Erectile function after urethral reconstruction

Advances in urogenital plastic surgical tissue transfer techniques have enabled urethral reconstruction surgery to become the new gold-standard for treatment of refractory urethral stricture disease. Questions remain, however, regarding the long-term implications on sexual function after major genital reconstructive surgery. In this article, we review the pathologic features of urethral stricture disease and urologic trauma that may affect erectile function （EF） and assess the impact of various specific contemporary urethroplasty surgical techniques on male sexual function.

Molecular Yin and Yang of erectile function and dysfunction

In regard to erectile function, Yin is flaccidity and Yang erection. In the past decade, research has mostly focused on the Yang aspect of erectile function. However, in recent years, the Yin side is attracting increasingly greater attention. This is due to the realization that penile flaccidity is no less important than penile erection and is actively maintained by mechanisms that play critical roles in certain types of erectile dysfunction （ED）; for example, in diabetic patients. In addition, there is evidence that the Yin and Yang signaling pathways interact with each other during the transition from flaccidity to erection, and vice versa. As such, it is important that we view erectile function from not only the Yang but also the Yin side. The purpose of this article is to review recent advances in the understanding of the molecular mechanisms that regulate the Yin and Yang of the penis. Emphasis is given to the Rho kinase signaling pathway that regulates the Yin, and to the cyclic nucleotide signaling pathway that regulates the Yang. Discussion is organized in such a way so as to follow the signaling cascade, that is, beginning with the extracellular signaling molecules （e.g., norepinephrin and nitric oxide） and their receptors, converging onto the intracellular effectors （e.g., Rho kinase and protein kinase G）, branching into secondary effectors, and finishing with contractile molecules and phosphodiesterases. Interactions between the Yin and Yang signaling pathways are discussed as well.

Impact of penile rehabilitation with low-dose vardenafil on recovery of erectile function in Japanese men following nerve-sparing radical prostatectomy

Erectile dysfunction （ED） is a major complication after radical prostatectomy （RP）; however, debatecontinues regarding the efficacy of penile rehabilitation in the recovery of the postoperative erectile function （EF）. This study includeda total of 103 consecutive sexually active Japanese men with localized prostate cancer undergoing nerve-sparing RP, and analyzed the postoperative EF, focusing on the significance of penile rehabilitation. In this series, 24 and 79 patients underwent bilateral and unilateral nerve-sparing RPs, respectively, and 10 or 20 mg of vardenafil was administered to 35 patients at least once weekly, who agreed to undergo penile rehabilitation. Twelve months after RP, 48 （46.6%） of the 103 patients were judged to have recovered EF sufficient for sexual intercourse without any assistance. The proportion of patients who recovered EF in those undergoing penile rehabilitation （60.0%） was significantly greater than that in those without penile rehabilitation （38.2%）. Of several parameters examined, the preoperative International Index of Erectile Function-5 （IIEF-5） score and nerve-sparing procedure were significantly associated with the postoperative EF recovery rates in patients with and without management by penile rehabilitation, respectively. Furthermore, univariate analysis identified the preoperative IIEF-5 score, nerve-sparing procedure and penile rehabilitation as significant predictors of EF recovery, among which the preoperative IIEF-5 score and nerve-sparing procedure appeared to be independently associated with EF recovery. Considering these findings, despite the lack of independent significance, penile rehabilitation with low-dose vardenafil could exert a beneficial effect on EF recovery in Japanese men following nerve-sparing RP.

The Effect of Aging on Erectile Function Induced by Apomorphine and Electric Field Stimulation to Rat

Objective To explore the effect and mechanism of aging on erection by using rat model. Materials & Methods Forty male SD rats of 3, 9, 18 and 24 months old were divided into 4 groups equally according to their age. Apomorphine given subcutaneously and cavernous nerve electric field stimulation was used to induce erection of rats. Results The successful erection rate, number of erection times, and intracavernous pressure (ICP) in the rats of 18 and 24 month old was significantly lower than that of 3 and 9 month old. Conclusion The erectile function in aging rats is deteriorated. The damage mechanism with aging might be related to dopaminergic system in central nerves.

