Deterioration Of Sexual Function Research Articles

Sexual function in patients with testicular neoplasm before specialized treatment methods. Clinical trial

Introduction. Testicular neoplasms (TN) are one of the most common oncological diseases among young men. Currently the sexual function of such patients remains understudied. The aim of the study was to assess the state of sexual function in men with testicular neoplasms before treatment.Material and methods. The cross-sectional continuous single-center study included 35 men with TN. The average age of patients was 34.2–8.2 years (95% CI: 31.4-37.1). The comparison group included 28 healthy volunteers, average age 30.5–4.9 years (95% CI: 28.6-32.4). Some social characteristics of the patient (marriage and children), the state of sexual function (using the IIEF-15 and ICF questionnaires), the level of anxiety and depression (according to the HADS scale), the levels of total and free testosterone, globulin-binding sex hormone (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin were evaluated.Results. Patients in the main group showed a decrease in erection in 10 (28.6%), satisfaction with sexual intercourse in 12 (34.3%), impaired orgasmic function in 2 (5.7%), decreased libido and overall satisfaction in 9 (25.7%). Nonparametric analysis revealed a statistically significant decrease in libido (p < 0.05), satisfaction with sexual intercourse (p < 0.05) and overall satisfaction (p = 0.007) in patients of the main group compared with the control group. Patients with testicular neoplasms had disorders of the mental component – in 12 (34.3%), erection – in 20 (57.1%), neurohumoral – in 25 (71.4%), ejaculatory – in 10 (28.6%) patients. Subclinical depression was observed in 13 (37.1%) and clinically pronounced depression in 11 (31.4%) patients of the main group. Anxiety and depression were statistically significantly more common in the main group (p = 0.0013). The level of anxiety and depression was more pronounced in unmarried (p = 0.013) children-free patients (p = 0.025). Low levels of total testosterone were detected in 13 (39.4%), free testosterone in 12 (38.7%), LH in 11 (33.3%), FSH in 6 (18.7%) patients from the main group. Elevated levels of LH were recorded in 4 (12.1%), FSH in 4 (12.5%), prolactin in 2 (6.9%) and SHBG in 1 (5%).Conclusion. Patients with TN have a deterioration in sexual function compared to a healthy population of the same age group. The further studies are needed to access the influence of tumor histology and treatment of sexual function.

Transperineal Laser Ablation (TPLA) Treatment of Focal Low-Intermediate Risk Prostate Cancer.

Background: This interventional pilot study aimed to evaluate the short-term (3 years) efficacy of focal laser ablation (FLA) in treating the index lesion of low-intermediate-risk prostate cancer, along with assessing the safety of the procedure (ClinicalTrials.gov ID NCT04045756). Methods: Forty patients aged between 46 and 86 with histologically proven organ-confined prostate cancer and low-to-intermediate progression risk were included. FLA was performed under percutaneous fusion magnetic resonance/ultrasound guidance in a Day Hospital setting under local anesthesia. Patients underwent regular clinical and functional assessments through the international index of erectile function (IIEF-5) and the International Prostatism Symptom Score (IPSS), PSA measurements, post-procedure MRI scans, and biopsies at 36 months or if positive findings were detected earlier. Statistical analyses were conducted to assess trends in PSA levels and cavity dimensions over time. Results: Forty patients were initially included, with fifteen lost to follow-up. At 36 months, a mean PSA reduction of 60% was observed, and 80% of MRI scans showed no signs of in-field clinically significant residual/recurrent cancer. Biopsies at 36 months revealed no malignant findings in 20 patients. No deterioration in sexual function or urinary symptoms was recorded. Conclusions: FLA appears to be safe, feasible, and effective in the index lesion treatment of low-intermediate-risk prostate cancer, with a high rate of tumor eradication and preservation of quality of life.

Pelvic floor and sexual function 3 years after hysterectomy - A prospective cohort study.

