Erectile Quality Research Articles

Trends, safety, and efficacy of wearable male sexual devices.

The prevalence of male sexual dysfunction (MSD) increases with age, with >50% of men aged >40years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been increasingly utilized by patients and recommended by sexual medicine clinicians. This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were based on patient reviews, cost, and specific features. Investigatory evidence and Food and Drug Administration status were also reviewed. Additionally, Google Trends was used to determine the popularity of devices over time. Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the RigiScan, the Adam sensor provides feedback on erectile quality while monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices such as the Morari Patch and vPatch/in2 Patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Overall, this review describes the available investigatory evidence for a range of WMSDs and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients.

Research Advances in Stem Cell Therapy for Erectile Dysfunction.

Erectile dysfunction (ED) is a common clinical condition that mainly affects men aged over 40 years. Various causes contribute to the progression of ED, including pelvic nerve injury, diabetes, metabolic syndrome, age, Peyronie's disease, smoking, and psychological disorders. Current treatments for ED are limited to symptom relief and do not address the root cause. Stem cells, with their powerful ability to proliferate and differentiate, are a promising approach for the treatment of male ED and are gradually gaining widespread attention. Current uses for treating ED have been studied primarily in experimental animals, with most studies observing improvements in erectile quality as well as improvements in erectile tissue. However, research on stem cell therapy for human ED is still limited. This article summarizes the recent literature on basic stem cell research on ED, including cavernous nerve injury, aging, diabetes, and sclerosing penile disease, and describes mechanisms of action and therapeutic effects of various stem cell therapies in experimental animals. Stem cells are also believed to interact with host tissue in a paracrine manner, and improved function can be supported through both implantation and paracrine factors. To date, stem cells have shown some preliminary promising results in animal and human models of ED.

(251) Exploring Trends, Safety, and Efficacy of Wearable Male Sexual Devices: Revolutionizing Intimacy

Abstract Introduction The prevalence of male sexual dysfunction (MSD) increases with age, with greater than 50% of men aged over 40 years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been both increasingly utilized by patients and recommended by sexual medicine clinicians. Objective This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Methods Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were made based on patient reviews, cost, and specific features of each device. Investigatory evidence and FDA status were also reviewed (Figure 1). Additionally, Google Trends was used to determine the popularity of different devices over time (Figure 2). Results Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were found to be the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the Rigiscan, the ADAM sensor provides feedback on erectile quality while also monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices like Morari Patch and vPatch/in2 patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Conclusions Overall, this review describes the available investigatory evidence for a range of WMSDs and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Charles A Loeb, MD - None relevant Muhammad A M Hammad, MBBCh - None relevant David W Barham, MD - None relevant Jake Miller MD - None relevant Kirsten Young, MS - None relevant Rainey Horwitz, MD – Paid collaboration with FirmTech on Instagram Eliad Amini, BS - None relevant Mai Xuan Nguyen, BS - None relevant Nitish Nag, MD, PhD - None relevant Lawrence Jenkins, MD – None relevant Amy M Pearlman, MD – Consultant for/received grant funding from Boston Scientific; consultant for Endo Pharmaceuticals; consultant for FirmTech; investor in ByteMD; influencer in Urology Times Faysal A Yafi, MD – Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(354) Revolutionizing Intimacy: Exploring Trends, Safety, and Efficacy of Wearable Male Sexual Devices

Abstract Introduction The prevalence of male sexual dysfunction (MSD) increases with age, with greater than 50% of men aged over 40 years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been both increasingly utilized by patients and recommended by sexual medicine clinicians. Objective This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Methods Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were made based on patient reviews, cost, and specific features of each device. Investigatory evidence and FDA status were also reviewed (Figure 1). Additionally, Google Trends was used to determine the popularity of different devices over time (Figure 2). Results Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were found to be the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the Rigiscan, the ADAM sensor provides feedback on erectile quality while also monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices like Morari Patch and vPatch / in2 patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Conclusions Overall, this review describes the available investigatory evidence for a range of WMSDs, and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Charles A Loeb, MD - None relevant Muhammad A M Hammad, MBBCh - None relevant David W Barham, MD - None relevant Jake Miller MD - None relevant Kirsten Young, MS - None relevant Rainey Horwitz, MD – Paid collaboration with FirmTech on Instagram Eliad Amini, BS - None relevant Mai Xuan Nguyen, BS - None relevant Nitish Nag, MD, PhD - None relevant Lawrence Jenkins, MD – None relevant Amy M Pearlman, MD – Consultant for/received grant funding from Boston Scientific; consultant for Endo Pharmaceuticals; consultant for FirmTech; investor in ByteMD; influencer in Urology Times Faysal A Yafi, MD – Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

