Ejaculatory Function Research Articles

Влияние гиперкапнической гипоксии на репродуктивную и копулятивную функции мужчин в комплексном лечении хронического абактериального простатита.

Introduction. The relationship between chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) and male infertility is the subject of numerous studies, and therefore various methods for correcting pathospermia have been proposed. The main concept is that in one way or another it is necessary to create conditions for a more perfect penetration of drugs into the zone of the prostate-vesicular complex. In this regard, the search for new and pathogenetically substantiated methods of therapy for such a patient seems to be very relevant Aim of study. To evaluate the effect of hypercapnic hypoxia on reproductive and copulatory functions of men in the complex treatment of CP/CPPS. Materials and methods. The study involved 24 patients who applied to a urologist with complaints about the absence of conception in marriage for 1 year or more. The examination revealed pathospermia and symptoms of CP/CPPS in these patients. Assessment of the severity of symptoms of CP/CPPS was assessed using a questionnaire on the symptoms of chronic prostatitis using the NIH-CPSI questionnaire. In order to identify and monitor violations of the male copulatory function, ICF questionnaires created by O.B. Loran and A.S. Segal and the International Index of Erectile Function (MIEF-5). Reproductive function analysis was monitored using a semen analysis and sperm DNA fragmentation index test. The patients were divided into 2 groups of 12 people. Both groups received phenotypically directed pathogenetic and symptomatic therapy. For patients of the 2nd group, the complex treatment included breathing training procedures using the carbonic simulator, which ensures blood saturation with CO2, leading to the effect of hypercapnic hypoxia. This phenomenon contributes to angiogenesis and improvement of blood circulation in organs and systems. The effectiveness of the treatment was evaluated after 1 and 3 months. Results. According to the results of the NIH-CPSI questionnaire, 3 months after treatment, therapy in patients of group number 2 was more effective. According to the results of the MIEF 5 and ICF questionnaires in patients with CP/CPPS, a violation of erectile and ejaculatory function was revealed, and according to the results of the spermogram and the sperm DNA fragmentation test (IFD), pathospermia was noted, which was expressed in a decrease in the concentration of spermatozoa (group number 1 – 15.3 ± 1.6 million / ml, group number 2 – 16.8±2.2 million/ml), their progressive mobility (group number 1 – 24 ± 2.6%, and in group number 2 23.25 ± 2.9%.), normal morphology (group number 1 – 2.1 ± 0.17%, group number 2 – 2.5 ± 0.29%) and an increase in IFD (group number 1 – 17.9 ± 2.06%, group number 2 – 19.75± 1.9%). 3 months after treatment, the concentration of spermatozoa was 21.1±2.16 million/ml in group number 1, and 31.8±2.5 million/ml in group number 2. Progressive mobility in group number 1 – 31.4±2.2%, in group number 2 – 38.4±1.9%. Normal morphology in group number 1 is 3.1 ± 0.32%, in group number 2 – 4.6 ± 0.6%. IFD in group number 1 – 12.25 ± 0.6%, in group number 2 – 7.8 ± 1.3%. Conclusion. Patients of the group number 2, who trained on the breathing device «carbonic», achieved a more significant clinical effect from the therapy. Hypercapnic hypoxia, in the complex treatment of CP/CPPS, can contribute not only to the relief of pain and dysuric symptoms, but also to improve both the copulative and reproductive functions of men.

The Effect of Transurethral Resection of the Prostate on Erectile and Ejaculatory Functions in Patients with Benign Prostatic Hyperplasia

Introduction: The aim of this study was to investigate the effect of TURP on erectile function (EF) and ejaculatory function (EJF). Methods: A total of 91 patients who underwent TURP were retrospectively assessed. Patients were divided into two groups based on International Index of Erectile Function (IIEF-5): group A included 41 patients with normal EF, and group B included 50 patients with erectile dysfunction (ED). All patients were evaluated for EF and EJF at baseline, 1, 3, and 6 months after TURP by using IIEF-5, Ejaculatory Domain-Male Sexual-Health Inventory (Ej-MSHQ). Results: In group A, there were no significant statistical differences in mean IIEF-5 at baseline and after TURP 22.88 ± 0.81 versus 22.63 ± 2.63 (p = 0.065). However, in group B, there was significant improvement in IIEF-5 after TURP all over the follow-up time points in comparison to the baseline (p = <0.001). The loss of EJF was significant among patients in group A. There was significant improvement of IPSS and Qmax in group A after surgery compared to group B. Conclusion: The results confirmed that TURP has no significant negative influence on EF, and patients with preexisting ED were improved after TURP. On the contrary, the loss of EJF was significant.

The success of dorsal onlay buccal mucosal graft urethroplasty in challenging urethral stricture cases after multiple failed urethrotomies.

