Intracorporeal Injection Research Articles

Evaluation of platelet-rich fibrin matrix combined with PGE-1 injection on erectile function in patients with refractory response to PDE5-I: a randomized placebo-controlled study.

We studied the effect of a platelet-rich fibrin matrix (PRFM) combined with prostaglandin E-1 (PGE-1) injection on erectile function in patients refractory to response for phosphodiesterase type 5 inhibitors (PDE5-Is). This randomized, double-blind, placebo-controlled study included 80 patients. The patients were randomly assigned to four groups and blinded together with the administrating physicians to the nature of the intracorporeal injection (ICI) therapies. Group (1) received saline, group (2) received platelet-rich fibrin matrix (PRFM), group (3) received prostaglandin E-1 (PGE-1), and group (4) received a combination of PRFM + PGE-1. The patients received ICI therapy weekly for 8 consecutive weeks. Clinical information and follow-up data were obtained at 1, 2, 3, and 6months. A significant increase occurred in the validated Arabic version of the International Index of Erectile Function (ArIIEF-5) score in group (4) compared to the other three groups (p value = 0.037). There was a significant difference in erection hardness scale (EHS) scores among all groups after receiving the different treatments (p = 0.004). A significant increase was seen in the ArIIEF-5 score in groups 4 and 3 compared to that in groups 1 and 2 (p < 0.001). There was also a significant increase in the arterial dilatation % in groups 4 and 3 compared to that in groups 1 and 2 (p = 0.019). The combination of PRFM plus PGE-1 had shown significant improvement in the ArIIEF-5 score, yet the patients still had mild to moderate ED.

(014) Safety and Efficacy of Platelet-Rich Plasma Injection for the Treatment of Erectile Dysfunction; A Randomized Prospective Study

Abstract Introduction Platelet-rich plasma (PRP) intracorporeal injection is one of the popular regenerative therapies that has been gaining much interest in recent years as an adjunct or alternative treatment for erectile dysfunction (ED). Nevertheless, scientific evidence to support its clinical efficacy remains controversial. Objective The aim of this study was to evaluate the safety and efficacy of PRP injections for the treatment of ED. Methods A prospective, randomized, double-blinded, placebo-controlled, interventional clinical study was conducted on 52 subjects at the Department of Urology, Faculty of Medicine, Beni-Suef University. Patients were randomized into two groups: the PRP group (n=26) and the placebo (saline) group (n=26). Each participant received three sessions (at two-week intervals) of PRP or saline injections according to his assigned group. International index of erectile function-5 (IIEF-5) scores and safety-related observations were collected at the 1st, 3rd, and 6th months of follow-up. Results The median age and ED duration were statistically comparable for both groups, 52.2 versus 52.5 years and 12.87 versus 11.8, respectively (P = 0.285). With regards to the efficacy of PRP, there were no statistically significant differences between both groups after 1, 3, and 6 months of treatment. After 1 month of treatment, the mean IIEF-5 score for the PRP group was 16.12 ± 1.25 versus 15.99 ± 1.21 for the placebo group (P = 0.683). After 3 months, the IIEF-5 score for the PRP group was 16.44 ± 1.17 compared to 16.31 ± 1.06 for the placebo group (P = 0.653). Also after 6 months, the IIEF-5 score for the PRP group was 16.35 ± 1.45 close to 16.23 ± 1.19 for the placebo group (P = 0.727). No transient hemorrhagic adverse events (hematuria, local petechial bleeding, or ecchymosis) or other side effects were reported during the injection and follow-up period for both groups. Conclusions The results of this trial suggest that although the treatment of ED with 3 injections of intracavernosal PRP separated by two-week intervals may be safe, it is not more effective than a placebo injection. Disclosure No.

(156) Real World Penile Measurements Comparison Between Malleable and Three-Piece Inflatable Implants: An Objective Comparative Study

