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1.
Nannan Thirumavalavan Christopher R.V. Hoover Martin S. Gross 《The journal of sexual medicine》2018,15(8):1195-1197
Introduction
Cavernoscopy (using a cystoscope in the corpora) is traditionally used to retrieve rear tip extenders (RTEs) that are embedded at the time of removal or replacement of inflatable penile prostheses.Aim
To describe indications and techniques of cavernoscopy.Methods
We describe our preferred method of cavernoscopy to retrieve retained rear tips and present a thorough review of the literature regarding cavernoscopy.Main Outcome Measure
Ability of cavernoscopy to retrieve embedded rear tips without causing complications.Results
Cavernoscopy is feasible anecdotally in case reports, but other less-invasive methods of retrieving RTEs seem to have similar efficacy.Conclusion
Cavernoscopy is a technically feasible procedure that can be attempted as part of a stepwise algorithm for removing retained RTEs.Thirumavalavan N, Hoover CRV, Gross MS. Surgeons Corner: Cavernoscopy for Rear Tip Extender Removal. J Sex Med 2018;15:1195–1197. 相似文献2.
Jared J. Wallen Enrique V. Barrera Liehui Ge Alexander W. Pastuszak Rafael E. Carrion Paul E. Perito Tariq S. Hakky 《The journal of sexual medicine》2018,15(7):1034-1040
Background
Throughout the last decade there has been a growing interest in the biomechanical differences between inflatable penile prostheses (IPPs) and their significance with regard to the patient experience.Aim
To present our findings assessing the biomechanical properties of IPPs with and without rear tip extenders (RTEs).Methods
This is a biomechanical study of the 3 most commonly used IPPs (AMS CX, AMS LGX, and Coloplast Titan) as assessed by column compression, modified cantilever deflection, and 3-point bending methods. The IPPs were surgically placed into 3 fresh cadavers via an infrapubic technique by a single large-volume implanter. A biomechanical evaluation of the properties of each IPP inside the fibroelastic tunica albuginea was assessed in blinded testing, and analyses were based on industry standard methods for assessment.Outcomes
Maximum axial load; kink formation; horizontal stiffness; and resistance to 3-point flexure testing were measured.Results
At maximum inflation, all 3 implants had similar performance. Differences appear to be most affected by fill pressures. In fact, only the AMS LGX at less than maximum inflation (LTMI) was unable to consistently withstand the roughly 0.9 kg (2 lbs) of pressure for column load testing mimicking vaginal intromission. The Coloplast Titan showed slightly better rigidity than the AMS LGX and CX devices in horizontal load testing, and, with 3-point flexure testing, the CX showed the best rigidity in the shortest phallus (A). Overall, the Titan showed slightly better rigidity in the longest phallus (C) and the phallus with mild Peyronie's disease (B).Clinical Translations
Penile implants with circumferential expansion had higher rigidity on biomechanical testing and should be considered in a patient's decision during selection of a penile implant.Strengths and Limitations
Strengths include blinding of the biomechanical testing and analyses, surgical procedures performed by a highly experienced surgeon, and that this is the “closest to” in vivo evaluation (inside the tunica albuginea) of penile implant function and properties to date. Weaknesses are that this study was performed in cadavers and not in live patients. It also has a small sample size, including the use of only 3 cadavers, and there was no correlation of performance to patient satisfaction.Conclusion
The results of this study support the conclusion that all devices are capable of functionally restoring erectile capacity. However, we observed that, in general, the 2 circumferentially expanding penile prosthesis showed greater resistance in biomechanical testing when compared with longitudinal and circumferential expanding devices. This should be considered as a guide during device selection for a patient undergoing penile prosthesis.Wallen JJ, Barrera EV, Ge L, et al. Biomechanical Comparison of Inflatable Penile Implants: A Cadaveric Pilot Study. J Sex Med 2018;15:1034–1040. 相似文献3.
Introduction
The sliding technique (ST), commonly done with a subcoronal circumcising incision with penile degloving, has been used to restore penile size in patients with severe Peyronie’s disease (PD) and erectile dysfunction, but with a potential risk of ischemic injury to the glans penis.Aim
To provide detailed surgical techniques regarding the nondegloving ventral incision and report our initial experience with this approach to perform the ST and penile prosthesis placement in patients with severe PD.Methods
This was a retrospective review of patient outcomes after penile prosthesis placement with penoplasty for severe PD and erectile dysfunction from January 2015 to December 2017.Main Outcome Measures
Primary outcomes included straightening rates, penile measurement, along with immediate and late complications. Secondary outcomes include operative time and overall patient satisfaction.Results
12 Patients had significant penile atrophy and/or curvature >60 degrees and underwent inflatable penile prosthesis placement with grafting procedure. Significant penile atrophy was determined by a combination of the patient’s subjective report and the surgeon’s objective assessment through stretched penile length. 7 (58.3%) of those patients underwent ST, of which the last 5 had the procedure performed through a nondegloving ventral incision. Mean degree of curvature prior to ST was 66 degrees (45–90 degrees). Mean penile length gain was 2.6 cm (2.0–3.0 cm). At a mean follow-up of 15.5 months (3–31 months), only 1 patient had minimal residual curvature of 15 degrees. There were no vascular complications.Clinical Implications
This nondegloving technique theoretically maintains blood flow continuity to the glans penis by preserving the continuity of the skin, dartos fascia, and neurovascular bundle.Strengths & Limitations
Strengths of this study include the novel nature of this approach, no incidence of vascular complications, and adaptability to other grafting procedures during penile prosthesis placement. Limitations include the use of 5-item International Index of Erectile Function scores to assess preoperative erectile function on PD, small population, longer incision, and a possible steep learning curve.Conclusion
While ischemic complications of ST and penile prosthesis implantation are rare, there are reports of ischemic injury in patients undergoing a subcoronal circumcising incision with penile degloving. The non-degloving technique with ventral incision provides for an alternative method for ST and penile prosthesis placement to maintain dartos and skin continuity to the glans penis while still allowing for adequate surgical exposure.Clavell-Hernández J, Wang R. Penile Size Restoration With Nondegloving Approach for Peyronie’s Disease: Initial Experience. J Sex Med 2018;15:1506–1513. 相似文献4.
