Normal Sexual Function Research Articles

SERUM TESTOSTERONE LEVEL RISES DRASTICALLY AT THE MOMENT OF EJACULATION

Testosterone is the major sex hormone in males and plays an important role in development of the penis and testes, muscle size, bone growth, sex drive, and sperm production. Changes in serum testosterone level at ejaculation are unclear, although sexual function is influenced by testosterone. We measured pre- and post-ejaculatory testosterone levels over time and evaluated changes in these levels. We also measured levels of prolactin and cortisol, which are hormones that also affect sexual function. Laboratory investigation. We enrolled 7 men (age 32–41 years, mean 35.7 years) with normal sexual function, and collected blood samples before, during, and after masturbation. Testosterone, prolactin, and cortisol levels were evaluated before erection, after erection, just before ejaculation, at ejaculation, and 10 min after ejaculation. Serum testosterone level increased significantly over time from before erection to the moment of ejaculation, and decreased to the pre-erection level 10 min after ejaculation (pre-erection, 5.86±2.45ng/mL; at ejaculation, 7.01±3.61 ng/mL; 10 min after ejaculation, 6.22±2.89 ng/mL; p < 0.05). Cortisol increased significantly over time from before erection to after ejaculation (pre-erection, 5.63±3.82μg/dL; at ejaculation, 6.94±4.59 μg/dL; 10 min after ejaculation, 7.70±4.99 μg/dL; p < 0.05). And prolactin increased approximately 2-fold over time from before erection to after ejaculation (pre-erection, 12.83±2.36ng/mL; at ejaculation, 17.48±4.51 ng/mL; 10 min after ejaculation, 23.47±6.27 ng/mL; p < 0.05). All 3 hormones changed drastically with ejaculation. The increase in testosterone level may be due to prostate contraction and testicular secretion. In addition, prolactin and cortisol levels changed before and after ejaculation. Changes in hormone secretion due to ejaculation may affect daily health and sexual function.Tabled 1beforeerectionclimaxejaculationafter 10 minTestosterone5.06±2.455.26±2.795.44±3.395.61±3.615.27±2.89Cortisol5.63±3.825.98±3.716.53±4.306.94±4.597.70±4.99Prolactin12.83±2.3612.51±2.2214.68±3.5917.48±4.5123.47±6.27 Open table in a new tab

Focal bipolar radiofrequency ablation for localized prostate cancer: Safety and feasibility.

To evaluate the safety and feasibility of focal bipolar radiofrequency ablation in men with localized prostate cancer. A review of 10 patients treated with a novel bipolar radiofrequency ablation probe integrated in a coil design (Encage; Trod Medical, Bradenton, FL, USA) between 2011 and 2017 in two prospective pilot trials. All men had clinical stage T1c prostate cancer, prostate-specific antigen <10ng/mL and Gleason score ≤7. Ablation was carried out under general anesthesia, and bipolar probes were inserted transperineally under transrectal ultrasound guidance. Treatment-related adverse events, quality of life and negative biopsy rate were evaluated at 6months after ablation. The Wilcoxon signed-rank test was used to compare baseline and post-treatment symptom scores. The median age was 58years (range 50-64years) and the median prostate volume was 49.65cc (range 21-68cc). Prostate cancer with a Gleason score of 6 (3+3) and 7 (3+4) was noted in seven and three patients, respectively. The median number of radiofrequency ablation cycles was 2.5 (range 2-5). All patients were catheter-free and able to void the day of surgery. Within 6months after ablation, all adverse events were low grade, with the exception of one grade3 hematuria that required cystoscopy without coagulation. Six months after ablation bowel, urinary and hormonal functions, and overall satisfaction remained stable. Erectile dysfunction occurred in two out of four patients who had normal sexual function before the procedure. Neither urinary incontinence nor urinary infection was noted. This first report on focal bipolar radiofrequency ablation documents a safe and feasible treatment option for selected patients with localized prostate cancer.

