Ischiocavernosus Research Articles

Castration Levels of Testosterone Results in Atrophy of Androgen-Sensitive Perineal Muscles: A Potential Biomarker for Male Hypogonadism

ObjectivesTo evaluate MRI-based measurements of androgen-sensitive perineal/pelvic muscles in men with prostate cancer before and after androgen deprivation therapy (ADT) as a novel imaging marker for end-organ effects of hypogonadism. Diagnosing hypogonadism or testosterone deficiency (TD) requires both low serum testosterone and clinical symptoms, such as erectile dysfunction and reduced libido. However, the non-specific nature of many TD symptoms makes it challenging to initiate therapy. Objective markers of TD help to better identify patients who may benefit from testosterone supplementation; however, current markers, such as low bone mineral density, lack sensitivity. Previous studies suggest that decreased bulbocavernosus-muscle (BCM) thickness may be associated with TD, although it remains unclear if this is a correlative relationship. MethodsData was prospectively collected for patients with intermediate/high-risk localized prostate cancer enrolled in a phase II trial (NCT02430480). Patients received ADT before prostatectomy and underwent prostate MRI pre-/post-ADT. BCM, ischiocavernosus-muscle (ICM), and levator-ani-muscle (LAM) measurements were made using T2W-MRI. Paired t-tests evaluated changes in BCM/ICM/LAM width, and linear regression analyses evaluated relationships between changes in testosterone and muscle width. ResultsThirty-eight consecutive patients with pre-/post-ADT MRIs were analyzed. Baseline testosterone was 286.5ng/dl, and 36/38 patients had post-ADT testosterone <50ng/dL. Pre-ADT and post-ADT measurements of the bilateral BCM/ICM/LAM width were 7.16mm/7.95mm/5.53mm and 5.68mm/6.71mm/4.89mm, respectively (p<0.001). Decreases in testosterone predicted reduction in combined perineal muscle (BCM+ICM) width (p=0.032). ConclusionsAndrogen deprivation led to significant and relatively rapid decreases in BCM/ICM/LAM thickness. This objective biomarker of low testosterone states may help identify patients who will potentially benefit from testosterone replacement.

Anatomy of the Male Reproductive System of Sugar Gliders (Petaurus breviceps).

The present study provides a detailed macroscopic examination (with some microscopic insights) of the genital apparatus of seven adult and intact male sugar gliders, as well as one castrated individual. The scrotum is pendulous and attached to the ventral abdominal wall, situated in the caudal part of the abdomen and cranial to the cloacal opening. The testes are oval shaped with their long axes oriented vertically. The epididymides are attached along the caudomedial border of their respective testes. The head and tail of the epididymides are in close proximity to the poles of the testes but are not directly attached. The deferent ducts are positioned laterally to their ipsilateral ureter as they run near the dorsal surface of the urinary bladder. The ampulla of the deferent duct is absent. The penis is located post-scrotally, lacks insertion into the bony pelvis, and has a bifid distal end. The crura of the penis originate within the ischiocavernosus muscles, and there are two bulbs of the penis. When flaccid, the entire penis is concealed in the perineal region and externalizes through an orifice situated in the ventral part of the cloaca, traversing its floor towards the cloacal opening. The urethral external orifice is positioned at the point where the bifurcation of the free part of the penis begins. The prostate gland resides in the pelvic cavity and consists of two parts: a macroscopically visible body surrounding the urethra and a microscopically identifiable portion embedded within the walls of the duct. Sugar gliders possess two pairs of bulbous bulbourethral glands, located dorsally and laterally to the rectum, but lack vesicular glands.

Evaluation of efficacy and safety of Botulinum toxin-A injection at three deferent sites in treatment of premature ejaculation.

Premature ejaculation (PE) is a common sexual problem, resulting in adverse effects on the quality of life, of both the patient and the partner. The idea of muscular contraction inhibition during the ejection phase of ejaculation by Botulinum toxin-A injection may delay ejaculation. This study was performed to assess the efficacy and safety of Botulinum toxin-A injection in PE treatment. This study included 45 married male patients diagnosed with primary PE. All included patients were injected with 75 units of Dysport equal efficacy of 25 units of Botulinum toxin-A (Botox) into three sites: the root of the penis (Group 1), glans penis (Group 2), and each side of the ischiocavernosus muscle (Group 3). All patients were subjected to an assessment of intravaginal ejaculation latency time (IELT) using a stopwatch and answering the Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire before and after treatment. There was a statistically significant improvement in IELT after treatment in all groups. The most significant improvement was shown in Group 3 (average 108% increase), followed by Group 1 (74%) and Group 2 (40%), respectively. There was a positive correlation between age and the improvement in improved IELT. There was a statistically significant improvement in PEDTq scores in Group 1 and Group 3. Botulinum toxin-A injection into the root of the penis and ischiocavernosus muscle could be recommended in the treatment of premature ejaculation.

