Persistent Erectile Dysfunction Research Articles

Characteristics and outcomes of men with erectile dysfunction as the presenting symptom due to a lactotroph adenoma

PurposeErectile dysfunction (ED) is frequently underreported in men suffering from prolactinomas and can be challenging to manage. Both dopamine agonists (DAs) and transsphenoidal surgery (TSS) correct hyperprolactinemia and restore gonadal function. However, there is scarce data regarding their effectiveness in correcting ED over the long term.MethodsThis study is a retrospective single-center comparative cohort study analyzing men diagnosed with prolactinomas, both with and without confirmed erectile dysfunction (ED) at diagnosis. Independent risk factors for persistent ED over the long term were examined using multivariate logistic regression.ResultsAmong the 39 men with lactotroph adenomas, ED was one of the presenting symptoms in 22 (56%). The mean age at diagnosis was 45 ± 12 years. Surgery was the primary treatment in 6 (27%) ED patients and 8 (47%) non-ED patients. After a mean follow-up of 74 ± 48 months, remission from hyperprolactinemia was achieved in the majority (76%) of men: 71% in the non-ED cohort and 81% in the ED group (p = 0.70), regardless of the primary treatment strategy (surgical 84% versus medical 72%, p = 0.46). Long-term remission of ED was noted in 16 (73%) patients. Interestingly, high baseline BMI levels emerged as potential risk factors for persistent ED over the long term (OR 1.4, 95%CI 1.0–1.9; p = 0.04), while neither the initial adenoma size nor the primary treatment strategy (i.e., TSS vs. DAs) reached statistical significance.ConclusionsCorrecting hyperprolactinemia and its associated hypogonadism significantly improves ED in the majority of men with prolactinomas over the long term, regardless of the primary treatment strategy employed. In addition to addressing endocrine deficiencies, the early initiation of weight control programs may be considered for men with lactotroph adenomas and ED. Although our study suggests an association between BMI and the risk of persistent ED, further research is needed to establish any causal relationships.

Poster 192: The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post

Objectives: Pudendal nerve palsy (PNP) is a poorly characterized but common postoperative complication of hip arthroscopy (HA) with a perineal post that can result in external genital numbness and sexual dysfunction in both men and women. Previous attempts to quantify the incidence of these symptoms have relied on patient-initiated reports, chart review, unvalidated questionnaires or have neglected the female experience altogether – failures which likely underestimate the incidence of this complication. We aimed to describe the incidence of postoperative PNP, the breadth of symptoms patient experience and their duration, as well as establish the relationship between PNP and table traction. Methods: We utilized a multisurgeon prospective cohort of HA patients a single academic center. All patients underwent primary unilateral hip arthroscopy, osteochondroplasty and labral repair in a supine position with a perineal post. Patients with preexisting PNP symptoms, including sexual dysfunction, and those who were not sexually active were excluded. Intraoperative traction duration and force were recorded using a Tekscan sensor applied to the perineal post. A PNP screening questionnaire and standardized, validated sexual function questionnaires were administered confidentially to patients at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Patient-reported hip function scores (iHOT-33) were completed preoperatively and at 6 months postoperatively. Results: A total of 100 patients were enrolled. The mean age was 36.2 ± 9.4 years old, 56 patients (56%) were male. The mean traction duration was 80 ± 19 minutes. In the acute postoperative period, 77 patients (77%) experienced symptoms consistent with PNP. The most common sensory symptom described was perineal numbness (n = 77, 77%), followed by paresthesias (n=26, 26%). Seventeen men (17%) and 13 women (13%) reported symptoms of sexual dysfunction postoperatively, in the form of erectile dysfunction (men) or reduced sexual lubrication/dyspareunia/anorgasmia (women). Of patients who experienced PNP symptoms (n = 77), 21% had symptoms resolve by 6 weeks, 71% by 3 months, 90% by 6 months. Two male patients (3.6%) had persistent erectile dysfunction beyond 6 months postoperatively. Persistence of PNP symptoms beyond 6 weeks was associated with lower 33-item International Hip Outcome Tool (iHOT-33) scores at 6 months (mean difference: 18.4 [95% CI: 6.5-30.4], p = 0.003). Analysis of the calibrated sensor data to establish the relationship between traction force, pressure, and duration with PNP is pending. Conclusions: In this preliminary analysis of a planned 100-patient cohort, patients experienced a high rate of PNP and sexual dysfunction symptoms following HA with perineal post, far higher than previous reports. Most symptoms resolved within the first 3 months postoperatively. Anticipated results from the sensor data within this ongoing study are likely to provide insight into the relationship between traction force and/or duration and PNP incidence. A postless HA setup could be considered as an alternative given the described morbidity.