Sexual function and quality of life in pregnant Iranian women

Pregnancy is associated with many physical and psychological changes in women. The purpose of this research was to investigate sexual function and its relation with Quality Of Life in pregnant women. This cross-sectional study was performed on 318 pregnant women, who referred for prenatal care to obstetric clinic of Jahrom, Iran, 2018. Data collection tools were Female Sexual Function Index and World Health Organization Quality Of Life(WHOQOL-BREF) questionnaire. Data were analyzed using t-test, ANOVA, and correlation coefficient. A portion of 218(68.9%) pregnant women had sexual dysfunction. The physical (p < 0.0001), psychological (p = 0.003), environmental health (p = 0.002), and social (p = 0.003) components of QOL were lower in women with sexual dysfunction. Total score of QOL had upper most correlations with orgasm and pain during intercourse (r = 0.29, p < 0.001). Total score of sexual function was highly correlated with the physical dimension of QOL (r = 0.60, p < 0.001). More than half of women with sexual dysfunction showed significant reductions in all aspects of QOL than those with normal sexual functions.

Management and long-term consequences of genital graft versus host disease following hematopoietic stem cell transplantation.

Vulvovaginal Graft-versus-host disease (VV-GVHD) is an underdiagnosed complication of hematopoietic stem cell transplantation (HSCT). The severity of the disease varies greatly, ranging from minor discomfort to severe, irreversible anatomic changes. This study sought to assess the long-term course of VV-GVHD. A retrospective analysis was conducted of 64 women who underwent HSCT and were followed over 9 years in a designated vulvovaginal clinic. VV-GVHD was detected in 56% of transplanted women. Adherence with follow-up correlated with diagnosis of VV-GVHD (p < 0.001) and with sexual activity (p = 0.023). Most of the women with VV-GVHD were symptomatic; however, 22% were asymptomatic upon diagnosis. Women were treated with topical steroids, topical estrogen, vaginal dilators, and vaginal silicone rings. Vaginal silicone rings were associated with higher patient adherence and better results. VV-GVHD is a common complication of HSCT and can adversely impact patients' sexuality and quality of life. The disease pattern is chronic, necessitating long term follow-up and adherence with treatment. Vulvar anatomical changes occurred despite treatment; however, vaginal patency can be maintained by early diagnosis, constant surveillance, and early treatment, consequently allowing preservation of normal sexual function. Awareness of VV-GVHD must be raised in order to better serve female patients and facilitate early diagnosis and treatment.

Prostatic irradiation-induced sexual dysfunction: a review and multidisciplinary guide to management in the radical radiotherapy era (Part I defining the organ at risk for sexual toxicities).

Prostate cancer is the most common malignancy and the second leading cause of cancer-related death in men. Radiotherapy is a curative option that is administered via external beam radiation, brachytherapy, or in combination. Erectile, ejaculatory and orgasm dysfunction(s) is/are known potential and common toxicities associated with prostate radiotherapy. Our multidisciplinary team of physicians and/or scientists have written a three (3) part comprehensive review of the pathogenesis and management radiation-induced sexual dysfunction. Part I reviews pertinent anatomy associated with normal sexual function and then considers the pathogenesis of prostate radiation-induced sexual toxicities. Next, our team considers the associated radiobiological (including the effects of time, dose and fractionation) and physical (treatment planning and defining a novel Organ at Risk (OAR)) components that should be minded in the context of safe radiation treatment planning. The authors identify an OAR (i.e., the prostatic plexus) and provide suggestions on how to minimize injury to said OAR during the radiation treatment planning process.

Необычное новообразование в мошонке

A clinical case of scrotal atavism in the form of bone plate, which simulated neoplasm of scrotal organs and has not been previously described, is presented in the article. In our opinion, the tumor is a vestige of Bakulyum, an organ, which disappeared in Homo sapiens. The patient was successfully operated in the outpatient surgical department with good functional and long-term results. After 1-year follow-up, there were no complaints or recurrence. The patient had normal sexual function.