The Association Between Insomnia, Insomnia Medications, and Erectile Dysfunction

BackgroundSleep quality and duration have been investigated for their association with health. Insomnia affects up to one-third of adults and may impact male erectile function. In addition, medical treatments for insomnia (many of which are sedatives) may also affect erectile quality. ObjectiveTo investigate the association of erectile dysfunction (ED) in patients diagnosed with and treated for insomnia. Design, setting, and participantsWe utilized the IBM MarketScan (2007–2016) Commercial and Medicare Supplemental Databases (v 2.0). Age- and enrollment-matched controls were selected among patients without insomnia diagnosis or treatment. Outcome measurements and statistical analysisCox proportional hazard models were used to estimate the risk of incident ED (ie, diagnosis alone, or diagnosis and treatment with phosphodiesterase-5 inhibitors [PDE5i], intracavernous injection (ICI)/urethral suppositories, and penile prosthesis) after the diagnosis or treatment of insomnia while adjusting for relevant comorbidities. Results and limitationsIn total, 539 109 men with an insomnia diagnosis were identified. Of these men, 356 575 were also medically treated for insomnia. The mean (±standard deviation) follow-up times for patients diagnosed with insomnia and those diagnosed with and treated for insomnia were 2.8 ± 1.6 and 3.1 ± 1.8 yr, respectively. Men with insomnia were more commonly smokers and had a higher number of office visits and comorbidities than controls (p < 0.001). On an adjusted analysis, both untreated and treated insomnia were associated with increased risks of ED diagnosis (hazard ratio or HR [95% confidence interval {CI}]: 1.58 [1.54–1.62] and 1.66 [1.64–1.69], respectively; p < 0.001). Similarly, men with treated insomnia had a higher risk of having ED treated with PDE5i (HR [95% CI]: 1.52 [1.49–1.55]; p < 0.001) and ICI (HR [95% CI]: 1.32 [1.14–1.54]; p < 0.001) when compared with controls. A limitation of this study was that a lack of granularity regarding patient clinical characteristics (eg, severity of disease, laboratory data, etc.) is inherent to insurance claims data. In addition, the follow-up was limited and may affect associations at longer time points. ConclusionsIn the current report, a consistent association between insomnia and ED diagnosis was identified. Men diagnosed with insomnia only were found to have a higher risk of developing ED. Moreover, men with pharmacological insomnia treatments were more often prescribed treatments for ED. Given the prevalence of insomnia, future studies are warranted to delineate the association of insomnia and its treatment with erectile function. Patient summaryInsomnia affects up to one-third of adults and impact male erectile function. Men only diagnosed with insomnia were found to have a higher risk of developing erectile dysfunction (ED). Moreover, men with pharmacological insomnia treatments were more often prescribed treatments for ED.

(487) Long-term Outcomes Following Partial Plaque Excision and Grafting (PEG) for Peyronie’s Disease and Subanalysis of Patients Who Undergo PEG Despite Pre-operative Counseling Against PEG