TREATMENT WITH SILDENAFIL CITRATE IN RENAL TRANSPLANT PATIENTS WITH ERECTILE DYSFUNCTION

Erectile dysfunction (ED) is a prevalent and distressing condition among renal transplant patients, often stemming from multifactorial causes such as medication side effects, psychological factors, and vascular complications associated with end-stage renal disease (ESRD) and transplantation. The basic aim of the study is to find the treatment with sildenafil citrate in renal transplant patients with erectile dysfunction (ED). This prospective observational study was conducted at the Institute of Kidney Disease Peshawar from 2017 to 2023. A total of 240 participants were recruited using convenience sampling methods. All male patients aged 18 years or older who had undergone renal transplantation and reported persistent ED for a duration of at least six months post-transplantation. Patients who use nitrate medications, severe cardiovascular disease, and uncontrolled hypertension were excluded from the study. Data were collected from 240 patients. The mean age of the patients was 52 ± 8.01 years and the mean duration of the transplant was 5.1 ± 3.2 years. Almost 70% of patients were suffering from hypertension, 45% from DM, and 30% from CVD. The mean level of serum creatinine was 1.5 ± 0.3 mg/dl and the mean GFR was 60 ± 10mL/min/1.73m². The assessment at baseline revealed an IIEF erectile function score of 12.5, which significantly improved to 20.2 at the 12-week follow-up, indicating a notable enhancement in erectile function among participants. Moreover, the frequency of successful intercourse also exhibited a positive change, with participants reporting an increase from 1-2 times per month at baseline to 3-4 times per month at the 12-week. It is concluded that sildenafil citrate demonstrates significant efficacy in improving erectile function and sexual satisfaction among renal transplant patients with erectile dysfunction.

An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report.

Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED. The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges. Atypical ED, psychogenic ED not excluded; infertility. Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife. The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization. The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.

Management of Persistent Erectile Dysfunction after COVID-19 Infection: An 18-Month Follow-Up Case Report

The coronavirus disease 2019 (COVID-19) is an emerging pandemic caused by a novel coronavirus (SARS-CoV-2). Since December 2019 the new virus has spread all over the world and has become a major health problem also because of the public measures that could affect people’s sexual activity. We report a case of a 35-year-old married male admitted to the andrology outpatient clinic in July 2021 because of sudden onset erectile dysfunction (ED). The diagnostic workup showed no risk factor for ED, normal levels of testosterone, increased levels of endothelial dysfunction markers, such as CRP (C-Reactive Protein) and Endothelin-1, and reduced Vitamin D (VD) levels. Dynamic penile duplex ultrasound (D-PDU) revealed dysfunctional penile arterial flow. The five-item International Index of Erectile Function (IIEF-5) and the Short-Form Health Survey (SF-36) showed a reduction in all domain scores. The patient, initially unresponsive to the high dose oral phosphodiesterase 5 inhibitors (PDE-5is), was treated with vitamin-D and then submitted to LI-SWT (low intensity shockwave treatment), with a progressive clinical benefit at the 12-month follow-up. After 18 months, hormone levels persisted in normal ranges, with a consistent reduction in CRP and Endothelin-1. Additionally, IIEF-5, SF-36 and arterial flow significantly improved over the follow-up period. Thus far, the erectile function was restored and the patient is no more treated with PDE-5i.

