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Bock M, Burns RT, Pereira TA, Bernie HL. A contemporary review of the treatments and challenges associated with penile rehabilitation after radical prostatectomy including a proposed optimal approach. Int J Impot Res 2024; 36:480-485. [PMID: 37853240 DOI: 10.1038/s41443-023-00782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
Prostate cancer is one of the most prevalent malignancies affecting men worldwide. Despite advancements in understanding prostate anatomy and minimally invasive approaches to surgical treatment, surgery can have significant adverse effects on sexual function. Penile rehabilitation strategies have emerged as a promising approach to mitigate the impact of prostate cancer treatments on erectile function and improve quality of life. Several methods have been employed for penile rehabilitation, including pharmacotherapy, vacuum erection devices, intracavernous injections, and emerging novel techniques. Yet, there is no consensus on the exact programs or timing of initiation that should be utilized for optimal recovery after surgery. This review discusses various rehabilitation protocols and long-term outcomes and explores the cost-effectiveness of different interventions. Additionally, this review discusses the importance of a multidisciplinary approach to penile rehabilitation which includes patient education, counseling, and the selection of an appropriate rehabilitation strategy tailored to each individual's needs and preferences. Continued research and collaboration among healthcare professionals are essential to refine rehabilitation approaches and ensure optimal outcomes for patients with prostate cancer.
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Affiliation(s)
- Megan Bock
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Ramzy T Burns
- Department of Urology, Indiana University, Indianapolis, IN, USA.
| | - Thairo A Pereira
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN, USA
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Castiglione F, Albersen M, Fiorenzo S, Hedlund P, Cakir OO, Pavone C, Alnajjar HM, Joniau S, Muneer A. Long-term consequences of bilateral cavernous crush injury in normal and diabetic rats: a functional study. Int J Impot Res 2022; 34:781-785. [PMID: 34611324 DOI: 10.1038/s41443-021-00474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/28/2021] [Accepted: 09/20/2021] [Indexed: 01/06/2023]
Abstract
A recent statement from the European-Society-for-Sexual-Medicine has highlighted the limitations of using the rat model for nerve-sparing prostatectomy. The use of young rats with no comorbidities and the early evaluation of the erectile function (EF) are deemed a source of bias. Our aim was to evaluate the long-term consequences in EF of bilateral nerve cavernous crush- injury (BNCI) in type 1 diabetic (DM) rats 30-male/12-week-old rats were divided into four groups: Sham, BNCI, DM, and BNCI + DM. Sham group underwent an intraperitoneal injection (IP) of saline solution and after 1 month underwent a sham laparotomy. BNCI underwent an IP of saline solution and after 1 month to BNCI. DM underwent an IP of 60 mg/kg-1-streptozotocin (STZ) and after 1 month to a sham laparotomy. BNCI + DM underwent an IP of 60 mg/kg-1-STZ and after 1 month to BNCI. After 5 months from the induction of diabetes, all rats underwent measurement of intracorporeal pressure (ICP) and mean arterial pressure (MAP) during CN-electrostimulation. Multiple groups were compared using Kruskal-Wallis one-way analysis of variance followed by Mann-Whitney U test for post hoc comparisons. Blood glucose-level was higher (p < 0.05) in the groups with DM and BNCI + DM. After 5-months, DM and BNCI + DM also showed a lower weight compared to other groups (p < 0.05). No differences were noted in ICP/MAP between the sham and BNCI. BNCI + DM showed lower ICP/MAP compared to all the groups (p < 0.05). DM Showed lower ICP/MAP compared to Sham and BNCI (p < 0.05). BNCI in rats without comorbidities did not induce long-term erectile dysfunction (ED) suggesting a spontaneous EF recovery. BNCI in DM induced long-term ED. The results of previous short-term studies can only provide evidence on the time to recovery of spontaneous EF as to the actual EF recovery rate.