Abstract Introduction Despite the fact that malleable penile implants are easier and faster to implant surgically, yet inflatable penile implants (IPPs) have usually shown to have higher patient satisfaction rate and lower rates of distal erosion. It was felt, but never shown that IPPs simulated better erections that filled out the penis better. Nevertheless, this had never been objectively proven in the literature to our knowledge. Objective In this study, to achieve objective comparisons, we introduced the Penile Implant Intraoperative Measurements Planning (PIIMP) chart to find out whether IPPs were more likely to procure greater penile dimensions in comparison to malleable implants. Methods 193 men undergoing penile prosthesis implantation were included in the study. 153 had malleable implants, while 40 had an IPP. Penile length and circumference were measured both in a stretched and unstretched state, both before and after a PGE1 intracorporal injection (ICI). Postoperative penile dimensions were re-taken after implantation and documented together with cylinders/rods dimensions. Results In malleable implants, postoperative penile length ranged between pre and post ICI stretched length in 71.4% of times (n=110/153), fell below pre-ICI stretched length in 26.2% of cases (n=40/153) and reached beyond post-ICI stretched length in 1.96% of cases (n=3/153). In IPPs, postoperative penile length ranged between pre and post ICI stretched length in 60% of times (n= 24/40), fell below pre-ICI stretched length in 27.5% of cases (n=11/40) and reached beyond post-ICI stretched length in 12.5% of cases (n= 5/40). Using Fisher's exact test, it was found that postoperative penile length was 6.37 times more likely to rise above preoperative post-ICI stretched length in inflatable penile implants compared to malleable implant cases (12.5% vs 1.96%) (P value=0.0105) As for penile circumference, malleable implants showed a postoperative penile circumference ranging between pre and post-ICI relaxed girth in 69.9% of cases (n=10), reaching above post-ICI relaxed girth in 10.9% of cases (n=17), and falling below pre-ICI relaxed girth in 19.2% of cases (n=30). On the other hand, IPPs cases had a postoperative penile circumference ranging between pre and post ICI relaxed girth in 57.1% of cases (n=24), reaching above post-ICI relaxed girth in 27.2% of cases (n= 12), and falling below pre-ICI relaxed girth in only 9.1% (n= 4) of cases. (P &amp;lt;0.05) Thus IPPs were 2.5 times more likely to increase the girth of the penis (27.2% vs 10.9%) (P value &amp;lt;0.05) and 2.1 times less likely to cause a decrease in circumference in comparison to malleable implants (9.1% vs 19.2%) (P value &amp;lt;0.05) Conclusions Our study demonstrated that IPPs were superior to malleable implants in attaining greater postoperative penile lengths and girths. We introduced the PIIMP chart as an objective standardized and easily reproducible instrument for intraoperative documentation of penile dimensions. Disclosure No.

(154) Safety and Efficacy of Platelet-rich Plasma Injection for the Treatment of Erectile Dysfunction; A Randomized Prospective Study

Abstract Introduction Platelet-rich plasma (PRP) intracorporeal injection is one of the popular regenerative therapies that has been gaining much interest in recent years as an adjunct or alternative treatment for erectile dysfunction (ED). Nevertheless, scientific evidence to support its clinical efficacy remains controversial. Objective The aim of this study was to evaluate the safety and efficacy of PRP injections for the treatment of ED. Methods A prospective, randomized, double-blinded, placebo-controlled, interventional clinical study was conducted on 52 subjects. Patients were randomized into two groups: the PRP group (n=26) and the placebo (saline) group (n=26). Each participant received three sessions (at two-week intervals) of PRP or saline injections according to his assigned group. International index of erectile function-5 (IIEF-5) scores and safety-related observations were collected during the 1st, 3rd, and 6th months of follow-up. Results The median age and ED duration were statistically comparable for both groups, 52.2 versus 52.5 years and 12.87 versus 11.8, respectively (P = 0.285). With regards to the efficacy of PRP, there were no statistically significant differences between both groups after 1, 3, and 6 months of treatment. After 1 month of treatment, the mean IIEF-5 score for the PRP group was 16.12 ± 1.25 versus 15.99 ± 1.21 for the placebo group (P = 0.683). After 3 months, the IIEF-5 score for the PRP group was 16.44 ± 1.17 compared to 16.31 ± 1.06 for the placebo group (P = 0.653). Also after 6 months, the IIEF-5 score for the PRP group was 16.35 ± 1.45 close to 16.23 ± 1.19 for the placebo group (P = 0.727). No transient hemorrhagic adverse events (hematuria, local petechial bleeding, or ecchymosis) or other side effects were reported during the injection and follow-up period for both groups. Conclusions The results of this trial suggest that although the treatment of ED with 3 injections of intracavernosal PRP separated by two-week intervals may be safe, it is not more effective than a placebo injection. Disclosure No.

(514) Are Intracorporal Injections Associated with Difficult Placement of Inflatable Penile Prosthesis Placement?