Cutoff score of the traditional Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12)

ObjectiveThe short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) is a condition-specific instrument used to evaluate sexual function in women with pelvic floor disorders. The traditional Chinese version of the PISQ-12 (CVPISQ-12) has been validated, however the cutoff score has yet to be determined. The aim of this study is to establish the cutoff score for the CVPISQ-12 and analyze the risk factors for female sexual dysfunction. Material and methodsA sub-analysis of data involving sexually active women who sought consultation for pelvic floor disorders at a medical center in 2016. Based on the known cutoff value of Female Sexual Function Index, the cutoff score of the CVPISQ-12 was analyzed using receiver operating characteristic (ROC) curve analysis. Other assessments included 1-h pad test and incontinence-related questionnaires using the short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). ResultsROC curve analysis showed a cutoff score of 32.5, with a sensitivity of 87% and specificity of 88%. The area under the ROC curve was 0.937 (p <0.001; 95% confidence interval: 0.895–0.979). The 1-h pad test (B = −0.266; p = 0.031), IIQ-7 (B = −0.378; p = 0.047) and age (B = −0.415; p = 0.001) were risk factors for sexual dysfunction in women with a score <32.5. However, age was the only significant risk factor for women with a higher score (B = −0.384; p = 0.035). ConclusionsA CVPISQ-12 score ≥32.5 suggested normal sexual function. For this patient group, age may be a more important factor associated with sexual function than pelvic floor disorders.

Intraoperative application of platelet-rich plasma to the neurovascular bundles during radical prostatectomy: A prospective clinical trial.

TPS380 Background: Radical prostatectomy (RP) is the most common surgical treatment for prostate cancer (PC). Yet even with nerve-sparing RP (NS-RP), a significant proportion of men experience transient or permanent erectile dysfunction (ED) partially due to intraoperative neurovascular bundle (NVB) damage from thermal or mechanical trauma. Studies have shown that platelet released growth factors counteract trauma and facilitate healing. We evaluate the use of platelet rich plasma (PRP) to facilitate early nerve healing and decrease ED after NS-RP. Methods: A prospective, open label, 20 subject human trial evaluating intraoperative topical NVB PRP application was approved by the IRB and FDA under an Investigational Device Exemption (IDE 16915) for the investigational use of an approved blood separation device. Men aged 50-60 with newly diagnosed, localized PC and normal preoperative sexual and urinary function, defined as a Sexual Health Inventory for Men (SHIM) score of &gt;19 and an answer of “none” on question 5 of the Expanded Prostate Cancer Index Composite (EPIC) are eligible. Intraoperatively, a 10ml PRP product is created from a 180 mL sample of the patient’s whole blood using the Angel Concentrated Platelet Rich Plasma System (Cytomedix, Inc., Gaithersburg, MD USA). PRP is applied via mechanical transfer to the NVB after completion of the vesicourethral anastomosis. The primary endpoint is the safety and tolerability of PRP on the NVB after NS-RP. Secondary endpoints include feasibility of intraoperative PRP application and longitudinal assessment of erectile function and urinary continence by questionnaire administration at 3, 6, 9, 12 and 18 months after NS-RP. Clinical trial information: NCT02957149.

Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life

BackgroundGenital pain (GP) is a common symptom in women of reproductive age. The prevalence of GP is difficult to gauge as it has been underreported by both patients and clinicians and neglected in clinical studies despite wide recognition of the adverse effects to women's health. AimThe purpose of the present study was 3-fold: (i) to explore the self-reported presence and perception of GP and its association with sexual functioning, sexual distress, emotions, psychopathology, and quality of life (QoL); (ii) to explore if, controlling for the pain effect, women with Female Sexual Function Index (FSFI) scores indicating sexual dysfunction also reported worse outcomes regarding sexual distress, emotions, psychological health, and QoL than GP women with higher FSFI scores; and (iii) to evaluate the effects of GP duration, comparing women with GP with shorter (<6 months) duration of symptoms with women with longer (≥6 months) duration of symptom of GP on sexual functioning, distress, emotions, psychopathology and QoL. MethodsA total of 1,034 women (age ranges between 18 and 40 years) from the Italian general population completed a web survey on sexual health. Outcomes6 self-report questionnaires exploring different biopsychosocial factors were assessed: the FSFI, the Female Sexual Distress Scale, the Positive and Negative Affect Schedule, the Short Form McGill Pain Questionnaire adapted for GP, the Short Form 36, and the Symptom Check List-90-Revised. ResultsWomen who reported GP (n = 319) indicated generally lower sexual function than women without GP (n = 648; P = .036). They reported a higher level of sexual distress (P < .001), more negative emotions related to sexual experiences (P = .001), lower scores in all QoL domains (P < .001), and higher levels of psychopathological symptoms (P < .001). Controlling for pain effects, women whose FSFI scores indicated sexual dysfunction (n = 150) reported higher rates of sexual distress than women whose FSFI scores indicated normal sexual function (n = 169; P < .001).The scores also indicated fewer positive (P < .001) and more negative emotions (P < .001) related to sexuality, lower QoL (P < .001) and significantly higher psychological burden (P < .001). Moreover, women experiencing GP for ≥6 months reported significantly lower means on the FSFI total score (P < .05; especially in the desire, satisfaction, and pain domains), distress (P < .001), and emotions (P < .05) than women experiencing GP duration <6 months. No significant differences were found on the QoL and the psychopathological symptoms. Clinical ImplicationsGP is significantly pervasive, but a high percentage of sexual problems and related emotional suffering is overlooked. Raising awareness about this issue is critical, both among clinicians and the general public. Strengths & LimitationsThe present study highlighted important characteristics of GP from a community sample; the results indicate problems related to pain experiences and their repercussions on sexual, psychological, affective health, and QoL. Major limitations are related to the use of self-report measures via a web-based study. ConclusionThe results provide evidence of a lack of awareness regarding pain experiences as they relate to sexual functioning in women; clinicians would be advised to more fully investigate sexual functioning and psychosocial variables associated with GP during routine consultation beginning with the first onset of the symptoms.Nimbi FM, Rossi V, Tripodi F, et al. Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life. J Sex Med 2020; 17:771–783.

Задержанная эякуляция: эпидемиология, диагностика, лечение

Delayed ejaculation is a form of sexual disorders, which is characterized by constant or intermittent delays or absence of ejaculation and orgasm, despite normal sexual arousal and erectile function. Delayed ejaculation is one of the most studied and rare types of male sexual dysfunctions, which leads to depression, anxiety, and often is a reason of low self-esteem, reduced satisfaction of a man with his partner, and worsening of relationships between partners. In some cases, delayed ejaculation and anejaculation cause infertility. Current views on epidemiology, diagnostics and treatment strategy of delayed ejaculation are presented in the article.

Female Sexuality: Assessing Satisfaction and Addressing Problems

Sexuality is important to women of all ages. Although changes in sexual function occur with aging, hormonal transitions, illness, the use of medications, and disability, many women can maintain a satisfying sex life by making appropriate adaptations. Clinicians who take the time to obtain a complete and careful sexual history and perform a pertinent physical examination can help the majority of women who present with sexual complaints. Effective treatment must address the contribution of psychological, relationship, and biologic factors and often requires the collaboration of physicians and psychotherapists, as well as sex and physical therapists in many circumstances. Simply initiating a discussion about sexual concerns is frequently the most valuable aspect of treatment for women and their partners. Also useful are provision of basic education about normal female genital anatomy and sexual function across the lifespan; permission to explore masturbation, erotica, and versatile sexual techniques, as well as nongenital pleasuring; information about lubricants; and the prescription of estrogen in the setting of vulvovaginal atrophy. There are as yet no approved agents to treat the biologic component of hypoactive sexual desire. However, it may be appropriate to consider using androgen supplementation in patients with surgical menopause, as well as the addition of bupropion in patients taking selective serotonin reuptake inhibitors (SSRIs). This review discusses the epidemiology of female sexual disorders, the female sexual response and sexual behavior, and the diagnosis and management of specific sexual disorders, including desire, arousal, orgasm, and sexual-pain problems. This review contains 4 figures, 41 tables, and 96 references. Keywords: Sexual dysfunction disorder, arousal, orgasm, desire, dyspareunia, vulvodynia, vestibulitis, vaginismus