Abstract Introduction Peyronie’s Disease (PD) is a debilitating condition characterized by progressive scarring of the tunica albuginea. The resulting deformities are often emotionally devastating to patients, and include erectile dysfunction, painful erections, penile curvature, indentation, hourglass, and hinge deformities. According to previously published surgical algorithm for PD in 1997, partial plaque excision and grafting (PEG) is recommended for patients with &amp;gt;60 degree curvature +/− hinge and strong pre-operative erections while placement of an inflatable penile prosthesis (IPP) is recommended when rigidity is sub-optimal.* Nevertheless, many patients counseled to undergo an IPP refuse and insist on proceeding with PEG due to personal preference. We hypothesize that men counseled to undergo IPP but choose to undergo PEG will report lower satisfaction rates and reduced ability to engage in sexual intercourse post-operatively. Objective Our objective was to evaluate and compare long-term patient-reported outcomes in men who underwent PEG at a single institution between 2007 and 2021. Methods A retrospective chart review was conducted from 2007 to 2021 on PEG surgeries performed at a single, tertiary-care institution in patients ≥18 years old who had &amp;gt;3 months of follow up. Results 251 patients underwent PEG with a mean follow up was 35.5 months. 54 patients (22%) were initially advised to undergo IPP but elected for PEG. Of these 54 patients, 17 (32%) had pre-operative 9-10 subjective erectile rigidity, relative to 110 of 197 (56%) patients who were initially counseled to undergo PEG (p=0.002). On duplex penile ultrasound, patients counseled to undergo IPP had a mean objective erectile rigidity of 7.8, compared to a mean objective rigidity of 8.6 in patients initially counseled to undergo PEG (p 15 units for pre-operative duplex ultrasound evaluation were less likely to be able to engage in post-operative intercourse following PEG surgery (48.6%) relative to those who needed &amp;lt;15 units (71.1%) (p=0.02). Conclusions Patients who were initially counseled to undergo IPP due to sub-optimal erectile rigidity but elected for PEG procedure had worse post-operative ability to engage in penetrative intercourse. Significantly more of these patients also eventually underwent IPP. Pre-operative trimix dosing &amp;lt;15U is a predictor of post-operative erectile function as it may be reflective of better pre-operative erectile quality. Subjective and objective measures of erectile function appear to be critical predictors of post-operative erectile function in patients who had underwent PEG, confirming the previously published 1997 algorithm on the surgical management of PD.* *J Urol 1997; 158: 2149-52. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific (Consultant)

Stem cell therapy and diabetic erectile dysfunction: A critical review.

Erectile dysfunction (ED) has been identified as one of the most frequent chronic complications of diabetes mellitus (DM). The prevalence of ED is estimated to be about 67.4% in all DM cases worldwide. The pathophysiological process leading to ED involves endothelial, neurological, hormonal, and psychological factors. In DM, endothelial and neurological factors play a crucial role. Damages in the blood vessels and erectile tissue due to insulin resistance are the hallmark of ED in DM. The current treatments for ED include phosphodiesterase-5 inhibitors and penile prosthesis surgery. However, these treatments are limited in terms of just relieving the symptoms, but not resolving the cause of the problem. The use of stem cells for treating ED is currently being studied mostly in experimental animals. The stem cells used are derived from adipose tissue, bone, or human urine. Most of the studies observed an improvement in erectile quality in the experimental animals as well as an improvement in erectile tissue. However, research on stem cell therapy for ED in humans remains to be limited. Nevertheless, significant findings from studies using animal models indicate a potential use of stem cells in the treatment of ED.

Epimedium brevicornumMaxim and its Efficacy in the Treatment of Sexual Dysfunction

Epimedium sp. is a famous plant as sexual enhancer. In Chinese Pharmacopeia, Five species of Epimedium brevicornum, E. sagittatum, E. pubescens, E. koreanum, and E. wushanense were recorded as Epimedium Herba (Yin Yang Huo). The aim of this review article was to evaluate the potential efficacy of E. brevicornum as a remedy for sexual dysfunction and infertility. For preparing of this manuscript, we searched in all accessible resources (PubMed, Science Direct, Wiley, Springer, and Google), books, thesis, and pharmacopeias. There are different traditional prescriptions containing E. brevicornum, which are recommended for the treatment of impotence and sexual disorders. Although, there is no clinical study on efficacy and safety of E. brevicornum on sexual functions, but animal and experimental analysis exhibited that E. brevicornum is an estrogenic plant and its flavonoid glycosides are inhibitors of phosphodiesterase 5 (PDE 5) and improved the erectile dysfunction, libido, impotence, sperm quality and fertility. Due to the lack of clinical study on the efficacy of E. brevicornum, designing the human clinical study on safety and efficacy of standard E. brevicornum can be the subject of future studies.