Abstract Introduction Inflatable penile prosthesis (IPP) is the gold-standard treatment for erectile dysfunction that is refractory to pharmacologic therapies. While complications occur in 1-10% of patients, there remains a paucity of data regarding the impact of intracorporal injections (ICI) on a more difficult IPP placement. Objective We sought to demonstrate correlation between prior ICI and increased difficult with IPP placement. We hope to use our data to help guide future pre-procedural planning as well as patient counseling. Methods The records of patients who underwent IPP placement via single surgeon between 2016 – 2021 were retrospectively reviewed. Baseline patient demographics in addition to history of priapism, shunt, presence of Peyronie’s disease (PD), ICI use and duration, and intraoperative details including need for multiple corporal dilations and corporal scarring were gathered. Exclusion criteria included patients with re-operative/revision IPPs, patients with 2-piece IPPs, and patients with semi-rigid IPPs. The associations were calculated using Chi-squared analysis and logistic regression. Results There were 96 patients that met inclusion criteria, with average age of 62 years. Half (48/96) had history of ICI use, with mean duration of 17.25 months (range 1-65). ICI was not associated with corporal scarring (p=0.51) or need for multiple dilations during IPP placement (p=0.46). Duration of ICI (comparing subgroups of &amp;lt; 20 months and &amp;gt;20 months) was not significantly different with respect to corporal scarring (p=0.343) or need for multiple dilations (p=0.839). History of priapism or shunt was not associated with corporal scarring (p=0.251). Patients with PD were more likely to require multiple dilations (p=0.033). Conclusions History of ICI and its duration were not associated with corporal scarring and increased intraoperative difficulty. Patients with a history of Peyronie’s disease were more likely to require multiple dilations. Other studied factors including ICI duration of &amp;gt;20 months, history of priapism, and history of shunt are NOT associated with corporal scarring or need for multiple dilations. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options

Pelvic malignancies, including prostate, rectal, and bladder cancers, are among the most frequent malignancies found in the male population. These issues are most effectively and commonly treated with radiotherapy and/or surgery. However, these treatments can cause collateral damage, resulting in significant impacts on quality of life, with erectile dysfunction being one of the most frequent postoperative complications. Currently, there are several treatment options for erectile dysfunction, including oral phosphodiesterase type 5 inhibitors, vacuum erection devices, intracorporeal injections, and penile prosthesis. The latter has shown to be an effective and safe technique, with results comparable to those obtained by patients without pelvic surgery or radiotherapy. The results of early penile rehabilitation programs are promising and they have been incorporated into a greater proportion of treatment plans more recently, with varying degrees of success. In this narrative review, we summarize the literature on erectile dysfunction after pelvic cancer treatments and its management.

Advanced hydrogels: New expectation for the repair of organic erectile dysfunction.

Organic erectile dysfunction (ED) is a type of sexual disorder in men that is usually associated with illness, surgical injury, normal aging and has a high incidence across the globe. And the essence of penile erection is a neurovascular event regulated by a combination of factors. Nerve and vascular injury are the main causes of erectile dysfunction. Currently, the main treatment options for ED include phosphodiesterase type 5 inhibitors (PDE5Is), intracorporeal injections and vacuum erection devices (VEDs), which are ineffective. Therefore, it is essential to find an emerging, non-invasive and effective treatment for ED. The histopathological damage causing ED can be improved or even reversed with hydrogels, in contrast to current therapies. Hydrogels have many advantages, they can be synthesized from various raw materials with different properties, possess a definite composition, and have good biocompatibility and biodegradability. These advantages make hydrogels an effective drug carrier. In this review, we began with an overview of the underlying mechanisms of organic erectile dysfunction, discussed the dilemmas of existing treatments for ED, and described the unique advantages of hydrogel over other approaches. Then emphasizing the progress of research on hydrogels in the treatment of ED.

Efficacy of intracorporeal injections of allogenic platelet derived growth factors in the treatment of erectile dysfunction refractory to phosphodiesterase type 5 inhibitors

Efficacy of intracorporeal injections of allogenic platelet derived growth factors in the treatment of erectile dysfunction refractory to phosphodiesterase type 5 inhibitors

