Ejaculatory Disorders Research Articles

Posterior Urethral Valves and Fertility: Insight on Paternity Rates and Seminal Parameters.

Posterior urethral valves (PUVs) represent the most common cause of male congenital lower urinary tract obstruction, often responsible for renal dysplasia and chronic renal failure. Despite recent improvements in patients' outcomes thanks to prenatal ultrasound early diagnosis, PUVs can still impact sexual function and fertility. This study aims to review the available evidence on fertility in PUV patients, examining paternity rates and semen parameters. A review was conducted of the PubMed, Cochrane, Scopus, and Embase databases. Studies focusing on fertility and paternity outcomes in PUV patients were selected, including case reports, case series, and retrospective and prospective studies. A total of 15 studies met the inclusion criteria. The review revealed that PUV patients often exhibit compromised semen parameters, including low sperm count, reduced motility, and abnormal morphology, as well as alterations in seminal plasma. PUV diagnoses are common in adults exhibiting infertility and ejaculation disorders, suggesting PUVs cannot be considered only a pediatric disease. Paternity rates among PUV patients were rarely reported in extenso, hampering the correct assessment of the overall medium paternity rate and its comparison with that of healthy individuals. Lastly, seminal parameters were assessed in a minimal cohort of patients, therefore, they could not be considered representative. Fertility and seminal parameters in PUV patients represent an under-investigated area. PUVs can variably and non-univocally affect fatherhood, and they may be associated with compromised semen quality. Early intervention and long-term follow-up are essential to address potential fertility issues. Future research should focus on developing targeted strategies to preserve and enhance fertility in this patient population.

Seminal vesicles - an overlooked pair of accessory glands in male sexual dysfunction: a narrative review.

The seminal vesicles (SVs) have long been recognized for their role in male fertility, yet their contribution to male sexual function is often underestimated. In recent decades, studies have gradually unveiled an association between SVs and various male sexual dysfunctions (SDs), including diminished libido, erectile dysfunction, premature ejaculation, delayed ejaculation, and orgasmic disorder. We conducted a comprehensive literature search of publications up until April 2024 in PubMed, Google Scholar, and CNKI, focusing on original studies, case reports, and reviews addressing the relationship between SVs and male SDs. The aim was to explore the pathophysiological mechanisms, clinical evaluation, and management of this relationship, providing urologists and andrologists with new insights into diagnosing and treating complex male SDs. Current research suggests that SVs may play a role in male sexual function, but the evidence remains limited. Future large-scale, rigorously designed studies are needed to further validate this relationship.

(299) EJACULATORY INSIGHT OF A SOUTH FLORIDA COHORT USING A MODIFIED EJACULATION SCORE QUESTIONNAIRE

Abstract Introduction Elements like erection and orgasm have been the main focus regarding male sexual health, overshadowing ejaculation in the comprehension and study of male sexual function. Objective We modified an ejaculation score questionnaire to assess the ejaculatory process and identify ejaculatory dysfunction. In addition to the questions to score and evaluate ejaculatory dysfunction, we included questions to apprehend the patient’s perspective of an ideal ejaculation. Methods At a male sexual health outpatient clinic in South Florida, patients were given an 11-question self-administered ejaculation score. These patients were not seeking care for ejaculatory disorders. Elements such as force, consistency, volume, and the significance of these factors were incorporated into the questionnaire to understand the patient’s perception of an ideal ejaculation. In addition, we explored whether having difficulties with ejaculation was bothersome and the importance of ejaculation for sexual satisfaction. All the responses were recorded and analyzed for further evaluation. Results Of the 221 patients who finished the self-administered questionnaire, those who particularly responded to the questions about their perception of ejaculation were evaluated. A substantial majority, 70% (126/180), preferred “Strong (Shoots out)” as their ideal force of ejaculation. A considerable 62.2% (107/172) favored a “Moderate (½ a shot glass)” amount regarding the ideal volume of semen expelled. Similarly, 54.4% (93/171) considered “Thin/thick, chunky” as an ideal consistency. Furthermore, 47.9% (79/165) of participants experiencing difficulties with ejaculation answered “A lot” when asked if it was a bother. Finally, a significant 81.2% (138/170) of respondents expressed the notable importance of ejaculation to the male sexual orgasm. Conclusions This ongoing pilot investigation gained valuable insights into the perceptions of ejaculation. This study can be a foundation for healthcare providers to improve patient-centered care by recognizing and addressing individual preferences and concerns. Thus, it provides enhanced support for patients so they can attain healthy and gratifying sexual experiences, thus improving their quality of life. Disclosure No.