Erectile dysfunction after COVID-19 recovery: A follow-up study.

Several studies confirm multiple complications after COVID-19 infection, including men's sexual health, which is caused by both physical and psychological factors. However, studies focusing on long-term effects among recovered patients are still lacking. Therefore, we aimed to investigate the erectile function at three months after COVID-19 recovery along with its predicting factors. We enrolled all COVID-19 male patients, who were hospitalized from May to July 2021, and declared to be sexually active within the previous two weeks. Demographic data, mental health status, and erectile function were collected at baseline and prospectively recollected three months after hospital discharge. To determine changes between baseline and the follow-up, a generalized linear mixed effect model (GLMM) was used. Also, logistic regression analysis was used to identify the associating factors of erectile dysfunction (ED) at three months. One hundred fifty-three men with COVID-19 participated. Using GLMM, ED prevalence at three months after recovery was 50.3%, which was significantly lower compared with ED prevalence at baseline (64.7%, P = 0.002). Declination of prevalence of major depression and anxiety disorder was found, but only major depression reached statistical significance (major depression 13.7% vs. 1.4%, P < 0.001, anxiety disorder 5.2% vs. 2.8% P = 0.22). Logistic regression, adjusted for BMI, medical comorbidities, and self-reported normal morning erection, showed a significant association between ED at three months and age above 40 years and diagnosis of major depression with adjusted OR of 2.65, 95% CI 1.17-6.01, P = 0.02 and 8.93, 95% CI 2.28-34.9, P = 0.002, respectively. Our study showed a high ED prevalence during the third month of recovery from COVID-19. The predicting factors of persistent ED were age over 40 years and diagnosis of major depression during acute infection.

Justification of vacuum prophylaxis as part of the penile rehabilitation in patients after nerve-sparing radical prostatectomy

Introduction. In healthy men, a significant increase in pO2 in the cavernous tissue occurs during episodes of nocturnal erections. This process ensures sufficient oxygenation and high-pressure substances such as prostaglandin-E1 and nitric oxide. These substances suppress the expression of transforming growth factor β1, thereby preventing collagen synthesis and the development of cavernous fibrosis. In patients undergoing nerve-sparing radical prostatectomy, nocturnal erections are absent, hypoxia inhibits the production of PGE-i, and neuropraxia inhibits NO. Thus, cavernous fibrosis develops through the production of pro-apoptotic and profibrotic factors, resulting in persistent erectile dysfunction. The importance of a vacuum in penile rehabilitation for the prevention of penile cavernous hypoxia is not fully understood. This is due to the deficiency of data on the gas composition of cavernous blood when a vacuum-induced erection is achieved.Purpose of the study. To investigate the cavernous blood at the time of vacuum-induced erection, to analyze the obtained results with the International Index of Erectile Function score and with the values of penile hemodynamics.Materials and methods. The study included i5 patients with prostate cancer and preserved sexual function. The average age of all men was 57.87 ±4.36 years. All patients underwent a preoperative comprehensive assessment of erectile function: International Index of Erectile Function questionnaire, dynamic duplex penile ultrasound. Immediately prior to the surgery, penile blood was collected at the time of achieving a vacuum-induced erection. The gas composition and oxygenation were assessed using the values of the partial oxygen pressure, carbon dioxide and saturation in accordance with the approved standards to differentiate arterial and venous blood. Statistical data processing was carried out using the PASW Statistics 22 software (IBM SPSS, IBM Corp., Chicago, IL, USA)Results. All patients were divided into 3 groups depending on the gas composition and oxygen level of the cavernous blood. Group I included 4 (26.6%) patients with a predominance of arterial blood, group II — 4 patients (26.6%) with venous blood and group III — 7 patients (46.6%) with a mixed composition of cavernous blood. The average International Index of Erectile Function score in group I was 23.5 [2i.0; 25.0], in group II — 22.0 [2i.0; 24.0] and in group III — 24.0 [i9.0; 25.0]. Peak systolic velocity (cm/s) in group I was 40.i [35.i; 45.2], in group II — 35.9 [29.5; 50.2], in group III — 32.5 [32.5; 34.4]. End-diastolic velocity (cm/s) in group I was 2.52 [0.55; i0.5], in group II — 8.3 [2.9; i0.8], in group III — 7.5 [7.5; 9.0]. Resistive index in group I was 0.87 [0.77; 0.98], in group II — 0.75 [0.63; 0.94], in group III — 0.75 [0.73; 0.75].Conclusions. Vacuum prophylaxis may be the method of choice for penile rehabilitation in patients after nerve-sparing radical prostateectomy, especially in the early postoperative period during neuropraxia. The use of vacuum devices should be prescribed to patients with preserved veno-occlusive mechanism, which should be confirmed by dynamic duplex penile ultrasound.

