kohei Hashimoto, Ryoji Furuya, Motoi Takeuchi, Youki Kyoda, Toshihiro Maeda, Ko Kobayashi, Toshiaki Tanaka, Koji Ichihara, Ryuichi Kato, Hiroshi Kitamura, Satoshi Takahashi, Naoya Masumori, and Taiji Tsukamoto Shin-ichi HisasueShin-ichi Hisasue More articles by this author , Kohei HashimotoKohei Hashimoto More articles by this author , Ryoji FuruyaRyoji Furuya More articles by this author , Motoi TakeuchiMotoi Takeuchi More articles by this author , Youki KyodaYouki Kyoda More articles by this author , Toshihiro MaedaToshihiro Maeda More articles by this author , Ko KobayashiKo Kobayashi More articles by this author , Toshiaki TanakaToshiaki Tanaka More articles by this author , Koji IchiharaKoji Ichihara More articles by this author , Ryuichi KatoRyuichi Kato More articles by this author , Hiroshi KitamuraHiroshi Kitamura More articles by this author , Satoshi TakahashiSatoshi Takahashi More articles by this author , Naoya MasumoriNaoya Masumori More articles by this author , and Taiji TsukamotoTaiji Tsukamoto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1142AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent reports suggested that the nerve fiber outside of the neurovascular bundle (NVB) also plays an important role in erectile function following radical prostatectomy. However, there is no study investigating the factor contributing to the distribution of the cavernous nerve in human. We explored the distribution of nNOS-positive nerve fiber around the prostate and the contributing factors to the fiber quantity. METHODS We investigated 46 hemispheres of 23 non-nerve-sparing radical prostatectomy specimens. We analyzed the preoperative IIEF5 score and maximum penile circumferential change (MPCC) during a night. We divided prostatic hemisphere into 6 parts; 0-1, 1-2, 2-3, 3-4, 4-5, and 5-6 o'clock at apex, middle, and base of prostate respectively. We conducted the multivariate analysis to investigate the factors contributing to the overall nNOS-positive nerve fiber quantity using the variables including specimen weight, age, BMI, IIEF5 score > 17, and MPCC > 20mm. MPCC ≤ 20mm was considered as objective erectile dysfunction (ED). RESULTS Median age was 68 years (57-74). Median IIEF5 score was 12 (0-24) and median MPCC was 25.0 mm (2.70-38.3). The median number of the overall nNOS-positive nerve fibers around the prostatic hemisphere was 866 (156-2916). The distribution of nNOS-positive nerve fiber was 2.7% in 0-1, 6.4% in 1-2, 13.1% in 2-3, 30.4% in 3-4, 35.0% in 4-5, and 12.4% in 5-6 o'clock. Approximately, 65 % of fibers distributed in 3-5 o'clock of NVB area (p<0.001). Logistic regression analysis revealed that the MPCC was the single significant variable (p=0.027, OR 6.22, 95%CI 1.23-31.40). The fiber count was greater in the objective ED group (1500: 382-2760), than in the non-ED group (649: 156-2916) (p=0.009). The significant difference in the fiber count between 2 groups was seen in 3-6 o'clock, especially at apex (Fig). CONCLUSIONS This is the first report suggesting that the baseline erectile function impacts on the cavernous nerve fiber quantity. The current result suggested that cavernous nerve preservation around NVB at apex is still important, especially for the ED patients. Sapporo, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e273-e274 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shin-ichi Hisasue More articles by this author Kohei Hashimoto More articles by this author Ryoji Furuya More articles by this author Motoi Takeuchi More articles by this author Youki Kyoda More articles by this author Toshihiro Maeda More articles by this author Ko Kobayashi More articles by this author Toshiaki Tanaka More articles by this author Koji Ichihara More articles by this author Ryuichi Kato More articles by this author Hiroshi Kitamura More articles by this author Satoshi Takahashi More articles by this author Naoya Masumori More articles by this author Taiji Tsukamoto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