Long term effects after hysterectomy, such as a worsening of pelvic floor and sexual function, have been studied with diverse results. Therefore, we investigated the long-term effects of hysterectomy for benign indication on pelvic floor and sexual function as well as differences in outcome depending on mode of hysterectomy. In a prospective clinical cohort study, we included 260 women scheduled for hysterectomy who answered validated questionnaires; pelvic floor impact questionnaire (PFIQ-7), pelvic floor distress inventory (PFDI-20) and female sexual function index (FSFI). Participants were followed up to 3 years after surgery. Nonparametric statistics and mixed effect models were used in analyses of the data. After exclusions, 242 women remained in the study, with a response rate at the 3-year follow-up of 154/242 (63.6%) for all questionnaires. There was an improvement of pelvic floor function with a mean score of PFIQ-7 at baseline of 42.5 (SD 51.7) and at 3 years 22.7 (SD 49.4), (p < 0.001) and mean score of PFDI-20 at baseline was 69.6 (SD 51.1) and at 3 years 56.2 (SD 54.6), (p = 0.001). A deterioration of sexual function was seen among the sexually active women after 3 years with a mean score of FSFI at baseline 25.2 (SD 6.6) and after 3 years 21.6 (SD 10.1), (p < 0.001). However, this was not consistent with the unaltered sexual function for the whole cohort. No difference in pelvic floor or sexual function was detected when comparing robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy. Three years after surgery robotic assisted laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent. Among the sexually active women, a decline of sexual function was seen after 3 years, not consistent with the entire cohort and independent of surgical methods. Whether this is a trend associated with aging or menopausal transition remains to be studied.

MP51-11 THE BUTTERFLY TRANSURETHRAL DEVICE FOR THE MANAGEMENT OF BPH – OVER 3-YEAR EXPERIENCE AND THE IMPACT OF THE LEARNING CURVE

You have accessJournal of UrologyCME1 Apr 2023MP51-11 THE BUTTERFLY TRANSURETHRAL DEVICE FOR THE MANAGEMENT OF BPH – OVER 3-YEAR EXPERIENCE AND THE IMPACT OF THE LEARNING CURVE Ran Katz, Muhamad Abu Ahmed, Mahran Kabha, Yoram Dekel, Shmuel Roizman, Amnon Zisman, Jack Baniel, Shachar Aharoni, and Shachar Aharoni Ran KatzRan Katz More articles by this author , Muhamad Abu AhmedMuhamad Abu Ahmed More articles by this author , Mahran KabhaMahran Kabha More articles by this author , Yoram DekelYoram Dekel More articles by this author , Shmuel RoizmanShmuel Roizman More articles by this author , Amnon ZismanAmnon Zisman More articles by this author , Jack BanielJack Baniel More articles by this author , Shachar AharoniShachar Aharoni More articles by this author , and Shachar AharoniShachar Aharoni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.11AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the safety and effectiveness of the Butterfly device and its effect on LUTS and ejaculation and the impact of the learning curve. METHODS: The study was approved by the Hospital's IRBs. A prospective clinical trial was conducted among 77 men who were treated for at least one year for BPH and were candidates for TURP prior to the intervention. All patients had a Qmax below 13 ml/sec and an IPSS score above 12. The device was inserted through cystoscopy under local anesthesia and sedation. No catheter was left. Follow up assessment was conducted after 2 weeks, 1, 3, 6, 9, and 12 months and then semiannually and included uroflowmetry, IPSS, QoL and sexual questionnaires. Cystoscopy was performed on 3 and 12 months. An analysis of the last 21 consecutive cases was performed and compared to the overall results of the series. RESULTS: Patients' mean age was 68 (50-82). 48 patients completed 1 year follow up with an intact device. The maximal follow-up period was 3.5 years. The average Qmax improvement was 1.4 ml/sec (25%), Average IPSS score decrease was 9.6 points (38.2%), and QoL score improved by 5.1 points (38%). Average PVR decreased by 25.2%. No patient reported deterioration of sexual function and sexually active patients reported antegrade ejaculation. Cystoscopy demonstrated gradual coverage of the device by the prostatic mucosa. Three patients underwent re-positioning of the device. Adverse events were mild, mainly Clavien-Dindo 1-2. One patient developed a bulbar urethral stricture. 24 patients (31%) had their device removed, and 7 of them subsequently underwent TURP. Comparing the last 21 patients in the series, their average age was 68 years, their improvement was identical to the general series yet only 3 devices (14%) were removed and no patient required prostate surgery. CONCLUSIONS: The butterfly device is safe and effective in the management of BPH with good tolerability and a low rate of complications. The gathered experience in this procedure resulted in significant improvement of the clinical outcome of the patients. Source of Funding: Butterfly Medical Ltd. Yoqneam, IL © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e697 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ran Katz More articles by this author Muhamad Abu Ahmed More articles by this author Mahran Kabha More articles by this author Yoram Dekel More articles by this author Shmuel Roizman More articles by this author Amnon Zisman More articles by this author Jack Baniel More articles by this author Shachar Aharoni More articles by this author Shachar Aharoni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Chronic kidney disease report differently on change in sexual function dependent on treatment: a cohort study