Urethroplasty is the gold standard treatment procedure for male patients with urethral stricture and is becoming increasingly popular among urologists worldwide. Procedure success rates have risen with increased experience. Here we aimed to examine the results of urethroplasty in challenging cases of urethral stricture and its effect on sexual function. Data were collected retrospectively from the patients who had undergone urethroplasty after multiple failed direct vision internal urethrotomy (DVIUs) from 2017 to 2020. All patients were monitored for a minimum of 12 months. Outcomes of urethroplasty were analyzed according to stricture location, length, and the number of prior DVIUs. Penile length and sensation, erectile, and ejaculatory function of the patients were evaluated pre- and postoperatively. The patient cohort consisted of 36 males with a mean age of 63 ± 3.2 years. The most prevalent stricture etiology was iatrogenic (83%). Patients who underwent three or more DVIUs before urethroplasty and stricture length >4 cm were included in the analysis. Accordingly, the overall success rate was 83% (30/36). When the success rate and the IIEF5 scores were assessed separately, there was no significant relationship between the number of DVIUs (P > 0.05). Similarly, no significant relationship was also found with the stricture length (P > 0.05). Appropriate and correctly applied surgical technique does not impair sexual activity, even in patients with severe urethral stricture, regardless of the length or location of the stricture and the number of prior endoscopic procedures.

Rezūm therapy for ≥80-mL benign prostatic enlargement: a large, multicentre cohort study.

To evaluate the efficacy and safety of Rezūm therapy in benign prostatic hyperplasia (BPH) patients with prostates ≥80 mL. A prospective registry was established at two high-volume Canadian centres. Patients had baseline medical history documented, and uroflowmetry and questionnaire results were recorded over 12 months. Eighty-three patients (median [interquartile range {IQR}] age 69.2 [63.2, 74.8] years) with a prostate size ≥80 mL were included. The median (IQR) prostate volume was 100.0 (88.5, 115.0) mL and 65% had a median lobe. Twenty-one patients had prior urinary retention. The median (IQR) number of injections was 13 (11, 15) and catheterization duration was 9 (7, 14) days. International Prostate Symptom Scores (IPSSs) improved by 24%, 57% and 59% at 1, 3 and 12 months, respectively (P < 0.001). IPSS Quality of Life (QoL) scores improved by 27%, 56% and 70% at these same timepoints (P < 0.001). Maximum urinary flow rate improved by 55% at 3 months (P = 0.002) and 59% at 12 months, and post-void residual urine volume improved by 58% at 3 months (P = 0.006). BPH Impact Index scores improved by 57% at 3 months and 71% at 12 months. International Index of Erectile Function-15 scores improved by 15% at 6 months, and Male Sexual Health Questionnaire for Ejaculatory Dysfunction scores improved by 22.4% at 1 month. Three patients (3.6%) noted reduced/anejaculation. No events of Clavien-Dindo grade III or higher occurred. This study demonstrates, for the first time, the safety and efficacy of Rezūm therapy in large glands >80 mL. IPSS improved by 59% and IPSS QoL score improved by 70% at 12 months. Objective maximum urinary flow measures improved at 12 months by 59%, while erectile and ejaculatory function remained preserved.

Assessment of erectile and ejaculatory functions after bladder-sparing therapy against muscle-invasive bladder cancer

ABSTRACT Introduction Radical cystectomy (RC) is still gold standard for muscle invasive bladder cancer (MIBC). Whereas, bladder-sparing therapy with transurethral resection of bladder tumor (TUR) and chemoradiation therapy (CRT) has been recognized as an alternative treatment to RC for selected patients with MIBC. We have developed and implemented tetra-modality bladder-sparing therapy (TeMT) incorporating partial cystectomy (PC) in addition to maximal TUR and induction CRT to overcome local recurrence after bladder-sparing therapy (Kageyama et al. Am J Clin Oncol 2003, Koga et al. BJU Int 2012, Kijima et al. BJU Int 2019). There are few studies on erectile and ejaculatory functions after bladder-sparing therapy. Objective To cross-sectionally survey erectile and ejaculatory functions after TeMT in patients with MIBC. Methods Of the total 117 male patients with MIBC who completed TeMT between 2006 and 2019, 70 patients were set as the target to distribute the questionnaires after excluding patients lost to follow up as of February 2020, patients with local recurrence of MIBC or additional prostate cancer treatment. Erectile function was assessed using the International Index of Erectile Function short form (IIEF-5), and ejaculatory function using Male Sexual Health Questionnaire Ejaculatory Dysfunction short form (MSHQ-EjD-SF). Attending physicians handed the questionnaires to the patients at the first regular outpatient visit after February 2020 and had the patients complete them outside the office. Results Of 44 patients received the questionnaires between February and August 2020, 35 completed the questionnaires. The median age (range) of the eligible patients was 70 (50-87) years old, and the median time from the date of PC to the date of response was 5.2 (0.35-14) years. The results of IIEF-5 showed that 3 (9%) had no erectile dysfunction (ED) (22-25 points), 9 (26%) had mild ED (17-21 points), 4 (11%) had mild to moderate ED (12-16 points), 4 (11%) had moderate ED (8-11 points), and 15 (43%) had severe ED (5-7 points). Based on the results of MSHQ-EjD-SF, 23 patients (66%) responded that they could ejaculate. Of those, 5 patients (14%) scored 4 or higher on all questions 1-3 of MSHQ-EjD-SF, suggesting that they did not have ejaculatory dysfunction. Conclusions Preservation of erectile and ejaculatory functions was observed in MIBC patients treated with bladder-sparing therapy. Along with that of lower urinary tract function, preservation of male sexual function in bladder-sparing therapy, especially ejaculatory function which is inevitably lost by RC, is considered to be an advantage over RC. Disclosure Work supported by industry: no.