Combination of low-energy shock-wave therapy and bone marrow mesenchymal stem cell transplantation to improve the erectile function of diabetic rats

Stem cell transplantation and low-energy shock-wave therapy （LESWT） have emerged as potential and effective treatment protocols for diabetic erectile dysfunction. During the tracking of transplanted stem cells in diabetic erectile dysfunction models, the number of visible stem cells was rather low and decreased quickly. LESWT could recruit endogenous stem cells to the cavernous body and improve the microenvironment in diabetic cavernous tissue. Thus, we deduced that LESWT might benefit transplanted stem cell survival and improve the effects of stem cell transplantation. In this research, 42 streptozotocin-induced diabetic rats were randomized into four groups： the diabetic group （n = 6）, the LESWT group （n = 6）, the bone marrow-derived mesenchymal stem cell （BMSC） transplantation group （n = 15）, and the combination of LESWT and BMSC transplantation group （n = 15）. One and three days after BMSC transplantation, three rats were randomly chosen to observe the survival numbers of BMSCs in the cavernous body. Four weeks after BMSC transplantation, the following parameters were assessed： the surviving number of transplanted BMSCs in the cavernous tissue, erectile function, real-time polymerase chain reaction, and penile immunohistochemical assessment. Our research found that LESWT favored the survival of transplanted BMSCs in the cavernous body, which might be related to increased stromal cell-derived factor-1 expression and the enhancement of angiogenesis in the diabetic cavernous tissue. The combination of LESWT and BMSC transplantation could improve the erectile function of diabetic erectile function rats more effectively than LESWT or BMSC transplantation performed alone.

NADPH oxidase： recent evidence for its role in erectile dysfunction

Important roles for reactive oxygen species （ROS） in physiology and pathophysiology have been increasingly recognized. Under normal conditions, ROS serve as signaling molecules in the regulation of cellular functions. However, enhanced ROS production as a result of the activation of nicotinamide adenine dinucleotide phosphate （NADPH） oxidase contributes significantly to the pathogeneses of vascular diseases. Although it has become evident that increased ROS is associated with erectile dysfunction （ED）, the sources of ROS in the penis remain largely unknown. In recent years, emergent evidence suggests the possible role of NADPH oxidase in inducing ED. In this review, we examine the relationship between ROS and ED in different disease models and discuss the current evidence basis for NADPH oxidase-derive＇d ROS in ED.

Periprostatic fat thickness measured on MRI correlates with lower urinary tract symptoms,erectile function,and benign prostatic hyperplasia progression

This study investigated the correlation between periprostatic fat thickness(PPFT)measured on magnetic resonance imaging and lower urinary tract symptoms,erectile function,and benign prostatic hyperplasia(BPH)progression.A total of 286 treatment-naive men diagnosed with BPH in our department between March 2017 and February 2019 were included.Patients were divided into two groups according to the median value of PPFT:high(PPFT>4.35 mm)PPFT group and low(PPFT<4.35 mm)PPFT group.After the initial evaluation,all patients received a combination drug treatment of tamsulosin and finasteride for 12 months.Of the 286 enrolled patients,244 completed the drug treatment course.Patients with high PPFT had larger prostate volume(PV;P=0.013),higher International Prostate Symptom Score(IPSS;P-0.008),and lower five-item version of the International Index of Erectile Function(IIEF-5)score(P=0.002)than those with low PPFT.Both high and low PPFT groups showed significant improvements in PV,maximum flow rate,IPSS,and quality of life score and a decrease of IIEF-5 score after the combination drug treatment.The decrease of IIEF-5 score was more obvious in the high PPFT group than that in the low PPFT group.In addition,more patients in the high PPFT group underwent prostate surgery than those in the low PPFT group.Moreover,Pearson’s correlation coefficient analysis indicated that PPFT was positively correlated with age,PV,and IPSS and negatively correlated with IIEF-5 score;however,body mass index was only negatively correlated with IIEF-5 score.