Interpretable machine learning models for predicting clinical pregnancies associated with surgical sperm retrieval from testes of different etiologies: a retrospective study

BackgroundThe relationship between surgical sperm retrieval of different etiologies and clinical pregnancy is unclear. We aimed to develop a robust and interpretable machine learning (ML) model for predicting clinical pregnancy using the SHapley Additive exPlanation (SHAP) association of surgical sperm retrieval from testes of different etiologies.MethodsA total of 345 infertile couples who underwent intracytoplasmic sperm injection (ICSI) treatment with surgical sperm retrieval due to different etiologies from February 2020 to March 2023 at the reproductive center were retrospectively analyzed. The six machine learning (ML) models were used to predict the clinical pregnancy of ICSI. After evaluating the performance characteristics of the six ML models, the Extreme Gradient Boosting model (XGBoost) was selected as the best model, and SHAP was utilized to interpret the XGBoost model for predicting clinical pregnancies and to reveal the decision-making process of the model.ResultsCombining the area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, F1 score, brier score, and the area under the precision-recall (P-R) curve (AP), the XGBoost model has the best performance (AUROC: 0.858, 95% confidence interval (CI): 0.778–0.936, accuracy: 79.71%, brier score: 0.151). The global summary plot of SHAP values shows that the female age is the most important feature influencing the model output. The SHAP plot showed that younger age in females, bigger testicular volume (TV), non-tobacco use, higher anti-müllerian hormone (AMH), lower follicle-stimulating hormone (FSH) in females, lower FSH in males, the temporary ejaculatory disorders (TED) group, and not the non-obstructive azoospermia (NOA) group all resulted in an increased probability of clinical pregnancy.ConclusionsThe XGBoost model predicts clinical pregnancies associated with testicular sperm retrieval of different etiologies with high accuracy, reliability, and robustness. It can provide clinical counseling decisions for patients with surgical sperm retrieval of various etiologies.

The Efficacy and Safety of Fluoxetine Delayed-Release 90 mg/Weekly in Psychiatry: An Evidence-Based Mini-Review

Context: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is widely used in the treatment of various psychiatric disorders. While the standard therapeutic dose of fluoxetine is typically 20 - 60 mg per day, slow-release higher doses, such as 90 mg/weekly and more recently 180 mg/weekly, have been explored to assess their potential benefits in certain psychiatric conditions. This mini-review aims to evaluate the evidence regarding the effects, efficacy, and safety profile of fluoxetine at a dosage of 90 mg in psychiatry. Evidence Acquisition: A comprehensive literature search was conducted using electronic databases (PubMed and Embase) to identify relevant studies published until July 2023. Studies investigating the use of fluoxetine at a dosage of 90 mg/week in psychiatric conditions were included. The identified studies were critically appraised for their methodology and quality. Results: Limited research has specifically examined the effects of fluoxetine at a dosage of 90 mg/week in psychiatry. However, some studies have investigated this dosage form and provided insights into its potential efficacy in treating certain psychiatric conditions, such as major depressive disorder (MDD), obsessive-compulsive disorder (OCD), premature ejaculation, and premenstrual dysphoric disorder. These studies have shown that compliance with weekly fluoxetine was better than with once-daily dosing. Conclusions: Once-weekly dosing may be effective in psychiatry, improving compliance and enhancing psychological well-being.

Male Sexual Dysfunction and Hypogonadism in Young Adults with Type 2 Diabetes Mellitus: A Cross Sectional Study.