Evaluation of ejaculation function using a simple questionnaire

ABSTRACT Introduction There is a wide range of problems associated with ejaculation, including decreased semen volume, vaginal ejaculation problems, premature ejaculation, delayed ejaculation, hematospermia, and pain associated with ejaculation. However, there is no simple questionnaire that can comprehensively evaluate these ejaculatory functions. Objective In this study, we evaluated the overall ejaculation function of the patients in question using an originally developed ejaculation function score (Kimura and Shoji's Ejaculation Function Score). Methods We examined 20 patients who visited our sexual function outpatient clinic with a chief complaint of ejaculation. As a control group, we also examined 20 patients who had undergone vasectomy using the same score. The questionnaire consisted of the following five items (1) Awareness of sufficient momentum, (2) Pleasant sensation during ejaculation, (3) Presence of pain associated with ejaculation, (4) Presence of blood in semen, and (5) Perception of decreased semen volume. The total score was also evaluated. In addition, satisfaction with the current ejaculation was assessed. Results The mean age of the ejaculation disorder group was 43.5±15.1 years. The main complaints were decreased semen volume in 7 cases (35%), vaginal ejaculation disorder in 6 cases (30%), delayed ejaculation in 2 cases (10%), premature ejaculation in 2 cases (10%), lack of orgasm in 1 case (5%), and pain associated with ejaculation in 1 case (5%). The mean scores for each item were 1.5 for item 1, 1.8 for item 2, 3.0 for item 3, 3.0 for item 4, and 2.0 for item 5, resulting in a mean total score of 11.2. On the other hand, the mean age of the vasectomy group was 42.0±9.4 years, item 1 was 2.8, item 2 was 2.9, item 3 was 3.0, item 4 was 3.0, item 5 was 2.9, and the mean total score was 14.6. When the two groups were compared, significant differences were found except for items 3 and 4. There was also a significant difference in satisfaction of present ejaculation with mean scores of 1.3 and 2.9. As a result of examining the clinical severity and the total score, the total score of 5-6 was considered severe, 7-9 moderate, 10-13 mild ejaculation disorder, and 14-15 within the normal range. Conclusion Although our ejaculation function score is still in the developmental stage, we believe that it can be a screening tool for ejaculation function in practical medical care and self-assessment. Disclosure Work supported by industry: no.

MP22-02 MODIFIED USS PROM FOR DVIU AND NON TRANSECTING URETHROPLASTY FOR SHORT BULBAR URETHRAL STRICTURES

You have accessJournal of UrologyCME1 May 2022MP22-02 MODIFIED USS PROM FOR DVIU AND NON TRANSECTING URETHROPLASTY FOR SHORT BULBAR URETHRAL STRICTURES Arun Chawla, Suraj Jaidev Reddy, and Sitaram Mummalaneni Arun ChawlaArun Chawla More articles by this author , Suraj Jaidev ReddySuraj Jaidev Reddy More articles by this author , and Sitaram MummalaneniSitaram Mummalaneni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the patient reported outcomes of Primary Direct visual internal urethrotomy (DVIU) and Non-transecting bulbar urethroplasty techniques (NTBU) for short segment (<2 cm) Non Traumatic bulbar urethral strictures using the Modified Urethral Stricture Surgery Patient Reported Outcome Measures (USS PROM). METHODS: The USS PROM questionnaire comprising of a six-item LUTS domain, a LUTS-specific QOL question, and a Peeling’s voiding picture score was further modified by adding a six-item IIEF and four-item version of MSHQ-EjD to evaluate Erectile and Ejaculatory domains. All cases of short non traumatic bulbar urethral stricture who underwent primary DVIU and NTBU who consented were asked to fill the modified PROM (USS -PROM+ IIEF +MSHQ-EjD) at initial evaluation, at 6 months and at 1 year. RESULTS: The LUTS score for NTBU at 12 months is significantly better (p=0.000). The Peeling score of the NTBU is significant better at 6 months (p=0.000) and 12 months (p=0.000). Erectile function score at 12 months for NTBU is significantly better than DVIU (p=0.001). The Ejaculatory function score at 6 months and 12 months is significantly better for the NTBU. Uroflowmetry (Qmax) is significant in NTBU group at 12 months (p =0.000). ROC AND Odd’s Ratio analysis for analyzing patient satisfaction showed Erectile function (AUROC-0.889, p <0.001), Ejaculatory function (AUROC-0.957, p <0.001) at 1 year and Qmax (AUROC-0.928, p <0.001) at 6 months and (AUROC-1.000, p <0.001) at 1year. Overall satisfaction rates in patients undergoing NTBU is 96.5%. CONCLUSIONS: NTBU shows superior outcomes in almost all domains of USS- PROM with better overall satisfaction rates. Improvement of Sexual function domain followed by the LUTS domain were the best predictors of overall patient satisfaction and improvement in the quality of life at one year. TABLE 2-Statistical Analysis Of Variables: Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e371 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arun Chawla More articles by this author Suraj Jaidev Reddy More articles by this author Sitaram Mummalaneni More articles by this author Expand All Advertisement PDF DownloadLoading ...