&lt;abstract&gt; &lt;p&gt;Patients with Chronic Kidney Disease (CKD) report sexual dysfunction to a large extent. The objective of this study was to investigate if CKD-stage and mode of treatment correlate to self-reported experience in sexual function before and after onset of symptomatic CKD in patients without active treatment, after transplantation or on dialysis. Participants (N = 234) answered a questionnaire on frequency of sexual desire, initiative, intercourse, erection (men) /vaginal lubrication (women), and orgasm, currently and compared with before onset of symptomatic CKD. Clinical data were taken from medical charts. Within-group differences in sexual function were compared for patients without active treatment (PreT), patients with a renal transplant (Tx) and patients on dialysis treatment (D). In a subgroup analysis, five patient groups were created based on mode of treatment and CKD stage. Between-group differences in sexual function were analyzed as differences in mean composite scores and 95% CI and were estimated using ordinary least square regression with robust standard errors. In the first analysis of the study, all CKD patients reported a decrease in the frequency of sexual desire, initiative, intercourse, erection (men)/vaginal lubrication (women), and orgasm (Bonferroni p &amp;lt; 0.001) compared to before disease onset, irrespective of treatment mode. In the subgroup analysis, when adjusting for sex and age, dialysis patients reported a statistically significant decrease in their average score of sexual function (−2.65; 95% CI: −4.19 to −1.11; p = 0.001) compared to patients without active treatment CKD 2–3 (the reference group). The self-reported experience of CKD-patients of a deteriorating sexual function over time correlates to treatment modality and CKD stage. It is important for health-care personnel to be aware of the patients' experience of a deterioration in sexual function over time regardless of treatment modalities.&lt;/p&gt; &lt;/abstract&gt;

Evaluating sexual function among women after recurrent pelvic organ prolapse transvaginal mesh repair

We aimed to evaluate women’s sexual function before and after pelvic organ prolapse (POP) surgery utilising light transvaginal mesh after a prior hysterectomy. Only sexually active women with recurrent cystocele stage 3–4 according to POP-Q, who had previously undergone vaginal hysterectomy with anterior native tissue repair without apical fixation, were enrolled in the study. Women with previous mesh implant POP surgery, persistent vaginal infection or pelvic inflammatory disease were excluded. All patients were surgically treated between 2012 and 2015 using single-incision transvaginal mesh Calistar A. Sexual function was evaluated before a surgery and two years postoperatively. The assessment was accomplished via the standardised validated Czech translation of PISQ-12SF questionnaire. For each patient, age, BMI and parity were monitored. Out of all (89) eligible patients, 48 patients met inclusion criteria and were subsequently enrolled in our study. Two years postoperatively, 31 women (79.5%) improved their PISQ-12 score; five (12.8%) had equivalent scores, and three patients (7.7%) reported lower scores. Overall PISQ-12 score was 37.1 ± 2.6 postoperatively with a 2.9 ± 2.3 statistically significant positive difference compared to the score preceding surgery. The majority of patients undergoing surgery using Calistar A experienced a significant improvement in sexual function. IMPACT STATEMENT What is already known on this subject? Pelvic organ prolapse has a significant impact on women’s sexual functioning in an adverse manner. Mesh implant repair is associated with lower rates of prolapse awareness and prolapse re-operation; however, it is linked with safety concerns. One of these concerns is the negative impact on women’s sexual function. Evaluative study results following sexual function among women with mesh implant transvaginal repair are contradictory. What do the results of this study add? The results showed, that contrary to finding some of the previous studies, transvaginal mesh implant use could benefit patients with previous native tissue POP surgery failure with a low risk of sexual function deterioration. What are the implications of these findings for clinical practice and/or further research? The study provides clinical data for vaginal mesh implants on women’s sexual function in the mid-term outcome. These data can be crucial for selecting the right POP surgical technique and evaluating its benefits and risks.