Male sexual dysfunction (MSD) is a common occurrence in diabetic patients, which is not routinely assessed in clinical settings. The aim of the study was to assess the prevalence of MSD and hypogonadism in young type 2 diabetes mellitus (T2DM) patients aged between 20 and 40 years and its association with duration, glycaemic control and complications of diabetes. This is a cross-sectional study involving 70 men with T2DM of 20-40 years of age visiting the endocrinology department in a tertiary care centre. This study was conducted from November 2021 to March 2023. Seventy subjects satisfying inclusion criteria were included in the study and assessed using the International Index of Erectile Function-15 questionnaire, intravaginal ejaculation latency time, androgen deficiency in ageing male questionnaire, hormonal parameters (Luteinising Hormone, Follicle stimulating hormone, Testosterone and sex hormone-binding globulin) and penile Doppler. The statistical analysis was done using SPSS version 21. A P < 0.05 is considered statistically significant. Data were checked for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. For determining statistical significance between continuous variables with non-normal data, the Mann-Whitney U test and Kruskal-Wallis tests were used. Pie charts, bar diagrams and scatter plots were used for descriptive statistics. Frequency, percentage, means, median, range and standard deviation were used for all quantitative data. The Chi-square test was used to find a significant association between categorical variables. Sixty per cent of men had at least one form of MSD. Hypoactive sexual desire disorder (HSDD) - 44.28% was the most common MSD, followed by erectile dysfunction (ED) - 42.85% and ejaculatory disorders - 18.57%. Penile Doppler was done in 15 patients, of whom 9 patients had normal Doppler, venous incompetence was present in 3, followed by mixed (arterial and venous) in 2 and arterial insufficiency in 1 subject. Hypogonadism was present in 27.14% of men and secondary hypogonadism was the most common cause (84.21%). There was a significant association between neuropathy and ED and between hypogonadism and HSDD. There was also a significant association between fasting plasma glucose, post-prandial plasma glucose and MSD. MSD is common in young T2DM men, which should be given due importance in clinical practice to improve their quality of life. Glycaemic control is of utmost importance in these men.

Assisted reproductive technologies in multiple sclerosis

Objective of the review: to study the topic of fertility, pregnancy and assisted reproductive technologies (ART) in patients with multiple sclerosis (MS). The analysis of scientific literature in international medical databases was performed.Analysis of literary data. MS is a chronic inflammatory demyelinating disease of the central nervous system that most often affects young people of reproductive age. Research in this area is important given that the average age of MS diagnosis in Ukraine is approximately 31–34 years. As a result, patients are in the process of making important decisions about their future lifestyle and family planning.According to the data of modern research, MS does not affect the course of pregnancy and is not associated with obstetric pathologies. However, patients are often forced to postpone their desire to become pregnant due to the risks of taking drugs for disease-modifying therapy (DMT), the need to stabilize the disease along with reducing its radiological activity. It is also important to consider the presence of sexual dysfunction in patients with MS, particularly in men, which often negatively affects male fertility and requires timely diagnosis and treatment. For example, in case of ejaculation disorders, a testicular biopsy or electroejaculation can be used to collect seminal fluid.The algorithm of proper counseling before conception for both partners was analyzed. It is important to use a multidisciplinary approach for joint decision-making of the patient with both a neurologist and a gynecologist, which allows for the formation of the most reasonable conclusions regarding pregnancy planning. In particular, the elimination periods of the main DMT drugs are discussed and drugs that can be used during pregnancy are specified.Conclusions. Women with MS are more likely to need AR than the general population. This is associated with a later age of pregnancy planning and infertility. In this regard, the method of in vitro fertilization and cryopreservation of oocytes as the most effective types of ART for patients with MS was considered in detail.

Sexual outcomes in men who have sex with men who underwent radical prostatectomy.