Ejaculation profiles in men after irreversible electroporation for prostate cancer

ABSTRACT Introduction Irreversible Electroporation (IRE) is an evolving strategy for the management of localized prostate cancer. Little data exists on sexual function, in particular ejaculation, in such patients. Objective We aimed to report the ejaculatory function in patients undergoing IRE. Methods Patients undergoing IRE with ≥1-year follow-up were evaluated. These patients were selected for focal therapy and consented to participate in a prospective registry. Eligibility criteria: Gleason score 3+4, PSA &amp;lt;20, no evidence of extracapsular extension, seminal vesicle invasion or lymph node involvement on standard imaging. The Gleason score 3+4 prostate cancer was allowed up to a maximum of two adjacent sextants within the prostate gland. Concomitant Gleason score 6 was untreated and monitored on active surveillance. They completed the Male Sexual Health Questionnaire ejaculation domain short form (MSHQ-EFD-SF) at 6 weeks, 3 months, 6 months, and 12 months post-IRE. This questionnaire has 4 questions: 3 questions sum scores (range 1-15), where lower scores indicate worse ejaculatory function, and the MSHQ-Bother question score (ranges 0-5), with higher scores indicating higher bother associated with ejaculatory difficulties. Comorbidities, demographics, and pathology parameters were recorded. Results 20 men have been evaluated to date with a mean age of 64.3 ± 4.8 years. Baseline testosterone and PSA were 536.3 ± 267.6 ng/dL and 6.2 ± 2.7 ng/mL. Mean prostate volume was 45.6 ± 11.9 cc. Median baseline score of MSHQ-EJD-SF was 13.5 (IQR 10, 14), and post-procedure median scores were 11 at 6 weeks; 12.5 at 3 months; 12 at 6 months; and 11.5 at 12 months (p-value =0.036). Scores for ejaculation strength and seminal volume ejaculated decreased significantly, and bother scores increased significantly between baseline and 1-year post-IRE. The ability to ejaculate during sexual activity did not change over time. Conclusions In our cohort of patients with prostate cancer who underwent IRE there was a significant difference in ejaculatory profiles between baseline and 1-year post-IRE. Disclosure Work supported by industry: no.

PD45-12 SEXUAL AND FUNCTIONAL OUTCOMES AFTER TRANS-URETHRAL INCISION OF THE PROSTATE: A LONG TERM FOLLOW UP ANALYSIS

You have accessJournal of UrologyCME1 May 2022PD45-12 SEXUAL AND FUNCTIONAL OUTCOMES AFTER TRANS-URETHRAL INCISION OF THE PROSTATE: A LONG TERM FOLLOW UP ANALYSIS Riccardo Lombardo, Antonio Maria Cicione, Antonio Nacchia, Carmen Gravina, Beatrice Turchi, Jordi Stira, Simone D'Annunzio, Lorenzo Maria Rivesti, Alessandro Guercio, Giorgio Guarnotta, Antonio Franco, Giacomo Gallo, Elisa Mancini, Olivia Alessandra Voglino, Valeria Baldassarri, Sara Riolo, Andrea Tubaro, and Cosimo De Nunzio Riccardo LombardoRiccardo Lombardo More articles by this author , Antonio Maria CicioneAntonio Maria Cicione More articles by this author , Antonio NacchiaAntonio Nacchia More articles by this author , Carmen GravinaCarmen Gravina More articles by this author , Beatrice TurchiBeatrice Turchi More articles by this author , Jordi StiraJordi Stira More articles by this author , Simone D'AnnunzioSimone D'Annunzio More articles by this author , Lorenzo Maria RivestiLorenzo Maria Rivesti More articles by this author , Alessandro GuercioAlessandro Guercio More articles by this author , Giorgio GuarnottaGiorgio Guarnotta More articles by this author , Antonio FrancoAntonio Franco More articles by this author , Giacomo GalloGiacomo Gallo More articles by this author , Elisa ManciniElisa Mancini More articles by this author , Olivia Alessandra VoglinoOlivia Alessandra Voglino More articles by this author , Valeria BaldassarriValeria Baldassarri More articles by this author , Sara RioloSara Riolo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , and Cosimo De NunzioCosimo De Nunzio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Long term data on functional and sexual outcomes after transurethral monoliteral incision of the prostate is poor. Aim of our study is to evaluate long term functional and sexual outcomes in patients undergoing transurethral incision of the prostate (TUIP). METHODS: A retrospective analysis of patients with LUTS and undergoing TUIP in our centre between 2011 and 2016 was performed. All patients underwent monolateral incision of the prostate. Demographic and clinical data was recorded. All patients were reassessed in September 2021 with medical history, IPSS, PSA, maximal urinary flow rate (Qmax), post void residual urine (PVR). Erectile function was evaluated with the SHIM score and ejaculatory function with sfMSHQ score. Reoperated patients were excluded from the analysis. RESULTS: Overall 92 patients were enrolled with a median age of 53 years and a median PV of 27 cc. Median follow up was 75 months. At end of follow up median IPSS was 9 (6/13), median PSA was 0,6 (0,51/0,89) and median Qmax was 15 (12/17). Moderate/severe symptoms (IPSS>8) were recorded in 59/92 (64%) patients and poor flow in 40/92 (44%). Moreover 6 (7%) patients required reintervention and 25/92 (25%) were on medications. Regarding sexual function median SHIM score was 22 (16/25) and median MSHQsf was 14 (12/15). Moreover only 6/92 (7%) patients presented aneiaculation. None of the preoperative variable was find to be a predictor of poor outcome. CONCLUSIONS: According to our single center study, patients after monolateral TUIP a have a good sexual function even in the long term. However, half of the patients present moderate symptoms and poor flow. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e787 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Lombardo More articles by this author Antonio Maria Cicione More articles by this author Antonio Nacchia More articles by this author Carmen Gravina More articles by this author Beatrice Turchi More articles by this author Jordi Stira More articles by this author Simone D'Annunzio More articles by this author Lorenzo Maria Rivesti More articles by this author Alessandro Guercio More articles by this author Giorgio Guarnotta More articles by this author Antonio Franco More articles by this author Giacomo Gallo More articles by this author Elisa Mancini More articles by this author Olivia Alessandra Voglino More articles by this author Valeria Baldassarri More articles by this author Sara Riolo More articles by this author Andrea Tubaro More articles by this author Cosimo De Nunzio More articles by this author Expand All Advertisement PDF DownloadLoading ...