(062) The Physiological Health of the Penile Fibro-Vascular Assembly Requires the Integrity of Ten Fibro-ligaments in the Human Penis

Abstract Introduction Although the human penis has existed on earth for 3000 centuries and extensive studies have been conducted for many recent centuries, there is still room for improvement, particularly in the fibro-ligaments' role in maintaining physiological sexual health. Thus far, there needs to be more interpretation concerning these ligaments. Objective We aimed to explore the penile fibrous ligaments thoroughly to fill this research gap. Methods We excluded cadaveric penises that had both sides of the corpora cavernosa (CC) and corpus spongiosum (CS) damaged. However, penises with one undamaged side of the CC, including the Colles' fascia and the corpus spongiosum, were included. A total of 15 out of 46 penises were meticulously examined. Dissection findings were supplemented with 101 cadaveric photos and data from 263 penile vascular surgeries, 11 CT imaging scans, 8 MRI imaging scans, eight hypospadias surgeries, and eight penile elongation surgeries performed elsewhere internationally. Results Bilaterally, the penile CC is primarily anchored to the pelvis wall through the unilateral cavernosal ligament bilaterally (CL=2), while the CS is connected to the urinary sphincter. The suspensory, fundiform, and arcuate pubic ligament (two anatomically and one functionally) assist in stabilizing and holding the penile shaft to the pelvic wall. Distally, a distal ligament (DL=1) and spongiosal ligament (SL=1) extend the CC and CS to the glans penis and frenulum, ensuring urethra patency when required. The CC is encircled by a bi-layered tunica consisting of a 360° inner circular tunica and a 300° outer longitudinal coat. The ischiocavernosus muscle wraps around the penile crus and envelops the CL connecting to the ischial tuberosity. The CS is partially secured by the bulbospongiosus muscle proximally and receives the SL distally. The entire penis interconnects with the skeletal muscle of the urogenital diaphragm eventually. Conclusions The physiologically sexual health of the human penis's hydraulic system relies on the integrity of ten anatomically and six functionally fibro-muscular ligaments. Disclosure No.

Patterns of connexin36 and eGFP reporter expression among motoneurons in spinal sexually dimorphic motor nuclei in mouse.

Sexually dimorphic spinal motoneurons (MNs) in the dorsomedial nucleus (DMN) and dorsolateral nucleus (DLN) as well as those in the cremaster nucleus are involved in reproductive behaviours, and the cremaster nucleus additionally contributes to testicular thermoregulation. It has been reported that MNs in DMN and DLN are extensively linked by gap junctions forming electrical synapses composed of connexin36 (Cx36) and there is evidence that subpopulation of MNs in the cremaster nucleus are also electrically coupled by these synapses. We used immunofluorescence methods to detect enhanced green fluorescent protein (eGFP) reporter for Cx36 expression in these motor nuclei. We document in male mice that about half the MNs in each of DMN and DLN express eGFP, while the remaining half do not. Further, we found that the eGFP+ vs. eGFP- subsets of MNs in each of these motor nuclei innervate different target muscles; eGFP+ MNs in DMN and DLN project to sexually dimorphic bulbocavernosus and ischiocavernosus muscles, while the eGFP- subsets project to sexually non-dimorphic anal and external urethral sphincter muscles. Similarly, eGFP+ vs. eGFP- cremaster MNs were found to project to anatomically distinct portions of the cremaster muscle. By immunofluorescence, nearly all motoneurons in both DMN and DLN displayed punctate labelling for Cx36, including at eGFP+/eGFP+, eGFP+/eGFP- and eGFP-/eGFP- cell appositions. Most if not all motoneurons in DMN and DLN are electrically coupled, including sexually dimorphic and non-dimorphic motoneurons with each other, despite absence of eGFP reporter in the non-dimorphic populations in these nuclei that have selective projections to sexually non-dimorphic target muscles.

The Cavernous Nerve Injury Rat Model: A Pictorial Essay on Post-Radical Prostatectomy Erectile Dysfunction Research.