Erectile function after WSTll vascular-targeted photodynamic therapy for low-risk prostate cancer treatment

Vascular-targeted photodynamic therapy(VTP)using padeliporfin is currently assessed as a low-risk prostate cancer(LRPCa)treatment.The aim of this study was to assess erectile function outcomes of VTP for LRPCa treatment.We prospectively included all patients treated with VTP for LRPCa.The primary endpoint was the post-treatment International Index of Erectile Function score(IIEF5 score)evolution(at 6 months,12 months,and then every year for 5 years).Secondary endpoints were the need of erectile dysfunction(ED)treatment and its efficacy.Eighty-two men were included.The median follow-up was 68(range:6-89)months.There was a 3-point significant decrease in the median IIEF5 score between baseline and at 6 months post-VTP(23[range:1-25]vs 20[range:1-25],P=0.005).There was a 1-point decrease at 1 year and 2 years post-VTP compared to baseline(22[range:2-25]and 22[range:0-25],P<0.005).There was no significant difference at 3,4,and 5 years compared to baseline.Twenty-seven(32.9%)patients received ED treatment:phosphodiesterase type-5 inhibitors(PDEI5;n=18),intracavernous injections(ICI;n=9),and intra-urethral gel(n=1).The median IIEF5 score statistically significantly increased after ED treatment(7[range:0-24]vs 21[range:1-25],P<0.001).ED treatment was efficient for 75%of the patients.There was no statistically significant difference between IIEF5 score at baseline and after ED treatment(P=0.443).Forty-six patients were totally potent before VTP and among them,13 needed ED treatment post-VTP with a success rate of 69.2%.VTP induced minimal changes in erectile function with a 3-point and a 1-point reduction in the IIEF5 score at 6 months and at 1 year,respectively.When required,ED treatment was efficient.

Relationship of preoperative androgen levels and metabolic syndrome with quality of life and erectile function in patients who are to undergo radical prostatectomy

This study aims to investigate whether clinical and biological preoperative characteristics of patients who were to undergo radical prostatectomy were associated with impairment in patient-reported quality of life(QoL)and erectile dysfunction immediately before intervention.We evaluated patient-reported outcomes among 1019 patients(out of 1343)of the AndroCan study,willing to score the Aging Male Symptom(AMS)and the International Index of Erectile Function 5-item(IIEF-5)auto-questionnaires.Univariate linear regression and robust multiple regression were used to ascertain the relationship between demographic,clinical,and hormonal parameters and global AMS or IIEF-5 scores.As a result,most patients(85.1%)of the Androcan cohort agreed to complete questionnaires.Significantly higher IIEF-5 global scores were found in non-Caucasian and obese patients,with larger waist circumference,metabolic syndrome,diabetes mellitus,cardiovascular disease,hypertension,high blood sugar,concomitant medications,and hypogonadism,while the AMS global score was significantly higher in patients with larger waist circumference,metabolic syndrome,high blood pressure,raised glycemia,and concomitant medication.The IIEF-5 global score was correlated to age,dehydroepiandrosterone(DHEA),fat mass percentage,and androstenediol(D5).The AMS global score was significantly correlated to DHEA,D5,and DHEA sulfate.Finally,the multivariate models showed that QoL and erectile function were significantly affected,before surgery,by symptoms and signs that are usually considered as pertaining to the metabolic syndrome,while sexual hormones are essentially correlated to erectile dysfunction.