Involvement of histamine H3 receptor agonism in premature ejaculation revealed by a novel evaluation system

ABSTRACT Introduction Premature ejaculation (PE) has been defined by the International Society for Sexual Medicine (ISSM) as follows: men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Although local anesthetics and serotonin selective reuptake inhibitors (SSRIs) have been mainly used for the treatment of PE, there are several safety concerns and weak efficacy. To date, there have been no pharmacological treatments for PE approved by the Food and Drug Administration (FDA) in the United States. Therefore, there is still a need for the development of novel therapeutics that have sufficient efficacy and fewer side effects. We identified Histamine H3 receptor (H3R) as a potential target for treatment of PE. It is well known that H3R is mainly expressed by neuronal cells of the central nervous system, but its expression on peripheral nerves, especially Aβ sensory nerves, has also been reported. Activation of H3R in peripheral sensory neurons has been reported to inhibit mechanical stimulation-induced pain. This suggests that H3R stimulation can suppress neural activity induced by mechanical stimulation in the penis, but there have been no reports on the role of H3R in ejaculation function, and its mechanism of action is unknown. Objective In order to characterize the role of H3R in ejaculation prolongation, electrophysiological and behavioral studies were performed with imetit (H3R agonist) and ciproxifan (H3R antagonist) in male rats. Methods We developed a novel electrophysiological evaluation system for analyzing the spinal-penile neurotransmission mechanism, investigated the effects of imetit on penile neurotransmission. Also, we evaluated the effect of imetit on mechanical stimuli induced neuronal firing at genitofemoral nerve. For evaluating the effects of imetit for ejaculation, we used the copulatory behavior test in order to directly measure ejaculation latency (EL), which is a primary endpoint in clinical trial. Results In vivo electrophysiological study, imeit significantly attenuated the mechanical stimuli induced firing at spinal dorsal horn in a novel evaluation system. This inhibitory effect of imetit was also observed at genitofemoral nerve. Inhibition on firing was significantly inhibited by ciproxifan, but not inhibited by H4R antagonist. In the copulatory behavior test, imetit showed a strong prolongation effect on EL. This effect was significantly inhibited by ciproxifan. Conclusions These results suggest that stimulation of H3R suppresses the mechanical stimuli induced neuronal firing on spinal-penile neurotransmission system, resulting in prolongation of ejaculation latency. H3R agonist is expected as a new treatment for PE. Disclosure Work supported by industry: yes, by Mitsubishi Tanabe Pharma Corporation. A consultant, employee (part time or full time) or shareholder is among the authors (Mitsubishi Tanabe Pharma Corporation).

V10-07 NEAR-INFRARED FLUORESCENCE IMAGING TECHNOLOGY APPLICATIONS IN UROLOGIC SURGERY

You have accessJournal of UrologyCME1 May 2022V10-07 NEAR-INFRARED FLUORESCENCE IMAGING TECHNOLOGY APPLICATIONS IN UROLOGIC SURGERY Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, and Giuseppe Simone Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical applications of near-infrared fluorescence (NIRF) with Indocyanine green (ICG) technology are rapidly growing. Potential improvements especially for functional outcomes have been described in different urologic procedures. In this video we highlights our experience with multiple clinical applications of NIRF-ICG technology in distinct urologic procedures. METHODS: In this video we collected multiple clinical applications of NIRF technology: ICG-marking of totally endophytic renal tumors selected for partial nephrectomy, assessment of thrombus extent during level III IVC tumor thrombectomy, identification of functioning adenomas during adrenal surgery, assessment of ureteral vascularization during robot assisted radical cystectomy and during ureteral reimplantation, identification of urethra and ejaculatory ducts during Madigan prostatectomy. RESULTS: First, NIRF-ICG technique was demonstrated useful to mark endophytic renal tumors in patients selected for purely off-clamp robotic partial nephrectomy. Lipiodol indocyanine green mixture was selectively delivered in the tertiary ordered arteries feeding the tumor. In this way, the use of NIRF imaging allow to easily recognize endophytic renal tumor. Therefore, parenchyma incision, margins scoring and deep part of enucleation were performed under NIRF imaging. Secondly, intravenous injection of ICG was used during robot-assisted radical nephrectomy with level III IVC tumor thrombectomy in order to better define thrombus boundaries, to control cranial IVC thrombus edge, to expect IVC lumen and to confirm proper restoration of IVC flow. Then, NIRF-ICG technology was used to easily identify hypervascularized adrenal mass during robotic partial adrenalectomy and to evaluate proper perfusion of distal ureters both during RARC and robot-assisted ureteral reimplantation. Finally, NIRF-ICG technology was reported as an essential tool during robot-assisted Madigan prostatectomy when ejaculation preservation is planned. A retrograde injection of ICG throw the urethral catheter placed on navicular fossa allowed to easily recognize proximal prostatic urethra, and therefore to preserve ejaculatory function avoiding unintended violation of the urinary tract. CONCLUSIONS: NIRF-ICG technology sounds a safe and feasible procedure. This technique allows to easy identify key anatomical landmarks, providing information about tissue vasculature and perfusion. NIRF-ICG technique demonstrated to potentially improve functional outcomes of robotic procedures even if larger series with longer follow-up are needed. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e850 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP46-04 10-YEAR EXPERIENCE WITH MIDLINE EXTRAPERITONEAL RETROPERITONEAL LYMPH NODE DISSECTION