Alexander K. Chow Steven A. Sidelsky Laurence A. Levine 《The journal of sexual medicine》2018,15(7):1021-1029
Background
There are limited data in the literature that describe the management of Peyronie's disease (PD) with severe compound curvature, which often requires additional straightening procedures after plaque excision and grafting (PEG) to achieve functional penile straightening (<20 degrees).Aim
This study highlights the clinical distinction and our experience with men with PD and severe compound curvature treated with PEG and supplemental tunica albuginea plication (TAP).Methods
We performed a retrospective chart review of patients with PD and acute angulation who underwent PEG (group 1) and patients with compound curvature who underwent PEG with TAP (group 2) between 2007 and 2016.Outcomes
Primary post-operative outcomes of interest include change in penile curvature, change in measured stretched penile length, and subjective report on penile sensation and sexually induced penile rigidity.Results
240 Men with PD were included in the study, of which 79 (33%) patients in group 1 underwent PEG and 161 (67%) in group 2 underwent PEG and TAP. There was no difference in associated PD co-morbidities including age, hypertension, hyperlipidemia, hypogonadism, diabetes, or tobacco use. After artificial induction of erection with intracorporal trimix injection, the average primary curvature was 73 (range, 20–120) degrees for group 1 compared to 79 (range, 35–140) degrees for group 2 (P = .01). Group 2 had an average secondary curvature of 36 (20–80 degrees). After completion of PEG, men in group 2 had an average residual curvature of 30 (range, 20–50) degrees which required 1–6 TAPs to achieve functional straightness (<20 degrees). At an average follow-up of 61 months, there was no difference for group 1 and group 2, respectively, for recurrent curvature (11.4% vs 12.4%, P = .33), change in penile length (+0.57 vs +0.36 cm, P = .27) or decreased penile sensation (6% vs 13%, P = .12). In all, 81% of group 1 and 79% of group 2 were able to engage in penetrative sex after penile straightening with or without pharmacotherapy (P = .73).Clinical Translation
Our review shows promising surgical outcomes for the use of PEG and supplemental TAP for this subtype of complex PD.Strengths and Limitations
This article reports the largest experience with treatment of PD with compound curvature to date. Limitations of this study include the retrospective nature of the analysis as well as the lack of a validated objective measurement of erectile function after penile straightening.Conclusion
Our study found no baseline difference in underlying co-morbidities in men with severe compound curvature compared with men with acute severe angulated curvature. Men with severe compound curvature represent a severe and under-recognized population of men with PD who can be surgically corrected with PEG and supplemental TAP(s) when needed without an increased risk of loss of penile length, recurrent curvature, decreased penile sensation, or erectile dysfunction when compared to men treated with PEG alone.Chow AK, Sidelsky SA, Levine LA. Surgical Outcomes of Plaque Excision and Grafting and Supplemental Tunica Albuginea Plication for Treatment of Peyronie's Disease With Severe Compound Curvature. J Sex Med 2018;15:1021–1029. 相似文献5.
Background
Patients with severe erectile dysfunction (ED) and penile size issues, especially seen in Peyronie's disease (PD), are candidates for more invasive penile prosthesis insertion techniques that aim for penile length and girth reconstruction.Aim
To present the feasibility and safety of penile length and girth restoration based on the so-called multiple-slit technique (MUST) for patients with severe ED and significant penile shortening with or without PD.Methods
From July 2013 through January 2016, 138 patients underwent the MUST. The International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction were completed.Outcomes
Outcome analysis was focused on penile length restoration, penile curvature correction, intra- and postoperative complications, and patient satisfaction.Results
138 patients underwent the procedure (103 malleable and 35 inflatable devices). Etiologies of penile shortening and narrowing were PD, severe ED, post-radical prostatectomy, and androgen-deprivation therapy with or without brachytherapy or external radiotherapy for prostate cancer, and post-penile fracture in 60.1%, 24.6%, 10.1%, 3.6%, and 2.2%, respectively. In PD cases, the mean deviation of the penile axis was 55° (range = 0–90°). Mean subjective penile length loss reported was 3.2 cm (range = 1–5 cm), and shaft constriction was present in 44.9%. Median follow-up was 15.2 months (range = 6–36 months). Mean penile length gain was 3.1 cm (range = 2–5 cm). No penile prosthesis infection caused device explantation. One glans necrosis was encountered. The average IIEF score increased from 22 points at baseline to 66 points at 6-month follow-up.Clinical Implications
The MUST helps address penile size issues in cases of severe ED with concomitant conditions that impair penile length or girth.Strengths and Limitations
The strength of the study is its applicability to provide surgeons with a solution for cases in which patients have severe ED and penile size impairment owing to underlying conditions such as PD. The study is limited by the relatively short follow-up.Conclusions
The MUST is an effective, safe, and viable treatment option for a selected patient cohort. Because of the potential complications, proper counseling should take place and only experienced surgeons should perform this type of surgery.Egydio PH, Kuehhas FE. The Multiple-Slit Technique (MUST) for Penile Length and Girth Restoration. J Sex Med 2018;15:261–269. 相似文献6.