Effects of estrogen and androgen level on erythrocyte deformability in endocrinological erectile dysfunction

Objective: To evaluate the effect of estrogen and androgen levels on erythrocyte deformability in endocrinological erectile dysfunction patients. Methods: The estrogen level, androgen level, IR of 30 psychogenic and 15 endocriological ED were studied and the correlation between the estrogen and androgen levels and RI were analyzed. Results: There is a negative correlation betweenthe androgen and estrogen levels and IR; The IR (5.9033 ± 1.9369), η_(10)(11.2810 ± 1.3120) values in the endcocrinological group were markedly higher than those (4.0589 ± 1.55339, 9.8321 ± 1.6415) in the psychogenic group. Conclusion: The lower level of the estrogen and androgen in endocrinological ED patients may result in the decrease of erythrocyte deformability causing the increase in blood viscosity. To enhance in time the levels of estrogen and androgen might improve penile erectile function of endocrinological ED patients in hemodynamics

Modulation of SIRT1 expression improves erectile function in aged rats

Silent information regulator 2-related enzyme 1(SIRT1)is an aging-related protein activated with aging.Herein,we evaluated the role of SIRT1 in aging-related erectile dysfunction.The expression of SIRT1 was modulated in aged Sprague-Dawley rats following intragastric administration of resveratrol(Res;5 mg kg^(-1)),niacinamide(NAM;500 mg kg^(-1))or Res(5 mg kg^(-1))+tadalafil(Tad;phosphodiesterase-5[PDE5]inhibitor;5 mg kg^(-1))for 8 weeks.Then,we determined erectile function by the ratio of intracavernosal pressure(IcP)/mean systemic arterial pressure(MAP).Cavernosal tissues were extracted to evaluate histological changes,cell apoptosis,nitric oxide(NO)/cyclic guanosine monophosphate(cGMP),the superoxide dismutase(SOD)/3,4-methylenedioxyamphetamine(MDA)level,and the expression of SIRT1,p53,and forkhead box O3(FOX03a)using immunohistochemistry,terminal deoxynucleotidyl transferase(TdT)-mediated 2'-deoxyuridine 5'-triphosphate(dUTP)nick-end labeling(TUNEL),enzyme-linked immunosorbent assays,and western blot analysis.Compared with the control,Res treatment significantly improved erectile function,reflected by an increased content of smooth muscle and endothelium,NO/cGMP and SOD activity,and reduced cell apoptosis and MDA levels.The effect of Res was improved by adding Tad.In addition,the protein expression of SIRT1 was increased in the Res group,accompanied by decreased p53 and FOxO3a levels.In addition,inhibition of SIRT1 by NAM treatment resulted in adverse results compared with Res treatment.SIRT1 activation ameliorated aging-related erectile dysfunction,supporting the potential of SIRT1 as a target for erectile dysfunction treatment.

Circadian disturbance induces erectile dysfunction by impairing endothelial function

In order to explore the impact of circadian disturbance on erectile function,we randomly divided 24 adult male rats into groups of control(light on at 8:00 a.m.and off at 8:00 p.m.),dark/dark(DD;constant dark),light/light(LL;constant light),and shift dark/light(DL;light off at 8:00 a.m.and on at 8:0o p.m.).Four weeks later,erectile function was measured and corpora cavernosa were harvested for analysis.The maximum intracavernous pressure(mlcP)and mCP/mean arterial pressure(MAP)ratio in the DD,LL,and DL groups were significantly lower than that in the control group.The LL and DL groups showed significantly attenuated endothelial nitric oxide synthase(eNOS),while DD,LL,and DL showed reduced neuronal nitric oxide synthase(nNOS)at both mRNA and protein levels.The production of nitric oxide(NO)and cyclic guanosinemonophosphate(cGMP)was inhibited by altered light/dark cycles to varying degrees.Circadian disturbance impaired endothelial function and contributed to erectile dysfunction.For the core circadian elements,mRNA expression of circadian locomotor output cycles kaput(Clock)and brain/muscle aryl-hydrocarbon receptor nuclear translocator-like protein 1(Bmal1)was elevated in the DL group,but their protein expression was not significantly changed.DD,LL,and DL increased period 1(Per1)and Per3 levels,while LL and DL increased PER1 levels.No significant difference was found for Per2levels,and PER2 and PER3 concentrations were not significantly changed.Moreover,LL and DL significantly increased cryptochrome-1(CRY1)and CRY2 at both mRNA and protein levels.The altered light/dark rat model showed that circadian disturbance contributed to erectile dysfunction probably by impairing endothelial function.Meanwhile,the core circadian elements were detected in the corpora cavernosa,but these were disrupted.However,which circadian element regulates erectile function and how it works need further analysis.