MP27-14 POLYPHARMACY AND MENTAL HEALTH DISORDERS ARE HIGHLY PREVALENT IN MEN WITH ISCHEMIC PRIAPISM

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP27)1 Sep 2021MP27-14 POLYPHARMACY AND MENTAL HEALTH DISORDERS ARE HIGHLY PREVALENT IN MEN WITH ISCHEMIC PRIAPISM John Weedin, Joanie Chung, Aravind Chandrashekar, and Marc Herskowitz John WeedinJohn Weedin More articles by this author , Joanie ChungJoanie Chung More articles by this author , Aravind ChandrashekarAravind Chandrashekar More articles by this author , and Marc HerskowitzMarc Herskowitz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002024.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ischemic priapism is an uncommon, but painful disorder with the potential risk for long term sexual dysfunction. While many etiologies exist, drug-induced priapism is estimated in 30%. Pharmaceutical and non-pharmaceutical drugs associated with ischemic priapism include vasoactive erectile agents, α-adrenergic antagonists, antidepressants, anxiolytics, antipsychotics, testosterone, anticoagulants, and anesthesia. We hypothesize that prior studies underestimate the modern incidence of drug-induced priapism. METHODS: After Institutional Review Board approval, a retrospective review was performed of men with ischemic priapism between 2008-2020 within Kaiser Permanente of Southern California. Priapism was defined as an unwanted erection lasting longer than 4 hours. Men with non-ischemic priapism, hemoglobinopathies, and malignancy were excluded. Multiple variables including demographics, medical problems, and drugs were evaluated. Treatment and outcomes were also examined. Statistical analysis was used to evaluate outcomes. RESULTS: After excluding 42 men with hemoglobinopathies or malignancy, 403 men with ischemic priapism were examined. Mean age was 41.1 years and follow-up was 51 months. Drug-induced priapism occurred in 92%. Polypharmacy with multiple priapism linked drugs occurred in 49%. A psychiatric diagnosis was present in 45% including anxiety, mood, and psychotic disorders. Two distinct populations of men were identified based on whether or not they transpired after intracorporeal injections (ICI) (see table). Priapism recurred in 28% of men, and was associated with recreational drug abuse, prescription narcotics, current tobacco use, and stuttering priapism (all p<0.05). New onset erectile dysfunction after priapism resolution occurred in 28%, and was associated with increased age, lower serum testosterone, nonHispanic ethnicity, priapism duration, shunt procedure, and prescription narcotic and benzodiazepine use (all p<0.05). CONCLUSIONS: Almost half of men with ischemic priapism have mental health disorders. Most men were taking drugs associated with priapism. Polypharmacy with multiple linked drugs in addition to prescription narcotics and benzodiazepines is common. Polypharmacy might lead to an increased risk and incidence of ischemic priapism. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e476-e477 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Weedin More articles by this author Joanie Chung More articles by this author Aravind Chandrashekar More articles by this author Marc Herskowitz More articles by this author Expand All Advertisement Loading ...

Smoking status and the baseline international index of erectile function score can predict satisfactory response to platelet-rich plasma in patients with erectile dysfunction: A prospective pilot study.

Erectile dysfunction (ED) is a common condition with a significant impact on the quality of life. Regenerative medicine maladies are intended to repair or replace damaged tissues and organs through different therapeutic mechanisms. Our aim was to study the effect of intra-corporeal injection (ICI) of platelet-rich plasma (PRP) in ED patients. Thirty-four patients' erectile function was evaluated by filling up an abridged form of the international index of erectile function (IIEF-5) before and after PRP therapy. ICI of PRP was done once per week for 2months. All patients were prescribed PDE5Is for one month after PRP therapy. Penile haemodynamics was assessed using 20µg of PGE1 before and 3months after initiating PRP therapy. Interestingly, our study had shown that there was a statistically significant difference in the IIEF-5 score after ICI of PRP (-5.5, ±5.2, p=<0.001). Furthermore, in multiple logistic regression model for PRP responsiveness, smoking and IIEF score before PRP were the only significant independent variables (p=.040, p=.023 respectively). PRP injection for ED patients may be a promising modality as well as baseline IIEF-5, and smoking status can be used as predictors for a satisfactory response to PRP in such patients.

Management of intra operative priapism after spinal anesthesia with intravenous glycopyrrolate and intracorporeal injection of ultra low dose of phenylephrine- A case report

Priapism following neuraxial anesthesia or general anesthesia is a rare but problematic event which may result in delay, complication or even cancellation of scheduled operations in urological endoscopic procedures. We present a case of successful management of intra operative priapism in a 32 years old male under spinal anesthesia posted for Ureteroscopic Lithotripsy (URSL) of bilateral ureteric stone.Different therapies for management of intra operative priapism have been quoted in the past like intracorporeal injection of vasopressors, dorsal penile nerve block, intravenous glycopyrrolate, intravenous ketamine/dexmedetomidine etc. In this case we treated with intravenous glycopyrrolate and intracorporeal injection of ultra low dose phenylephrine.