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Affiliation(s)
- Fabio Castiglione
- Department of Urology, University College London Hospital, London, UK. .,Division of Surgery and Interventional Science, University College London, London, UK. .,Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Maarten Albersen
- Laboratory for Experimental Urology, Organ systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Salvatore Fiorenzo
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Petter Hedlund
- Department of Clinical and Experimental Pharmacology, Lund University, Lund, Sweden.,Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Omer Onur Cakir
- Department of Urology, University College London Hospital, London, UK
| | - Carlo Pavone
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | | | - Steven Joniau
- Laboratory for Experimental Urology, Organ systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Asif Muneer
- Department of Urology, University College London Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Division of Surgery and Interventional Science and NIHR Biomedical Research Centre University College London Hospital, London, UK
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Kandhari S, Sharma D, Samuel S, Sharma G, Majumdar P, Edgerton VR, Gad P. Epidural spinal stimulation enables global sensorimotor and autonomic function recovery after complete paralysis: 1st study from India. IEEE Trans Neural Syst Rehabil Eng 2022; 30:2052-2059. [PMID: 35271446 DOI: 10.1109/tnsre.2022.3158393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
While the loss of sensorimotor and autonomic function often occurs due to multiple trauma and pathologies, spinal cord injury is one of the few traumatic pathologies that severely affects multiple organ systems both upstream and downstream of the injury. Current standard of care therapies primarily maintains health and avoids secondary complications. They do not address the underlying neurological condition. Multiple modalities including spinal neuromodulation have shown promise as potential therapies. The objective of this study was to demonstrate the impact of activity-based neurorehabilitation in presence of epidural spinal stimulation to enable simultaneous global recovery of sensorimotor and autonomic functions in patients with complete motor paralysis due to spinal cord injury. These data are unique in that it quantifies simultaneously changes multiple organ systems within only 2 months of intense activity-based neurorehabilitation when also delivering epidural stimulation consisting of sub-motor threshold stimulation over a period of 12-16 hours/day to enable 'self-training' in 10 patients. Finally, these studies were done in a traditional neurorehabilitation clinical in India using off-the-shelf electrode arrays and pulse generators, thus demonstrating the feasibility of this approach in simultaneously enabling recoveries of multiple physiological organ systems after chronic paralysis and the ability to perform these procedures in a standard, well-controlled clinical environment.
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Lo SP, Hsieh TC, Pastuszak AW, Hotaling JM, Patel DP. Effects of SARS CoV-2, COVID-19, and its vaccines on male sexual health and reproduction: where do we stand? Int J Impot Res 2022; 34:138-144. [PMID: 34707243 PMCID: PMC8548269 DOI: 10.1038/s41443-021-00483-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 01/08/2023]
Abstract
Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first discovered, there have been questions surrounding the effects of coronavirus disease 2019 (COVID-19), and more recently the COVID-19 vaccine, on men's health and fertility. Significant research has been conducted to study viral tropism, potential causes for gender susceptibility, the impact of COVID-19 on male sexual function in the acute and recovery phases, and the effects of the virus on male reproductive organs and hormones. This review provides a recent assessment of the literature regarding the impact of COVID-19 and its vaccine on male sexual health and reproduction.
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Affiliation(s)
- Sharon P Lo
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Darshan P Patel
- Department of Urology, University of California San Diego, La Jolla, CA, USA.
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Duthie CJ, Graham K, Rapsey CM, Wibowo E. Factors associated with various strategies for maintaining sexual activity after prostate cancer treatment. Int J Impot Res 2021; 34:769-775. [PMID: 34455426 DOI: 10.1038/s41443-021-00466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/21/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022]
Abstract
Many men experience sexual difficulties after receiving prostate cancer treatment. We investigated sexual and relationship factors associated with management strategies to maintain sexual activity in prostate cancer patients. 210 prostate cancer patients (66.7 ± 7.4 years old) completed our survey online. Higher sexual function distress (Incidence rate ratio, IRR = 0.99, p = 0.005) and less frequent relationship strain (IRR = 1.01, p = 0.002) were associated with trying a higher number of sexual management strategies. Higher sexual function distress was associated with the use of oral medication (Odds Ratio, OR = 0.98, p = 0.026), vacuum erection device (OR = 0.98, p = 0.005), and vibrators (OR = 0.97, p = 0.005). Perceived importance of sexual interaction with a partner was associated with using oral medication (OR = 1.95, p = 0.027). Participant's higher ideal frequency of sexual interaction with a partner was a predictor for the use of vibrators (OR = 1.03, p = 0.024). Less frequent relationship strain was associated with the use of vacuum erection device (OR = 1.03, p = 0.002), and vibrators (OR = 1.02, p = 0.012). Lastly, patients' communication with their partner about sexual intimacy was also associated with use of vacuum erection device (OR = 3.24, p = 0.050, CI 1.0-10.5). Few participants (13-27%) were interested in trying penile implant, penile support device, external penile prosthesis, penile sleeve and anal devices. From our qualitative analyses, the main barriers to retaining sexual activity were erectile dysfunction and psychological issues. Three themes participants found useful to maintain sexual activity: preparatory behaviours for initiating or maintaining erections, adapting their sexual activity to fit with what was now possible, and the importance of the relationship or intimacy with their sexual partner. Psychological and relationship factors contribute to patients' motivation to remain sexually active after treatment.
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Affiliation(s)
- Cassian J Duthie
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Katie Graham
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Charlene M Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand.
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Sansone A, Mollaioli D, Ciocca G, Limoncin E, Colonnello E, Vena W, Jannini EA. Addressing male sexual and reproductive health in the wake of COVID-19 outbreak. J Endocrinol Invest 2021; 44:223-231. [PMID: 32661947 PMCID: PMC7355084 DOI: 10.1007/s40618-020-01350-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a "cytokine storm", which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients. METHODS A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed. RESULTS Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED. CONCLUSION COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.
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Affiliation(s)
- A Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - D Mollaioli
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - G Ciocca
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - E Limoncin
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - E Colonnello
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - W Vena
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - E A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
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