How routine pharmacovigilance failed to identify finasteride's persistent sexual side effects.

How routine pharmacovigilance failed to identify finasteride's persistent sexual side effects.

MP04-06 SEXUAL DYSFUNCTION ON QUALITY OF LIFE AFTER PELVIC FRACTURE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-06 SEXUAL DYSFUNCTION ON QUALITY OF LIFE AFTER PELVIC FRACTURE Alice Wang, Monica Vavilala, Frederick Rivara, and Niels Johnsen Alice WangAlice Wang More articles by this author , Monica VavilalaMonica Vavilala More articles by this author , Frederick RivaraFrederick Rivara More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life in men. METHODS: 228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated post-injury health-related quality of life and sexual function. Inverse probability weighting was utilized to adjust for survey non-response. Pelvic fracture characteristics were classified based on the Orthopaedic Trauma Association (OTA) classification system. Sexual function was evaluated utilizing the International Index of Erectile Function (IIEF) and health-related quality of life (HrQOL) was evaluated utilizing the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL. RESULTS: After inverse probability weighting and adjustment for potential confounders, a decrease in IIEF was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (ß=0.28, p=0.02). No association was identified between OTA pelvic fracture configuration and risk of post-injury erectile dysfunction (ED) (p=0.99). 53.3% of men reported persistent ED at a median of 42.6 months (IQR 28.0, 63.3) following injury. The presence of ED was independently associated with a decrease in HrQOL (ß=10.92, p<0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10-years for men with ED following pelvic fracture relative to those without. CONCLUSIONS: Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation. Source of Funding: 2018 Sexual Medicine Society of North America Pfizer Research Fellowship in Men's Health © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e69-e69 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alice Wang More articles by this author Monica Vavilala More articles by this author Frederick Rivara More articles by this author Niels Johnsen More articles by this author Expand All Advertisement Loading ...

The effect of sexual dysfunction on health-related quality of life in men following traumatic pelvic fractures.

Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life (HrQOL) in men. A total of 228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated postinjury HrQOL and sexual function. Inverse probability weighting was used to adjust for survey nonresponse. Pelvic fracture characteristics were classified based on the Orthopedic Trauma Association classification system. Sexual function was evaluated using the International Index of Erectile Function, and HrQOL was evaluated using the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL. After inverse probability weighting and adjustment for potential confounders, a decrease in International Index of Erectile Function was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (β = 0.28, p = 0.02). No association was identified between Orthopedic Trauma Association pelvic fracture configuration and risk of postinjury erectile dysfunction (ED) (p = 0.99). Furthermore, 53.3% of men reported persistent ED at a median of 42.6 months (interquartile range, 28.0-63.3 months) following injury. The presence of ED was independently associated with a decrease in HrQOL (β = 10.92, p < 0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10 years for men with ED following pelvic fracture relative to those without. Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation. Prognostic, level IV.

Abstract #1002232: Drug Induced Severe Hyperprolactinemia in a Male with Persistent Erectile Dysfunction and Hypogonadism

Abstract #1002232: Drug Induced Severe Hyperprolactinemia in a Male with Persistent Erectile Dysfunction and Hypogonadism

A systematic review of outcomes after thermal and nonthermal partial prostate ablation.