The Practices, Orientation, Satisfaction, and Sexual Response in Men with Spinal Cord Injury

In several spinal injuries, motor impairments significantly compromise the individual's activities. Thus, in an individual with a spinal cord injury (SCI) some sexual mechanisms are compromised, such as erectile capacity, ejaculation, semen quality, orgasm, fertility, and psychological changes. To understand the sexuality and the personal history of sexual function of the individual is crucial, since the recovery of sexual function is reported as a priority by individual with an SCI. So, the aim of this study was to investigate the practices, orientation, satisfaction, and sexual response in men with spinal cord injury (SCI). This is a cross-sectional study. The Human Sexuality Questionnaire LM (LM-QSH) was used to compare the responses before and after an SCI. The paired t-test was used to compare responses before and after the SCI. After SCI, it was observed that 94%, of men maintained an active sex life, with 50% having sex ≤ 1 time per week. After SCI individuals reported greater pleasure in the mouth, neck, and ears, and there was a reduction in sexual responses. Of men reporting, 90% made medium to large sexual adjustments, both physically and psychologically. The results of the present study demonstrated that men with SCI maintained an active sex life and unchanged sexual desire. Most of men with SCI were not advised about physical and psychological sexual adjustments when adapting to sex, both physical and emotional.

Effects of testicular sperm aspiration upon first cycle ICSI-ET for type 2 diabetic male patients

ABSTRACT Male diabetes mellitus (DM) can affect erectile function and sperm quality. In severe cases, DM can lead to retrograde or no ejaculation, so testicular sperm aspiration (TESA) is combined with intracytoplasmic sperm injection (ICSI) to treat subfertility and infertility for DM couples. However, the effect of TESA upon ICSI (TESA-ICSI) for DM patients remains unclear. This research investigated the effect of TESA-ICSI on first cycle ICSI-embryo transfer (ICSI-ET) for type 2 diabetic mellitus (T2DM) patients and the potential mechanisms. The subjects consisted of 1219 male patients with azoospermia or retrograde ejaculation who were treated with TESA-ICSI from 2015.01 to 2019.11. They were classified into two groups, the T2DM group (n = 54) and non-diabetic control group (n = 1165). Sperm selection for injection was performed using motile sperm organelle morphology examination criteria. The number of available embryos and the high-quality embryo rates following a single ET as well as cleavage, fertilization, implantation, clinical pregnancy and the abortion rates were noted. Compared with the non-diabetic group, the available embryo rate (75.20 ± 26.40% vs.78.36 ± 23.25%) and high-quality embryo rate (46.49 ± 30.37% vs. 47.55 ± 28.57%) in the T2DM group were lower and the abortion rate (20.83% vs. 8.88%) was higher, but these differences were not statistically significant. There were no significant differences in clinical pregnancy, implantation, normal fertilization, and cleavage rates between the two groups. The results show that TESA for male T2DM patients does not influence the effect of ICSI. For T2DM patients with severe oligozoospermia, asthenospermia, teratozoospermia, or retrograde ejaculation that do not meet ICSI criteria, TESA-ICSI may perhaps be considered for reproductive assistance. Abbreviations DM: diabetes mellitus; TESA: testicular sperm aspiration; ICSI: intracytoplasmic sperm injection; ICSI-ET; ICSI-embryo transfer; LH: luteinizing hormone; mL: milliliter; TES: testosterone; FSH: follicle-stimulating hormone; P: progesterone; HCG: human chorionic gonadotropin

INTREPId (INTermediate Risk Erection PreservatIon Trial): A randomized trial of radiation therapy and darolutamide for prostate cancer.