Osama Shaeer Kamal Shaeer Islam Fathi AbdelRahman 《The journal of sexual medicine》2018,15(12):1818-1823
Introduction
A shorter penis is a frequent complaint following penile prosthesis implantation (PPI), and a large redundant suprapubic fat pad can conceal the penis and possibly compromise patient and partner satisfaction with length.Aim
To evaluate feasibility and outcome of same-session, same-incision, PPI and suprapubic lipectomy (SPL).Methods
In 22 patients, SPL was performed through an abdominal crease incision. Through the same incision, the superficial perineal pouch was opened to gain access to the base of the penis. Penile prosthesis was implanted (semirigid in 16 patients and girth-expanding 3-piece inflatable in 6). Scarpa’s fascia, subcutaneous fat, and the abdominal crease skin incision were closed.Main Outcome Measure
Evaluation was in terms of implant survival, preoperative vs postoperative patient and partner satisfaction with penile length on a 5-point rating scale, subjective opinion over penile length postoperatively, compared with recall of erect length before erectile dysfunction (ED) had set in (longer, same, or shorter), and penile length with the implant rigid, compared in the supine and standing positions postoperatively (pubic skin to tip, using a rigid ruler).Results
No infections or extrusions or mechanical failures were encountered. There was a 53.3% increase in patient satisfaction with length comparing preoperative (2.55 ± 0.67) to postoperative (4.77 ± 0.43) ratings, P < .0001. Partner satisfaction showed a 40.2% increase, from 1.77 ± 0.61 to 4.41 ± 0.50, P < .0001. 19 of 22 patients reported that postoperative length was longer than their recall of erect length before ED had set in, and 3 patients reported that length was the same. With the implant rigid, there was no statistically significant difference in visible length between the supine and standing positions (14.1 cm ± 2.3 and 13.9 cm ± 2.3, respectively, P = .38).Clinical Implications
Patients with refractory ED and a concealed penis can be counseled as to the option of simultaneous SPL and PPI (SPL-PPI), a modification that may help avoid patient and partner dissatisfaction with length.Strength & Limitations
Strengths include objective evaluation of the efficacy of the procedure by comparing supine and standing penile length. Limitations of the current study include inability to evaluate erect length preoperatively owing to refractory ED, and subjectivity of patient and partner opinion.Conclusion
Same-incision SPL-PPI appears to be a safe and effective procedure, with high patient and partner satisfaction rates.Shaeer O, Shaeer K, Abdel Rahman IF. Simultaneous suprapubic lipectomy and penile prosthesis implantation. J Sex Med 2018;15:1818–1823. 相似文献7.
Zhi-Hua Wan Guo-Hao Li Yong-Lian Guo Wen-Zhou Li Lin Chen Yuan-Jie Zhang 《The journal of sexual medicine》2018,15(3):304-313
Background
Cavernous nerve injury (CNI) causes fibrosis and loss of smooth muscle cells (SMCs) in the corpus cavernosum and leads to erectile dysfunction, and lysyl oxidase (LOX) activation has been found to play an important role in fibrotic diseases.Aim
To evaluate the role of LOX in penile fibrosis after bilateral CNI (BCNI).Methods
Rats underwent BCNI or a sham operation and were treated with vehicle or β-aminopropionitrile, a specific LOX activity inhibitor. 30 days after BCNI, rats were tested for erectile function before penile tissue harvest. LOX and extracellular matrix component expression levels in the corpus cavernosum, including matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), fibronectin (FN), collagen (COL) I, and COL IV, were evaluated by real-time quantitative polymerase chain reaction and western blot. Corporal fibrosis was evaluated by Masson trichrome staining. Localization of LOX and SMC content in the corpus cavernosum were assessed by immunohistochemistry.Outcomes
Ratio of intracavernous pressure to mean arterial blood pressure; LOX, MMPs, TIMPs, COL I, COL IV, and FN expression; penile fibrosis; penile SMC content.Results
After BCNI, there was an increase in penile LOX expression and activity, increased penile fibrosis, decreased SMC content, and impaired erectile function. TIMP1, TIMP2, COL I, COL IV, and FN expression was markedly upregulated, whereas the enzyme activity of MMPs was decreased after BCNI. β-Aminopropionitrile treatment, at least in part, prevented a decrease in the ratio of intracavernous pressure to mean arterial blood pressure, decreased penile expression of TIMP1, TIMP2, COL I, COL IV, and FN, increased MMP activity, prevented corporal fibrosis, and preserved SMC content.Clinical Translation
LOX over-activation contributes to penile fibrosis and LOX inhibition could be a promising strategy in preventing the progression of CNI-induced erectile dysfunction.Strengths and Limitations
This is the 1st study to demonstrate the role of LOX activation in penile fibrosis. However, the exact mechanism of how LOX influences extracellular matrix protein synthesis and SMC content preservation awaits further investigation.Conclusion
CNI induced LOX over-activation in cavernous tissue, and inhibition of LOX preserved penile morphology and improved erectile function in a rat model of BCNI.Wan Z-H, Li G-H, Guo Y-L, et al. Amelioration of Cavernosal Fibrosis and Erectile Function by Lysyl Oxidase Inhibition in a Rat Model of Cavernous Nerve Injury. J Sex Med 2018;15:304–313. 相似文献8.