Fluoroquinolone-macrolide combination therapy for chronic bacterial prostatitis： retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category Ⅱ chronic bacterial prostatitis （CBP）. The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin （500 rag, thrice-weekly） with a once-daily 500- or 750-mg dose of ciprofloxacin （Cipro-500 or Cipro-750 cohort, respectively）. Combined administration of azithromycin （1500 mg week^-1） with ciprofloxacin at the rate of 750 mg day^- 1 for 4 weeks rather than at 500 mg day^- 1 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen （PSA） were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction （ED） at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.

Sexual dysfunctions and their treatment in liver diseases

Sexual dysfunction(SD)is a prevalent but very commonly ignored aspect in the treatment of liver diseases and cirrhosis.The etiology of SD is multifactorial and therefore treatment strategies are complex,especially in females.Phosphodiesterase inhibitors are useful and effective in erectile dysfunction in males but in females,no single drug is available for SD,therefore multimodal treatment is required depending upon the cause.The foremost and fundamental requirement in both genders is to be stress-free and have adequate control of liver diseases.Improved quality of life is helpful in improving SD and vice versa is also true.Therefore,patients suffering from liver diseases should come forward and ask for treatment for SD,and physicians should actively enquire about SD while history taking and evaluating these patients.SD results in deterioration of quality of life,and both are modifiable and treatable aspects of liver diseases,which are never addressed actively,due to social taboos and fears of SD treatment in the presence of liver diseases.The diagnosis of SD does not require costly investigations,as the diagnosis can be established based on validated questionnaires available for both genders,therefore detailed targeted history taking using questionnaires is essential.Data are emerging in this area but is still at an early stage.More studies should be dedicated to SD in liver diseases.

Leech-Centipede Granules Suppress EndMT to Improve Erectile Dysfunction in Rats with Diabetes Mellitus via TGF-β/Smad Pathway

Objective:To investigate whether Leech-Centipede(LC) Granules can improve erectile function in rats with diabetes mellitus-associated erectile dysfunction(DMED) through endothelial-to-mesenchymal transition(EndMT) inhibition.Methods:Components of LC Granules were identified via ultra-high-performance liquid chromatography.Thirty male Sprague Dawley rats were injected with streptozotocin and fed continuously for 8weeks to establish the DMED rat model.Rats with erectile dysfunction symptoms diagnosed using apomorphine were divided into DMED and low-,medium-,and high-doses LC groups(n=6 in each).The negative control(NC, n=6) and DMED groups were given 5 mL of deionized water via intragastric gavage,and the low-,mediumand the high-doses LC groups were administered LC at 1.6,3.2,and 6.4 g/kg,respectively,via intragastric gavage for 4 weeks.The intracavernous pressure(ICP),mean arterial pressure(MAP),and nitric oxide(NO) levels in cavernous tissue were measured for each group.Quantitative reverse transcription-polymerase chain reaction and Western blot were used to detect mRNA and protein expressions of endothelial and mesenchymal markers.Immunofluorescence staining was used to observe α-SMA, and Masson’s trichrome staining was performed to determine the myofiber/collagen ratio.Results:A total of 474 active components were identified.After treatment,the ICP/MAP value and NO level were significantly higher in the medium-and high-dose LC groups than in the DMED group(P<0.05).Compared with the DMED groups,the medium-and high-dose groups LC significantly increased and decreased endothelial and mesenchymal markers expression,respectively(P<0.05).Tumor growth factor(TGF) β RⅡ,p-Smad2, and p-Smad3 levels were considerably higher following diabetes onset but reduced following LC intervention(P<0.05),except for TGF β 1(P>0.05).α-SMA expression was significantly higher in the DMED group and was reduced in all LC intervention groups(P>0.05).The myofiber/collagen ratio in the LC groups was higher than that in the DMED group but lower than that in the NC group(all P<0.05).Conclusions:LC Granules may improve the erectile function of DMED rats by suppressing TGF-β/Smad pathway to reverse EndMT.