Female Sexuality: Assessing Satisfaction and Addressing Problems

Sexuality is important to women of all ages. Although changes in sexual function occur with aging, hormonal transitions, illness, the use of medications, and disability, many women can maintain a satisfying sex life by making appropriate adaptations. Clinicians who take the time to obtain a complete and careful sexual history and perform a pertinent physical examination can help the majority of women who present with sexual complaints. Effective treatment must address the contribution of psychological, relationship, and biologic factors and often requires the collaboration of physicians and psychotherapists, as well as sex and physical therapists in many circumstances. Simply initiating a discussion about sexual concerns is frequently the most valuable aspect of treatment for women and their partners. Also useful are provision of basic education about normal female genital anatomy and sexual function across the lifespan; permission to explore masturbation, erotica, and versatile sexual techniques, as well as nongenital pleasuring; information about lubricants; and the prescription of estrogen in the setting of vulvovaginal atrophy. There are as yet no approved agents to treat the biologic component of hypoactive sexual desire. However, it may be appropriate to consider using androgen supplementation in patients with surgical menopause, as well as the addition of bupropion in patients taking selective serotonin reuptake inhibitors (SSRIs). This review discusses the epidemiology of female sexual disorders, the female sexual response and sexual behavior, and the diagnosis and management of specific sexual disorders, including desire, arousal, orgasm, and sexual-pain problems. This review contains 4 figures, 41 tables, and 96 references. Keywords: Sexual dysfunction disorder, arousal, orgasm, desire, dyspareunia, vulvodynia, vestibulitis, vaginismus

PREVALENCE OF SEXUAL DYSFUNCTION AND SEXUAL ATTITUDES AMONG POSTMENOPAUSAL FEMALES PATIENTS IN PHRAMONGKUTKLAO HOSPITAL

Background: Sexual function and attitudes towards sexuality among postmenopausal women have been investigated in many ethnicities, Nonetheless, a limited number of studies have been conduected among Thai postmenopausal women.&#x0D; Objective: The study aimed to determine the prevalence of sexual dysfunction and sexual attitudes among Thai postmenopausal women.&#x0D; Methods: Adescriptive cross-sextional study was conducted from 1st, 2018 to 31 July 31st, 2018 at the Gynecologic Outpatient Department, Pharmingkutklao Hospital. In all, 293 postmenopausal women. aged 45 years or over were recruited in the study. The Thai version Female Sexual Function Index (Thai-FSFI) questionnaire was used to evaluate the sexual function for which scores les than 26.5 constituted sexual dysfunction. To assess attitudes, validated questionnaires were used to evaluate using scores 0-8, 9-16 and 17-24 as negative, neutral and positive, respectively. &#x0D; Results: The participant mean age was 55.53 ± 5.07 years. The pravalence of sexual dysfunction was 96.59% (282/293), which was significantly higher compared with those with those with normal sexual function. Postmenopausal women with sexual dysfunction were significantly order (p&lt;0.001), had a longer menopause period (p=0.001), had spouses at old age (p&lt;0.001) and had underlying diseases (p=0.034) significantly more than those with normal sexual function. Regarding sexual attitudes. 52.56% had positive attitudes while 4.44% had negative attitudes.&#x0D; Conclusion: Sexual dysfunction is a common problem among Thai postmenopausal women. However, most had positive sexual attitudes.

Arousal disorder in women

Recurrent / persistent inability to attain/ maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual arousal. Recurrent inability to get aroused. Your response to stimulation is physiologically / somatically maladaptive. And your perceptions about your inability to get aroused are distorted. The disturbance causes distress. The disturbance causes marked distress or interpersonal difficulty. Worldwide prevalence of arousal disorder in women is 26-43% and can be maintained depending on partner, stimulation, situation or regardless partner, stimulation, situation etc. The disorder may emerge from the beginning of the sexual life or begin after a period of relatively normal sexual function. Keywords: arousal disorder in women, s-on, therapy, testing, evaluation, sexual disorders.