Spyridon Skoufias Mikaël Sturny Rodrigo Fraga-Silva Theodore G. Papaioannou Nikolaos Stergiopoulos Ioannis Adamakis Constantinos A. Constantinides 《The journal of sexual medicine》2018,15(11):1558-1569
Introduction
Many studies have shown that electrostimulation of the cavernosal nerve can induce and maintain penile erection. Based on these discoveries, neurostimulation to activate the erectile response has been considered a potential solution to treat erectile dysfunction (ED). However, despite recognized potential, this technology has not been further developed. The barrier is the complex anatomy of the human cavernous nerve, which challenges the intraoperative identification of the cavernosal nerves for electrode placement.Aim
To overcome this major barrier, we proposed a practical solution: a 2-dimensional flexible electrode array that can cover the entire plexus area, ensuring that at least 1 of the electrodes will be in optimal contact with the cavernosal nerve, without the need of intraoperative identification. The present study aims to evaluate this concept intraoperatively.Methods
24 patients enrolled for open radical prostatectomy were recruited. During the surgical procedures, the electrode array was positioned on the pelvic plexus (on the prostatic apex or pelvic wall) and electrical stimulation was applied to induce penile erection. Penile erectile response was assessed by (i) visual change of penile tumescence and (ii) by a penile plethysmograph system.Main Outcome Measure
Ability and success rate of evoking penile response were measured by applying electrical stimulation using the developed electrode array.Results
Electrical stimulation produced immediate penile response in all cases when tested before (on prostatic apex) or after prostate removal (on pelvic wall). Clear visual penile engorgement was observed in 75% of the cases, whereas 25% showed minimal to moderate penile tumescence. As expected, patients with lower International Index of Erectile Function-5 score presented a reduced response, whereas stimulation before prostate removal showed greater response than following removal. Interestingly, erectile response was potentiated by bilateral stimulation (circumference increase [mm]: 2.7 ± 1.02 vs. 8.2 ± 1.9, P = .01).Clinical Implications
These data bring sufficient proof of concept of a conceivable novel medical implant for the treatment of ED caused by mechanical nerve injury, such as prostatectomy and spinal cord injury.Strength & Limitations
This is the first approach that can ensure the optimal site stimulation of the erectogenic neuronal path within the lower pelvic area and overcome the major barrier of individual anatomic variability. However, because this study was performed intraoperatively in an acute scenario, further studies are needed to evaluate its chronic efficacy for clinical practice.Conclusion
The flexible electrode array concept can ensure the electrostimulation of erectogenic neuronal path when positioned on the prostate apex or pelvic floor.Skoufias S, Sturny M, Fraga-Silva R, et al. Novel concept enabling an old idea: A flexible electrode array to treat neurogenic erectile dysfunction. J Sex Med 2018;15:1558–1569. 相似文献9.
Faysal A. Yafi Robert Andrianne Laith Alzweri Jeffrey Brady Michael Butcher Daniel Chevalier Kenneth J. DeLay Antoine Faix Georgios Hatzichristodoulou Wayne J.G. Hellstrom Lawrence Jenkins Tobias S. Kohler Daniar Osmonov Sun Hung Park M. David Schwabb Robert Valenzuela Koenraad van Renterghem Steven K. Wilson 《The journal of sexual medicine》2018,15(5):789-796
Background
After radical prostatectomy (RP), erectile dysfunction, often necessitating the need for inflatable penile prosthesis (IPP) insertion, and urinary incontinence and climacturia can ensue.Aim
To assess the efficacy and safety of the mini-jupette, a mesh used to approximate the medial aspects of the 2 corporotomies at the time of IPP insertion, for the management of climacturia and urine leakage in patients with minimal incontinence.Methods
We conducted a pilot multicenter study of patients with post-RP erectile dysfunction and climacturia and/or mild urinary incontinence (≤2 pads/day [ppd]) undergoing IPP insertion with concomitant placement of a mini-jupette graft.Outcomes
Pre- and postoperative erectile function, continence and climacturia, and overall surgical outcomes were assessed.Results
38 patients underwent the mini-jupette procedure. The mean age of the population was 65.3 years (SD = 7.7). 30 had post-RP climacturia and 32 patients had post-RP incontinence (mean = 1.3 ppd, SD = 0.8). 31 patients received Coloplast Titan, 4 received AMS 700 LGX, and 3 received AMS 700 CX IPPs. Mean corporotomy size was 2.9 cm (SD = 1.0). Mean graft measurements were 3.2 cm (SD = 0.9) for width, 3.3 cm (SD = 1.3) for length, and 11.0 cm2 (SD = 5.1) for surface area. At a mean follow-up of 5.1 months (SD = 6.9), there were 5 postoperative complications (13.2%) of which 4 required explantation. Climacturia and incontinence were subjectively improved in 92.8% and 85.7%, respectively. Mean ppd decreased by 1.3 postoperatively.Clinical Implications
The Andrianne mini-jupette is a feasible adjunct to IPP placement that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence.Strengths and Limitations
Strengths of this study include the novel nature of this intervention, the multi-institutional nature of the study, and the promising results demonstrated. Limitations include the retrospective nature of the study and the heterogeneity of the techniques and grafts used by different surgeons involved.Conclusion
Longer follow-up and larger patient cohorts are needed to confirm the long-term safety and benefits of this intervention.Yafi FA, Andrianne R, Alzweri L, et al. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med 2018;15:789–796. 相似文献10.