We sought to compare oncologic and functional outcomes between thermal and nonthermal energy partial gland ablation (PGA) modalities. We conducted comprehensive, structured literature searches, and 39 papers, abstracts, and presentations met the inclusion criteria of pre-PGA magnetic resonance imaging, oncologic outcomes of at least 6 months, and systematic biopsies after PGA. Twenty-six studies used thermal ablation: high-intensity focused ultrasound (HIFU), cryotherapy, focal laser ablation, or radiofrequency ablation. In-field recurrence rates ranged from 0 to 36% for HIFU, 6 to 24% for cryotherapy, 4 to 50% for focal laser ablation, and 20 to 25% for radiofrequency ablation. Twelve studies used nonthermal technologies of focal brachytherapy, vascular-targeted photodynamic therapy, or irreversible electroporation. Focal brachytherapy had the lowest reported failure rate of 8%, vascular-targeted photodynamic therapy had >30% positive in-field biopsies, and irreversible electroporation had in-field recurrence rates of 12–35%. PGA was well tolerated, and nearly all patients returned to baseline urinary function 12 months later. Most modalities caused transient decreases in erectile function. Persistent erectile dysfunction was highest in patients who underwent HIFU. Although oncologic outcomes vary between treatment modalities, systematic review of existing data demonstrates that PGA is a safe treatment option for patients with localized prostate cancer.

Beneficial Effects of Human Umbilical Cord Blood Mononuclear Cells on Persistent Erectile Dysfunction After Treatment of 5-Alpha Reductase Inhibitor in Rats

Effects of human umbilical cord blood (HUCB) as a valuable source for stem cell-based therapies have not been studied in persistent post-5-alpha reductase inhibitors (5ARI) erectile dysfunction (PPED). To determine the effect of intracavernosal injection of HUCB mononuclear cells (MNCs) on ED associated with dutasteride treatment. Twenty five adult male Sprague-Dawley rats were divided into 5 groups (n=5 per group): (i) control, (ii) 8-week dutasteride (0.5 mg/kg/day, in drinking water), (iii) 12-week dutasteride, (iv) 8-week dutasteride+HUCB-MNCs (1×106) and (v) 12-week dutasteride+HUCB-MNCs. HUCB-MNCs were administered intracavernosally after eight weeks of dutasteride treatment. Experiments were performed at 4 weeks following the injection of HUCB-MNCs. Erectile responses and isometric tension of corpus cavernosum (CC) were measured. The protein expressions of phosphodiesterase type 5 (PDE5), endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS), hypoxia-inducible factor (HIF)-1α and smooth muscle/collagen contents in penile tissue were evaluated by Western blotting, immunohistochemistry, and Masson's trichrome staining, respectively. In vivo erectile function, in vitro relaxant and contractile responses of CC, protein expression and localization of PDE5, eNOS, nNOS, HIF-1α, and smooth muscle content in penile tissue. Erectile responses in the dutasteride-treated groups were significantly decreased compared with controls (P < .001), persisting after 4-wk of washout. HUCB-MNCs restored diminished intracavernosal pressure responses, acetylcholine-, sodium nitroprusside-, sildenafil-induced relaxations, and increased phenylephrine and electrical field stimulation (EFS)-induced contractions. Decreased EFS-induced relaxations in dutasteride-treated groups were not restored by HUCB-MNCs. Increased PDE5 and reduced nNOS expressions in dutasteride groups were restored by HUCB-MNCs in the 12-week dutasteride group. eNOS and HIF-1α protein expression and serum total and free testosterone levels were similar among groups. HUCB-MNCs reversed the decreased smooth muscle/collagenratio in dutasteride-treated tissues. There was a significant increase in PDE5 and HIF-1α staining in 8-week dutasteride animals. This study demonstrates the corrective potential of HUCB-MNCs on some persistent structural and functional deterioration caused by 5ARI treatment in rats, which may encourage further evaluation of HUCB-MNCs in men with PPED. Therapeutic application of intracavernosal HUCB-MNCs is a novel approach for the rat model of post-5ARI ED. Lack of serum and tissue dihydrotestosterone measurements, vehicle injections and characterization of the cells remain limitations of our study. The persistent ED after prolonged administration of dutasteride in rats is reversed by HUCB-MNC treatment, which holds promise as a realistic therapeutic modality for this type of ED. Oztekin CV, Yilmaz-Oral D, Kaya-Sezginer E, etal. Beneficial Effects of Human Umbilical Cord Blood Mononuclear Cells on Persistent Erectile Dysfunction After Treatment of 5-Alpha Reductase Inhibitor in Rats. J Sex Med 2021;18:889-899.