TPS384 Background: Men with intermediate risk prostate cancer are often recommended external beam radiation therapy (EBRT) with or without 4-6 months of androgen deprivation therapy (ADT). However, ADT can be associated with prolonged erectile dysfunction due to delayed testosterone recovery. Darolutamide is a second-generation androgen receptor with low blood-brain barrier penetration. We hypothesize that men who receive Darolutamide with RT rather than ADT with RT are able to achieve surrogate PSA endpoints indicative of long-term disease control while preserving erectile function. Methods: This is an open label, phase 2B, multi-center, randomized controlled trial. Eligibility criteria include intermediate risk prostate cancer, good erectile quality per the EPIC-26 questionnaire, and archival tissue suitable for submission to Decipher Biosciences (San Diego, CA). Men will be stratified by Decipher score (low/intermediate vs high), RT modality (EBRT vs Brachytherapy/stereotactic body radiation therapy/combination RT), and age (&gt;65 vs &lt;65). Men with a Decipher high score will be strongly encouraged to undergo extreme RT dose-escalation. The primary endpoint is PSA nadir ≤ 0.5 within 6 months from end of treatment (EOT). The hierarchical endpoint is maintenance of good erectile quality at 3 months from EOT. The key secondary endpoint is interval to PSA failure at 3 years from EOT. Endpoints will be analyzed in a fixed-sequence hierarchical method. 220 patients will be accrued over 3 years. Non-inferiority margins for the primary and key secondary endpoints are 9% (90% power) and 4.9% (80% power), respectively. Men will be randomized to 6 months of GnRH agonist plus bicalutamide 50 mg daily with RT or 6 months of darolutamide 600 mg twice daily with RT. Assessments will occur at baseline, during treatment, EOT, and at regularly scheduled intervals up to 36 months from EOT. Correlative endpoints include discovering transcriptomic and radiomic predictors of response. Clinical trial information: NCT04025372.

Long-term Follow-up after Radiotherapy for Prostate Cancer with and without Rectal Hydrogel Spacer: A Pooled Prospective Evaluation of Sexual Function of Men with Good Baseline Sexual Function

Hydrogel spacers are a tool to improve dosimetry and overall quality of life with limited follow-up in men receiving radiotherapy for prostate cancer. This study is a pooled analysis of prospective cohorts with long-term quality of life (QOL) follow-up with or without a rectal spacer to minimize dose to rectum as well as other adjacent organs at risk. QOL was examined using the Expanded Prostate Cancer Index Composite (EPIC) and mean changes from baseline to EPIC domains were evaluated. A total of 126 patients with good pre-treatment sexual function (baseline EPIC >/=60) including 88 patients from a randomized multi-institutional trial of radiation with or without hydrogel rectal spacer with a QOL end-point were pooled with 38 non-randomized patients from a single institution with prospective QOL collection in patients with or without hydrogel spacer. The proportions of men with a predetermined minimally important differences (MIDs) relative to pre-treatment baseline (11 point decline from baseline = MIDx1 and 22 point decline from baseline = MIDx2) in sexual function were evaluated. A total of 126 men were evaluated (64% with spacer and 36% without) with QOL data being available for 68 men beyond 24 months of follow-up (median: 33 months, range: 2.5-69.4 months). MID was more common in men without a rectal spacer at 15 months (60.5% vs 44.4%) and at >/= 24 months (80% vs 55%). MIDX2 occurred at 15 months of 45% in men without rectal spacer vs 29% in men with rectal spacer and >/= 24months in 68% of men without rectal spacer vs 39% with rectal spacer. At >/= 24 months of follow up, men without spacer were more likely to have 1xMID in sexual QOL (11 point decline, p= 0.041, Fisher Exact) as well as 2xMID (22 point decline, p=0.025, Fischer Exact) declines. The use of rectal separation was associated with adequate erectile quality. In men with rectal spacer at late follow up, 63% of patients had firm enough erections for intercourse and 1% had no erectile function compared to 28% adequate erectile function for intercourse and 12% without any erectile function in patients without rectal spacer. In this pooled analysis of QOL after prostate radiotherapy with up to 5-years of follow-up, utilization of a hydrogel rectal spacer was associated with less MID per patient reported sexual QOL. This was especially important in patient reported adequate erectile function for intercourse.

Four-year outcomes of hypofractionated proton therapy for localized prostate cancer.