Understanding and addressing post-radical prostatectomy (RP) erectile dysfunction (ED) is of paramount importance for clinicians. Cavernous nerve (CN) injury rat model studies have provided consistently promising experimental data regarding regaining erectile function (EF) after nerve damage-induced ED. However, these findings have failed to translate efficiently into clinical practice, with post-RP ED therapeutic management remaining cumbersome and enigmatic. This disparity highlights the need for further standardization and optimization of the elaborate surgical preparation protocols and multifaceted reporting parameters involved in reliable CN injury rat model experimentation. Even so, despite its technical complexity, this animal model remains instrumental in exploring the functional implications of RP, i.e., surgical lesions of the neurovascular bundles (NVBs). Herein, besides cavernous nerve (CN) dissection, injury, and electrostimulation, multiple pressure measurements, i.e., mean arterial pressure (MAP) and intra-cavernosal pressure (ICP), must also be achieved. A transverse cervical incision allows for carotid artery cannulation and MAP measurements. Conversely, ICP measurements entail circumcising the penis, exposing the ischiocavernous muscle, and inserting a needle into the corporal body. Finally, using an abdominal incision, the prostate is revealed, and the major pelvic ganglia (MPG) and CNs are dissected bilaterally. Specific surgical techniques are used to induce CN injuries. Herein, we provide a narrative and illustrative overview regarding these complex experimental procedures and their particular requirements, reflecting on current evidence and future research perspectives.

0971 Case Report: Sleep-Related Painful Erections Treated with Sodium Oxybate

Abstract Introduction Sleep-related painful erection (SRPE) is a rare parasomnia characterized by painful penile erections during rapid eye movement sleep. Normal, painless erections continue to occur while awake. Approximately thirty cases have been reported in the literature. Multiple theories about potential pathophysiology have been proposed including neurologic dysfunction of the ischiocavernosus and bulbocavernosus, correlation with obstructive sleep apnea, and/or autonomic dysfunction. There is no known single effective treatment to date resulting in durable response despite multiple attempts at therapy. Report of case(s) A 39-year-old male presented with SRPE. This started in 2018 and occurred in the second half of the night every twenty minutes, contributing to discomfort and poor sleep quality. While awake, his erections were painless. He was prescribed baclofen at doses up to 30mg daily decreasing episode frequency to 1-6 times per night, but disabling somnolence precluded continuation. Pelvic physiotherapy was unhelpful while imipramine and clonazepam provided partial relief. Tadalafil was ineffective and cinitapride was not available in the United States. Oxycodone used for pain after a motor vehicle accident did effectively treat him for five hours per night, so morphine was trialed. This was effective for two weeks, but symptoms returned. In April 2022, he was begun on sodium oxybate. With an initial dose of 2.25 g twice nightly, symptoms were treated for four hours a night. After increasing to 2.75 g twice nightly, the SRPE was effectively treated. As of September 2022, he is taking sodium oxybate 3 g at bedtime, 3 g 3.5 hours later and the final 3 g at the 7th hour, promoting 9.5 hours of sleep without SRPE. Conclusion This 39-year-old male who presented with SRPE was trialed on multiple therapies without success, and ultimately successfully treated with an appropriate and titrated dose of sodium oxybate. This may represent a new treatment option, which we hypothesize may act by modulating GABA to result in relaxation of the bulbospongiosus and ischiocavernosus muscles. Further studies should include the study of both the efficacy of this drug for SRPE as well as potential mechanisms of action. Support (if any)

(030) Reliability of Shear Wave Elastography for the Assessment of Pelvic Floor Muscle Stiffness