You have accessJournal of UrologyCME1 May 2022MP46-04 10-YEAR EXPERIENCE WITH MIDLINE EXTRAPERITONEAL RETROPERITONEAL LYMPH NODE DISSECTION Muhannad Alsyouf, Sanam Ladi Seyedian, Arman Ashrafi, Hamed Ahmadi, Madeleine Burg, Alireza Ghoreifi, Antoin Douglawi, Sumeet Bhanvadia, Anne Schuckman, Hooman Djaladat, and Siamak Daneshmand Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Sanam Ladi SeyedianSanam Ladi Seyedian More articles by this author , Arman AshrafiArman Ashrafi More articles by this author , Hamed AhmadiHamed Ahmadi More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Antoin DouglawiAntoin Douglawi More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002612.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A midline extraperitoneal approach for retroperitoneal lymph node dissection (EP-RPLND) has demonstrated significantly decreased morbidity compared to a transperitoneal approach. We aimed to review our 10-year experience in patients with germ cell tumors (GCT) who underwent EP-RPLND at USC. METHODS: All patients with GCT who underwent EP-RPLND between 2010 and 2021 were reviewed. All patients were considered for EP-RPLND except for men undergoing aortic resection, extensive retrocrural dissection, or intraperitoneal resection. Perioperative and long-term outcomes were analyzed including recurrence rates and patterns. Ileus was defined as nausea/vomiting requiring nasogastric decompression. Mann-Whitney U and Chi-square tests were used for univariate analysis, with p<0.05 considered significant. RESULTS: Overall, 172 patients underwent EP-RPLND, of which 73% were performed in the post-chemotherapy (PC) setting. Median size of radiologic retroperitoneal disease was 3.2 cm (IQR 2 – 5.4), of which 12 cases were >10 cm. Median number of lymph nodes resected was 29 (IQR 17–39). There were no cases of postoperative ileus, and median hospital stay was 2 (IQR 1-3) days (Table 1). In the PC group, 23% underwent adjunct procedures including: vascular reconstruction (10), cavectomy (9), nephrectomy (8), ureteral resection (3), retrocrural dissection (2), suprahilar dissection (1), neck dissection (2), iliac vessel resection (2), & bone biopsy (1). Twenty three patients experienced 24 (13.5%) 90-d complications. In patients who underwent nerve-sparing, 86.9% maintained antegrade ejaculatory function. Out of 18 patients who experienced disease recurrence at a median of 4.4 mo, 4 were in-field recurrences (Table 2). CONCLUSIONS: Midline extraperitoneal approach for RPLND in GCT is safe, associated with rapid gastrointestinal recovery, short hospital stay, and low complication rates. It also demonstrates acceptable oncologic outcomes in the primary and post-chemotherapy settings, even when adjunct procedures are necessitated. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e773 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muhannad Alsyouf More articles by this author Sanam Ladi Seyedian More articles by this author Arman Ashrafi More articles by this author Hamed Ahmadi More articles by this author Madeleine Burg More articles by this author Alireza Ghoreifi More articles by this author Antoin Douglawi More articles by this author Sumeet Bhanvadia More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Modified Procedure to Diagnose Erectile Dysfunction Using the International Index of Erectile Function (IIEF-6) Combined With the Premature Ejaculation Diagnosis Tool (PEDT) via an Internet Survey.

BackgroundThe reliability of the International Index of Erectile Function (IIEF-5) in diagnosing erectile dysfunction (ED) is significantly decreased for the population with premature ejaculation (PE).AimWe aimed to illustrate a better way of diagnosing ED among the general population through a web survey study.MethodsWe collected online surveys from 2,746 men between the ages of 18 and 65. Two methods were used to determine the prevalence of ED, and these 2 methods were compared. Additionally, we divided our sample into 2 equally sized groups by median age and repeated the analyses for each group. In Method Ⅰ (M Ⅰ), men with an IIEF-5 score ≤ 21 were diagnosed with ED. In Method Ⅱ (M Ⅱ), PE was defined as a PEDT score ≥ 9, and no-PE was defined as a PEDT score ≤ 8. We used an IIEF-6 score cutoff of ≤ 24 among the PE population and a cutoff of ≤ 25 among the no-PE population to diagnose ED.Main outcome measuresWe examined the results from the IIEF-5, PEDT, and IIEF-6.ResultsOf the 2,746 men, 1,540 were in a stable heterosexual relationship, and the prevalence of ED among these men was determined. The prevalence of ED, as measured by Method Ⅰ, was significantly higher than that measured by Method Ⅱ. The kappa coefficients between the 2 methods were 0.595, 0.704, and 0.430 for the overall, no-PE, and PE populations, respectively. The internal consistency of the IIEF-5 for the PE population increased if Question 5 (intercourse satisfaction) was removed. Similar trends were observed for the groups, and there were no substantial differences.Clinical implicationsOur research suggests that before using the erectile function assessment scale to evaluate erectile function, ejaculatory function should be assessed with the PEDT.Strengths and limitationsThis was the first study to highlight the importance of evaluating ejaculatory function using the PEDT before diagnosing ED via an internet survey. There may have been recruitment bias because our study was an internet survey.ConclusionEstablishing the prevalence of ED by using a combination of the IIEF-6 and PEDT was more reliable than using the IIEF-5 alone. Further validation of the modified procedure, especially regarding the effects of age on the results, in future studies is required.Wang C, Zhang H, Liu Z, et al. A Modified Procedure to Diagnose Erectile Dysfunction Using the International Index of Erectile Function (IIEF-6) Combined With the Premature Ejaculation Diagnosis Tool (PEDT) via an Internet Survey. Sex Med 2022;10:100506.