Sexual difficulties are a recognized consequence of prostate cancer (PCa) treatments. An estimated one in three men who have sex with men (MSM) receive PCa a diagnosis during their lifetime. MSM may experience all types of sexual dysfunction as reported in men who have sex with women (MSW), along with a number of more specific bothersome problems. This systematic literature review aims to evaluate sexual outcomes in MSM who have undergone radical prostatectomy (RP). A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The searches were made using relevant keywords in the PubMed, Scopus, and Web of Science databases, thus including the whole literature from January 2000 to November 2023. Studies which did not allow to retrieve data on sexual outcomes on MSM treated with RP for PCa were excluded. Data on sexual outcomes and health-related quality of life (HRQoL) were retrieved, mostly including changes in libido, erectile function, ejaculatory disorders, orgasm, climacturia, changes in role-in-sex identity, changes in sexual partnerships, and the presence of painful receptive anal intercourses (AI). CRD42024502592. Six articles met the inclusion criteria. In total, data of 260 patients were analyzed. Three main themes emerged: (a) MSM may experience specific sexual dysfunctions due to the different dynamics of their intimacy; (b) the lack of tool validated on gay and bisexual population to assess sexual outcomes (c) the need for a tailored approach that also takes into account sexual orientation throughout the oncological journey. MSM undergoing RP may experience similar sexual problems as MSW. Painful AI should be considered a potential post-operative adverse outcome in MSM. Future studies should prioritize validating a questionnaire that explores AI. Healthcare providers should adopt a tailored approach that takes into account sexual orientation throughout the cancer journey.

(082) DELAYED ORGASM CAN RESULT FROM LUMBOSACRAL DISC DISEASE DISRUPTING GENITAL SENSORY TRANSMISSION IN THE CAUDA EQUINA: A REVIEW

Abstract Introduction Delayed orgasm may be considered an unwanted, atypically long latency during most genital/sexual activity despite sexual stimulation, causing significant distress to the individual and/or partner, persisting for at least 6 months. Delayed orgasm is reported to affect 6.9% of women. It is associated with negative effects on sexual function, sexual satisfaction, and relationship satisfaction. Pharmacologic, endocrinologic, and neurobiological pathophysiological factors have been identified as possible etiologies of delayed orgasm, but an under-researched etiology is lumbosacral disc disease, specifically lumbosacral annular tear-induced sacral radiculopathy. The pelvic, pudendal, and sciatic nerves all merge at the S2-4 foramina where they coalesce to form the S2-4 nerve roots. These sacral spinal nerve roots (S2-4) ascend to the first synapse in the conus medullaris. During their ascent, they can be irritated mechanically by impingement/compression or chemically by exposure to the extruded nucleus pulposus from lumbosacral annular tears, and thereby disrupt genital sensory transmission with resultant delayed orgasm. The new evidence that delayed orgasm can be successfully treated by endoscopic spine surgery supports the association of delayed orgasm with sacral radiculopathy. There is still a paucity of research regarding delayed orgasm from lumbosacral disc disease. Objective To review the existing literature concerning the contribution of lumbosacral disc disease to delayed orgasm. Methods A literature search on delayed orgasm, its impacts and possible etiologies was performed. The following keywords were searched on Pubmed individually and in combination, related to the association between delayed orgasm and lumbosacral disc disease: delayed orgasm, delayed ejaculation, sexual dysfunction, anorgasmia, and persistent genital arousal disorder. Current definitions were compiled, and overall epidemiology, anatomy, and biopsychosocial factors of delayed orgasm were explored. Results There are a number of publications (n = 19) demonstrating the development of sexual dysfunction after damage to the sacral spinal nerve roots. Furthermore, several studies (n = 4) and case reports (n = 1) have demonstrated that treating lumbosacral disc disease reduces sexual dysfunction including improvement in delayed or reduced ejaculation. While delayed ejaculation encompasses the experience of delayed orgasm for some individuals, the literature fails to address delayed orgasm comprehensively in relation to lumbosacral disc disease, and thus fails to address treatment of lumbosacral disc disease and subsequent resolution of delayed orgasm. People with vulvas are particularly underrepresented in the literature studying the connection between lumbosacral disc disease and delayed orgasm. Conclusions While lumbosacral disc disease has many side effects that may impede daily function, sexual side effects can further detract from one’s personal life and relationship satisfaction. Thus, improving clinician awareness of sexual side effects, particularly delayed orgasm, can help improve treatment for individuals especially as they age. Further research is needed to strengthen the understanding of the effect of sacral radiculopathy on delayed orgasm as well as other sexual dysfunctions. Disclosure No.

