Outcome of implanting penile prosthesis for treating erectile dysfunction： experience with 42 cases

Aim： To report a short-time result of three-piece inflatable penile prosthesis （IPP） implantation on treating patients with organic erectile dysfunction （ED）. Methods： Three-piece IPPs were implanted in 42 Chinese patients with ED refractory to systemic treatment between May 2002 and May 2004. The etiologies of ED were neurogenic （28 with paraplegia and seven with traumatic nervi-erigentes injury）, congenital venous leakage （5 cases）, fibrosis of corpus cavernosum （lcase） and Klinefelter＇s syndrome （1 case）. The follow-up period ranged from 24 to 57 months. Results： Implantation procedures were successfully performed upon all 42 patients. The length of implanted prosthesis was from 13 cm to 18 cm, and the diameter was 1 cm. The implanted prosthesis was made by the Medical Instrumentation Company of Muping （Muping, Shandong, China）. Localized infection occurred in only one patient and mechanical complications occurred in five patients. Coitus could be performed in 41 cases （97.6%）. Three patients with congenital venous leakage made their spouses pregnant after implantation. Conclusion： Implantation of three-piece IPP is an effective and safe modality for treating patients with ED. It can be well accepted by Chinese patients because of its efficacy.     

硅胶银丝阴茎假体置入治疗勃起功能障碍

目的:探讨硅胶银丝阴茎假体在勃起功能障碍患者中的应用,特别是在置入三件套可膨胀阴茎假体后出现机械并发症的患者中的应用.方法:选用AMS(American Medical Systems)公司生产的AMS Malleable 650TM阴茎假体治疗13例勃起功能障碍患者,其中6例是由于置入的三件套可膨胀性阴茎假体出现机械性并发症后,要求更换阴茎假体.结果:13例患者切口均Ⅰ期愈合,平均随访12个月,除2例出现阴茎疼痛及1例出现假体过短外,其余患者夫妻双方性生活满意,未发现其他并发症.结论:对于一些经济困难的患者及部分置入三件套可膨胀阴茎假体后出现机械故障的患者而言,硅胶银丝阴茎假体仍不失为一个理想的选择.     

Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures

OBJECTIVE: To evaluate the outcome of penile prosthesis surgery for different types of prosthesis. PATIENTS AND METHODS: The notes of 447 men who had 504 penile prosthesis implanted between August 1975 and December 2000 were evaluated. Of the prostheses inserted, 393 were malleable, 81 were three-piece inflatable and 30 were self-contained hydraulic prostheses. The mean (range) age of the men was 52 (21-78) years; 404 men had primary implants and 43 had revision surgery after operations at other institutions. The mean follow-up was 50 (1-297) months. RESULTS: Of the 447 men, 22 were lost to follow-up immediately after surgery. The most serious postoperative complications were infection (8%) and erosion (5%), which was more common in diabetic patients (10%) and after pelvic trauma with a urethral injury (21%). Of 482 prostheses, 21 failed mechanically (4%) and revision surgery was needed for 5% of the prostheses inserted (24/482). Overall, 89% (377/425) of men could have sexual intercourse and 344 (81%) were satisfied with the results. CONCLUSIONS: Of the men implanted with a penile prosthesis, 81% were satisfied with the outcome and an even higher proportion were satisfied with the inflatable prostheses. Dissatisfaction was mainly due to complications that resulted in removal of the prosthesis.     

三件套可控性阴茎假体植入术治疗器质性勃起障碍

目的观察三件套可控性阴茎假体植入术治疗器质性阴茎勃起障碍(ED)的疗效、安全性及可靠性。方法我科自1999年3月~2003年10月起使用国产/进口可控性阴茎假体对7例器质性ED患者进行假体植入治疗,并对其进行随访观察。结果7例器质性ED假体植入患者术后1周内均有不同程度的阴茎疼痛,其中1例因长期焦虑症状和阴茎勃起疼痛取出假体;其余假体目前使用情况良好。结论可控性阴茎假体植入术治疗器质性ED有效、安全、疗效可靠。良好的医患沟通,严格掌握手术适应证,正确仔细术中操作,正确及时假体使用指导是手术成功有效的保证。     