The Use of Begraft® Balloon-Expandable Covered Stents as Cerab Technique for the Treatment of Aorto-Iliac Aortic Disease

Introduction - Peripheral arterial disease (PAD) affects more than 20% of the population above 70 years old. Nowadays, the treatment of occlusive aorto-iliac disease has moved to an endovascular-first approach in many centers, even for complex TASC C and D lesions. In this situation, balloon-expandable covered stents have demonstrated superior results. However, few options exist when dealing with aortic lesions requiring large diameter covered stents. Methods - To report a case of the use of large diameter BeGraftÒ balloon-expandable covered stents with the CERAB technique in the treatment of aorto-iliac occlusive disease. Results - A 77-year-old man was referred to our Department for pelvis and thigh claudication and impotence worsening over the last 2 years. He underwent an angio-CT scan, which demonstrated a significant tight stenosis of the infra-renal aorta extending to the iliac bifurcation. Flows were monophasic at the femoral level on both sides. The patient was offered percutaneous endovascular treatment using the CERAB technique. Firstly an aortic balloon-expandable covered stent BeGraft (Bentley, Hechingen, Germany) 18x48 mm was placed and dilated to 20mm proximally and then two iliac 10x38mm BeGraft were successfully implanted partially in the first aortic stent. Completion angiography demonstrated a patent aorta, no residual stenosis and a rapid flow down to the limbs. Patient was discharged on the following day. At 1 month follow up, the patient was free from pain during exercise and described normal sexual function. Vascular examination revealed palpable pedal pulses. An angio CT-scan confirmed a patent CERAB, without any complications. Conclusion - To our knowledge, this is the first report of the implantation of a large diameter BeGraft covered stent at the level of the abdominal aorta to treat occlusive disease using the CERAB technique. Aortic lesions are often highly calcified, partially thrombosed and thus difficult to cross. Due to the risk of flow limiting dissection, perforation or embolization, the use of covered stent allows to immediately treat these complications. The CERAB technique has been shown to offer better hemodynamics conditions as compared to kissing stents, reducing the risk of restenosis. BeGraft stent appears to be a safe and valid in the treatment of aorto-iliac stenosis. Further cases and studies are required to confirm this preliminary excellent result.

Sexual Dysfunction and Abnormal Androgen Level after Hematopoietic Stem Cell Transplantation

Introduction: Hematopoietic stem cell transplantation (HSCT) is a potentially curative or consolidative therapy for a large number of hematological diseases. Sexual dysfunction (SD) and abnormal level of the sexual hormone are common in patients after HSCT, which are usually caused by intensive myeloablative conditioning. The change of sexual hormone level and SD resulted in the poor quality of life in this population after transplantation. The current aims of this study were to determine: (i) the incidence rate of SD and the association with androgen post both autologous (auto) and allogeneic (allo) HSCT; (ii) multi-factors analysis between SD and clinical characteristics, primary diease, donor type, cGVHD, etc; (iii) the association of androgen with cGVHD and glucocorticoid (GC) therapy. Methods: From April 2010 to February 2019, a total of 126 (74 males and 52 females) patients with hematological diseases undergoing HSCT were enrolled in our study. The reason for the small sample of patients was that only 126 patients completed our Sexual Function Questionnaire. Controls were 108 healthy, age and gender matched persons came from Medical Examiniation Center of our hospital. Assessment indexes included clinical characteristics, donor type, GVHD incidence, sex hormone levels, and Sexual Functioning Questionnaire (SFQ). The SFQ was implemented by the team members of our research group through a telephone interview, email, paper letter, and WeChat. All of the information and privacy of each patient was strictly conserved. Results: 1. Clinical characteristics of the 126 patients who underwent HSCT were shown in Table 1. The median age of the patients was 38 years old (range 16-66) and the follow up after HSCT was from 6 months to 7 years. The predominant disease spectra were multiple myeloma (MM) and acute leukemia in auto- and allo-HSCT group, respectively. Our results showed a significant difference in gender (P&lt;0.004), donor type (P&lt;0.004), and GVHD development (P&lt;0.0001), indicating a higher incidence of SD when we included these indicators into our analysis. There was no singficant difference of SD development in age, education background, annual family income, primary disease, time post HSCT, and phycological state. 2. Figure 1 showed a higher incidence of SD in both female and male patients after HSCT compared to the healthy controls (P&lt;0.001). Most of them complained that they had trouble in normal sex life and sexual function had not yet recovered to the pre-transplantation level. Moreover, female patients exhibited much significantly decline in overall sexual function (OSD) than the male group (P&lt;0.004). As depicted in the figure 2a and 2b, 54% female and 44% of male developed at least one physical sexual problem. Almost all of the female patients of childbearing age were infertility, and only a small number of young (&lt; 30 years) male patients post transplantation could store fertility (data not shown). 3. From the foregoing data analysis, we confirmed that patients after allo-HSCT with or without GVHD usually acompanied with a higher incidence of SD compared to auto-HSCT group (Table 2). Female patients undergoing allo-HSCT who developed SD had a significantly lower level of androgen (P = 0.02, Table 3a), and that of the male patients was lower compared to healthy control with no significance (Table 3b). Female patients diagnosed with cGVHD had much lower adrongen level, especially in those received GC therapy (Table 4). 4. Although some young female patients had been given regular leuprolide injection every 28 days during their chemotherapy period or pre-transplantation, no significant difference was observed both in SD incidence and androgen level (P &gt; 0.05, due to a small sample, data not shown here). Conclusions: Our results here indicated SD remained a major obstacle for patients to have a better quality of life after HSCT. We should pay more attention to the female patients because they might be at a higher risk to develop SD, especially in those underwent cGVHD and received GC therapy. To improve the sexual function for this population, more intervention methods including optimization of conditioning, better controlling of cGVHD, and reproductive function reservation might be helpful to reduce the incidence of SD. Finally, our study suggested that low androgen levels may contribute to SD and androgen replacement therapy might be a promising choice to improve OSD for patients undergoing HSCT. Disclosures No relevant conflicts of interest to declare.