Abstract Introduction Shear wave elastography (SWE) has gained popularity for assessing skeletal muscle stiffness and could potentially overcome some limitations associated with the assessment of the pelvic floor muscles (PFMs). Additionally, SWE is a non-invasive and painless alternative to the current method of assessing the PFMs, which is often painful or even impossible to perform in women with sexual pain. Before implementing this promising method, it is of the utmost importance to assess its reliability. Available data are limited and currently, there is no study investigating the reliability of SWE for the assessment of the different PFMs. Objective To investigate the intra-rater and inter-rater reliability of SWE in measuring the stiffness of the different PFMs at rest and during maximal voluntary contraction in asymptomatic women. Methods Thirty asymptomatic nulliparous women participated in the study. They each attended a single assessment session conducted by two independent assessors. SWE assessments were performed using the Aixplorer device (Supersonic Imaging) equipped with linear probes. Four PFMs (i.e., bulbospongiosus, ischiocavernosus, transverse perineal, puborectalis) and the perineal body were assessed at rest and during maximal voluntary contraction. Measurements were taken twice by the first assessor (intra-rater reliability) and once by the second assessor (inter-rater reliability). SWE data were saved and analyzed offline. For both the resting and contraction states, three consecutive frames with stable SWE maps were selected. The average shear modulus was evaluated by manually defining a region of interest that corresponded to the structure assessed. To determine intra- and inter-rater reliability, intraclass correlation coefficients (ICC) were calculated. Results Intra-rater reliability was excellent for the ischiocavernosus and puborectalis at rest and during contraction as well as for the transverse perineal and perineal body during contraction (ICC 0.82-0.95); good for the bulbospongiosus during contraction as well as the transverse perineal and perineal body at rest (ICC 0.61-0.79); and fair for the bulbospongiosus at rest (ICC 0.51). For the inter-rater reliability, the results were as follows: excellent for the transverse perineal and puborectalis during contraction (ICC 0.84-0.89); good for the puborectalis and transverse at rest as well as the perineal body during contraction (ICC 0.62-0.72); fair for the perineal body at rest (ICC 0.48); and poor for the bulbospongiosus and ischiocavernosus muscles (ICC 0.22-0.38) in both states. Conclusions These findings support the intra- and inter-rater reliability of SWE for the assessment of PFM stiffness in women, especially in the puborectalis muscle, transverse perineal muscle, and perineal body. By enabling the assessment of localized areas of stiffness in the different PFMs, SWE may be a stepping stone in enhancing our understanding of the role of the PFMs in the pathophysiology and treatment of sexual pain. Further studies investigating PFM stiffness with the use of SWE assessment are encouraged. Disclosure No

(298) MRI Measurement of Perineal and Pelvic Muscles as a Novel Imaging Marker for Hypogonadism

Abstract Introduction Low serum testosterone (T) in the presence of clinical symptoms of hypogonadism is essential in determining who may benefit from T replacement therapy. However, clinical symptoms associated with hypogonadism are non-specific and challenging to discriminate from other etiologies. While low bone mineral density is an objective primary end-organ effect of low testosterone, DEXA scans are not recommended by national guidelines due to poor sensitivity and specificity, and the limitation that these changes likely manifest over a prolonged period of time. Notably, prior studies have demonstrated that perineal ultrasound of the bulbocavernosus muscle (BCM) can be an effective surrogate to evaluate end-organ activity of hypogonadism. However, it is unclear if low BCM area is secondary to or rather correlated with hypogonadism, and longitudinal studies assessing men in both the eugonadal and hypogonadal state are lacking. Objective To report an initial experience with measuring the androgen-sensitive BCM, ischiocavernosus muscle (ICM), and levator ani muscles (LAM) on MRI in men before and after androgen deprivation therapy (ADT) as a novel imaging marker for end-organ effects of hypogonadism. Methods Data was collected from treatment-naive patients with intermediate or high-risk localized prostate cancer enrolled in a clinical trial involving six months of neoadjuvant treatment with goserelin and enzalutamide prior to prostatectomy. Patients underwent 3-Tesla multiparametric MRI of the prostate prior to treatment and again immediately prior to prostatectomy. An expert genitourinary trained radiologist retrospectively assessed MR images and measured width of the bilateral BCM, ICM, and LAM on coronal T2W MRI (Figure 1). Paired t-tests were performed to evaluate changes in muscle width before and after ADT. Linear regression was performed to evaluate the relationship between change in total testosterone levels and change in muscle width. The lower detection limit of testosterone was 20 ng/dL, and T less than 20 ng/dL was set to 0 for statistical analysis. Results 38 patients with pre- and post-treatment MRIs were identified with a median time between scans of 6.85 months. Median age at start of trial was 62.5 years (IQR: 58-69). 28/38 patients had documented AUA/IPSS and SHIM questionnaires with median scores of 8 and 19.5, respectively. Mean total testosterone prior to androgen deprivation was 289.5 ng/dL (SD= 121.7). 34/38 patients reached castrate level (T less than 20 ng/dL) after treatment completion, with mean testosterone 4.7 ng/dL (SD= 15.4). Muscle width was significantly reduced in all three muscle groups following ADT (Table 1). Linear regression found that decreases in testosterone significantly predicted decreases in combined perineal muscle (BCM + ICM) width (β = 0.0056, p = 0.032). Conclusions Decreases in testosterone to castrate levels led to significant and rapid decreases in sizes of both perineal and pelvic muscles. This shows initial plausibility in using an image-based approach to assess a short- to intermediate-term objective marker of end-organ effects of hypogonadism. Future prospective studies with larger samples and refinement of MRI sequences may lead to a useful clinical tool in the diagnosis and clinical workup of hypogonadism, and help clinicians better understand who would benefit from testosterone supplementation. Disclosure No

Automatic segmentation of prostate and extracapsular structures in MRI to predict needle deflection in percutaneous prostate intervention.