0711 Do postmenopausal women with insomnia and obstructive sleep apnea have deterioration in sexual function?

Abstract Introduction Sleep problems and sexual dissatisfaction are among the most common complaints during and after the menopause transition. The prevalence of insomnia and obstructive sleep apnea (OSA) reach 31% and 44% of postmenopausal women, respectively. The sexual dissatisfaction is frequently caused by a decline in hormonal levels and urogenital atrophy, resulting in inadequate lubrication and pain during intercourse, with orgasm difficulties and low sexual. Both behaviors – sleep and sexual function - play an important part in women’s wellness. The objective of this study was to investigate whether insomnia in association with OSA would increase climacteric and sexual symptoms compared with women with only insomnia or OSA. Methods Our sample comprised 47 postmenopausal women distributed into 3 groups: 1) insomnia, 2) OSA, and 3) OSA+insomnia. All participants completed the questionnaires: Insomnia Severity Index, Female Sexual Function Index, and Blatt-Kupperman menopausal index. Of the 47 participants, 34 women undergone polysomnography. The 3 groups were compared in respect of climacteric symptoms, sexual function score, and sleep. Results Our results showed that 85.1% of the postmenopausal women were classified with insomnia, 46.8% were diagnosed with OSA, and 82.9% had low sexual function. All groups had sleep efficiency of &amp;lt;80%, wake after sleep onset of &amp;gt;65 min, and a total sleep time of &amp;lt;6h, indicating poor sleep quality. There were no statistically significant differences among the groups in all sexual domains. The group of OSA+insomnia reported more climacteric symptoms (27.1±9.7) when compared to OSA group (15.7±9.6, P=0.03). Conclusion In our sample, the presence of insomnia and OSA associated with postmenopause revealed a low score for sexual function. Climacteric symptoms were higher in the groups with insomnia, and the association with low sexual function can lead to worsening of clinical condition. Support (If Any) Support: AFIP and CNPq. ACKNOWLEDGEMENTSOur studies are supported by the following funding agencies: AFIP (Associação Fundo de Incentivo à Pesquisa), CNPq (fellowships to LL, MLA, HH and ST). This study received indirect funding from AFIP and CNPq.

A longitudinal long-term observation study on sexual function and satisfaction rates in men with partial penectomy for penile cancer in a prospectively clinical database

ABSTRACT Introduction Organ-preserving partial penectomy provides a reasonable oncological approach in managing early-stage penile cancer with preservation of normal urinary function and many men can retain some aspects of sexual domains. However, there is limited published data regarding the longer-term sexual outcomes and satisfaction rates in men who remain sexually active in the context of penile cancer survivorship. Objective To evaluate sexual outcomes and satisfaction rates in sexually active men who underwent partial penectomy at a minimum 36-month follow-up study. Methods A prospective database on men treated with penile cancer was set up in 2011 following ethics approval. All men with pre-existing normal erectile function (EF) as defined by the International Index of Erectile Function (IIEF-5) score of 21 and above, and have a stable active sexual lifestyle were included in this study. Patient demographics including EF and sexual satisfaction scores based on IIEF questionnaire, erection hardness scores (EHS) and Brief Sexual Function Inventory (BSFI), use of erectile agents, and sexual satisfaction outcomes were recorded and compared between preoperative vs. 36 months postoperative. Results Of a total of 85 men with partial penectomy identified over the 10-year period, 44 men reported normal EF preoperatively and were in a stable sexual relationship. Six men underwent subsequent completion penectomy during that time while 3 men were lost to follow-up, and only 25 men were identified to be sexually active. Of these, 4 men can achieve satisfactory spontaneous erection for sexual intercourse, while 18 men take regular phosphodiesterase type-5 inhibitor drugs, and 3 men use intracavernosal injections. The median patient age was 54 (38-70) years, and the median follow-up was 44 (38-118) months. The mean penile length measurements were 4.2cm and 6.8cm in flaccid and erect states. Two-thirds of patients maintained the same frequency and level of sexual desire as before surgery and 36-month postoperative, and 80% continued to have ejaculation and orgasm every time they had sexual intercourse. Deterioration in both IIEF-5 and EHS scores were reported in 80% of patients at the 36 months review with lower sexual domains scores in BMSFI recorded in 72% of patients especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). Multivariate analysis using logistic regression confirmed that older age (OR 1.18, 95% CI 1.02-1.21, p&amp;lt;0.01), shorter penile length (OR 0.45, 95% CI 0.38-0.69, p&amp;lt;0.01) and quality of erection (OR 1.23, 95% CI 1.10-1.41, p&amp;lt;0.01) were significantly associated with lower sexual satisfaction rates. Conclusions While most sexually active men retained the ability to have sexual intercourse following partial penectomy, many required erectile aids and reported clinical deterioration in sexual function and overall satisfaction rates at 36 months. Disclosure Work supported by industry: no.

Опыт лечения соматизированной депрессии в общей медицинской практике

Somatic and vegetative-somatic depressive symptom clusters (decreased libido, abnormal body sensations, etc.) are one of the reasons for the prolonged patient's follow-up and delayed start of antidepressant therapy. However, many vegetative-somatic side effects of antidepressants (somnolence, hyperphagia, deterioration of sexual function, etc.) can cause poor patient compliance and premature discontinuation of thymoleptic therapy. Modern antidepressants, such as trazodone (Trittico) successfully stop various somatic manifestations of depression and eliminate the adverse somatic effects of the previous psychotropic medication. The paper presents clinical cases of effective trazodone therapy in a woman with somatic depression and a man with depression and SSRI-induced decrease in libido.