Medicolegal evaluation of the erectile function of patients referred from the Forensic Medicine Authority of the Ministry of Justice in Upper Egypt

In Upper Egypt, the Forensic Medicine Authority of the Ministry of Justice transfers patients with marital conflicts or accusation of rape for proper sexual function evaluation, which helps in making its decisions according to the law. Therefore, our study aims to evaluate the pattern of 40 cases referred for sexual function evaluation, their clinical, laboratory, imaging characteristics and finally the decisions of these cases. The study included 40 patients who referred from the Forensic Medicine Authority for erectile function evaluation. Initial evaluation was done through history taking, general & genital examination. Hormonal profile including total testosterone, free testosterone, follicle stimulating hormone, luteinizing hormone, prolactin, estradiol and random blood sugar were done. Penile color doppler with intracorporeal injection of PGE1 was done. The final decision for erectile function cases was considered as normal evaluation, venogenic, arteriogenic, and psychogenic erectile dysfunction were 35% (14/40), 25% (10/40), 15% (6/40) and 12.5% (5/40), respectively. There is a great diversity in patients referred for medicolegal evaluation in Upper Egypt; with the erectile function problems are the commonest. A more meticulous well-designed approach is needed for proper evaluation of those patients as serious legal consequences result from this evaluation.

Erectile dysfunction post radical cystectomy. The role of early rehabilitation with pharmacotherapy in nerve sparing and non-nerve sparing group: A randomized, clinical trial

No clinical studies testing erectile function (EF) post radical cystectomy (RC) were done. Our objective was to assess the effect of early pharmacologic therapy after RC using intracorporeal injection (ICI), phosphodiesterase inhibitor (PDE5i) and PDE5i+ICI. In our randomized, double-blinded study, we prospectively enrolled 160 potent male patients with invasive bladder cancer. Patients were operated by RC using the nerve-sparing (NS) or non-nerve sparing (NNS) technique. They were treated since 1 month postoperatively by different regimens (PDE5i vs. ICI vs. ICI+PDE5i). Patients were evaluated using the international index of erectile function questionnaire and were followed up regularly at 1, 3, 6, and 12 months using the same parameters. One month after therapy, the mean of EF domain improved in both NS and NNS group. In the NNS group, in patients treated with ICI alone and ICI+PDE5i, the EF domain at 12 months moved to the moderate and to the mild category respectively. In patients treated by the NS approach, the mean value remained in the mild category with or without therapy. Early pharmacotherapy since one-month post RC using ICI and a combination of ICI+PDE5i can improve the erectile function of patients operated with a NNS approach.

Relation of pharmacopenile duplex ultrasonography parameters and glycated hemoglobin (HbA1c) in diabetic patients with erectile dysfunction

Introduction and objectivesErectile dysfunction (ED) is one of the main threats in diabetic patients. This research aimed to assess the relationship between glycated hemoglobin (HbA1c) level and pharmacopenile duplex ultrasonography (PPDU) indices in diabetic patients with ED. Materials and methodsA total of 130 males with ED were recruited (100 had diabetes mellitus (DM) and 30 did not as control). The International Index of Erectile Function (IIEF) was used to evaluate patients for ED. Measurement of HbA1c, lipid profile and assessment of erectile function using PPDU were performed. All participants were assessed to take the medical history. ResultsThe mean age±SD was 53.8±8.9 and 53.6±2.8 years for patients and controls, respectively. Patients had variable grades of ED: mild in 20%, mild to moderate in 32.3%, moderate in 35.3%, and severe in 12.3%. A significant association was found between the existence of DM and a deprived response to intracorporeal injection (ICI), rising end-diastolic velocity (EDV), and reducing resistance index (RI) values. Comparing all diabetic groups according to HbA1c with controls, a significant relationship was found in; severity of IIEF-5 score, poor response to ICI, decreased peak systolic velocity (PSV) at 10min, increased EDV at 10, 20min and decreased RI at 10, 20min. A significant relationship was found between smoking, dyslipidaemia, and decreased PSV at 10, 20min and decreased increment ratio. However, a non-significant relationship was observed between age, type of DM and PPDU parameters. ConclusionPoor glycaemic control of DM is associated with an increase in EDV and decrease in RI, and PSV of PPDU.

Prevalence of post-prostatectomy erectile dysfunction and a review of the recommended therapeutic modalities.