Epigenetic Effects of Finasteride on Human Leydig Cells

Finasteride is a synthetic 4‐azasteroid, used in the treatment of both androgenetic alopecia and benign prostatic hyperplasia. In some men, its use is associated with persistent erectile dysfunction, ejaculatory dysfunction, loss of libido, altered sperm counts and infertility ‐ even after cessation of the drug. This condition has been termed “Post‐finasteride Syndrome” (PFS). We want to understand the underlying biochemical mechanisms that govern the development of this condition. Therefore in this experiment we tested the effects of exposure of finasteride on human Leydig cells, the main hormone‐producing cell of the testis, to identify epigenetic changes in the cells that could be at least partially responsible for PFS. We cultured human Leydig cells in the presence of 0.5 μM finasteride for 14 days and performed whole‐genome DNA methylation analysis using the NimbleGen Human DNA Methylation 3×720K Promoter Plus CpG Island Array and Ingenuity Pathway Analysis. Here we describe initial identification of specific genes and pathways involved that may ultimately lead to treatments to reverse PFS.Support or Funding InformationNIH/NIA (IR25AG047843‐01) to ABC

MP39-11 SURGICAL OUTCOMES OF TRAUMATIC PENILE FRACTURE REPAIR ON LONG-TERM ERECTILE AND URINARY FUNCTIONS: ANALYSIS OF TRAUMA REGISTRY

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II (MP39)1 Apr 2020MP39-11 SURGICAL OUTCOMES OF TRAUMATIC PENILE FRACTURE REPAIR ON LONG-TERM ERECTILE AND URINARY FUNCTIONS: ANALYSIS OF TRAUMA REGISTRY Caleb Natale*, Niklos Moring, Laith Alzweri, Amit Reddy, Jacob Greenberg, Ayad Yousif, Cooper Benson, Wayne Hellstrom, and Omer Raheem Caleb Natale*Caleb Natale* More articles by this author , Niklos MoringNiklos Moring More articles by this author , Laith AlzweriLaith Alzweri More articles by this author , Amit ReddyAmit Reddy More articles by this author , Jacob GreenbergJacob Greenberg More articles by this author , Ayad YousifAyad Yousif More articles by this author , Cooper BensonCooper Benson More articles by this author , Wayne HellstromWayne Hellstrom More articles by this author , and Omer RaheemOmer Raheem More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000888.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile fracture (PF) is a traumatic injury necessitating timely surgical intervention. This study examines the impact of an early vs delayed surgical intervention for PF on long-term erectile and urinary outcomes. METHODS: Patients who underwent surgical treatment for traumatic PF from March 2010 to October 2019 at our institution were evaluated to characterize demographics, surgical interventions and long-term outcomes. Non-traumatic PF patients were excluded. International Index of Erectile Function (IIEF-5) was utilized for objective post-operative erectile assessments. RESULTS: A total of 23 patients were evaluated with mean follow-up of 11.6 months. Mean age was 38.5 years and mean BMI was 28.6. No history of erectile dysfunction (ED) or Peyronie’s disease prior to trauma. Majority of patients 18/23 (78%) had surgical interventions within 24 hours (early repair), whereas 5/23 (22%) patients received surgical repair beyond 24hrs (delayed repair). In both groups, the preferred approach at the time of PF repair was the degloving incision 18/23 (78%) compared to ventral raphae incision 5/23 (22%). All patients underwent unilateral or bilateral corpora cavernosa repair of PF. Anastomotic urethroplasty for concomitant corpora spongiosum rupture was required in 6/23 patients. Although the most common complication after surgery was ED (62%), erectile function recovery after six months was 15/18 (83%) and 1/5 (20%) in the early vs delayed groups (p<0.05) (Table). 7 patients (3 in early and 4 in delayed groups) developed severe and persistent ED (IIEF-5: 5-7). 8 (17%) patients complained of post-operative penile curvature (6/18, 33% vs 2/5 40%). Deviation was <30° in all cases. One case of subjective penile shortening was reported in each group. In the delayed repair group, there was one each of reoperation for urethral stricture and transient priapism. CONCLUSIONS: Early surgical repair of PF provides satisfactory long-term outcomes with adequate recovery of erectile and urinary functions. Majority of patients preserve erectile and urinary functions without the development of debilitating long-term sequalae. Large multi-institutional prospective follow-up would further elucidate the relationship between time to surgical intervention, aiding the surgical decision making. Source of Funding: NONE © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e580-e581 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Caleb Natale* More articles by this author Niklos Moring More articles by this author Laith Alzweri More articles by this author Amit Reddy More articles by this author Jacob Greenberg More articles by this author Ayad Yousif More articles by this author Cooper Benson More articles by this author Wayne Hellstrom More articles by this author Omer Raheem More articles by this author Expand All Advertisement PDF downloadLoading ...

