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.

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.

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.

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.

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.

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.

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.

Penile mass formation after neglected penile fracture:Surgical management with pericardial graft reinforcement

Background:Penile fracture is defined as the rupture of the tunica albuginea of the corpora cavernosa while in an erect state,during mostly intercourse or masturbation.Diagnosis of such condition is mainly clinical,while on the other hand,seeking medical attention is often delayed,and treatment options depend upon the time of presentation.Methods:This case report details a patient who developed a penile cystic fibro-hematoma lesion,2 months after a neglected penile fracture.After proper assessment including detailed history,physical exam and a penile doppler ultrasound,patient was elected for surgery.Results:The patient underwent surgical removal of the mass,correction of the curvature,and reinforcement of the weakened tunica albuginea with a pericardium graft.Postoperative course was uneventful.At follow-up,he reported normal erectile function with resolved penile curvature.Conclusion:This highlights the importance of seeking prompt medical attention for suspected penile fractures to avoid potential long-term complications.