Radical prostatectomy (RP) represents one of the most commonly used first-line treatment modalities in men with localized prostate cancer. One of the most feared post-surgical complications is erectile dysfunction (ED), usually caused by direct damage to the cavernous nerves or due to neuropraxia. Penile rehabilitation is an emerging concept that was proposed to stimulate and accelerate recovery of erectile function after RP. The goal is to improve blood flow to the penis, increasing cavernous oxygenation and avoiding fibrosis. The most common used modalities include oral phosphodiesterase type 5 inhibitors (PDE5-I), vacuum erection devices (VEDs), intracorporeal injection (ICI) therapy, medicated urethral system for erections (MUSE), and a combination of these treatments. For those patients with severe ED, ED refractory to medical therapy and/or seeking long term reliable results, the penile prosthesis implant remains an excellent alternative. We conducted a broad review of post-prostatectomy ED prevalence with different techniques and the success rates of the different therapeutic approaches.

Priapism with Essential Thrombocythemia Review of Literature, Where We Stand and Where We Are Heading

Introduction Priapism is a persistent erection of the penis that is not associated with sexual stimulation or desire lasting more than 4 hours. Priapism can be classified as ischemic, non-ischemic, or stuttering. Stuttering priapism is defined as recurrent priapism lasting less than 4 hours. Commonly, no cause is identified, secondary causes include medications specially intracorporal injections or medical conditions such as hematological diseases particularly sickle cell disease, but it is uncommon to be seen with essential thrombocythemia (ET). It adversely affects the quality of life, sexual function, and physical wellness of the affected patients besides the risk of penile fibrosis and permanent erectile dysfunction. The underlying pathophysiology is not clearly understood but the mechanism involves disturbed nitrous oxide, phosphodiesterase enzyme activity, and disturbed auto-regulation of the penile circulation. Method Literature searched in google scholar, PubMed, and Scopus search engines with keywords priapism, essential thrombocythemia, essential thrombocytosis results found from 1960 to 2020. Results Using the keywords above we found 11 cases of ET devolved or presented with priapism. With the case in our center (not published) the total number of cases will be 12. The cases arranged by chronological order. Almost all age groups are involved from 7 years to 71 years. The table shows hematological parameters, type of mutation, and the management of priapism. Discussion In ET the mechanism of priapism is probably related to high platelet count and platelets sludging in the corpora cavernosa, similar to RBC sludging in sickle cell disease and WBC sludging in leukemia. Subsequent stasis and disturbed NO and cGMP signaling. This might be precipitated by increased viscosity or release of free hemoglobin secondary to hemolysis similar to sickle cell anemia as many patients had low hemoglobin levels (table-1). Looking at the table with the available data most hemoglobin levels are in the lower normal limits, but no patient had high hemoglobin levels, opposite to what can be expected that polycythemia might enhance the viscosity of the blood and enhance thrombosis. Observing other MPN who developed priapism, in one study 430 patients with CML 8 patients developed priapism at diagnosis, they had lower hemoglobin levels compared to CML patients who didn't develop priapism. The mean hemoglobin level in patients with priapism was 8.4 ± 2.3 g/dL, compared to 10.8 ± 2.5 g/dL in CML patients control who didn't develop priapism. To the best of our knowledge, there are no reports of cases of adults with polycythemia Vera who devolved priapism which might indicate that anemia has a synergistic effect with leukocytosis in the pathogenesis of priapism in CML patients. But, it is difficult to generalize this observation to ET. However, anemia can enhance thrombosis and the risk of thromboembolism by different mechanisms not related to reactive thrombocytosis. Some patients presented after years from the onset of priapism. This may indicate the complaint of priapism is underreported especially for patients with stuttering priapism who develop erection for a shorter duration of time and subsides spontaneously. While patients with ischemic priapism have prolonged, painful erection usually seeks medical attention from the first time. This can be the reason that CML reports of priapism are relatively more common 1.9 % compared to ET because CML type is predominantly ischemic. At the same time, ET can be ischemic or stuttering. Most of these cases are reported before 2008 WHO criteria for ET, which explains why no genetic studies done for the cases. This case is the first reported case of CLAR mutation associated with priapism. In the table 6/12 had splenomegaly or splenectomy a ratio close to general ET patients. Conclusion Priapism is a rare presentation and complication of ET. It can present as ischemic or stuttering types. ET with stuttering priapism might be underreported. The main risk factors aren't clear due to old and few reported cases. Splenomegaly, age, and type of mutation appear to have little impact. But the characteristic features are the high platelet count and lower hemoglobin level. Disclosures No relevant conflicts of interest to declare.