Understanding the three-dimensional anatomy of percutaneous intervention in prostate cancer is essential to avoid complications. Recently, attempts have been made to use machine learning to automate the segmentation of functional structures such as the prostate gland, rectum, and bladder. However, a paucity of material is available to segment extracapsular structures that are known to cause needle deflection during percutaneous interventions. This research aims to explore the feasibility of the automatic segmentation of prostate and extracapsular structures to predict needle deflection. Using pelvic magnetic resonance imagings (MRIs), 3D U-Net was trained and optimized for the prostate and extracapsular structures (bladder, rectum, pubic bone, pelvic diaphragm muscle, bulbospongiosus muscle, bull of the penis, ischiocavernosus muscle, crus of the penis, transverse perineal muscle, obturator internus muscle, and seminal vesicle). The segmentation accuracy was validated by putting intra-procedural MRIs into the 3D U-Net to segment the prostate and extracapsular structures in the image. Then, the segmented structures were used to predict deflected needle path in in-bore MRI-guided biopsy using a model-based approach. The 3D U-Net yielded Dice scores to parenchymal organs (0.61-0.83), such as prostate, bladder, rectum, bulb of the penis, crus of the penis, but lower in muscle structures (0.03-0.31), except and obturator internus muscle (0.71). The 3D U-Net showed higher Dice scores for functional structures ([Formula: see text]0.001) and complication-related structures ([Formula: see text]0.001). The segmentation of extracapsular anatomies helped to predict the deflected needle path in MRI-guided prostate interventions of the prostate with the accuracy of 0.9 to 4.9 mm. Our segmentation method using 3D U-Net provided an accurate anatomical understanding of the prostate and extracapsular structures. In addition, our method was suitable for segmenting functional and complication-related structures. Finally, 3D images of the prostate and extracapsular structures could simulate the needle pathway to predict needle deflections.

Triple Junction Theory and Maneuver: reinforcement of Ischiocavernosus, Bulbocavernosus and Rhabdosphincter muscles

Background: Until today, pelvic floor training protocols are focused on the mm. levator ani, although most dysfunctions are of superficial or urethral muscles. Aims:To present the theoretical and empirical bases of the Triple Junction Theory and introduce the Triple Junction Maneuver to strenght the ischiocavernosus (ICs), bulbocavernosus (BCs) and rhabdosphincter (RE) muscles. Method: Theoretical essay based on anatomical, kinesiological and biomechanical findings and exercise physiology. Results: The ICs, BCs and RE muscles are joined in the region adjacent to the glans of the clitoris and the external urethral meatus, in a Triple Junction. It was possible to develop a maneuver to strengthen these three muscles, the Triple Junction Maneuver, superficial and non-invasive, for women, men and children. Most urinary and sexual dysfunctions are caused by one of these three muscles, so such a maneuver can increase the efficiency of pelvic floor training in general. Conclusion: The Triple Junction between mm. ICs, BCs and RE allowed the creation of a strenght maneuver that, however, still lacks new evidence.

The variation in shape and thickness of the pelvic floor musculature in males and females: a geometric-morphometric analysis

Introduction and hypothesisIn women, the risk of pelvic floor prolapse is known to be associated with age and parity. Different studies suggested that it is also related to pelvic dimensions, e.g. biomechanical modelling showed that a larger pelvic canal results in higher values of displacement, stress and strain in the pelvic floor muscles, which can increase the risk of pelvic floor disorders. To better understand the multiple factors contributing to pelvic floor disorders, we assessed how age, body weight, body height, parity (in women), pelvic canal size and overall muscle development affected pelvic floor geometry.MethodsA comprehensive geometric morphometric analysis of variation in pelvic floor muscle shape was conducted based on a dense set of 3D landmarks measured on CT scans in a cohort of 49 deceased men and 52 deceased women. The multivariate association between biological variables (parity, dimensions of the true pelvis, age, body weight, height) and pelvic floor muscle morphology was explored by reduced rank regression in both sexes.ResultsIn women, advanced age, high body weight relative to body height and a large pelvic canal were associated with a deeper pelvic floor. Surprisingly, parity did not have any strong association with overall pelvic floor shape. In men, high body weight was associated with a deep pelvic floor. Age had little effect on male pelvic floor shape, except for the thickness of the ischiocavernosus muscle, which reduced with age. ConclusionThese results suggest that age, relative body weight and the size of the pelvic canal contribute to the risk of female pelvic floor disorders via their effect on pelvic floor shape, independently of birth-related factors such as injury and avulsion of pelvic floor muscles.