80 Background: Hypofractionated radiation therapy (HFRT) is an effective treatment for localized prostate cancer (LPC). This study was performed to determine the toxicity profile and biochemical-clinical failure (BCF) rates for patients with LPC treated with hypofractionated proton therapy (HFPT). Methods: Between 2010 and 2017, 184 men were enrolled on a trial of 70Gy in 28 fractions of HFPT for low to intermediate-risk LPC. Androgen suppression (AS) was allowed. Acute and late toxicity was evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. Urinary and erectile quality of life changes were captured using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) Questionnaire, respectively. Results: Median follow-up was 49.2 months. Enrolled patients had low-risk [LR] (n = 18), favorable intermediate-risk [FIR] (n = 78), and unfavorable intermediate-risk [UIR] (n = 88) disease. Twenty-six percent of patients received neoadjuvant and concurrent AS, with a median duration of 6 months. Four-year rates of BCF free survival were 95.7%, 94.4%, 98.7%, and 93.2% in the overall group and the LR, FIR, and UIR cohorts, respectively (p = .21). Overall survival at 4 years was 97.3%. No deaths were attributable to prostate cancer. Median IPSS before and 1 year post-HFPT were 6 and 7 for LR patients, 6 and 6 for FIR patients, and 8 and 7 for UIR patients. Median IIEF-5 before and 1 year post-HFPT were 21 and 18 for LR patients, 18 and 16.5 for FIR patients, and 15 and 10.5 for UIR patients. The incidence of acute grade 2 or higher gastrointestinal (GI) and urologic (GU) toxicities were 3.8% and 12.5%, respectively. One acute grade 3 GI toxicity was reported. The 4-year incidence of late grade 2 or higher GU and GI toxicity was 7.6% and 13.6%, respectively. One late grade 3 GI toxicity was reported. The predominant late grade 2 GI and GU toxicities were rectal bleeding and urinary frequency, respectively, accounting for 79% and 57% events. All late toxicities were transient. Conclusions: HFPT is associated with low rates of toxicity in the treatment of prostate cancer. Further analyses are warranted to assess long term toxicity and understand differences between proton and photon HFRT. Clinical trial information: NCT01352429.

The Rear Tip Extender for Inflatable Penile Prostheses: Introduction of "Rigidity Factor" and Review of the Literature.

Rear tip extenders (RTEs) are often used in penile prosthesis surgery, and their value and use have varied with the evolution of penile prostheses. To review the literature addressing RTEs and to introduce a new term, rigidity factor, which quantifies the ratio of inflatable to non-inflatable component of the cylinders. The urologic literature was reviewed for all mention of RTEs. In addition, literature regarding penile prostheses was explored for mention of RTEs. A search on PubMed for "rear tip extender" resulted in 17 publications. These publications were reviewed, and references were also explored for related publications. The history of the development of RTEs, complications associated with the use of RTEs, and current practices in the use of RTEs are all discussed. In addition, recent publications regarding RTEs were examined in detail. RTEs were introduced in the 1980s to improve mechanical survival of prostheses. They were thought to decrease input tubing wear. Although the trend recently has been to place more rear tips, evidence has surfaced suggesting a link to increased need for reoperation with additional RTEs. In addition, we believe that increased length of RTEs can decrease erectile quality. Rigidity factor, defined as the ratio of the live (inflatable) portion of cylinder to the total cylinder length, can be used to quantify the effect of RTE on erectile strength. However, the effects of RTEs on biomechanical properties of the penis when fully inflated are still not fully understood. The use of RTEs is a relatively underexplored area of penile prosthesis placement. Further laboratory and invivo work will allow for a better understanding of the optimal role of RTEs in penile prosthesis surgery. Thirumavalavan N, Cordon BH, Gross MS, etal. The Rear Tip Extender for Inflatable Penile Prostheses: Introduction of "Rigidity Factor" and Review of the Literature. Sex Med Rev 2019;7:516-520.

Advantages and limitations of sleep-related erection and rigidity monitoring: a review.

Over the past decades, sleep-related erection and rigidity monitoring has been used to differentiate psychogenic from organic erectile dysfunction (ED), due to the involuntary nature of erections in sleep. This study retrospectively reviewed all available literature focusing on sleep-related erection and rigidity monitoring through a systematic PubMed search. To date, there are mainly seven methods and their modifications, including: sleep laboratory testing, the mercury strain gauge, the stamp test, the erectometer, the Snap gauge, the RigiScan, and nocturnal electrobioimpedance volumetric assessment. This study analyzes and summarizes the advantages and limitations of seven monitoring methods. This study indicates that both of the above methods possess the capacity to assess erectile quality and provide guidance to the diagnosis, etiology, and differential diagnosis of ED. However, some limitations still exist for the application. New devices which can continuously monitor kinds of variables, including sleep-related erection, axial and radial rigidity, and oxygen saturation are needed.