Current management strategy of treating patients with erectile dysfunction after radical prostatectomy: a systematic review and meta-analysis.

The aim of this study is to present a summary of current evidence concerning the various treatments in the management of penile rehabilitation after radical prostatectomy (RP) and provide recommendations for future research. Randomized controlled trials (RCTs) were identified from electronic databases including PubMed, the Cochrane Library, Embase, and Web of Science from inception through March 2020 with no limitation to language. Comparable data from each study were combined in a meta-analysis where possible, otherwise data were synthesized narratively. The data analysis was completed by Review Manager version 5.3. A total of 39 RCTs were included in this study. At present, phosphodiesterase type 5 inhibitors (PDE5is) remain the first-line treatment for patients with erectile dysfunction (ED) after RP. Compared with the placebo group, patients in regular PDE5is group (mean difference (MD): 0.76; 95% confidence interval (CI): 1.69-4.44; p < 0.0001) and on demand group (MD: 3.92; 95% CI: 2.95-4.88; p < 0.00001) had a significantly higher mean Erectile Function domain of the International Index of Erectile Function (IIEF-EF) scores within 3 months after RP. As for the proportion of IIEF-EF ≥ 22, patients in regular PDE5is group and on demand PDE5is group had significantly higher proportion than those in placebo group 6 months after RP, and the odds ratios were 1.87 (95% CI: 1.32-2.66; p = 0.0005) and 2.17 (95% CI: 1.20-3.93; p = 0.01), respectively. No significant difference was observed between regular PDE5is group and on demand group regardless of mean IIEF-EF score or the proportion of IIEF-EF ≥ 22. Intracorporeal injection therapy seemed to have similar efficacy to PDE5is. The International Index of Erectile Function-5 items (IIEF-5) scores were significantly higher in vacuum constriction devices group than control group at 6-9 months after RP (MD: 6.70, 95% CI: 2.30-11.10, p = 0.003) with great between-study heterogeneity (p = 0.06, I2 = 72%). The other therapeutics including low-intensity extracorporeal shockwave therapy, statin therapy, psychotherapy interventions, and pelvic floor muscle training plus electrical stimulation showed certain improvement on erectile function. We found that the combination therapy showed certain advantages over monotherapy. Currently, PDE5is-based combination therapy remains the mainstream treatment for ED after RP. Intracorporeal injection therapy and vacuum therapy could be served as alternative treatments if PDE5is are ineffective and contraindicated.

Management of erectile dysfunction following robot-assisted radical prostatectomy: a systematic review.

We aimed to summarize evidences about the efficacy of available treatments for erectile disfunction after robotic assisted radical prostatectomy (RARP). A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines were followed. Population consisted of patients with erectile disfunction after RARP (P), conservative and surgical intervention were considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of erectile function after conservative treatments and sexual function after surgical treatments (O). Eleven studies were included. Seven studies focused on the use of phosphodiesterase-5 inhibitors (PDE5i) alone (five studies) or associated with other treatments (two studies). All the studies confirmed the efficacy of PDE5i, while the most promising association is with vacuum pump erectile devices. Two studies investigated topical treatments, namely low intensity extracorporeal shock wave therapy and alprostadil. Low intensity extracorporeal shock wave therapy may be a promising option in patients in whom nerve-sparing surgery was performed. The use of alprostadil could be an effective alternative to intracorporeal injection in those who underwent non-nerve-sparing surgery. One study focused and confirmed the efficacy of penile implants. Furthermore, one study reported the efficacy of a multi-modal treatment with preoperative medication, showing the benefits of a multimodal approach. Penile rehabilitation with PDE5i is effective after nerve sparing RARP. The association of PDE5i with vacuum devices could led to a faster recovery. A multimodal approach with preoperative specific care seems to be effective to fasten erectile function recovery.