Prevalence of Ejaculatory Disorders among Post COVID-19 Egyptian Males

Prevalence of Ejaculatory Disorders among Post COVID-19 Egyptian Males

Incidence and Predictors of Ejaculatory Disorders Following Transurethral Resection of Prostate at Muhimbili National Hospital

Incidence and Predictors of Ejaculatory Disorders Following Transurethral Resection of Prostate at Muhimbili National Hospital

Exploring the association between isotretinoin and sexual dysfunction: a comprehensive scoping review.

A potential link between isotretinoin and sexual dysfunction has been reported in various studies. However, such an association has not been explored within the context of a literature review until now. To evaluate the methodology and quality of studies investigating this association, and to examine the definitions of sexual dysfunction used. A scoping review approach was used to identify peer-reviewed research articles. The search terms used were 'isotretinoin', 'sexual dysfunction', 'erectile dysfunction', 'ejaculatory disorders', 'decreased libido', 'female sexual interest', 'female arousal disorder', 'libido', 'pelvic pain', 'dyspareunia', 'orgasmic disorder', 'impotence', 'ovaries', 'fertility' and 'menstrual irregularity'. In total, 55 peer-reviewed manuscripts were included, consisting of 8 animal studies and 46 human studies with 2420 patients. Of the studies in humans, there were 18 case reports or case series, 2 case-control studies, 4 cross-sectional studies, 6 longitudinal studies, 3 pharmacovigilance reports and 13 cohort studies. The most frequently observed dose range of isotretinoin was 0.5-1.0 mg kg-1 per day, usually for a duration of 1-6 months. More than half of the studies (54%, n = 25) reported a beneficial or neutral effect of isotretinoin on sexual function. The majority of studies (89%, n = 41) were categorized as Oxford Evidenced-Based Medicine level 4. This scoping review revealed very weak evidence supporting a link between isotretinoin and sexual dysfunction. Notably, the diverse definitions of sexual dysfunction pose a significant challenge for comparative analysis. The authors advocate for a standardized definition of sexual dysfunction and a framework for determining causality in order to contribute to a more comprehensive understanding of the relationship between isotretinoin and sexual dysfunction.

Testicular Cancer Treatments and Sexuality: A Narrative Review.

The incidence of testicular cancer (TC) has been rapidly increasing over the past years. Diagnosis and early treatment have shown good oncological control, guaranteeing the patient different treatment approaches according to histology and tumor stage. Currently, physicians usually prioritize oncological outcomes over sexual outcomes and quality of life, considering as a first aim the overall survival of the patients; however, differently from other neoplasms, quality of life is still strongly affected among TC patients, and sexual outcomes are frequently compromised after each TC treatment. Several studies have suggested that each treatment approach may be associated with sexual dysfunctions, including erectile dysfunction, ejaculatory disorders, fertility issues, and hormonal changes. Since testicular cancer patients are more frequently young men, the subject of this work is substantial and should be analyzed in detail to help specialists in the management of this disease. The aim of the current narrative review is to generally describe every treatment for TC, including surgery, chemotherapy, radiotherapy, and retroperitoneal lymph node dissection, and to establish which sexual dysfunction may be specifically associated with each therapy.

(192) Evaluating Effect of hCG and hCG+rFSH Therapy on Ejaculation Disorders in Middle-Aged Men: A Case Study