Effects of penile fracture and its surgical treatment on psychosocial and sexual function.

The current therapy for penile fracture is immediate surgical repair, but sexual and psychosocial effects of the repair have been poorly investigated. We aimed to assess the impact of surgical correction of penile fracture on psychosocial status, sexual function, and erectile quality. Sixty-four patients classified into two subgroups according to follow-up: 2-24 months (Group 1), and longer than 24 months (Group 2), and 28 healthy men (Control group). The mean overall follow-up period was 39.1±32.7 months. The number of sexual intercourse origin was 44 (68.8%), the mean time interval from incident-to-surgery was 13.6±9.3 h. The mean sexual relationship score decreased during first year (P=0.001), and significant recovery was observed over 12-24 months. The mean overall relationship scores and the mean self-esteem scores of the study groups decreased until the end of the 24 months (P<0.05). The mean erectile function domains remained stable in all groups (P>0.05). The mean EHS scores were lower but the difference was not significant in the study groups (P>0.05). Penile fracture repair have no detrimental effect on sexual function, but psychogenic aspect may be adversely affected. This article concludes lower complication rates can be reached with immediate surgical correction of the penile fracture whereas psychogenic recovery might prolonged.

Mobility, hydrocephalus and quality of erections in men with spina bifida

Little is known about erectile dysfunction (ED) among men with spina bifida (SB). The goal of this study was to determine quality of erections and possible factors affecting erections in this population. It was hypothesized that men who ambulate and do not have a ventriculoperitoneal shunt (VPS) are more likely to have erections sufficient for intercourse. An online survey was administered over an 18-month period to men aged ≥18 years and with SB. Participants were recruited through local, national and international SB organizations via social media. Exclusion criteria were: poor English proficiency, not completing the questionnaire or missing information regarding erections, VPS or ambulation. Data were collected on demographics, previous surgeries and function. Ambulatory status was classified using the Hoffer classification (Hoffer etal., 1973). Those able to walk at least at home, with or without crutches/braces, were classified as "ambulators." Erections were assessed using a single question from the validated Expanded Prostate Cancer Index Composite questionnaire (e.g. normal: "firm enough for intercourse"). Logistic regression was used for statistical analysis. The median age of 122 participants was 33 years, 53.3% were ambulators and 70.5% had a VPS. Overall, 41.0% reported normal erections. Ambulators were more likely to report normal erections than non-ambulators (63.1% vs 15.8%, P<0.001) (Table). Those with and without a VPS reported similar rates of normal erections (37.9% vs 48.6%, P=0.32). On multivariate analysis, ambulators were more likely to have normal erections (OR ≥8.65, P≤0.001) after correcting for age and VPS status. Age and VPS status were not correlated with normal erections on multivariate analysis (P≥0.32 and P=0.62, respectively). Approximately 59% of men with SB reported ED, with ambulators being far more likely to have normal erections. This suggests that ambulatory status, similar to neurological lesion level, is a confounder of erectile function in the SB population. A limitation of the study was that a single item was used to assess erectile function. Rather than performing a comprehensive analysis of sexual health, the study aimed to gauge the prevalence of normal erections and assess possible risk factors. It did not assess sexual activity, erection duration or ED treatments. However, this is the largest study, to date, on SB and erectile quality with international participants. About 40% of men with SB reported normal erections. Ambulatory status, rather than hydrocephalus, appeared to be the primary factor associated with erectile function. Approximately 2/3 of ambulators and 1/6 of non-ambulators reported normal erections.