Pelvic Floor HIFEM in Men Improves Ejaculation

ABSTRACT Introduction High-Intensity Focused Electromagnetic (HIFEM) field technology utilizes rapidly changing magnetic fields that generate electrical currents in the underlying tissue where it depolarizes motor neurons and causes muscle contractions. BTL Emsella provides non-invasive electromagnetic stimulation of pelvic floor musculature for the purpose of rehabilitation of weak pelvic muscles and restoration of neuromuscular control for the treatment of male and female incontinence. Novel protocol U2 is intended for men and uses a field intensity max of 2.5 T and a 10 cm depth of penetration for 28 minutes. Objective Determine the effects of High-Intensity Focused Electromagnetic (HIFEM) field technology on the intensity and duration of ejaculation in men, with additional observations on erectile function using the IIEF-15 and urination using the IPSS. Methods We looked at the effects of HIFEM on ejaculation, erectile function, and urination. Our IRB-approved protocol was one 28 minutes pelvic floor treatment per week for 4 weeks. At baseline, end of treatment, and one month post-treatment, the patient completed the IIEF-15, IPSS, and the LuBE Score, a four-question 5 point Likert style questionnaire created specifically for this study to investigate patient-reported aspects of orgasm, including volume, force, duration, and intensity of ejaculation. 0 is no change, 1 is increased, 2 is dramatically increased, -1 is decreased, -2 is dramatically decreased. Men participated with their sexual partners who also received four weekly treatments. Results 12 men, average age of 57, completed the protocol. The range of the LuBE score is -8 to 8. The LuBE Score increased from baseline 0 up to 2.1 (median is 3 with a range of -1 to 5) to 2.7 (median of 3 with a range of 0 to 4) one month after the completion of treatment. The IIEF-15 increased from 54 at baseline to 60.3 at the completion of treatment and 60.4 one month after the completion of treatment. The IPSS declined from 7.1 to 4.6 at the completion of treatment and down to 3.3 one month after th Conclusions We conclude that the U2 protocol for HIFEM boosts the strength of the bulbocavernosus and ischiocavernosus muscle and the pelvic floor resulting in an increase in volume, force, duration and intensity of ejaculation. In addition, there was a six-point increase in IIEF-15 score. There was a 3 to 4 point drop in IPSS score. We were surprised to see improvements in IIEF-15 and IPSS, and this should be investigated further. COVID limited patient recruitment, but the results indicate that pelvic HIFEM potentially improves ejaculation. Based on patient communications, I believe that more treatments than the four provided will add to the benefits. I plan on studies with more participants and extended treatment sessions. Disclosure Yes, this is sponsored by industry/sponsor: BTL Clarification: No industry support in study design or execution Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science

Effects of unilateral/bilateral amputation of the ischiocavernosus muscle in male rats on erectile function and conception

BackgroundThe ischiocavernosus muscle (ICM) encompasses a pair of short pinnate muscles attached to the pelvic ring. The ICM begins at the ischial tuberosity and ends at the crus of the penis while covering the surface of the crus. According to the traditional view, the contraction of the ICM plays an auxiliary role in penile erection. However, we have previously shown that the ICM plays an important role in penile erection through an indirect method of diagnosing erectile dysfunction (ED) caused by ICM injury by observing the infertility of paired female rats. Since intracavernosal pressure (ICP) is the current gold standard for diagnosing ED, this study aimed to amputate unilaterally/bilaterally the ICM to establish an ED model by detecting the ICP, recording the infertility of matching female rats, and comparing the two methods.ResultsForty sexually mature adult male rats were selected and randomly divided into the following groups: the control group (n = 10), sham operation group (n = 10), unilateral ischiocavernosus muscle (Uni-ICM) amputation group (n = 10), and bilateral ischiocavernosus muscle (Bi-ICM) amputation group (n = 10). Eighty female reproductive rats were randomly assigned to the above groups at a ratio of 2:1. We evaluated the time to conception for the paired female rats and the effects of unilateral/bilateral severing of the ICM on erectile function. The results showed that the baseline and maximum intracavernosal pressure (ICP) in the control group, sham operation group, Uni-ICM amputation group, and Bi-ICM amputation group were 17.44±2.50 mmHg and 93.51±10.78 mmHg, 17.81±2.81 mmHg and 95.07±10.40 mmHg, 16.73±2.11 mmHg and 83.49±12.38 mmHg, and 14.78±2.78 mmHg and 33.57±6.72 mmHg, respectively, immediately postsurgery. The max ICP in the Bi-ICM amputation group was lower than that in the remaining three groups (all P<0.05). The pregnancy rates were 100, 100, 90, and 0% in the control group, sham operation group, Uni-ICM amputation group, and the Bi-ICM amputation group, respectively. The pregnancy rate in the Bi-ICM amputation group was significantly lower than that in the remaining groups (all P<0.05). The time to conception was approximately 7–10 days later in the Uni-ICM amputation group than in the control and sham groups (all P<0.05).ConclusionsMale rats undergoing Bi-ICM amputation may develop permanent ED, which affects their fertility. In contrast, rats undergoing Uni-ICM amputation may experience transient ED.