糖尿病性勃起功能障碍相关因素分析

目的 研究糖尿病性勃起功能障碍(ED)的发病情况及其影响ED程度的相关因素。 方法 调查90例男性2型糖尿病病人的性功能状态、年龄、糖尿病病程、测量血压,同时测定其糖化血红蛋白(HbA1C)血脂等指标。结果 糖尿病病人中ED患病率为75.6%(68/90),患病率随年龄的增加而增加,在非ED组与不同程度ED组之间,年龄存在非常显著差异(P<0.01),DM病程、HbA1C存在显著差异(P<0.05)结论 糖尿病病人ED患病率高,糖尿病性ED的程度随年龄、DM病程、HbA1C的增加而加重,长期良好的血糖控制有助于延缓糖尿病性ED的加重。     

The relationship between serum irisin levels and erectile dysfunction in diabetic men (irisin and erectile dysfunction in diabetic patients)

Irisin is an exercise-induced myokine that alleviates endothelial dysfunction and reduces insulin resistance in type 2 diabetes mellitus. We conducted this cross-sectional prospective study to determine the association of serum irisin levels and erectile dysfunction in type 2 diabetic patients. We compared 34 diabetic patients with erectile dysfunction with 30 diabetic patients without erectile dysfunction. In our study, serum irisin levels were found to be statistically significantly higher in diabetic patients without erectile dysfunction compared to those with erectile dysfunction (p = .016) and according to correlation analysis, irisin levels had a significantly negative correlation with the serum HbA1C value (r = −.294, p = .018). Based on the results of our study, we think that this molecule can be used in the diagnosis or treatment of erectile dysfunction in diabetic patients, if these findings are supported by larger studies.     

Penile shortening complaints in males with erectile dysfunction: a narrative review on penile lengthening procedures during penile prosthesis surgery

Patients complaining of short penile length pose a challenge in urology practice. Those men who present seeking penile lengthening surgery usually overestimate ''normal'' penile length, and may in often cases relate their penile length with the degree of masculinity and self-esteem. Penile prosthetic devices are the gold standard treatment of erectile dysfunction (ED) after failure of conservative options. Penile shortening is the most prevalent long-term complaint after successful inflatable penile prosthesis (IPP) placement. This has a significant impact on patient’s overall satisfaction and quality of life. Using PubMed, we performed a thorough literature review of the current procedures of preservation or enhancement of penile length as well as reported perioperative protocols in patients undergoing penile prosthesis (PP) insertion. Keywords used were “penile lengthening”, “penile enhancement”, “penile girth”, “inflatable penile prosthesis” and “glans augmentation”. Several surgical techniques can be offered in the setting of penile shortening concurrently with PP insertion, e.g., sub-coronal approach of PP placement, sliding technique, modified sliding technique (MoST), multiple-slide technique (MuST), and tunica mesh expansion procedure (TMEP). Adjuvant techniques can also improve subjective penile length include, ventral phalloplasty, suprapubic lipectomy, suspensory ligament release and use of expanding penile implants. Preoperative protocols including use of a vacuum erectile device, traction therapy also seem to improve postoperative outcomes, minimizing postoperative pain, and encouraging the early device use. Currently, there is no consensus among experts on a particular lengthening procedure or when they can be performed to optimize outcomes. Furthermore, it is imperative to set proper expectations before surgery, with extensive patient and partner counseling. When used in the properly selected patient, penile lengthening procedures show promising results with minimal complication rates.     