Pharmacology of the lower urinary tract: update on LUTS treatment.

The number of compounds used in the pharmacological treatment of lower urinary tract symptoms (LUTS) of patients who do not respond to conservative measures has been relatively stable during the last decade, with the exception of the introduction of the new class of β3 adrenoceptor agonists. However, different combinations have been investigated, and the long-term use of these compounds has raised new concerns about adherence and safety. This review summarizes the current state of pharmacology for LUTS, and presents a thorough discussion of the possible challenges concerning their future use. In this narrative review, we analyze the most recent articles related to LUTS pharmacotherapy, after an initial review of mechanisms of bladder function relevant in present clinical practice. The main problems with pharmacotherapy in LUTS are associated with its moderate efficacy, low persistence on treatment, and the incidence of short- and long-term adverse events (AE) associated with some compounds. The long-term AE, such as cognitive impairment in the elderly vulnerable patients associated with antimuscarinic drugs or persistent erectile dysfunction in sexually active men after treatment with 5-α-reductase inhibitors (5-ARI), are some of the problems addressed in this review. Combination therapy taking advantage of the synergistic mechanisms of action between some classes of compounds may overcome AE associated with dose escalation. LUTS pharmacotherapy offers moderate results to most patients but not a full cure. The use of combination drugs to achieve better clinical results, reduce AE and improve both efficacy and adherence, will be used more frequently in the future. The recently raised concern on potential long-term irreversible AE associated with some of these drugs, like antimuscarinics and 5-ARI, are critically important and require further investigation.