Robotic surgery in giant multilocular cystadenoma of the prostate:A rare case report

BACKGROUND Giant multilocular cystadenoma(GMC)of the prostate gland is a very rare benign tumor.Although the benign nature has been known,complete surgical excision is the major treatment consensus because of its high recurrence rate.We report a rare case of GMC with accompanying lower urinary tract symptoms and repeated urine retention initially thought to be symptoms of benign prostatic hyperplasia,which was treated with robot-assisted laparoscopic radical prostatectomy.CASE SUMMARY A 65-year-old man presented with a 2-year history of lower urinary tract symptoms that had deteriorated gradually within the previous six months,even though he had received treatment with a selective alpha-blocking agent.He had undergone two transurethral resections of the prostate(TURP)at a local hospital during a 4-mo interval because initial ultrasound imaging and prostatic core needle biopsy showed benign prostate hyperplasia.Upon the third recurrence,the patient underwent TURP with a green-light laser at our institution.The diagnosis was a tumor composed of variously sized dilated glandular and cystic structures lined by blended prostatic type epithelia positive for prostate-specific antigen;the final diagnosis was giant multilocular cystadenoma.Magnetic resonance imaging showed a large multilocular retrovesical mass 8.0 cm×7.3 cm×6.4 cm,with heterogeneous enhancement.A coexisting malignant part could not be excluded.Considering the high recurrence rate,risk of coexisting malignancy,and possible sequelae of open surgery for radical excision,the patient decided to undergo robot-assisted radical prostatectomy,with good outcomes at the 2-year follow-up.CONCLUSION Robot-assisted surgery for the treatment of prostate GMC provides another choice for simultaneous attention to disease-control and postoperative quality of life.

Grafts in Peyronie’s surgery without the use of prostheses:a systematic review and meta-analysis

Peyronie’s disease(PD)is characterized by abnormal penile curvature,and various surgical methods have been developed usingdifferent graft materials.However,there is currently no universal agreement on which type of graft is the best.The objective of thisreview was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD.A literature search was conducted using electronic databases,including PubMed,Scopus,and the Cochrane Library.The patients,intervention,comparison,and outcome(PICO)approach was used to define the eligibility of studies.Two authors independentlyselected studies,evaluated them,and extracted data.Random-effect models using the DerSimonian–Laird method were used.Moststudies were single-arm studies and had a high risk of bias.Buccal mucosa grafts(BMG)were found to result in the highest penilestraightening rates and were associated with the least de novo erectile dysfunction.TachoSil grafts demonstrated a high successrate in straightening despite a higher mean preoperative curvature,while Tutoplast grafts had a higher incidence of postoperativeerectile dysfunction.BMG had the highest percentage of postoperative penile straightening.Overall,the TachoSil graft showed thebest performance when preoperative curvature is taken into account.Based on the available literature,BMG appear to be the mosteffective for penile curvature correction in PD,but this is offset by the requirement for low preoperative curvature.The TachoSilgraft shows the best overall performance when preoperative curvature is considered.Comparative randomized clinical trials arestill needed to determine graft superiority.