Do vaginal pessaries used to treat pelvic organ prolapse impact on sexual function? A systematic review and meta-analysis.

Pelvic organ prolapse (POP) is common and associated with sexual dysfunction. Vaginal pessaries are an effective treatment for POP, but their impact on sexual function is not well established. The aim of this systematic review and meta-analysis was to establish the impact of vaginal pessaries used for POP on female sexual function. Systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. A comprehensive search was conducted across Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, CINAHL, ClinicalTrials.gov , The WHO International Clinical Trials Registry Platform, ProQuest Dissertations & Theses, Open Grey and Scopus Citation Database. Randomised controlled trials and cohort studies that assessed sexual function in women pre- and post-pessary treatment for POP were included, assessed for risk of bias and their results synthesised. A total of 1,945 titles and abstracts were screened, 104 full-text articles were assessed for eligibility, 14 studies were included in the narrative analysis and 7 studies were included in the meta-analysis. The results suggest that, in sexually active women, there is no evidence of a deterioration in sexual function and some evidence of an improvement. This review offers reassurance that in sexually active women who successfully use a pessary for treatment of their prolapse, there is no deterioration in sexual function. There is some evidence of an improvement in sexual function, but given the clinical heterogeneity in the studies included, caution should be taken in generalising these findings.

Female sexual dysfunction

Key content Female sexual dysfunction (FSD) is defined as any sexual complaint or problem resulting from disorders of desire, arousal, orgasm or sexual pain that causes marked distress or interpersonal difficulty. Various gynaecological problems such as pelvic organ prolapse and endometriosis affect sexual function and this impacts on their treatment. Management often requires the need to address different components of the sexual dysfunction. Women wish to keep their options relating to sexual function open well past the menopause, and more women are presenting in later life with FSD. Learning objectives To know how to assess FSD in clinical practice. To appreciate the reasons why all women attending a gynaecology clinic should have their sexual function assessed to establish a baseline. To establish realistic expectations of outcomes on sexual function following treatment of gynaecological problems. Ethical issues Failure to inform women of the risk of deterioration in sexual function following gynaecological surgery can lead to litigation. Some essential treatments, such as vulvectomy or prophylactic oophorectomy, will result in adverse effects on sexual function, and women should make informed choices regarding their treatment.

Оценка сексуальной функции женщин с первичным синдромом болезненного мочевого пузыря

Introduction. Primary bladder pain syndrome (PBPS) also known as interstitial cystitis/bladder pain syndrome is a disease with a significant deterioration in quality of life. The reason of that is not only the presence of constant pain in the bladder and urinary disorders, but also due to psychoemotional disorders and sexual dysfunctions. The aim of the study was to assess the prevalence, nature and severity of sexual dysfunctions in women with PBPS. Materials and methods. The study involved 75 women (mean age 42.4±3.1 years) with a confirmed diagnosis of PBPS, the control group consisted of 75 women (mean age 41.8 ± 2.9 years) without dysuria and pelvic pain. The severity of clinical manifestations of PBPS was assessed on the basis of a 10-point visual analogue scale of pain in the bladder (VAS-10), questionnaires «Pelvic Pain and Urgency/Frequency Patient Symptom Scale, PUF Scale» and O'Leary-Sant Interstitial Cystitis Symptoms Index (ICSI). Sexual function was assessed using a specialized questionnaire «Female Sexual Function Index» (FSFI). Results. The overall assessment of sexual function according to the FSFI questionnaire in patients with PBPS was significantly lower than in the control group. In the patients of the main group the mean score according to the FSFI questionnaire was 16.5 ± 4.4, while in the control group it was 30.5 ± 4.2 points (p &lt;0.01). Sexual dysfunctions were detected in 69 (92%) of 75 patients with PBPS and in 24 (32%) women in the control group. The most common type of dysfunction was dyspareunia, which was reported by 72% of women with PBPS. For all components of the sexual function of women with PBPS, its deterioration was noted in older age groups. The degree of sexual dysfunction significantly correlated with the intensity of PBPS symptoms. Discussion. Our results confirm a significant deterioration in sexual function in women with PBPS, which coincides with the data of other authors. The most common disorder is pain during intercourse. The symptoms of PBPS leads to the development of various sexual dysfunctions. It is advisable at the diagnostic stage for all women with chronic pelvic pain to assess their sexual function to understand the presence and severity of sexual dysfunctions. Conclusions. The results of this study indicate a high prevalence of sexual dysfunction in women with PBPS. The presence of pain during intercourse is the most frequent clinical manifestation and causes the development of other sexual disorders: desire, arousal, lubrication, orgasm and satisfaction. The high frequency of sexual dysfunctions and a significant impact on the quality of life of women with PBPS indicates the need for additional therapeutic measures to restore sexual function.