THE EFFECT OF KEGEL EXERCISE ON THE QUALITY OF LIFE IN POST TURP PATIENTS AT MUHAMMADIYAH HOSPITAL

Introduction: Urinary incontinence is a comorbid condition that often occurs in post TURP clients. Low urinary incontinence scores were found in post TURP clients who did Kegel exercises. The purpose of this study was to explain the effect of Kegel exercise on urinary incontinence, and quality of life in post- TURP clients. Methods: The study design was a true experiment pre-post test control group design. The sample size was 32 people who were selected by systematic random sampling, consisting of 16 people in the control group and 16 people in the group treatment. The independent variable in this study was Kegel exercise and the dependent variable was quality of life. Data were collected using a quality of life questionnaire with WHOQOL-BREF. Inferential analysis used statistical t-test (Independent t-Test and Paired t-Test), MANOVA with a significance level of α &lt; 0.05. Results: The results showed that: Kegel exercises improve quality of life scores of the significance level p = 0.045. Conclusion: Kegel exercise can build pubococcygeus muscle mass, improve blood circulation, and improve the bulbocavernosus and ischiocavernosus muscles, thereby reducing urinary incontinence, and quality of life for post TURP clients in a wider population by increasing the reach of the study population and increasing monitoring of client exercise

A correlation study of ischiocavernosus muscle injury with different types of pelvic fractures and erectile dysfunction after pelvic fracture.

Objective:To explore the correlation between ischiocavernosus muscle injury (ICMI) with different types of pelvic fractures and erectile dysfunction (ED) after pelvic fracture.Design:Retrospective analysis of a prospective database.Setting:The study was carried out at the affiliated hospital of Zunyi Medical University.Patients/participants:A total of 776 male patients with pelvic fracture, aged 18 to 67 years, were recruited for this study by retrospective analysis, and based on the diagnosis of ED and the presence of ICMI, the participants were divided into ED and non-ED groups as well as ICMI and non-ICMI groups.Intervention:No.Main outcome measurements:ICMI, the type of pelvic fracture, International Index of Erectile Function-5 scores. Computed tomography/magnetic resonance imaging scans, electromyography (motor unit potential) was used to diagnose ICMI.Results:The International Index of Erectile Function-5 score was 19.7 ± 5.9. The incidence of ED was 27.3%, the duration time of ED was 30 ± 23 months, and the incidence of reversible ED was 39.6% and of irreversible ED was 60.4%. The incidence of ICMI was 29.4%, among which the incidence of unilateral injury was 57.9%, and the incidence of bilateral injury was 42.1%. Among all pelvic fractures, the incidence of pubic ramus fracture was 88.1%. Bilateral pubic ramus fractures, bilateral fractures of the ischial ramus, and ICMI were independent risk factors for ED after pelvic fracture. Bilateral pubic ramus fractures and pubic symphysis separation were independent risk factors for ICMI. Unilateral ICMI was an independent risk factor for reversible ED, while bilateral ICMI was an independent risk factor for irreversible ED.Conclusions:ICMI is associated with ED and may be a cause for ED, while pubic ramus fracture, ischial ramus fracture, and pubic symphysis separation may be the main causes of ICMI. Unilateral ICMI may be the main risk factor for transient ED, and bilateral ICMI may be the main risk factor for permanent ED.

Evaluation of Age- and Radical-Prostatectomy Related Changes in Male Pelvic Floor Anatomy Based on Magnetic Resonance Imaging and 3-Dimensional Reconstruction.