Dynamic Changes in Erectile Function and Histological Architecture After Intracorporal Injection of Human Placental Stem Cells in a Pelvic Neurovascular Injury Rat Model

IntroductionThe human placenta provides a bountiful and noncontroversial source of stem cells which have the potential for regeneration of injured tissue. These cells may restore erectile function after neurovascular tissue injury such as that seen in radical pelvic surgeries and pelvic trauma. AimTo determine the effect of human placenta–derived stem cells on erectile function recovery and histological changes at various time points in a cavernous nerve injury rat model and to study the fate of injected stem cells throughout the regenerative process. MethodsHuman placental stem cells (PSCs) were dual labeled with monomeric Katushka far red fluorescent protein (mKATE)-renLUC using a lentivirus vector. A pelvic neurovascular injury–induced erectile dysfunction model was established in male, athymic rats by crushing the cavernous nerves and ligating the internal pudendal neurovascular bundles, bilaterally. At the time of defect creation, nonlabeled PSCs were injected into the corpus cavernosum at a concentration of 2.5 × 106 cells/0.2 mL. The phosphate-buffered saline–treated group served as the negative control group, and age-matched rats (age-matched controls) were used as the control group. Erectile function, histomorphological analyses, and Western blot were assessed at 1, 6, and 12 weeks after model creation. The distribution of implanted, dual-labeled PSCs was monitored using an in vivo imaging system (IVIS). Implanted cells were further tracked by detection of mKATE fluorescence in histological sections. Main Outcome MeasureThe main outcome measure includes intracavernous pressure/mean arterial pressure ratio, neural, endothelial, smooth muscle cell regeneration, mKATE fluorescence, and IVIS imaging. ResultsThe ratio of intracavernous pressure to mean arterial pressure significantly increased in PSC-injected rats compared with phosphate-buffered saline controls (P < 0.05) at the 6- and 12-week time points, reaching 72% and 68% of the age-matched control group, respectively. Immunofluorescence staining and Western blot analysis showed significant increases in markers of neurons (84.3%), endothelial cells (70.2%), and smooth muscle cells (70.3%) by 6 weeks in treatment groups compared with negative controls. These results were maintained through 12 weeks. IVIS analysis showed luminescence of implanted PSCs in the injected corpora immediately after injection and migration of cells to the sites of injury, including the incision site and periprostatic vasculature by day 1. mKATE fluorescence data revealed the presence of PSCs in the penile corpora and major pelvic ganglion at 1 and 3 days postoperatively. At 7 days, immunofluorescence of penile PSCs had disappeared and was diminished in the major pelvic ganglion. Clinical ImplicationsPlacenta-derived stem cells may represent a future “off-the-shelf” treatment to mitigate against development of erectile dysfunction after radical prostatectomy or other forms of pelvic injury. Strength & LimitationsSingle dose injection of PSCs after injury resulted in maximal functional recovery and tissue regeneration at 6 weeks, and the results were maintained through 12 weeks. Strategies to optimize adult stem cell therapy might achieve more effective outcomes for human clinical trials. ConclusionHuman PSC therapy effectively restores the erectile tissue and function in this animal model. Thus, PSC therapy may provide an attractive modality to lessen the incidence of erectile dysfunction after pelvic neurovascular injury. Further improvement in tissue regeneration and functional recovery may be possible using multiple injections or systemic introduction of stem cells.Gu X, Thakker PU, Matz EL, et al. Dynamic Changes in Erectile Function and Histological Architecture After Intracorporal Injection of Human Placental Stem Cells in a Pelvic Neurovascular Injury Rat Model. J Sex Med 2020;17:400–411.

Erectile dysfunction in diabetes mellitus: A review

The International Diabetes Federation estimates that globally there are 425 million people with diabetes. Estimates of the prevalence of erectile dysfunction (ED) in men with diabetes range from 20% to 85% in different studies. Among men with ED, those with diabetes are likely to experience the problem 10–15 years earlier than men without diabetes. This review aims to provide an update of the epidemiology, pathophysiology and management of ED in diabetes patients in India. The proposed mechanisms of ED in diabetic patients include elevated advanced glycation end-products and increased levels of oxygen-free radicals, impaired nitric oxide (NO) synthesis, increased endothelin B receptor binding sites and ultrastructural changes, upregulated RhoA/Rho-kinase pathway, NO-dependent selective nitrergic nerve degeneration and impaired cyclic guanosine monophosphate-dependent kinase-1. Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome and excessive alcohol consumption. Therefore, the promotion of healthful lifestyles would yield great benefits in reducing the burden of ED. The treatment of diabetic ED is multimodal. The treatment of the underlying hyperglycaemia and comorbidities is of utmost importance to prevent the progression of the disease. The peripherally acting oral phosphodiesterase type 5 inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional a non-invasive treatment option. The local administration of vasoactive medication through urethral suppository or intracorporal injection can be effective with minimal side-effects.