Ron Golan Neal A. Patel Tianyi Sun Christopher E. Barbieri Art Sedrakyan James A. Kashanian 《The journal of sexual medicine》2018,15(11):1653-1658
Introduction
Considering that radiation therapy (RT) compromises soft tissue microvasculature, impairs wound healing, and causes cavernosal fibrosis, inflatable penile prosthesis (IPP) outcomes may be adversely affected in men treated with RT.Aim
To compare IPP outcomes among those who had undergone prior RT vs a cohort who underwent radical prostatectomy (RP) before insertion of IPP.Methods
The Surveillance, Epidemiology, and End Results (SEER)-Medicare Database was queried for men with prostate cancer (PCa) who underwent RT (n = 83,277) or RP (n = 32,608) with subsequent IPP insertion between 2002 and 2013. Men who had undergone both RT and RP were excluded from the analysis.Main Outcome Measure
The primary outcome was reoperation, defined by removal, revision, or replacement of the IPP.Results
We identified 350 men who received an IPP following RT and 653 who received an IPP following RP. Men who underwent RT were older (P < .01) and had more comorbidities (P < .01). There were no significant differences in overall reoperation rates at 90 days (P = .78), 1 year (P = .52), or 3 years (P = .48). Time-to-event analysis demonstrated that RT was not associated with an increased likelihood of overall reoperation (hazard ratio [HR] 1.46, 95% confidence interval [CI] 0.94–2.29, P = .09). There was no association between time from RT to IPP and overall reoperation rates.Clinical Implications
Prior RT for the treatment of PCa does not impact the revision or removal rates of IPPs as compared with a cohort of non-radiated patients who underwent RP.Strength & Limitations
The strength includes the analysis of outcomes among a contemporary, nationwide cohort with robust follow-up. Using diagnosis and procedure codes, we were thoroughly able to capture reoperations. Limitations include the lack of specific indications for reoperation and inability to control for surgeon experience or technique.Conclusion
IPP is a safe and effective treatment of erectile dysfunction that should be offered to men with a history of pelvic radiation who have failed medical therapy.Golan R, Patel NA, Sun T, et al. Impact of pelvic radiation therapy on inflatable penile prosthesis reoperation rates. J Sex Med 2018;15:1653–1658. 相似文献11.
Kenia Pedrosa Nunes Amanda Almeida de Oliveira Theodora Szasz Vinicia Campana Biancardi R. Clinton Webb 《The journal of sexual medicine》2018,15(9):1235-1245
Introduction
While increased toll-like receptor (TLR)4 activity may contribute to the pathophysiology of vascular diseases, the molecular mechanisms disrupted by this receptor in the vasculature are still poorly understood. Additionally, it is unknown if TLR4 mediates erectile dysfunction (ED) during diabetes.Aim
To investigate whether pharmacological blockade of TLR4 affects erectile function in a murine model of diabetes.Methods
Sprague Dawley rats (Charles River Laboratory, Wilmington, MA, USA) received a single streptozotocin injection (65 mg/kg, 28 days) and were treated with an anti-TLR4 antibody (1 μg/d, intraperitoneally) for the last 14 days of the treatment. Additionally, cavernosal strips were acutely incubated for 30 minutes with CLI-095 (10?5 mol/L), a TLR4 inhibitor. Functional studies, Western blotting, erectile function, immunohistochemistry, and biochemical analyses were performed.Main Outcome Measures
Oxidative stress, cyclic guanosine monophosphate (cGMP) levels, and functional studies were evaluated in treated and nontreated cavernosal strips from control and diabetic animals. Additionally, in vivo erectile function was assessed.Results
Enhanced TLR4 expression was observed in corpus cavernosum from diabetic rats compared with control animals. Long-term blockade of TLR4 slightly improved diabetes–induced ED in rats due to attenuation of oxidative stress and increased cGMP levels in penile tissue, which ameliorated cavernosal relaxation. Functional experiments revealed that acute or chronic inhibition of TLR4 decreased hypercontractility in response to phenylephrine and improved nitrergic relaxation in corpus cavernosum from diabetic rats.Clinical Implications
TLR4 blockade may be a novel therapeutic strategy to assist in ED management.Strengths & Limitations
The strength of this article stems from the fact that we showed that TLR4 blockade partly improves erectile function in vivo in diabetic rats. Its limitations mainly include that messenger RNA analysis for the nitric oxide/cGMP pathway were not performed.Conclusion
In summary, TLR4 participates in the mechanisms of diabetes-associated ED and blockade of this receptor positively affects penile vascular function.Nunes KP, de Oliveira AA, Szasz T, et al. Blockade of Toll-Like Receptor 4 Attenuates Erectile Dysfunction in Diabetic Rats. J Sex Med 2018;15:1235–1245. 相似文献12.