Abstract Introduction The prevalence of various ejaculation disorders affecting middle-aged and older men has gained increasing attention due to their significant impact on quality of life. One of them, Late-Onset Hypogonadism (LOH) syndrome, can result in a decline in overall well-being. Testosterone replacement therapy (TRT) is commonly used to address LOH; however, it presents challenges such as diminishing endogenous testosterone secretion and incomplete symptom relief. Objective This study aimed to investigate the effects of human chorionic gonadotropin (hCG) or hCG plus recombinant follicle-stimulating hormone (rFSH) therapy in patients experiencing ejaculation disorders characterized by low semen volume and decreased pleasure during ejaculation. Methods Four male patients, aged 55 to 59 years, complaining of decreased ejaculatory pleasure and low semen volume, were enrolled in the study. One patient received hCG+rFSH therapy, while three patients received hCG alone. The initial dose of hCG was 5,000 units administered twice a week, and if deemed insufficient, it was increased to three times a week. rFSH was administered at a dosage of 150 units three times a week. Levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol (E2) were measured monthly. Anastrozole (1 mg) was added for patients exhibiting elevated E2 levels. Results Case 1: A 58-year-old male. Prior to treatment, testosterone and E2 levels were 4.84 ng/mL and 34.2 pg/mL, respectively. hCG+rFSH therapy resulted in increased testosterone levels (10.2 ng/mL) and elevated E2 levels (109.0 pg/mL) after three months of treatment. Addition of anastrozole resulted in testosterone levels of 10.90 ng/mL and E2 levels of 57.9 pg/mL in the following month. The patient experienced improved sexual desire, increased semen volume, and hair loss as a side effect. Treatment was discontinued after six months. Case 2: A 57-year-old male with diabetes mellitus. Pre-treatment testosterone and E2 levels were 2.19 ng-mL and 21.9 pg/mL, respectively. After changing the hCG dosage to 5,000 units three times a week, testosterone levels reached 5.33 ng/mL and E2 levels increased to 72.8 pg/mL after two months. With the addition of anastrozole four months into treatment, E2 levels were 44.4 pg/mL after five months. The patient reported improved morning erections, increased libido, increased semen volume, and improved glycemic control (HbA1c decreased from 9.0 to 7.0). Case 3: A 55-year-old male. Pre-treatment testosterone and E2 levels were 4.99 ng/mL and 32.3 pg/mL, respectively. In the first month of hCG therapy, testosterone levels increased to 13.6 ng/mL, while E2 levels rose to 75.5 pg/mL. Then, despite testosterone remaining in the 9.0–10.0 ng/mL range, E2 levels increased to 100 pg/mL. With the addition of anastrozole in the fifth month, the patient reported increased semen volume thereafter. Case 4: A 59-year-old male with a history of bipolar disorder. Prior to treatment, testosterone and E2 levels were 2.45 ng/mL and 23.0 pg/mL, respectively. hCG therapy resulted in testosterone levels of 6.71 ng/ml and E2 levels of 51.0 pg/mL after two months. Conclusions This case study highlights the outcomes of hCG or hCG+rFSH therapy in middle-aged men experiencing ejaculation disorders. Disclosure No.

(012) Sexual Dysfunction in Men After Failed Hypospadias Repair

Abstract Introduction Hypospadias is commonly treated in childhood, and future sexual function of such patients is sometimes overlooked. Some published reports reveal excellent sexual function following hypospadias repair at long term, while other authors state high prevalence of sexual dysfunction which depends on original position of urethral meatus. Patients with complications of primary hypospadias repair are one of the most difficult subpopulations to evaluate. This is a unique subset of patients who should be described separately from men who underwent successful hypospadias repair. Objective To describe the spectrum of sexual dysfunction in patients with sequelae of failed hypospadias repair and our experience in its management. Methods We evaluated 112 patients with a history of failed hypospadias repair, defined as presence of voiding symptoms or cosmetic problems remaining despite previous surgery or caused by it. Patients’ median age was 29.5 years (range: 18–62). There were no intersex cases. Only 9.8% (11/112) underwent single attempt at surgical reconstruction, the median number of attempts was 3.5 (range: 1–9). Patients with IIEF-EF score ≤ 25 were considered to have erectile dysfunction; those with IIEF-EF ≤ 16 underwent penile doppler ultrasound, penile electromyography and endocrine assessment. Results 64.2% of patients (72/112) were dissatisfied with penile appearance, 40.2% (45/112) had ED, 71.4% (80/112) had ejaculation disorders. Psychogenic ED was diagnosed in 21 patients with preserved non-coital erections and no evidence of organic ED. Median IIEF-EF in ED patients was 20 (range: 8–25). Asthenic ejaculation, delayed ejaculation and anejaculation were present in 63.4% (71/112), 7.1% (8/112) and 3.5% (4/112) patients, respectively. Premature ejaculation was present in 28.6% (32/112) patients, but its association with hypospadias or previous surgery is unlikely. On univariate analysis only the number of previous attempts at surgical repair was a significant predictor of sexual dysfunction following definitive surgery (p = 0.033). Rate of normal sexual function was 37.5%, 23.5% and 9.1% among patients with history of ≤ 3, 4–6 and ≥ 7 procedures, respectively. Conclusions Failed hypospadias repair may lead to a wide spectrum of sexual dysfunction, involving sexual desire, erection and ejaculation. Repeated surgery leads to increased risk of sexual dysfunction which may be devastating for patient’s quality of life. Disclosure No.