700 DIRECT EVIDENCE THAT VISCERAL FAT RATIO AFFECTS THE BASELINE ERECTILE FUNCTION AMONG THE RADICAL PROSTATECTOMY PATIENTS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research I1 Apr 2010700 DIRECT EVIDENCE THAT VISCERAL FAT RATIO AFFECTS THE BASELINE ERECTILE FUNCTION AMONG THE RADICAL PROSTATECTOMY PATIENTS Motoi Takeuchi, Shin-ichi Hisasue, Kohei Hashimoto, Ryoji Furuya, Akihiko Iwasawa, Keishi Ogura, Yu-ki Kyoda, Khoji Ichihara, Naoya Masumori, and Taiji Tsukamoto Motoi TakeuchiMotoi Takeuchi More articles by this author , Shin-ichi HisasueShin-ichi Hisasue More articles by this author , Kohei HashimotoKohei Hashimoto More articles by this author , Ryoji FuruyaRyoji Furuya More articles by this author , Akihiko IwasawaAkihiko Iwasawa More articles by this author , Keishi OguraKeishi Ogura More articles by this author , Yu-ki KyodaYu-ki Kyoda More articles by this author , Khoji IchiharaKhoji Ichihara More articles by this author , Naoya MasumoriNaoya Masumori More articles by this author , and Taiji TsukamotoTaiji Tsukamoto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1141AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Metabolic syndrome is a cluster of cardio-metabolic risk factors including visceral fat accumulation, dyslipidemia, hyperglycemia and hypertension. It is also associated with erectile dysfunction in aged male. We investigated the impact of visceral fat measured with the computed tomography (CT) on the baseline erectile function in the radical prostatectomy patients. METHODS We reviewed 74 of 178 organ confined prostate cancer patients who underwent radical prostatectomy between 2005 and 2009 in our institution. The patients whose preoperative CT was available were included, and those who had any kind of testosterone ablation were excluded. We measured both area of the visceral fat and the subcutaneous fat at the level of the umbilicus from abdominal CT and calculated the visceral fat ratio. Erectile function was assessed by IIEF5 and maximum penile circumferential change (MPCC) during a night. RESULTS Median age was 66 years and median visceral fat ratio was 51.8% (range 20.3-72.4). Median IIEF5 score was 15 and median MPCC was 2.6cm (range 0.4-5.0). We investigated the relationship between the visceral fat ratio and erectile function, and there was no significant difference in the IIEF5 score, but 75‰ of MPCC (3.25cm) showed the significant difference in the univariate analysis. We carried out the multivariate analysis using parameters which were selected as risk factors for erectile dysfunction including age, smoking, hypertension, diabetes, BMI and visceral fat ratio. It revealed that a single predictor for the baseline erectile function was visceral fat ratio (p=0.04). The median visceral fat ratio was significantly higher in the MPCC < 3.25cm group (52.4%) than ≥ 3.25cm group (49.9%). (p=0.04, Fig. 1) CONCLUSIONS This is the first study which suggested the impact of the visceral fat accumulation on the erectile function. The further study will be necessary to clarify the influence of the visceral fat ratio on the recovery of erectile function following the radical prostatectomy. Sapporo, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e273 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Motoi Takeuchi More articles by this author Shin-ichi Hisasue More articles by this author Kohei Hashimoto More articles by this author Ryoji Furuya More articles by this author Akihiko Iwasawa More articles by this author Keishi Ogura More articles by this author Yu-ki Kyoda More articles by this author Khoji Ichihara More articles by this author Naoya Masumori More articles by this author Taiji Tsukamoto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Classic Citations: Nocturnal Erections, Differential Diagnosis of Impotence, and Diabetes I Karacan, FB Scott, PJ Salis, SL Attia, JC Ware, A Altinel, and RL Williams

K et al. published this landmark paper [1] in 1976 with the aim of proposing the monitoring of nocturnal penile erections as “the” tool that might remove the bias in the diagnosis of erectile dysfunction. In the Introduction authors stated that the diagnosis and treatment of impotence remained, at that time, “essentially an art, if not a myth,” because of a belief that impotence was only result of psychological disturbances. They wrote that nocturnal erections had been known for almost 30 years and in the last 10 years their group had concluded that the normality of nocturnal penile tumescence (NPT) was a reliable and objective indicator of the psychological or organic basis of erectile dysfunction (ED); an abnormal NPT indicated an organogenic ED, whereas a normal NPT lead to the diagnosis of psychogenic ED. The objective of the paper was to describe their first 100 patients and to present NPT data on patients with psychogenic and organogenic ED. Most of the patients had been referred for prosthesis implantation with Dr. Brantley Scott. NPT recording was part of an extensive “medical, neurological, endocrinological, psychiatric, and psychological evaluation” that the patient underwent before the surgery itself. For NPT recording patients usually spent three nights in the Sleep Disorder Center, where three electroencephalography channels, two eye movement channels, two penile circumference channels, and two perineal muscle activity channels were monitored continuously throughout each night. Penile circumference was monitored with mercury-filled strain gauges placed at the tip and at the base of the penis. On one evaluation night a patient was awakened during a typical erection the degree of the erectile response. The examiner tested at that moment the buckling tendency of the penis and photographed the erect penis. Based on the data on penile circumference change and rigidity, the patient’s NPT was classified as normal, borderline normal, abnormally diminished, or absent. From the sample of 100 patients, authors selected 11 patients with ED and diabetes who had exhibited absent or abnormal NPT and 11 patients with ED, age-matched with the first group, without known medical diseases and whose nocturnal erections were normal. They also selected for comparison 11 age-matched normal individuals who had undergone three consecutive nights of NPT monitoring. The diabetic patients had significantly less nocturnal erections and spent less time with full erections than other patients and normal control subjects. The maximum penile circumference change exhibited by diabetic patients was approximately one-fifth that of individuals of the other two groups. In the discussion, authors claimed that their study provided the first objective data on the organic impairment of erection of diabetic patients. They concluded that “NPT recording © 2009 International Society for Sexual Medicine

Alcohol and erectile response: The effects of high dosage in the context of demands to maximize sexual arousal.