PurposePuborectalis muscles (PRM) and ischiocavernosus muscles (ICM) play important roles in urinary continence and male erectile functions. Understanding of anatomy and surgical-injury related changes to these muscles is critical to monitor changes in continence or erectile function. Anatomical description of these muscles has undergone revisions because these conclusions were derived from cadavers. Our objectives were to: (i) elucidate male pelvic muscles by in-vivo magnetic resonance imaging (MRI) and 3-dimensional (3-D) reconstruction of these images and (ii) compare PRM and ICM thickness in healthy volunteers and symptomatic patients.Materials and MethodsHealthy young male (mean age, 25 years; n=5), older male (age, 65–70 years; n=5), and post-prostatectomy patients with erectile dysfunction and urinary incontinence (age, 65–70 years; n=5) were scanned on a 3T-magnetic resonance scanner. Images were acquired from slices above urinary bladder base to urethra entry into penis. Pelvic bone, bladder/urethra, corpus cavernosum, ICM, PRM, and prostate were segmented. 3-D models of each structure were generated and assembled into composite images, and ICM and PRM thicknesses were calculated.ResultsWe successfully reconstructed 3-D male pelvic floor anatomy including ICM, PRM, bladder, urethra, bulbospongiosus, corpus cavernosa, prostate and bones from the two groups. We documented significant reduction in PRM and ICM thickness in older men.ConclusionsThis is perhaps the first 3-D reconstruction of male pelvic floor structures based on in-vivo MRI in healthy and symptomatic patients. Observed reduction in PRM and ICM thickness is possibly due to age-related atrophy.

Lumbosacral ventral root avulsion alters reflex activation of bladder, urethra, and perineal muscles during micturition in female rabbits.

To determine the effect of the lumbosacral ventral root avulsion (VRA) on the reflex activation of bladder, urethra, and activation of perineal muscles during micturition in female rabbits. We allocated 14 virgin female rabbits to evaluate, first, the gross anatomy of lumbosacral spinal cord root (n = 5) and, second, to determine the effect of VRA on perineal muscles during micturition (n = 9). We recorded cystometrograms, urethral pressure, and electromyograms of the bulbospongiosus (Bsm) and ischiocavernosus (Ism) muscles before and after the L6-S2 VRA. Standard variables were measured from each recording and analyzed to identify significant differences (P < .05). We found that the L6-S2 VRA affected directly the bladder and urethral function and reduced the duration and the frequency of the bursting of Ism and Bsm muscles during voiding. The Ism and Bsm showed a phasic activation, of different frequencies, during the voiding phase and the L6-S2 VRA inhibited the co-contraction of the Ism and Bsm-bladder-urethra. The Ism and Bsm are activated at different frequencies to trigger the voiding phase. The L6-S2 VRA affected the activity pattern of both perineal muscles. These modifications affected the bladder and urethra function. It is possible that the restoration of the activation frequency of perineal muscles contributed for an efficient bladder contraction.

Pathobiology of ischiocavernosus and bulbospongiosus muscles in long-term diabetic male rats and its implication on erectile dysfunction

Objective To analyze pathobiology of ischiocavernosus (IC) and bulbospongiosus (BS) muscles in long-term diabetic male rats and its implication on erectile dysfunction (ED). Methods Male rats were grouped into control and diabetic rats (received single injection of 60 mg/kg bw. of streptozotocin [STZ]). At 120th day, the animals were subjected to various analyses like serum hormone, penile reflex, electromyography of IC and BS muscles, after euthanasia IC and BS muscles were processed for morphological, histology, histometric analysis, immunostaining and immunoblotting synaptophysin, nNOS and NADPH diaphorase histochemistry. Results Significant reduction in serum hormone level, penile reflex, reduced action potential or activity in both these muscles and wide range of histological alterations were observed in STZ rats. Muscles showed significant reduction in the diameter, volume and numerical density of the fiber in both muscles of STZ rats. Synaptophysin, nNOS and NADPH diaphorase were significantly reduced in diabetic animal IC and BS. Conclusion Severe neuromuscular circuitry alteration in IC and BS. Study concludes that degenerative changes in IC and BS may play a major role in ED in diabetic condition. Indicating diabetic-induced postsynaptic neuronal degeneration along with impaired motor action of the muscle and severe muscle degeneration affecting ED.

Cavernous Nerve Stimulation and Recording of Intracavernous Pressure in a Rat.

The stimulation of the cavernous nerve (CN) and measurement of intracavernous pressure (ICP) have been used extensively to test and evaluate therapies for erectile dysfunction. However, the methods used vary between laboratories, and pitfalls still exist. The goal of this study was to describe a surgical technique that would provide a reliable and reproducible model. By exposing the ischiocavernosus muscle at its point of insertion on the ischial tuberosity, the penile crus could be cannulated with minimal dissection and injury to the structures involved in erectile function. Repeated stimulation of the CN, without the need for lifting and drying, was achieved by using a 125 µm bipolar silver electrode and biocompatible silicon glue to isolate the electrode-nerve complex. This method prevents neuropraxia by reducing stretching and drying the nerve and provides complete isolation of the nerve, negating electrical leakage and preventing stimulation of alternative pathways.