150 The Impact Of Surgical Treatment Of Penile Fracture On Long-term Erectile and Urinary Functions

Penile fracture (PF) is a relatively uncommon genitourinary traumatic injury that often necessitates timely surgical intervention. The aim of this study is to examine the impact of an early vs delayed surgical interventions for PF on the long-term erectile and urinary outcomes. Patients underwent surgical treatment for traumatic penile fractures (PF) from March 2010 to October 2019 at our institution were evaluated to characterize demographics, surgical interventions and long-term outcomes. Patients with a history of non-traumatic PF including Collagenase intralesional injections were excluded. International Index of Erectile Function (IIEF-5) utilized for objective post-operative erectile assessments. A total of 23 patients evaluated. The mean age was 38.5 years (range 18-52 years) and mean BMI of 28.6. Ethnicity were 11 African American, 6 Caucasian, 4 Hispanic and 2 unknown. Mean follow up was 11.6 months (range 6-18 months). No history of erectile dysfunction (ED) or Peyronie’s disease (PD) prior to trauma. Majority of patients 18/23 (78%) had surgical interventions (PF repair) within 24hrs (range 6-18hrs) (early repair), whereas 5/23 (22%) patients received surgical repair beyond 24hrs (range 3-21 days) (delayed repair). In both groups, the degloving circumcision incision was the preferred approach at time of PF repair 18/23 (78%), compared to ventral raphae incision 5/23 (22%). All patients underwent either unilateral or bilateral corpora cavernosa repair of PF, and 6/23 patients (5 vs 1 patients in early vs delayed group) underwent anastomotic urethroplasty for concomitant corpora spongiosum rupture. Although the most common complication following surgical repair of PF was ED (62%), erectile function recovery after six months were 15/18 (83%) vs 1/5 (20%) in the early vs delayed repair groups respectively (p<0.05) (Table 1). Seven patients (3 in early and 4 in delayed groups) developed severe and persistent ED (IIEF-5: 5-7) at time of last follow-up. Eight (17%) patients complained of penile curvature after surgery (6/18, 33% vs 2/5 40%). Intracavernosal injection test showed deviation <30 degree in all cases. Subjective penile shortening was reported in both groups (1 in each group). In the delayed repair group, only 1 patient required reoperation for urethral stricture disease at site of prior urethroplasty and one patient developed transient priapism.

Erectile dysfunction in renal failure and transplant patients.

Erectile dysfunction (ED) is a prevalent and pertinent condition in the chronic kidney disease (CKD) population. It has a multifactorial etiology, including disruptions of the hypothalamic-pituitary-gonadal axis, the endothelial paracrine signaling system, calcium and vitamin D homeostasis, along with several other factors. Efficacy of treatment of ED in the CKD population is comparable to non-CKD patients across multiple modalities, including PDE5 inhibitors, vacuum erectile devices, intracavernosal injections and penile prostheses. Renal transplant improves the contributing comorbid conditions that lead to ED in CKD patients; thus rates of ED are improved post-transplant. It is important to note that there is a small percentage of patients with persistent ED after renal transplantation.

263 Penile Rehabilitation Program with “early” low-dose tadalafil after nerve-sparing radical prostatectomy - increased “early” nocturnal penile tumescence 8 days after nerve-sparing radical prostatectomy is correlated with further erectile function r

Cytotoxic factors in the corpora cavernosa released within the first 48 to 72 hours after surgery seem to play a major role for developing persistent erectile dysfunction. Several pathophysiologies are postulated for postoperative erectile function rehabilitation. In previous prospective studies nocturnal penile tumescense and rigidity (NPTR) in the acute phase during the first night after catheter removal was shown in 93% of the patients after nerve-sparing radical prostatectomy (nsRP) and the improvement of erectile function by using daily low dose PDE5-inhibitors. But the “optimal” time to initiate a rehabilitation program with PDE5-inhibitors is still unknown. 24 sexual active patients were operated by nerve-sparing retropubic radical prostatectomy. All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively. To maintain and support recovery of spontaneous erectile function 12 patients received tadalafil 5mg/d at night starting at the 3rd night after surgery (group 1). A control of 12 patients received tadalafil 5mg/d at night beginning one day after catheter removal (group 2). 8 days after surgery the transurethral catheter was removed and an erectometer measurement of NPTR (Rigi-Scan®) was carried out on each patient at the following night. All patients completed an IIEF-5 questionnaire concerning erectile function at 3, 6, 12 and 18 months after surgery to evaluate further erectile function recovery.

Cyberspace Chat

</br>![][1]</img> One of the more recent online discussion threads revolved around the use of finasteride and dutasteride for androgenetic alopecia. The subject arose because of two new events: 1) a recent article by Kiguradze et al about persistent erectile dysfunction in men taking finasteride