Although drinking often precedes men's sexual activity, basic questions about alcohol's effects on men's sexual arousal remain unanswered. Inconsistencies in findings from studies examining subjective and physiological effects on erectile functioning suggest these effects are context specific, for example, dependent on whether a man wants to maximize or suppress his arousal. To address unresolved questions about alcohol and erectile functioning, the authors evaluated the effects of high blood alcohol concentrations (BACs) and arousal instructional demands on indices of penile circumference change and self-reported sexual arousal. In Study 1, a target BAC of .10% (vs. .00%) attenuated peak circumference change from a neutral baseline but did not affect mean change, latency to arousal onset (a 5% increase in circumference from baseline), latency to peak achieved arousal, or subjective arousal, which correlated moderately with physiological indices. In Study 2, instructions to maximize (vs. suppress) arousal increased peak and mean circumference change and interacted with a target BAC of .08% (vs. .00%) to influence latency to arousal onset. Sober men instructed to maximize showed a shorter latency to arousal onset than did those instructed to suppress arousal; however, intoxicated men did not show a differential pattern. Moreover, compared with intoxicated counterparts, sober men instructed to maximize arousal showed a marginally shorter latency to arousal onset. Overall, alcohol and arousal instructions had small but discernible effects. Findings highlight the importance of contextual factors in alcohol's impact on erectile functioning.

CORPUS CAVERNOSUM ELECTROMYOGRAPHY DURING MORNING NAPS IN HEALTHY VOLUNTEERS: FURTHER EVIDENCE THAT CORPUS CAVERNOSUM POTENTIALS REFLECT SYMPATHETICALLY MEDIATED ACTIVITY

We assessed the practicability of corpus cavernosum (CC) electromyography (EMG) in volunteers during morning naps in the laboratory and further validated this method. A total of 11 healthy volunteers with a mean age of 23.8 years (range 19 to 31) were included. CC-EMG was started between 6:30 a.m. and 7 a.m. Two surface electrodes were placed at the base of the penis bilaterally and a reference electrode was placed on 1 kneecap. A strain gauge or Barlow gauge (Behavioral Technology, Salt Lake City, Utah) was used to monitor changes in penile circumference. Subjects were asked to sleep. Recording duration was 2 to 3 hours. Two recordings were performed per subject. Full erection was observed on 17 of the 22 recordings (77%), partial erection was noted on 3 (14%) and no tumescence was observed on the other 2 (9%). CC potentials consistently disappeared during tumescence and erection, while continuous CC potential oscillations reappeared during detumescence. During flaccidity bursts of CC potentials and electrical silence were recorded. Penile shrinkage was observed to accompany CC potentials but not to accompany electrical silence. CC-EMG during morning naps is a practical and valid method for investigating CC electrophysiology. CC-EMG signal patterns during tumescence, detumescence and flaccidity fit the existing theory that CC potentials reflect cavernous smooth muscle sympathetically mediated activity.

VARIABILITY OF RESULTS OF CAVERNOUS NERVE STIMULATION DURING RADICAL PROSTATECTOMY

We assess the reliability of intraoperative cavernous nerve stimulation for producing an erectile response during radical prostatectomy. In 61 patients cavernous nerve function was assessed during radical retropubic prostatectomy using a CaverMap nerve stimulator. Control stimulation was also performed before and after prostatic dissection by placing the nerve stimulator tip on the anterior bladder wall. An increase in penile circumference measured by the device was considered a tumescence response while any measurable detumescence was also categorized. Patient age ranged 43 to 72 years (mean 59.8). Before apical dissection 41% and 46% had tumescence, 31% and 21% had detumescence, and 28% and 33% had no response with stimulation of the neurovascular bundle and anterior bladder wall, respectively. After dissection 42% and 25% had tumescence, 16% and 18% had detumescence, and 42% and 57% had no response with stimulation of the neurovascular bundle and anterior bladder wall, respectively. A response to neurovascular bundle stimulation using this device does not necessarily correlate with the precise anatomical location of the cavernous nerves. There is considerable background variability related to anesthesia, surgical manipulation and other undefined factors that may cause minor but measurable changes in penile circumference.

Sexual arousal to erotic and aggressive stimuli in sexually coercive and noncoercive men.