Ejaculation Profiles in Men after Irreversible Electroporation for Prostate Cancer

ABSTRACT Introduction Irreversible Electroporation (IRE) is an evolving strategy for the management of localized prostate cancer. Little data exists on sexual function, in particular ejaculation, in such patients. Objective We aimed to report the ejaculatory function in patients undergoing IRE. Methods Patients undergoing IRE with ≥1-year follow-up were evaluated. These patients were selected for focal therapy and consented to participate in a prospective registry. Eligibility criteria: Gleason score 3+4, PSA &amp;lt;20, no evidence of extracapsular extension, seminal vesicle invasion or lymph node involvement on standard imaging. The Gleason score 3+4 prostate cancer was allowed up to a maximum of two adjacent sextants within the prostate gland. Concomitant Gleason score 6 was untreated and monitored on active surveillance. They completed the Male Sexual Health Questionnaire ejaculation domain short form (MSHQ-EFD-SF) at 6 weeks, 3 months, 6 months, and 12 months post-IRE. This questionnaire has 4 questions: 3 questions sum scores (range 1-15), where lower scores indicate worse ejaculatory function, and the MSHQ-Bother question score (ranges 0-5), with higher scores indicating higher bother associated with ejaculatory difficulties. Comorbidities, demographics, and pathology parameters were recorded. Results 20 men have been evaluated to date with a mean age of 64.3 ± 4.8 years. Baseline testosterone and PSA were 536.3 ± 267.6 ng/dL and 6.2 ± 2.7 ng/mL. Mean prostate volume was 45.6 ± 11.9 cc. Median baseline score of MSHQ-EJD-SF was 13.5 (IQR 10, 14), and post-procedure median scores were 11 at 6 weeks; 12.5 at 3 months; 12 at 6 months; and 11.5 at 12 months (p-value =0.036). Scores for ejaculation strength and seminal volume ejaculated decreased significantly, and bother scores increased significantly between baseline and 1-year post-IRE. The ability to ejaculate during sexual activity did not change over time. Conclusions In our cohort of patients with prostate cancer who underwent IRE there was a significant difference in ejaculatory profiles between baseline and 1-year post-IRE. Disclosure No

Effect of partial preservation versus complete preservation of Denonvilliers’ fascia on postoperative urogenital function in male patients with low rectal cancer (PREDICTION): protocol of a multicentre, prospective, randomised controlled clinical trial

IntroductionTotal mesorectal excision (TME) has been the gold standard for the surgical treatment of mid-low rectal cancer, but traditional TME removal of Denonvilliers’ fascia (DVF) is too low and is...

The importance of inquiring the ejaculation function in men with premature ejaculation who do not actively seek treatment.

To evaluate the clinical characteristics of men presenting for other complaints whose ejaculatory function inquiry indicated premature ejaculation (PE). The data of 536 PE patients, including those who presented with the complaint of PE (group 1) and those presenting with other complaints who were diagnosed with PE (group 2) as a result of ejaculatory function inquiry using estimated intravaginal ejaculation latency time (IELT) and Premature Ejaculation Diagnostic Tool (PEDT), were retrospectively evaluated. Age, PE type, comorbidities, recommended treatments, and treatment acceptance status of all patients were recorded. These characteristics were compared for each group. Among all the patients, those who presented with PE complaints constituted 22.4%. Among the patients with both PE and ED, 98.1% applied with ED complaint and only 1.9% with PE complaint. The percentage of patients with one comorbidity was significantly higher in group 2 (p = 0.032). 90.1% of all patients and 88.5% of patients in group 2 accepted the recommended treatment for PE. The mean age and comorbidities were significantly higher in patients that refused the treatment. The most common reason for treatment refusal was the patients' lack of expectation for treatment. This study shows that men more frequently tend to seek treatment for ED than PE, and treatment acceptance rate may be higher when the patients with PE complaints who don't seek treatment are reached through ejaculatory function inquiry. The presence of comorbidities negatively affects the treatment expectation and acceptance as well as treatment seeking behavior of men with PE.