The impact of sildenafil citrate on sexual satisfaction profiles in men with a penile prosthesis in situ

OBJECTIVE: To assess the efficacy of sildenafil in increasing penile glans tumescence and improving patient satisfaction in men with a penile prosthesis, as this remains a major treatment for erectile dysfunction but a common complaint is the lack of glans engorgement. PATIENTS AND METHODS: To determine whether sildenafil combined with a penile prosthesis improves satisfaction, patients used an implant alone for at least 1 month, after which they completed the International Index of Erectile Function (IIEF) questionnaire. The same patients were then given sildenafil citrate and completed the IIEF questionnaire after using the sildenafil/implant combination. RESULTS: Patients who responded to sildenafil with glans engorgement reported significantly greater satisfaction scores than with an implant alone. CONCLUSION: We currently offer sildenafil citrate after implantation to all men who have a penile prosthesis placed.     

Assessment of erectile dysfunction in diabetic patients

Erectile dysfunction (ED) aetiology is multifactorial, including endocrine, neurological, vascular, systemic disease, local penile disorders, nutrition, psychogenic factors, and drug-related. This study was performed to compare the relevant comprehensive biochemical parameters as well as the clinical characteristics in diabetic ED and healthy control subjects and to assess the occurrence of penile neuropathy in diabetic patients and thus the relationship between ED and diabetes. A total of 56 patients accepted to undergo assessment for penile vasculature using intracavernosal injection and colour Doppler ultrasonography. Of the 56 diabetic patients, 38 patients were found with normal blood flow and thus they were considered as the diabetic-ED group, whereas, ED diabetic patients with an arteriogenic component were excluded. These patients with an age range between 17 and 58 years, complaining of ED, with duration of diabetic illness ranging from 2 to 15 years. The Control group comprised of 30 healthy subject aged between 19 and 55 years. Peripheral venous levels of testosterone, prolactin, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), malondialdehyde and glycosylated haemoglobin (HbA(1)c) were obtained in all subjects. Valsalva manoeuvre and neurophysiological tests were also determined. Testosterone, prolactine, FSH, LH, and TSH hormones of the diabetic patients were not significantly different from those of the control group. Diabetic patients with ED have higher HbA(1)c and oxidative stress levels while the R-R ratio was significantly decreased. Bulbocavernosus reflex latency was significantly prolonged, whereas its amplitude, the conduction velocity and amplitude of dorsal nerve of penis were significantly reduced in the diabetic patients. We concluded that although ED is a multifactorial disorder, yet, the present study revealed that in ED patients without arteriogenic ED a neurogenic component is present. Furthermore, the complex effect of the Valsalva manoeuvre on cardiovascular function is the basis of its usefulness as a measure of autonomic function. Thus, it can be of value in the diagnosis of ED although these hypotheses require follow-up in a large study cohort.     

滋阴壮阳胶囊对糖尿病性勃起功能障碍大鼠血清NO、ET-1的影响*

目的通过研究滋阴壮阳胶囊对糖尿病性勃起功能障碍(DED)大鼠血清中NO和ET-1的影响,探讨该药治疗DED的作用机制.方法雄性SD大鼠70只,60只以STZ诱导建立糖尿病(DM)模型后,通过阿朴吗啡(APO)进行阴茎勃起实验筛选DED模型,余10只为空白对照组.造模后的DED大鼠随机分成滋阴壮阳胶囊治疗组、六味地黄软胶囊对照组和模型组,在灌胃2周后,腹主动脉取血检测各组大鼠NO和ET-1.结果各组间ET-1和NO差异均有统计学意义(P<0.01);与空白对照组比较,模型组ET-1水平显著升高、NO显著下降(P<0.01);与模型组比较,治疗组和对照组均可降低ET-1水平,升高NO水平(P<0.01、P<0.05),且在降低ET-1方面治疗组优于对照组(P<0.05).结论滋阴壮阳胶囊可通过升高NO的浓度,降低ET-1的水平,重新调整ET-1与NO之间的平衡,这可能是该药治DED的机理之一.     

Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction

Aim： To assess the behavior of patients with diabetes mellitus （DM） and erectile dysfunction （ED） during 10 consecutive years of treatment with self-injection of vasoactive drugs. Methods： Thirty-eight diabetic men, including 12 with type Ⅰ and 26 with type Ⅱ diabetes, were followed up regularly for 10 years after they began self-injecting for severe ED. Real time rigidity assessment was used for the objective determination of the initial dosage and then doses were regulated in order to introduce an erection suitable for penetration and maintenance of erection for approximately 30 min. Patients were followed up every two months, and doses were increased only when the treatment response was not satisfactory. Results： The number of injections used per year by the patients was reduced each year （mean numbers： 50 in the first year and 22.5 in the 10th） and treatment shifted towards stronger therapeutic modalities （mixtures of vasoactive drugs instead of prostaglandin E1 alone）. Type Ⅰ diabetic men were standardized to a level of treatment as early as 5 years after the initiation of treatment. That level was finally reached by type Ⅱ patients after another 4-5 years. Conclusion： Treatment with self-injections of vasoactive drugs in diabetic men with severe El） is a safe and effective alternative in the long term. Diabetic men of both types show the same preferences in quality and quantity of treatment after 10 years. The key point for maintenance in treatment is the adjustment of the therapeutic method and dosage to optimal levels for satisfactory erections. （Asian J Androl 2006 Mar; 8： 219-224）     

Glycosylated haemoglobin levels and the severity of erectile function in diabetic men

OBJECTIVE: To evaluate the association between the levels of glycosylated haemoglobin (HbA1c) and the severity of erectile dysfunction (ED) in men with diabetes mellitus (DM). PATIENTS AND METHODS: This cross-sectional study included sexually active men with a diagnosis of DM attending a urological medical centre from January 2000 to December 2001. The 115 men with ED (95%) completed the International Index of Erectile Function questionnaire, and fasting serum glucose and HbA1c serum levels were measured. The relationship between the severity of ED and serum HbA1c levels was assessed. RESULTS: Of men with HbA1c levels of < 8%, half had mild, and 18% and 32% had moderate and severe ED, respectively (P = 0.038); of men with HbA1c levels of > or = 8%, 25%, 29%, and 46% had mild, moderate and severe ED, respectively (P = 0.008). In addition, men with HbA1c levels of > or = 11% had a statistically higher prevalence of severe ED (P = 0.002). There was no difference in severity of ED in the HbA1c subgroups when the duration of DM was < or = 5 years (P = 0.87), but most men with HbA1c levels of > or = 8% and a history of DM of 6-10 or > 10 years had severe ED (P < 0.03). CONCLUSION: This study suggests that the severity of ED is associated with increasing HbA1c levels in diabetic men.     

Determination of serum testosterone in experimental diabetes with erectile dysfunction

To study the mechanisms of erectile dysfunction (ED) in ex-perimental diabetic (DM) rats, streptozotocin (STZ) was injectedintraperitoneally into Sprague-Dewley rats to make experimentalmodels of DM. Rats showing apparent ED after apomorphine injec-tion were selected for the experiment. Penile erections were studiedon the 6th, 8th and 12th week after injection of apomorphine. Theconcentration of LH, FSH and testosterone (T) were examined andmicrostructure of testes were observed. Results indicated that theserum T was decreased significantly with marked changes in testicu-lar histology; the degree of both was closely related to the durationof DM. The concentration of LH did not change on the early days,but decreased significantly later in the course. FSH concentrationswere not changed. As conclusions, penile erection and synthesis oftestosterone are affected seriously by DM, and the decrease of Tconcentration may be one of the most important mechanisms.(Chin J Androl 2000; 4: 227 - 230)     

胰岛素对糖尿病大鼠阴茎内nNOS神经纤维的影响

目的探讨糖尿病性阴茎勃起功能障碍（ED）的发病机制及胰岛素的治疗作用。方法注射链脲佐菌素建立糖尿病（DM）大鼠模型，胰岛素治疗组于成模后注射胰岛素。7周和12周后注射阿扑吗啡（APO）进行大鼠阴茎勃起功能实验，取大鼠阴茎和血浆，用ABC免疫组织化学法观察nNOS神经纤维的变化。测定血浆NOS活性。结果（1）与对照组相比，DM组大鼠阴茎勃起次数明显减少;胰岛素治疗后症状缓解;（2）与对照组相比，DM组血浆NOS活性明显增高;DM组血浆NOS活性与病程延长呈负相关;与DM组比较，胰岛素治疗组血浆NOS活性明显降低;（3）与对照组相比，DM组阴茎内nNOS阳性神经纤维明显减少;与DM组比较，胰岛素治疗组nNOS阳性神经纤维表达增加。结论糖尿病性ED阴茎内nNOS阳性纤维的数量及光密度随DM病程的延长而下降;早期给予胰岛素治疗可预防糖尿病大鼠ED的出现及阴茎内nNOS含量的下降。     