James A. Kashanian Ron Golan Tianyi Sun Neal A. Patel Michael J. Lipsky Peter J. Stahl Art Sedrakyan 《The journal of sexual medicine》2018,15(2):245-250
Introduction
Penile prostheses (PPs) are a discrete, well-tolerated treatment option for men with medical refractory erectile dysfunction. Despite the increasing prevalence of erectile dysfunction, multiple series evaluating inpatient data have found a decrease in the frequency of PP surgery during the past decade.Aims
To investigate trends in PP surgery and factors affecting the choice of different PPs in New York State.Methods
This study used the New York State Department of Health Statewide Planning and Research Cooperative (SPARCS) data cohort that includes longitudinal information on hospital discharges, ambulatory surgery, emergency department visits, and outpatient services. Patients older than 18 years who underwent inflatable or non-inflatable PP insertion from 2000 to 2014 were included in the study.Outcomes
Influence of patient demographics, surgeon volume, and hospital volume on type of PP inserted.Results
Since 2000, 14,114 patients received PP surgery in New York State; 12,352 PPs (88%) were inflatable and 1,762 (12%) were non-inflatable, with facility-level variation from 0% to 100%. There was an increasing trend in the number of annual procedures performed, with rates of non-inflatable PP insertion decreasing annually (P < .01). More procedures were performed in the ambulatory setting over time (P < .01). Important predictors of device choice were insurance type, year of insertion, hospital and surgeon volume, and the presence of comorbidities.Clinical Implications
Major influences in choice of PP inserted include racial and socioeconomic factors and surgeon and hospital surgical volume.Strengths and Limitations
Use of the SPARCS database, which captures inpatient and outpatient services, allows for more accurate insight into trends in contrast to inpatient sampling alone. However, SPARCS is limited to patients within New York State and the results might not be generalizable to men in other states. Also, patient preference was not accounted for in these analyses, which can play a role in PP selection.Conclusions
During the past 14 years, there has been an increasing trend in inflatable PP surgery for the management of erectile dysfunction. Most procedures are performed in the ambulatory setting and not previously captured by prior studies using inpatient data.Kashanian JA, Golan R, Sun T, et al. Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State. J Sex Med 2018;15:245–250. 相似文献13.
14.
Introduction
Historically, contra-indications for immediate salvage of an infected penile prosthesis have included purulence on the device, purulent infections in diabetic patients, and severe diabetes. These clinical principles are from the 1990s to early 2000s and based on limited retrospective series or expert opinion. Since the publication of these contra-indications there have been improvements in device design, surgical technique, corporal washout protocols, and perioperative antibiotic prophylaxis that allow us to re-evaluate whether we can broaden the criteria for immediate salvage of an infected penile prosthesis.Aim
To report whether patients with severe diabetes can safely have a purulent inflatable penile prosthesis (IPP) immediately salvaged.Methods
We considered a “severe diabetic” as a patient whose disease has progressed past diet control and oral medications and, therefore, has insulin-dependent type 2 diabetes mellitus (IDDM II). We retrospectively reviewed 6 consecutive patients with IDDM II and a purulent IPP who had been immediately salvaged from July 2011 to November 2017. In addition to immediate exchange, each received catheter-directed anti-microbial intracorporal irrigation and device culture. All patients were discharged home the next day with oral antibiotics.Main Outcome Measure
Outcomes included repeat penile prosthesis infection or any other complication following immediate salvage.Results
All 6 patients have healed well and remained infection free at their 6- to 8-week post-operative follow-up appointment. 15–39 months after salvage, no patients have had a repeat infection or any other complication. 5 patients received a malleable replacement device and 1 patient was electively converted to an IPP 7 months after his salvage procedure. 1 patient received an IPP during salvage per patient preference. All patients are currently pleased with either their malleable penile prosthesis or IPP.Clinical Implications
Immediate salvage attenuates the morbidity associated with an infected penile prosthesis such as irreversible penile shortening and corporal fibrosis. Our findings suggest that more patients than originally thought may be a candidate for immediate salvage.Strength & Limitations
To our knowledge, this is the first study evaluating outcomes after immediate salvage of a purulent IPP in patients with advanced diabetes. Limitations of the study include the small sample size and retrospective nature.Conclusion
Our results suggest that those with IDDM II who have a purulent penile prosthesis may be candidates for safe and effective immediate salvage.Peters CE, Carlos EC, Lentz AC. Purulent Inflatable Penile Prostheses Can Be Safely Immediately Salvaged in Insulin-Dependent Diabetics. J Sex Med 2018;15:1673–1677. 相似文献15.