The role of estradiol in male reproductive function

Traditionally, testosterone and estrogen have been considered to be male and female sex hormones, respectively. However, estradiol, the predominant form of estrogen, also plays a critical role in male sexual function. Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis. Estrogen receptors, as well as aromatase, the enzyme that converts testosterone to estrogen, are abundant in brain, penis, and testis, organs important for sexual function. In the brain, estradiol synthesis is increased in areas related to sexual arousal. In addition, in the penis, estrogen receptors are found throughout the corpus cavernosum with high concentration around neurovascular bundles. Low testosterone and elevated estrogen increase the incidence of erectile dysfunction independently of one another. In the testes, spermatogenesis is modulated at every level by estrogen, starting with the hypothalamus-pituitary-gonadal axis, followed by the Leydig, Sertoli, and germ cells, and finishing with the ductal epithelium, epididymis, and mature sperm. Regulation of testicular cells by estradiol shows both an inhibitory and a stimulatory influence, indicating an intricate symphony of dose-dependent and temporally sensitive modulation. Our goal in this review is to elucidate the overall contribution of estradiol to male sexual function by looking at the hormone＇s effects on erectile function, spermatogenesis, and libido.

A trifunctional contraceptive gel enhances the safety and quality of sexual intercourse

Current contraceptive methods come with a number of drawbacks,including low efficacy,in the case of commercial contraceptive gels,and a reduction in the quality of sexual intercourse,in the case of condoms.Adding pharmacologically-active agents to contraceptive gels holds the potential to improve sexual experience,and hardbor safety and hygiene.In this study,we fabricated a carbomer-based contraceptive gel consisting of three agents:tenofovir,gossypol acetate,and nitroglycerin(TGN),with pH adjusted to 4.5(to be compatible with the vagina).In vitro,the gossypol component of the contraceptive gel proved to be an effective spermicide.When the concentration of gossypol acetate was 10 mg/ml,the spermicidal ability reached 100%after 30 s.In addition,tenofovir in the gel significantly inhibited lentiviral transfection efficiency in cell-containing media.In 6 pairs of rats,the gel successfully prevented all females from conceiving after successful mating.Moreover,increased sexual frequency and enhanced erection,which were promoted by the nitroglycerin in the components,were observed in male rats that had the gel applied to their penises.This novel TGN contraceptive gel yielded a higher contraceptive success rate than that of the commercial contraceptive gel(Contragel®).In addition,it has the added benefits to prevent sexually transmitted diseases and improve male libido and erectile function during sexual intercourse.Combining three FDA-approved and marketed agents together,our trifunctional TGN gel has a great potential for further translation and commercialization.

Impact of low-intensity extracorporeal shockwave therapy on vascular parameters and sexual function in patients with arteriogenic erectile dysfunction

Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy(Li-ESWT).However,the clinical significance of these findings remains unclear,and definitive selection criteria for Li-ESWT based on preexisting comorbidities have yet to be established.This was an observational study of 113 patients with ED,evaluated between January 2019 and December 2021 in Andrology Unit at the Department of Urology and Renal Transplantation,University of Foggia(Foggia,Italy).Penile dynamic Doppler was performed to evaluate vascular parameters and 5-item version of the International Index of Erectile Dysfunction(IIEF-5)questionnaire was administered to assess the severity of ED.This was repeated 1 month after treatment.Patients with a peak systolic velocity(PSV)<30 cm s−1 were considered eligible for Li-ESWT.Our protocol consisted of 8 weekly sessions with 1500 strokes distributed in 5 different locations along the penis.After treatment,a significant mean(±standard deviation[s.d.])PSV increase of 5.0(±3.4)cm s−1 was recorded and 52/113(46.0%)patients reached a PSV>30 cm s−1 at posttherapeutic penile dynamic Doppler.A clinically significant IIEF-5 score improvement was observed in 7 patients,21 patients,and 2 patients with mild-to-moderate,moderate,and severe pretreatment ED,respectively.No different outcomes were assessed based on smoking habits,previous pelvic surgery,or use of oral phosphodiesterase-5 inhibitor(PDE5i).On the other side,only 1(6.7%)in 15 patients with diabetes mellitus showed an IIEF-5 score improvement after Li-ESWT.Shockwave treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED patients.This advantage seemed particularly evident for moderate ED and was not affected by smoking habits,previous pelvic surgery,and use of PDE5i.Conversely,diabetic patients did not benefit from the treatment.