Ejaculatory Function Following Stereotactic Body Radiation Therapy for Prostate Cancer

Ejaculatory dysfunction is an important male quality of life issue which has not yet been studied in the setting of prostate stereotactic body radiation therapy (SBRT). The purpose of this study is to evaluate ejaculatory function following SBRT for prostate cancer. Two hundred and thirty-one patients on a prospective quality of life study with baseline ejaculatory capacity treated with prostate SBRT from 2013 to 2019 were included in this analysis. Ejaculation was assessed via the Ejaculation Scale (ES-8) from the Male Sexual Health Questionnaire. Patients completed the questionnaire at 1, 3, 6, 9, 12, 18, and 24 months post-SBRT. Elderly patients (Age > 70) and those who received hormonal therapy were excluded from analysis. Patients were treated to 35-36.25 Gy in 5 fractions delivered with theCyberKnifeRadiosurgical System (Accuray). Ejaculatory function was assessed by ES-8 scores (range 4-40) with lower values representing increased interference or annoyance. Median age at the time of treatment was 65 years. Median follow up was 24 months (IQR 19-24.5 months). 64.5% of patients had ED at baseline (SHIM < 22). The 2-year anejaculation rate was 15%. Mean composite ES-8 scores showed a decline in the first month following treatment then stabilized: 30.4 (start of treatment); 26.5 (1 month); 27.6 (3 month); 27.0 (6 month); 26.2 (9 month); 25.4 (12 month); 25.0 (18 month) and 25.4 (24 month). White race, higher pre-treatment SHIM (≥22), and higher ES-8 (≥31) at treatment start were significantly associated with a decreased probability of a clinically significant decline. Patient-reported ejaculate volume was significantly reduced at all time points post-SBRT. Ejaculatory discomfort peaked at 1 month and 9 months post-SBRT. Prior to treatment, 8.0% of men reported that they were very to extremely bothered by their ejaculatory dysfunction. The number of patients reporting this concern increased to 14.4% at one year and dropped to 11% at 24-months post-SBRT. Patients undergoing prostate SBRT may experience meaningful changes in ejaculatory function and should be counseled on the trajectory of these side effects. This was a retrospective analysis of a prospectively maintained database. Subjective questionnaire responses captured limited aspects of ejaculatory function in this cohort. The high incidence of moderate to extreme bother in ejaculatory function before and after SBRT suggests a need for novel approaches to improving ejaculation. Sholklapper T, Creswell M, Cantalino J, etal. Ejaculatory Function Following Stereotactic Body Radiation Therapy for Prostate Cancer. J Sex Med 2022;19:771-780.

Minimally invasive retroperitoneal lymph node dissection for men with testis cancer: a retrospective cohort study of safety and feasibility

To describe the perioperative safety, functional and immediate post-operative oncological outcomes of minimally invasive RPLND (miRPLND) for testis cancer. We performed a retrospective multi-centre cohort study on testis cancer patients treated with miRPLND from 16 institutions in eight countries. We measured clinician-reported outcomes stratified by indication. We performed logistic regression to identify predictors for maintained postoperative ejaculatory function. Data for 457 men undergoing miRPLND were studied. miRPLND comprised laparoscopic (n = 56) or robotic (n = 401) miRPLND. Indications included pre-chemotherapy in 305 and post-chemotherapy in 152 men. The median retroperitoneal mass size was 32mm and operative time 270min. Intraoperative complications occurred in 20 (4%) and postoperative complications in 26 (6%). In multivariable regression, nerve sparing, and template resection improved ejaculatory function significantly (template vs bilateral resection [odds ratio (OR) 19.4, 95% confidence interval (CI) 6.5-75.6], nerve sparing vs non-nerve sparing [OR 5.9, 95% CI 2.3-16.1]). In 91 men treated with primary RPLND, nerve sparing and template resection, normal postoperative ejaculation was reported in 96%. During a median follow-up of 33months, relapse was detected in 39 (9%) of which one with port site (< 1%), one with peritoneal recurrence and 10 (2%) with retroperitoneum recurrences. The low proportion of complications or peritoneal recurrences and high proportion of men with normal postoperative ejaculatory function supports further miRPLND studies.

Does a 55-year-old Male with Lower Urinary Tract Symptoms and a 50-ml Gland Have To Decide Between Ejaculation and Voiding Function?

Treatment of lower urinary tract symptoms secondary to benign prostatic obstruction may affect ejaculatory function. However, preservation of ejaculation via minimally invasive surgical therapies might impair the long-term durability of voiding improvement.

BGIG10116_34868: A Newly Discovered Gene Regulating Ejaculation Function.

Ejaculation is a complex biphasic process involving a series of neurophysiological activities, such as the contraction of a large number of muscle groups and the ejaculation of semen from the urethra anterior. Due to the complexity of the process, many related factors have not been fully clarified, resulting in ejaculation dysfunction. As a common ejaculation dysfunction, lifelong premature ejaculation (LPE) is a problem for many people. Notably, gene polymorphism might play an important role in the etiology of LPE. However, the quest for identifying the actual genetic loci that contribute to LPE etiology has not been successful. Due to discrepancies in the design and methods of research, the correlation of most reports was not obtained in subjective replication experiments, and the conclusions may be inconsistent. In our study, three groups of ejaculation rats, namely, “rapid, normal, and delayed,” were selected based on the animal model of premature ejaculation (PE) in rats and the theory of ejaculation. Among them, the rats in the “rapid” ejaculation group can be used to stimulate humans with PE. Subsequently, we used the rat brain tissue for whole-transcriptome sequencing to screen the differential genes among the three groups. We tried to identify the actual genetic loci that contribute to PE etiology and provide a theoretical basis for the targeted therapy of PE.