James Furr Kristi Hebert Eric Wisenbaugh Joel Gelman 《The journal of sexual medicine》2018,15(12):1811-1817
Introduction
The objective of genital enlargement surgery is to increase length and/or girth for cosmetic reasons; however, newer techniques have been recently reported to be associated with only minor complications in a small percentage of patients.Aim
We aim to report the severe complications of penile augmentation surgery seen at a referral center and describe their subsequent management.Methods
Institutional review board approval was obtained. We reviewed our prospectively collected database for all patients who presented with complications of genital enlargement surgery from 2002–2016.Main Outcome Measure
Interventions following complications of genital enlargement surgery.Results
11 Patients were identified. Mean age was 47 (21–77) years. Prior procedures included subcutaneous injection of silicone outside a medical setting, girth enhancement procedures involving the subcutaneous placement or injection of substances including fat, other substances, or subcutaneous silicone implants. All patients who underwent subcutaneous penile implant underwent removal prior to presentation. Adverse changes included sexually disabling penile deformity and severe shortening, curvature, edema, subcutaneous masses, infection, non-healing wounds, and sexual dysfunction. 10 patients underwent corrective surgery, with 2 requiring multiple procedures and 3 requiring split-thickness skin grafting. All 10 patients had an improved cosmetic appearance and those who had disabling shortening had significantly improved functional length.Clinical Implications
Report of such adverse events should assist in appropriate perioperative counseling prior to genital enhancement surgery.Strength & Limitations
Few reports of debilitating complications of penile enlargement exist in literature. However, without knowing the overall number of procedures performed, the true complication incidence is not known.Conclusion
Penile and scrotal enhancement surgery can be associated with major disabling complications, leading to deformity and functional compromise in men with prior normal anatomy and function. Patients should be aware of these risks.Furr J, Hebert K, Wisenbaugh E, et al. Complications of Genital Enlargement Surgery. J Sex Med 2018;15:1811–1817. 相似文献16.
Background
Currently the Ambicor is the only 2-piece inflatable penile prosthesis (IPP) available in the United States. By eliminating the separate reservoir, this provides certain advantages for patient and surgeon. Nevertheless, it composes a small percentage of all IPPs implanted in the United States.Aim
To detail the surgical technique for implantation, describe the ideal patient candidates best suited for the Ambicor, and discuss the most common and some rare complications with a review of the available published literature in combination with our clinical experience.Methods
A PubMed literature search was performed to obtain all peer-reviewed articles published in English specifically on the Ambicor 2-piece IPP. We also reviewed our clinical experience with the Ambicor during the past 2 decades.Results
The published data remain limited, because few articles on the Ambicor have been published in the past 10 years. Overall complication rates were 2.1% to 9.5%. Patient satisfaction rates were 75% to 96.4%, with similar partner satisfaction rates. Relative contraindications for implantation include patients with significant penile deformities, long narrow phalluses, or short phalluses.Strengths and Limitations
Despite the limited available published data with short follow-up periods, this review provides a comprehensive discussion on the technical aspects and relevant perioperative counseling recommended for Ambicor implantation.Conclusion
The prosthetic urologist should offer the Ambicor 2-piece IPP to patients with erectile dysfunction whose non-surgical treatment has failed. Certain implanters might want to avoid the blind retropubic reservoir placement that occurs with 3-piece IPPs and might not be comfortable with an ectopic approach and therefore prefer using a 2-piece device. We believe the ideal Ambicor candidate is a patient with a current or future pelvic organ transplant, decreased manual dexterity, in need of complete phallic reconstruction, or with known extensive prior abdominopelvic surgery.Abdelsayed GA, Levine LA. Ambicor 2-Piece Inflatable Penile Prosthesis: Who and How? J Sex Med 2018;15:410–415. 相似文献17.
Mohit Khera Anthony Bella Edward Karpman William Brant Brian Christine Bryan Kansas LeRoy Jones Tobias Kohler Nelson Bennett Eugene Rhee Gerard Henry 《The journal of sexual medicine》2018,15(5):786-788
Background
Although there is a strong correlation between erectile dysfunction and Peyronie's disease (PD), there are limited data on the efficacy and satisfaction of inflatable penile prosthesis (IPP) placement in this population.Aim
To assess the efficacy and overall satisfaction of IPP placement in men with erectile dysfunction and concomitant PD using the Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER).Methods
Data from the PROPPER study were examined to determine patient baseline characteristics and primary and secondary etiologies before IPP treatment and included type and size of implant received, presence of corporal fibrosis, and operative time. Men completed 5 validated questionnaires at baseline and annually out to 5 years.Outcomes
IPP placement was performed in 250 patients with PD with comparable surgical times and outcomes as in patients without PD.Results
1,180 men underwent IPP insertion at 11 sites; of these, 250 (21.2%) were diagnosed with PD. This is an ongoing study; 1- and 2-year data are available for 177 (70.8%) and 130 (52.0%) patients, respectively. Intraoperatively, 51.2% patients with PD had corporal fibrosis, with an average operative time of 52.8 minutes. At baseline, 19.3% of men (36 of 187) with PD reported being depressed, with a decrease to 10.5% (6 of 57; P = .02) and 10.9% (5 of 46; P = .07) at 1- and 2-year follow-ups, respectively. More than 80% of patients with PD were satisfied or very satisfied at 1- and 2-year follow-ups. In addition, more than 88% of patients with PD were using their device at the 1- and 2-year follow-up visits.Clinical Implications
Patients with concomitant PD and erectile dysfunction can safely and effectively have an IPP placed with similar outcomes as patients without PD.Strengths and Limitations
The 1st limitation was that all participating prosthetic urologists were high-volume implanters and these results might not be representative of those of general urologists. A 2nd limitation was that none of the patients were randomized. A 3rd limitation was that although most study points were mandatory, some of the data collection, including depression data, was optional, with not all sites participating. A 4th limitation was that depression data were self-reported.Conclusion
IPP can be inserted in patients with PD with acceptable patient satisfaction and usage and depressive symptoms appear to lessen in patients with PD after IPP placement.Khera M, Bella A, Karpman E, et al. Penile Prosthesis Implantation in Patients With Peyronie's Disease: Results of the PROPPER Study Demonstrates a Decrease in Patient-Reported Depression. J Sex Med 2018;15:786–788. 相似文献18.