Evaluation of Erectile Function and Quality of Life in Patients Undergoing Methadone Maintenance Treatment

The controversial data for erectile function and quality of life of patients undergoing methadone maintenance treatment (MMT) and lack of questionnaire-based studies, providing information about these bio-psycho-social issues, in Bulgaria motivated the investigators to examine the frequency of erectile dysfunction among patients on methadone maintenance treatment, and to identify quality of life among these subjects. For these needs cross-sectional, observational with no intervention, case-control, questionnaire-based study was performed which included participants from 18 to 40 years of age undergoing MMT for at least six months and clinically healthy people. A total of 91 patients from 5 clinical programs for MMT in Bulgaria took part in the study and 27 clinically healthy people from the same age and without a history of drug abuse, psychiatric and somatic diseases which served as a control group. All participants signed informed consent. For evaluating erectile function International Index of Erectile Function survey was used. SF 36 v.2 quality of life survey was used for assessing the quality of the participants. When comparing results of the quality of life survey in Patient and Control group significant differences were found in all of the components of the survey (p<0.05) with lower results in the Patient group. When analysing results from the IIEF survey significantly lower total scores were present for all components of the survey in the patient as compared to the group of healthy men (p<0.05).

Does supplemental external beam radiation therapy impact urinary, bowel, and erectile function following permanent prostate brachytherapy?: results of two prospective randomized trials.

PurposeTo evaluate the impact of supplemental external beam radiation therapy (EBRT) prior to permanent prostate brachytherapy on long term urinary, bowel, and erectile function.Material and methodsPatient administered urinary, bowel, and erectile quality of life (QoL) instrument were obtained prior to treatment and following brachytherapy. The study population was comprised of the 457 patients who were alive as of June 2016, had been randomized to two markedly different supplemental EBRT dose regimens and a third arm without supplemental EBRT, and had completed the June 2016 QoL survey. The need for urinary or bowel surgical intervention was prospectively recorded during routine follow-up. Multiple parameters were evaluated for effect on outcomes.ResultsThe urinary catheter was removed on day 0 in 92.1% of patients and 0.4% required a post-implant transurethral prostatic resection (TURP). On average, the International Prostate Symptom Score (IPSS) normalized at week 14. The 10-year rate of urethral strictures was 5.3%. No significant differences were discerned between baseline and post-implant rectal function assessment score (RFAS), and no patient developed a rectal ulcer or fistula. The 10-year potency preservation rate was 50.3%. Supplemental EBRT did not affect urinary, bowel, or erectile function. Urethral strictures were most closely related to bulbomembranous urethral brachytherapy doses, post-implant rectal function to pre-implant hemorroidal bleeding, and RFAS and erectile function to pre-brachytherapy international index of erectile function and age.ConclusionsSupplemental EBRT did not significantly effect catheter dependency, IPSS resolution, urethral stricture rate, the need for post-implant TURP, bowel, or erectile function. Careful attention to brachytherapy dose distributions appears to be most important in minimizing post-brachytherapy morbidity.

Patient-reported long-term sexual outcomes following plication surgery for penile curvature: A retrospective 58-patient study

To evaluate long-term sexual function results following plication surgery for the correction of penile curvature using patient questionnaires. We performed a single-center, retrospective study in a cohort of patients with Peyronie's disease or congenital penile curvature. All patients who underwent plication surgery on the convex aspect using the Nesbit, Yachia or diamond-shaped techniques were included. At a mean 34 months after the interventions, the patients were asked to respond to the IIEF5 questionnaire and a 19-item questionnaire. Forty-six patients operated for Peyronie's disease and 12 for congenital curvature (total: 58) were included in the study. The questionnaire response rate was 69% (40/58). The shortened penis bothered 47.5% of patients in their sexuality at least regularly. Involuntary exit from the vagina occurred for 35% of the patients in at least one out of two sexual intercourse sessions. Postoperative sexual life was as good as or better than preoperative sexual life for 35% of the patients and 95% stated that they could achieve erection at least sometimes, in coherence with the mean IIEF5 result of 19.3/25. Our study suggests that even when successful, a relatively high rate of patients may be unsatisfied with the results of plication surgery, and there may be a relatively low rate of maintenance or improvement of postoperative sexual life. Furthermore, our in-house questionnaire, although not validated, shed light on how bothersome the loss of penis length is in postoperative sexuality, an aspect the IIEF5 and its sole evaluation of erectile quality cannot detect. 4.