PD18-11 THE "BUTTERFLY", A NOVEL MINIMALLY INVASIVE TRANSURETHRAL RETRACTION DEVICE FOR BPH

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-11 THE "BUTTERFLY", A NOVEL MINIMALLY INVASIVE TRANSURETHRAL RETRACTION DEVICE FOR BPH Ran Katz, Ali Safadi, Muhamad Abu Ahmed, Shmuel Roizman, Amnon Zisman, Maharan Kabha, Yoram Dekel, Jack Baniel, and shachar Aharoni Ran KatzRan Katz More articles by this author , Ali SafadiAli Safadi More articles by this author , Muhamad Abu AhmedMuhamad Abu Ahmed More articles by this author , Shmuel RoizmanShmuel Roizman More articles by this author , Amnon ZismanAmnon Zisman More articles by this author , Maharan KabhaMaharan Kabha More articles by this author , Yoram DekelYoram Dekel More articles by this author , Jack BanielJack Baniel More articles by this author , and shachar Aharonishachar Aharoni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Butterfly Prostatic Retraction Device is a novel minimally invasive, non-surgical implant that is delivered into the prostatic urethra in order to retract the lateral lobes of the prostate, increase the diameter of the prostatic urethra thus treating symptoms associated with BPH. The device is made of nitinol and consists of two lateral wings connected by several transverse rails and is available in five sizes. It is folded into a 5 mm introducer, inserted via rigid cystoscopy and deployed in the prostatic urethra between the verumontanum and the bladder neck. In body temperature the device expands, pushes the prostate lobes laterally, opening a wide path in the prostatic urethra while preserving the bladder neck. It is designed for day surgery or in office settings. We present our results in the management of men suffering from BPH. METHODS: A prospective, Open-Label clinical study for assessing the safety and efficacy of the Butterfly device in male patients suffering from LUTS due to BPH was performed enrolling up to date 50 men who were treated for BPH for at least one year and were candidates for prostatectomy. All patients had Qmax≤ 13 ml/sec and IPSS > 12. Patients with previous prostate procedure, prostatitis, cystolithiasis, prostate median lobe, urethral/bladder neck stricture and atonic bladder were excluded. The study was approved by the hospitals’ IRBs. Insertion of the device was performed under sedation in a day care setting. No catheter was left. Follow up visits were performed at 2 weeks, 1, 3, 6, and 12 months and included uroflowmetry, IPSS, QoL and sexual function questionnaires. Cystoscopy was performed on 3 and 12 months. RESULTS: Patient age range was 50-82 years. 23 patients completed a 1 year follow up and median follow up was 9 months. In one-year Qmax improved by 33%, IPSS score by 40% and QoL score improved by 38% compared to baseline. No patient reported deterioration of sexual function and all sexually active patients reported antegrade ejaculation. On cystoscopy, gradual coverage of the device with urethral mucosa was observed and there were no cases of encrustation. No unanticipated device related AE occurred. In one patient the device was re-positioned. Five patients elected to remove the device and returned to alpha blocker therapy. Seven patients underwent TURP. One patient developed a bulbar urethral stricture. CONCLUSIONS: The butterfly device is simple and efficient minimally invasive device for the management of LUTS due to BPH with a low complication rate, comparable to other minimally invasive devices, and good tolerability. Source of Funding: Butterfly Medical - Yokneam, Israel © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e359-e359 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ran Katz More articles by this author Ali Safadi More articles by this author Muhamad Abu Ahmed More articles by this author Shmuel Roizman More articles by this author Amnon Zisman More articles by this author Maharan Kabha More articles by this author Yoram Dekel More articles by this author Jack Baniel More articles by this author shachar Aharoni More articles by this author Expand All Advertisement PDF downloadLoading ...

What Is New with Rezūm Water Vapor Thermal Therapy for LUTS/BPH?