Inhibition of inducible nitric oxide synthase improved erectile dysfunction in rats with type 1 diabetes

Diabetes mellitus (DM), which is closely related to microvascular dysfunction, is a risk factor for erectile dysfunction (ED). Furthermore, the upregulation of inducible nitric oxide synthase (iNOS) is associated with systemic vascular dysfunction in rats with diabetes. The purpose of this study was to investigate the role of iNOS in diabetes mellitus erectile dysfunction (DMED). First, we developed a type 1 DM rat model using streptozotocin and selected those that developed DMED. Then, we injected these rats with the 1400W, an iNOS inhibitor, for 10 weeks and subsequently assessed their ED. Lastly, we performed various molecular studies and histopathological analyses of penile tissues collected from these rats after the experiments. Through the histopathological studies, we also found that the treatment restored the ratios of the smooth muscle to collagen fibres, delayed the development of microvascular injury and alleviated the oxidative stress caused by hyperglycaemia. Based on these results, we confirmed that upregulation of iNOS leads to microvascular dysfunction in patients with ED. Overall, we found that inhibition of iNOS displayed beneficial effects in the treatment of ED, suggesting that its mechanism should be further explored.     

Platelet Indices as a marker for early prediction of erectile dysfunction in diabetic patients

Erectile dysfunction is one of the major concerns in diabetic patients. Platelet Indices including mean platelet volume, platelet count and platelet distribution width are important biomarkers for platelet activation and pathophysiology of atherothrombosis. Measurement of Platelet Indices may early predict erectile dysfunction in diabetic men. This study aimed to measure Platelet Indices in diabetic patients with erectile dysfunction and to correlate between them and erectile dysfunction especially of vasculogenic type. The study included 30 diabetic patients with diagnosed erectile dysfunction and 20 normal males as a control. Each patient was evaluated by history, International Index of Erectile Function‐5, general and local examination, HbA1c, pharmaco‐penile duplex ultrasonography and blood sample to measure Platelet Indices. Platelet distribution width and mean platelet volume were significantly higher in patients than controls (p < 0.001). Their levels were significantly higher in vasculogenic erectile dysfunction than other types (p < 0.001). No statistically significant association regards the platelet count (p > 0.05). We concluded that Platelet Indices are high in diabetic patients with erectile dysfunction especially those with vasculogenic aetiology. They can predict erectile dysfunction in diabetic men early, and so they may be considered as cheap, available and useful biomarker for early diagnosis of vasculogenic erectile dysfunction in diabetic patients.     

糖尿病性阴茎勃起功能障碍动物模型血清雄激素测定

ＳＤ大鼠注射链脲佐菌素制造溏尿病（ＤＭ）动物模型后,注射阿朴吗啡观察不同时期大鼠阴茎勃起情况,筛选ＤＭ性阴茎勃起功能障碍（ＥＤ）大鼠模型,测定其血清ＬＨ、ＦＳＨ及睾酮的浓度,并观察睾丸组织的显微结构,研究ＤＭ性ＥＤ的发病机理。结果ＤＭ性ＥＤ大鼠血清睾酮浓度显著降低,睾丸组织显微结构发生明显病理性改变,且上述变化与ＤＭ病程密切相关;ＬＨ在ＤＭ早期无改变、晚期明显降低;ＦＳＨ无明显改变。提示ＤＭ严重影阴茎勃起功能及雄激素的合成分泌,雄激素降低可能是其主要发病机理之一。