Successful replantation of amputated penis with adjuvant hyperbaric oxygen therapy

Successful penile replantations are rarely reported in the literature and are associated with significant complications. We present a case of a patient who auto-amputated his penis. Delayed microvascular replantation was performed approximately 14 hours following injury. He was treated with a phosphodiesterase inhibitor postoperatively, and adjuvant hyperbaric oxygen (HBO2) therapy was started 58 hours after replantation; 20 treatments at 2.4 atmospheres absolute (ATA), twice daily for eight days, followed by once daily for four days. Perfusion of the replanted penis was serially assessed using fluorescent angiography. With some additional surgical procedures including a split- thickness skin graft to the shaft due to skin necrosis he has made a complete recovery with return of normal urinary and sexual function. This unusual case illustrates the potential benefit of HBO2 therapy in preserving viability of a severed body part. Fluorescent angiography may have potential utility in monitoring efficacy of HBO2.

Reoperative Urethroplasty after Failed Hypospadias Repair

AbstractBackground: Reported reoperation rates after primary hypospadias repair can exceed 50%. Failed hypospadias occurs when the primary surgery does not achieve the cosmetic and functional goals of a straight penis with glanular meatus that enables normal urinary and sexual function. Treatment of patients with failed hypospadias repair can be a challenging task in the majority of cases and the selection of the most appropriate technique for this repair is the corner stone for success in these cases.Aim of Study: Is to evaluate the results and success rate of some common techniques for redo urethroplasty in cases with failed hypospadias repair.Patients and Methods: The study included forty two patients with recurrent hypospadias and their ages ranged from 2-15 years. The final position of the external urethral meatus after release of chordee, was subcoronal (13 cases), distal penile (13 cases), mid-penile (13 cases) and penoscrotal (3 cases). TIP technique was applied in 12 cases, Mathieu technique in 10 cases, transverse dorsal preputial onlay flap in 10 cases and two-stage repair with buccal mucosa graft in 10 cases. The operative technique was selected according to the status of the urethral plate and the nearby penile skin.Results: Our overall results showed that 24 patients (57.14%) had successful repair while failed repair was reported in 8 patients (19.04%). Minor complications were also reported in 10 cases (23.80%) which included urethrocutaneous fistula, meatal stenosis and urethral diverticulum. The success rates of TIP, Mathieu, transverse dorsal preputial onlay flap and the two-stage repair were 58.33%, 50%, 50% and 70% respec-tively.Conclusion: TIP urethroplasty is an effective technique for redo hypospadias repair if the patient has a non-scarred and wide urethral plate. Similar results can also be achieved by Mathieu's repair or transverse onlay flap in patients with narrow and non-scarred urethral plate. However, patient with scarred unhealthy urethral plate should have a two stage repair with buccal mucosa graft.