Rezum® is a novel convection-based thermal therapy for benign prostatic hyperplasia (BPH) induced lower urinary tract symptoms (LUTS). This review provides an overview of its safety, efficacy, cost, and potential role in the paradigm of BPH/LUTS therapies. Data regarding Rezum® stems primarily from one large randomized controlled trial of 197 patients with 4years of follow-up. The efficacy and safety of Rezum® is further supported by 4 additional studies including 1 prospective pilot study, 1 crossover study, and 2 retrospective studies. Durable improvements in IPSS (47-60%), QoL (38-52%), Qmax (45-72%), and PVR (11-38%) were seen without causing deterioration of sexual function. Rezum® offers a cost-effective and safe approach to treating BPH/LUTS and should be considered as a possible first-line therapy for patients with moderate to severe symptoms.

The role of Rezūm ™ team ablation of the prostate in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia. A single center, single surgeon case series and literature review

Objectives Acute urinary retention (AUR) is one of the most significant complication of benign prostatic hyperplasia (BPH). The gold standard surgical treatment for BPH, transurethral resection of the prostate (TURP), is not without significant side effects and a prolonged hospital stay. The aim of this study is to evaluate the role of Rezūm ™ steam ablation in the treatment of patients with AUR secondary to BPH. Methods Patients who developed AUR and failed their trial without a catheter (TWOC) were recruited. They were counselled about the procedure and offered the treatment. Pre-operative, intraoperative and post operate data were collected. Results All patients were followed up for a mean period of 7.2 months. 100% of patients passed their TWOC and stopped taking any BPH medications after. There was an average of 43.8% decrease in TRUS volume and a fall of 52.5% in PSA value after intervention. The mean operation time was 8.8 min and mean duration in hospital was 5.8 h. No deterioration in sexual function was reported. Conclusions Rezūm ™ steam ablation of the prostate is safe, fast and effective day case procedure in treating patients with AUR secondary to BPH. All patients were satisfied with the functional outcomes.

Prostatic Artery Embolization Allows to Maintain Full Sexual Activity in Patients Suffering from Bothersome Lower Urinary Tracts Symptoms related to Benign Prostatic Hyperplasia.

The effect of prostate artery embolization (PAE) on male sexual function is currently the subject of debate in the literature. The main purpose of this study was to define changes in all domains of sexual activity after PAE, using the international index of erectile function score (IIEF-15). A single-center retrospective study was conducted on 129 patients (mean age of 65.5 ± 7years), who underwent PAE from February 2014 to January 2017 for symptomatic benign prostatic hyperplasia (BPH). Fifty consecutive patients fulfilling the inclusion criteria were evaluated before and after PAE follow-up using the IIEF-15, IPSS, prostate volume (PV) and cardiovascular risk factor and BPH drugs. The IIEF-15 domains analyzed were: erectile function (EF) ejaculation and orgasm (Ej/O), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A paired sample t test or Wilcoxon signed-rank test was used to compare IIEF-15 between baseline and follow-up. The study showed nonsignificant change in IIEF-15 total score (58.0 ± 13.8 SD;p = 0.71) and the five domains (EF 24.5 ± 7.0 SD, p = 0.82; EJ/O 8.2 ± 2.3 SD, p = 0.50; SD 7.2 ± 2.7 SD, p = 0.57; IS 10.3 ± 3.0 SD, p = 0.77; OS 8.2 ± 2.7 SD; p = 0.11) after PAE. We also found a significant improvement in IPSS score after PAE. Based on the IIEF-15 questionnaire, PAE was showed to allow good urinary symptoms results and no deterioration in sexual function.

The Impact of Deep Brain Stimulation on the Sexual Function of Patients With Parkinson's Disease.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is used in the treatment of advanced Parkinson's disease (PD) with well-established benefits over motor complications. However, few studies addressing the impact of DBS on nonmotor dimensions such as sexual function have been conducted. This study aims to determine the effect of DBS-STN on the sexual activity of patients with PD and to establish predictive factors for sexual function decline after surgery. Twenty-one patients with PD submitted to DBS-STN were compared with 19 eligible surgery candidates. Clinical measures included disease progression (Hoehn and Yahr scale), sexual function evaluation (Female Sexual Function Index and International Index of Erectile Function), severity of depressive symptoms (Beck Depressive Inventory-II), motor symptoms (Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III), and quality of life (39-item Parkinson's Disease Questionnaire). The primary outcomes were the development of sexual dysfunction in women and erectile dysfunction in men. Regression analysis was performed to outline risk factors for developing sexual function deterioration. Erectile dysfunction was present in 83.3% of men and sexual dysfunction in 77.8% of women treated with DBS-STN. Women with sexual dysfunction had higher emotional well-being 39-item Parkinson's Disease Questionnaire scores (P=0.017) and a higher prevalence of cardiovascular diseases (P=0.012) comparing with women without sexual dysfunction. Age was an independent predictive factor for developing erectile dysfunction in men (relative risk=1.26; P=0.033) and sexual dysfunction in women (relative risk =1.30; P=0.039), regardless of DBS-STN submission. Sexual function in both sexes of patients with PD does not seem to be influenced by DBS-STN itself, but by psychological and clinical features.