Jia-feng Fang Xu-na Huang Xiao-yan Han Xi Ouyang Lei Fan Xin Zhao Ze-hong Chen Hong-bo Wei 《The journal of sexual medicine》2018,15(3):284-295
Background
Whether combined transplantation of mesenchymal stem cells (MSCs) and endothelial progenitor cells (EPCs) is more effective than transplantation of a single cell type in the restoration of erectile function is unknown.Aim
To investigate the effect of combined transplantation of MSCs and EPCs on restoration of erectile function in rats with cavernous nerve injury (CNI).Methods
MSCs were isolated from human bone marrow and EPCs were isolated from human umbilical cord blood. MSCs and EPCs were identified by flow cytometry and in vitro differentiation or immunofluorescence staining. 25 8-week-old male Sprague-Dawley rats were allocated to 1 of 5 groups: sham operation group, bilateral CNI group receiving periprostatic implantation of MSCs plus EPCs, MSCs, EPCs, or phosphate buffered saline (control group). 2 weeks after CNI and treatment, erectile function of rats was measured by electrically stimulating the CN. The penis and major pelvic ganglia were harvested for histologic examinations. RNA and protein levels of neurotrophin factors (vascular endothelial growth factor, nerve growth factor, and brain-derived neurotrophic factor) in mono- or coculture MSCs and EPCs were assessed by real-time polymerase chain reaction and enzyme-linked immunosorbent assay, respectively.Outcomes
Intracavernous pressure and mean arterial pressure were measured to evaluate erectile function. Histologic examinations of the penis and major pelvic ganglia and RNA and protein levels of neurotrophin factors in MSCs and EPCs were performed.Results
MSCs and EPCs expressed the specified cell markers and exhibited the typical appearance and characteristics. Treatments using MSCs and/or EPCs could increase endothelial and smooth muscle contents of the corpus cavernosum, decrease caspase-3 expression and increase penile neuronal nitric oxide synthase expression, and restore the neural component of the major pelvic ganglia in rats with CNI. Combined transplantation of MSCs and EPCs had a better effect on improving erectile function than single transplantation of MSCs or EPCs. Expression levels of vascular endothelial growth factor and nerve growth factor in coculture MSCs and EPCs were significantly higher than those of primary MSCs or EPCs.Clinical Translation
Combined transplantation of MSCs and EPCs was more effective in restoring erectile function in CNI-related erectile dysfunction models.Strengths and Limitations
The study, for the 1st time, proved that combined transplantation of MSCs and EPCs was more effective in restoring erectile function in rats with CNI. The rat model might not represent the human condition.Conclusion
Combined periprostatic transplantation of MSCs and EPCs could restore erectile function in rats with CNI more effectively. MSCs might restore CN fibers by secreting neurotrophin factors such as vascular endothelial growth factor and nerve growth factor, and EPCs could enhance the paracrine activity of MSCs.Fang J-f, Huang X-n, Han X-y, et al. Combined Transplantation of Mesenchymal Stem Cells and Endothelial Progenitor Cells Restores Cavernous Nerve Injury-Related Erectile Dysfunction. J Sex Med 2018;15:284–295. 相似文献19.
Ozlem Dural Cenk Yasa Ercan Bastu Funda Gungor Ugurlucan Gamze Yilmaz Bahar Yuksel Suleyman Engin Akhan Faruk Buyru 《Journal of pediatric and adolescent gynecology》2017,30(1):128-131
Study Objective
To evaluate the outcomes of laparoscopic surgery for the treatment of adnexal pathology in older children and adolescents.Design
A retrospective cohort review.Setting
A tertiary academic center in Istanbul, Turkey.Participants
Pediatric and adolescent patients aged between 9 and 19 years (n = 69) who underwent laparoscopic surgery for adnexal pathology from January 2005 through September 2015. The patients who were pregnant or with non-gynecologic pathology detected during surgery were excluded from the study.Interventions
Patients were divided into 2 groups according to their age. Group 1 consisted of 31 patients aged between 9 and 16 years and group 2 included 38 patients aged between 17 and 19 years.Main Outcome Measures
The indication for surgery, procedures performed, anesthesia time, length of hospital stay, pathology findings, and complication rates were evaluated.Results
Ovarian cystectomy and adnexal detorsion with or without cystectomy were the most frequently performed. Ovary-sparing conservative surgery was possible for all patients, except those with gonadal dysgenesis and testicular feminization (n = 6), who underwent laparoscopic gonadectomy. The most common pathologic finding was mature cystic teratoma (30.2%), followed by benign paratubal cyst, and simple cysts of the ovary. Anesthesia time was shorter in group 2 (P = .018). The procedures performed, length of hospital stay, complication rate, and pathology findings were not significantly different between the 2 groups.Conclusions
Laparoscopic surgery can be successfully performed as an efficient, safe, and well tolerated procedure for treating a wide variety of adnexal pathology among children and young adolescents without any significant variation between different age groups. 相似文献20.
Steven A. Rooker Krishna S. Vyas Emma C. DiFilippo Ian T. Nolan Shane D. Morrison Richard A. Santucci 《The journal of sexual medicine》2019,16(5):661-672