Sexual arousal to erotic stimuli depicting various levels of force were examined among college men. Study 1 used phallometric indices to measure penile circumferential change during combined audio-tape and slide presentations varying in degree of force. The results indicated that the sexually coercive group exhibited more penile tumescence than controls to scenes involving verbal pressure and verbal threats. Analyses across time blocks suggested that control participants inhibited sexual arousal with the introduction of force cues but that the sexually coercive group did not. Study 2 was a replication of Study 1 without slides. Both groups showed increases in penile tumescence in response to the consent scenario. Only the sexually coercive men demonstrated significant tumescence in response to force scenarios. The results indicated that the sexually coercive males had a lower threshold for arousal to sexual cues and did not inhibit sexual arousal when force cues were introduced.

Is homophobia associated with homosexual arousal?

The authors investigated the role of homosexual arousal in exclusively heterosexual men who admitted negative affect toward homosexual individuals. Participants consisted of a group of homophobic men (n = 35) and a group of nonhomophobic men (n = 29); they were assigned to groups on the basis of their scores on the Index of Homophobia (W. W. Hudson & W. A. Ricketts, 1980). The men were exposed to sexually explicit erotic stimuli consisting of heterosexual, male homosexual, and lesbian videotapes, and changes in penile circumference were monitored. They also completed an Aggression Questionnaire (A. H. Buss & M. Perry, 1992). Both groups exhibited increases in penile circumference to the heterosexual and female homosexual videos. Only the homophobic men showed an increase in penile erection to male homosexual stimuli. The groups did not differ in aggression. Homophobia is apparently associated with homosexual arousal that the homophobic individual is either unaware of or denies.

Study of sexual function in male hemodialysis patients--analysis of the cause of erectile dysfunction

Erectile dysfunction is a well documented complication among male hemodialysis patients. The cause has been reported to be related to multiple factors, including neurological, endocrinological and vasculogenic elements. The purpose of this study was to identify the factors which most greatly determine erectile dysfunction in hemodialysis patients. Male hemodialysis patients without diabetes mellitus and severe anemia (Hb value < 8.0 g/dl) were entered into the study. We measured nocturnal penile tumescence (NPT) values in these patients and carried out neurological studies (measurement of the penile dorsal nerve conduction velocity and the bulbocavernosus reflex (BCR) latency). a vasculogenic study (measurement of the penile blood pressure index (PBPI) and endocrinological studies (measurement of serum free testosterone levels and serum prolactin levels before hemodialysis). NPT values (maximum penile circumference changes) in hemodialysis patients decreased compared with those in healthy males. In both hemodialysis patients and healthy males, NPT values decreased with age. NPT values in hemodialysis patients were significantly lower than those in healthy males in the fifties and sixties. 32.2% of hemodialysis patients had severe penile neurological disorder. 55.6% of them showed abnormal NPT. PBPI was low in only 10.0% of hemodialysis patients. However, there was a significant correlation between PBPI and the NPT value (r = 0.387). Serum free testosterone levels in hemodialysis patients were significantly lower than those in healthy males. There was a significant correlation between the serum free testosterone level and the NPT value (r = 0.328). However, there was no correlation between the serum prolactin level and the NPT value. To identify the factors which most greatly determine erectile dysfunction in hemodialysis patients, we carried out multivariate analysis. The criterion variables in this analysis were NPT values. The coefficient of determination was highest for a neurological disorder (30.7%), followed by an endocrinological disorder (a reduction in the serum free testosterone level) (11.6%) and a vasculogenic disorder (a reduction in PBPI) (4.2%).

Study on nocturnal penile tumescence (NPT) in healthy males study on age-related changes of NPT

Nocturnal penile tumescence (NPT) occurs in all healthy males as a physiological phenomenon. Male sexual function can be evaluated by NPT. However, the age dependent changes and the significance of NPT have still remained unknown. Thus, we measured NPT throughout the night in healthy 189 subjects, ranging from 3 to 84 years old, and studied the relationship between this phenomenon and age. The parameters obtained by NPT appeared to be greater in men over about 10 years old. This increase of the parameters was related to the maturation of the hypothalamo-pituitary-testicular axis, which starts rapidly at puberty. A significant decrease in the total tumescence time in men over 30 years of age was related to a decrease of androgen. In men over 55 years of age, the maximum penile circumference change and the maximum increase rate in penile circumference were significantly lower than those of men in their twenties. These results suggest that the decrease in the parameters of NPT in men over 55 years of age had a relationship with the decrease of androgen, and organic changes in the corpus cavernosum and penile vascular system that occurred with aging. In conclusion, NPT may be related to the sexual maturation and decline in men. We also provide standard reference parameters for NPT in Japanese, which could be useful in the diagnosis and treatment of male sexual dysfunction.