Linfedema penoscrotal primario, una entidad clínica inusual: reporte de un caso

Caso clínico: Masculino de 52 años a quien se diagnostica linfedema penoscrotal primario tardío gigante, que fue tratado con linfangiectomía más reconstrucción de los genitales. En su seguimiento de un año, no ha habido recurrencia de la enfermedad y se logra conservar la función sexual.&#x0D; Relevancia: El linfedema penoscrotal gigante es una condición patológica de muy baja incidencia, pero con alto impacto en la morbilidad; Se desencadena por la acumulación de líquido rico en proteínas en el tejido celular subcutáneo, que genera deformidad, pérdida de la función sexual e infecciones por repetición.&#x0D; Implicaciones clínicas: Esta entidad clínica condiciona deterioro de la calidad de vida en los pacientes, ya que provoca malestar para la deambulación y sobre todo produce deterioro de la función sexual.&#x0D; Discusión y conclusión: El tratamiento quirúrgico de esta afección representa actualmente la mejor opción terapéutica, ya que previene la progresión de la enfermedad, la deformidad y preserva la función. La mejor de las técnicas es la linfangiectomía más la reconstrucción de los genitales, la cual se describe en el presente caso con evolución favorable.

Hysteroscopic endometrial resection vs. hysterectomy for abnormal uterine bleeding: impact on quality of life and sexuality. Evidence from a systematic review of randomized controlled trials.

The aim of this systematic review is to summarize the current evidence regarding the effectiveness of hysterectomy and hysteroscopic endometrial resection in improving quality of life (QoL), sexual function and psychological wellbeing of women abnormal uterine bleeding. We performed a systematic literature search in PubMed/MEDLINE and Embase for original studies written in English (registered in PROSPERO 2019 CRD42019133632), using the terms 'endometrial ablation', 'endometrial destruction', 'endometrial resection', 'hysterectomy', 'menorrhagia', 'dysfunctional uterine bleeding', 'quality of life', 'sexuality' published up to April 2019. Our literature search produced 159 records. After exclusions, nine studies were included showing the following results: both types of treatment significantly improve QoL and psychological wellbeing; hysterectomy is associated with higher rates of satisfaction; hysterectomy is not associated with a significant deterioration in sexual function. Hysterectomy is currently more advantageous in terms of improving abnormal uterine bleeding and satisfaction rates than hysteroscopic endometrial destruction techniques. Furthermore, there is some evidence of a greater improvement in general health for women undergoing hysterectomy. However, high-quality prospective randomized controlled trials should be implemented to investigate the effectiveness of hysterectomy and endometrial ablation in the improvement of QoL outcomes in larger patient cohorts.

Deterioration of sexual function is associated with central hemodynamics in adult Japanese men.

Elevated aortic blood pressure is more strongly related to the onset of cardiovascular disease (CVD) than elevated brachial blood pressure. On the other hand, erectile dysfunction (ED) is a peripheral vascular disfunction and is also associated with CVD; however, the association between aortic blood pressure and ED has not yet been clarified. Therefore, we aimed to investigate the association between ED severity and aortic blood pressure in adult men. In 253 Japanese adult men (59 ± 16 years), aortic (estimated using a generalized transfer function) and peripheral hemodynamics were measured. Erectile function was assessed with a questionnaire (the International Index of Erectile Function 5: IIEF5), and participants were stratified into three groups based on the IIEF5 score (no ED, mild-to-moderate ED, and moderate-to-severe ED). Aortic systolic blood pressure (SBP) and pulse pressure (PP) were significantly higher in subjects with moderate-to-severe ED than in subjects with no ED or mild-to-moderate ED. In addition, the severity of ED was significantly associated with the time to reflection, augmentation pressure, and augmentation index. Multivariate linear regression analyses suggested that moderate-to-severe ED was significantly associated with aortic SBP and PP (β = 0.129; p = 0.047, β = 0.165; p = 0.013, respectively) but not brachial SBP or PP, after confounding factors were considered. These results suggest that moderate-to-severe ED is associated with elevated aortic blood pressure due to an earlier arrival of the reflected wave and is an independent predictor of elevated aortic blood pressure in Japanese men.