Characteristics of α1-adrenoceptor antagonists-induced ejaculatory dysfunction on spontaneous seminal emission in rats.

Although α1-adrenoceptor (α1-AR) antagonists used to treat benign prostatic hyperplasia can cause ejaculation disorders, the aetiology of this adverse event is still controversial. Therefore, we investigated the effects of antagonists with different affinities for α1-AR subtypes on ejaculatory function and their mechanisms of action in normal rats. In the spontaneous seminal emission (SSE) test, systemically administered prazosin, terazosin, tamsulosin and naftopidil decreased the weight of ejaculated seminal material in a dose-dependent manner; the potency order was as follows: tamsulosin > terazosin > prazosin > naftopidil. The selective α1D-AR antagonist BMY7378 had no effect on SSE. Intrathecal tamsulosin and naftopidil did not inhibit SSE. Tamsulosin, the most potent, was ineffective as a single dose and significantly increased seminal vesicle fluid in rats treated for 2weeks but did not significantly change retrograde ejaculation. These results indicated that the difference in inhibitory potency of the five α1-AR antagonists against SSE was due to the involvement of α1A-AR subtypes. Our results further suggested that α1-AR antagonist-induced ejaculatory dysfunction at the peripheral level was mainly due to the loss of seminal emission, although some retrograde ejaculation may also be involved.

Analysis of sexual dysfunction development among male and female living kidney donors.

Living kidney donations (LKDs) face a persistent demand for patients with end-stage renal disease, emphasizing the importance of LKDs' growth and success. Although living kidney donors generally exhibit excellent survival rates, little research has explored the development of long-term sexual dysfunction following LKD. This study aimed to analyze differences in 5-year sexual dysfunction outcomes between male and female living kidney donors, utilizing the TriNetX database, a federated network of electronic medical records from multiple U.S. healthcare organizations. A propensity score-matched cohort study compared 45-year sexual dysfunction outcomes in adult male and female living kidney donors from December 2013 to December 2022. Cohorts were matched on age; sex; race and ethnicity; diabetes, cardiovascular, genitourinary, and psychiatric comorbidities; lifestyle-related factors; and medications that may impact normal sexual functioning. Primary outcomes included hazard ratio (HR) for decreased libido, sexual dysfunction (composite of male erectile dysfunction, ejaculatory disorders, vaginismus/dyspareunia, infertility, orgasmic disorders, arousal/desire disorders), and sexually transmitted diseases. Secondary outcomes assessed sex counseling and interpersonal relationship issues with spouses or partners. The matched cohorts included 2315 patients each (male, female), and the mean age was 42.3 ± 12.5years. At 5 years, male donors had a significantly higher HR for sexual dysfunction (HR, 3.768; 95% confidence interval, 1.929-7.358). Erectile dysfunction occurred in 1% of male patients, while vaginismus/dyspareunia affected <1% of female patients. Other sexual disorders, decreased libido, sexually transmitted diseases, and incidences of sexual and interspousal counseling were not significantly different. Male living kidney donors faced a higher risk of developing sexual dysfunction 5 years after donation. While LKD remains a safe and viable alternative, clinicians and donors should be mindful of the potential association with sexual dysfunction postdonation. Further research may enhance support for the well-being of living kidney donors.