Gold nanoshell-localized photothermal ablation of prostate tumors in a clinical pilot device study

Biocompatible gold nanoparticles designed to absorb light at wavelengths of high tissue transparency have been of particular interest for biomedical applications. The ability of such nanoparticles to convert absorbed near-infrared light to heat and induce highly localized hyperthermia has been shown to be highly effective for photothermal cancer therapy, resulting in cell death and tumor remission in a multitude of preclinical animal models. Here we report the initial results of a clinical trial in which laser-excited gold-silica nanoshells (GSNs) were used in combination with magnetic resonance-ultrasound fusion imaging to focally ablate low-intermediate-grade tumors within the prostate. The overall goal is to provide highly localized regional control of prostate cancer that also results in greatly reduced patient morbidity and improved functional outcomes. This pilot device study reports feasibility and safety data from 16 cases of patients diagnosed with low- or intermediate-risk localized prostate cancer. After GSN infusion and high-precision laser ablation, patients underwent multiparametric MRI of the prostate at 48 to 72 h, followed by postprocedure mpMRI/ultrasound targeted fusion biopsies at 3 and 12 mo, as well as a standard 12-core systematic biopsy at 12 mo. GSN-mediated focal laser ablation was successfully achieved in 94% (15/16) of patients, with no significant difference in International Prostate Symptom Score or Sexual Health Inventory for Men observed after treatment. This treatment protocol appears to be feasible and safe in men with low- or intermediate-risk localized prostate cancer without serious complications or deleterious changes in genitourinary function.

Efficacy of transurethral endoscopic surgery in treating foreign body-induced lower urinary tract injury

Objective To investigate curative efficacy of transurethral endoscopic surgery for foreign body-induced lower urinary tract injury. Methods A retrospective case series study was conducted to analyze the clinical data of 31 patients with foreign body-induced lower urinary tract injury admitted to Henan Provincial People's Hospital from January 1998 to January 2018. There were 27 males and four females, aged 6-68 years [(27.1±16.3)years]. Foreign bodies were located at the bladder in 12 patients, at urethra in 16, and at bladder and urethra in three. The foreign bodies were placed into the body by patients themselves in 23 patients, by other people in one, iatrogenic implantation in six, and by unknown approach in one. All patients underwent urethral surgeries, and individualized treatment plan was formulated according to the specific conditions such as the foreign body type, size, shape, location, activity and combined injury. The success rate, operation time and hospitalization time were recorded. The sexual function of the married males was evaluated by international index of erectile function-5 (IIEF-5) (IIEF-5 score≥22 points as normal) before and after the operation. The urination after the operation was evaluated by the maximum urinary flow rate (Qmax) (Qmax<15 ml/s as abnormal) and the complications were recorded. Results All the patients underwent successful surgeries and the foreign bodies were removed, including 26 patients who underwent transurethral endoscopic surgery alone with success rate of 84% and five patients underwent open surgery due to failed transurethral endoscopic removal. All patients were followed up for 6-36 months [(27.0±7.7)months]. The operation lasted for 20-72 minutes [(42.0±21.7)minutes]. The hospitalization time was 2-7 days [(4.0±1.7)days]. During the follow-up, 11 married males obtained normal sexual function after surgery [postoperative IIEF-5: (23.4±1.1)points vs. preoperative IIEF-5: (23.8±0.9)points]. Twenty-nine patients had normal urination [Qmax=(21.7±5.9)ml/s]. Two patients had narrow urinary tract (Qmax<15 ml/s), of whom one patient received regular urethral dilatation and another received resection and anastomosis of urethral stricture, both with satisfactory improvement of urination. Three patients had fever caused by urinary tract infection and recovered within 2 weeks after anti-infection treatment. There were no serious complications such as male sexual dysfunction, complex urethral stricture or septic shock. Conclusions Transurethral endoscopic surgery for foreign body-induced lower urinary tract injury has high success rate, minor impact on the sexual function of male patients and low incidence of complications, which is worthy of clinical practice. Key words: Urinary tract; Foreign body; Natural endoscopic surgery