Medications Mostly Associated With Ejaculatory Disorders: Assessment of the Eudra-Vigilance and Food and Drug Administration Pharmacovigilance Databases Entries

ObjectivesTo identify which medications are mostly associated with ejaculatory disorders through a disproportionality analysis. MethodsThe Food and Drug Administration Adverse Event Reporting System (FDA-FAERS) and the Eudra-Vigilance (EV) database were queried to identify medications more commonly associated to ejaculatory disorders from 10th September 2012 to 1st June 2023. Proportional Reported Ratios (PRRs) were computed for all the selected drugs. ResultsOverall, 7404 reports of ejaculatory disorders reports were identified, and of these, 6854 cases (92,6%) were attributed to ten specific medications. On FDA-FAERS and EV databases, Paroxetine and Tamsulosin were the main responsible of delayed ejaculation (103/448 events, 23,0%) and retrograde ejaculation (366/1033 events, 35,4%), respectively. Finasteride was mostly related to painful ejaculation and ejaculation failure, with 150 events (7,8%) and 735 events (38,4%) respectively. Within the group of high-risk medications, Sildenafil presented higher risk of ejaculatory disorders than Tadalafil (PRR=5.85 (95%CI 5.09-6.78), p<0,01). ConclusionsTen drugs were recognized to display significant reporting levels of ejaculatory disorders. Among them, Finasteride and Sildenafil were responsible for the most reports in FDA-FAERS and in EV databases, respectively. Physicians should thoroughly counsel patients treated with these drugs about the risk of ejaculatory disorders. Further integration into clinical trials is needed to enhance the applicability and significance of these results.

Can ChatGPT help patients understand their andrological diseases?

We aimed to assess the reliability of Chat Generative Pre-training Transformer (ChatGPT)'s andrology information and its suitability for informing patients and medical students accurately about andrology topics. We presented a series of systematically organized frequently asked questions on andrology topics and sentences containing strong recommendations from the European Association of Urology (EAU) Guideline to ChatGPT-3.5 and 4.0 as questions. These questions encompassed Male Hypogonadism, Erectile Dysfunction and Sexual Desire Disorder, Disorders of Ejaculation, Penile Curvature and Penile Size Abnormalities, Priapism, and Male Infertility. Two expert urologists independently evaluated and assigned scores ranging from 1 to 4 to each response based on its accuracy, with the following ratings: (1) Completely true, (2) Accurate but insufficient, (3) A mixture of accurate and misleading information, and (4) Completely false. A total of 120 questions were included in the study. Among these questions, 50.0% received a grade of 1 (completely correct) (55.4% for 4.0 version). The combined rate of correct answers (grades 1 and 2) was 85.2% for frequently asked questions (88.8% for 4.0 version) and 81.5% for questions obtained from the guideline. The rate of completely incorrect answers (grade 4) was 1.8% for frequently asked questions (0% for 4.0 version) and 5.2% for questions based on strong recommendations. The response rate of version 4.0 to questions created from sentences containing strong recommendations from the EAU guideline was the same as version 3.5. ChatGPT provided satisfactory answers to the questions asked, although some responses lacked completeness. It may be beneficial to utilize ChatGPT under the guidance of a urologist to enhance patients' comprehension of their andrology issues.

Benign prostat obstrüksiyonu için yapılan minimal invaziv cerrahi terapilerin seksüel fonksiyonlar üzerine etkileri

The aim of this review is to compare the effects of minimally invasive surgical therapies (MIST) on sexual function in the treatment of benign prostatic obstruction (BPO). Compared to conventional methods, minimally invasive techniques have a less detrimental impact on sexual functions, such as erectile dysfunction and ejaculatory disorders. Nowadays, there is an increasing patient expectation for the preservation of sexual function, which has further elevated the importance of MIST techniques. Long-term outcomes of techniques such as Rezum™, UroLift®, Aquablation®, Transperineal Laser Ablation –TPLA (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy), iTind®, and Prostatic Artery Embolization (PAE) support their positive effects on sexual function. Although the variability in the questionnaires assessing sexual function makes cross-study comparisons challenging, meta-analyses have observed that MIST techniques tend to preserve sexual function. These treatment methods are particularly recommended for patients with mild to moderate urinary symptoms who are concerned about losing sexual function. However, it should be noted that they may fall short in improving urinary parameters compared to the gold standard, TURP. Keywords: BPO, sexual outcomes, erectile dysfunction, ejaculation, MIST, iTind, Rezum, TPLA, PAE, aquablation, PUL