The incidence of prostatic cancer rises with increasing age and early diagnosis rate of the disease keeps increasing at the same time. Early diagnosis provides opportunities for radical prostatectomy to cure prostatic cancer. However, the problem of erectile dysfunction (ED) post operation puzzles urologists and exerts negative impacts on the patients life quality. Study on the prevention and treatment of peri-operational ED is of great importance to dwindle the occurrence rate of ED and is the key to improve the life quality of such patients.
Erectile Dysfunction ; etiology ; prevention & control ; Humans ; Male ; Phosphodiesterase Inhibitors ; therapeutic use ; Postoperative Complications ; Prostatectomy ; Prostatic Neoplasms ; surgery

OBJECTIVETo report the amelioration of the three-piece inflatable penile prosthesis (IPP) implantation and the prevention of its complications.

METHODSThirty-two patients with moderate to severe erectile dysfunction (ED) irresponsive to conservative treatments received the implantation of the three-piece IPP. The surgical techniques were ameliorated in the course of operation. The patients were guided in using the IPP after operation. The effects and complications of the implantation were observed based on IIEF of the patients before and after operation.

RESULTSSexual life was resumed and no complication was found in 28 of the patients. The complications that developed in the other 4 were pump failure (2 cases), urethral perforation (1 case), and penis contraction (1 case). The former 3 achieved normal sexual intercourse after the second operation. Comparison between the IIEF scores before and after operation showed a very remarkable difference (P < 0.01). The occurrence rate of complications was 12.5%. The satisfaction rate of sexual intercourse was 87.5% and the total satisfaction rate of sexual life was 84.4%.

CONCLUSIONThe complications of the three-piece IPP implantation were obviously reduced by ameliorating operation techniques. The implantation of the three piece-IPP is safe and effective for advanced ED patients.

Adult ; Aged ; Erectile Dysfunction ; surgery ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Penile Implantation ; Penile Prosthesis ; Postoperative Complications ; prevention & control

The neurovascular bundle of the prostate and cavernosal nerves have been used to describe the same structure ever since the publication of the first studies on the neuroanatomy of the lower urogenital tract of men, studies that were prompted by postoperative complications arising from radical prostatectomy. In urological surgery every effort is made to preserve or restore the neurovascular bundle of the prostate to avoid erectile dysfunction (ED). However, the postoperative potency rates are yet to be satisfactory despite all advancements in radical prostatectomy technique. As the technology associated with urological surgery develops and topographical studies on neuroanatomy are cultivated, new observations seriously challenge the classical teachings on the topography of the neurovascular bundle of the prostate and the cavernosal nerves. The present review revisits the classical and most recent data on the topographical anatomy of the neurovascular bundle of the prostate and cavernosal nerves and their implications on radical prostatectomy techniques.
Erectile Dysfunction ; prevention & control ; Humans ; Hypogastric Plexus ; anatomy & histology ; Male ; Postoperative Complications ; prevention & control ; Prostate ; innervation ; surgery ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery

With the approaching of the aged society, the number of patients with BPH and those with prostate cancer is increasing, particularly the latter. As the gold standard for the treatment of the two diseases, prostate surgery falls into various types, each with its own characteristics in postoperative recovery of sexual function. In the past few years, the traditional laparotomy procedure has been gradually replaced by the laparoscopic technique. Doctors and patients are not merely satisfied with the improvement of micturition function any longer; they are beginning to pay more attention to the pre- and post-operative sexual function. This paper gives an overview of the influence of various types of prostatectomy on male sexual function.
Erectile Dysfunction ; etiology ; physiopathology ; prevention & control ; Humans ; Male ; Postoperative Complications ; etiology ; physiopathology ; prevention & control ; Prostatectomy ; adverse effects ; methods ; Prostatic Hyperplasia ; surgery ; Prostatic Neoplasms ; surgery

Objective: To explore the treatment of penile incarceration with a metal ring. METHODS: Based on our experience in the successful management of a case of penile incarceration with a metal ring by coiling and bloodletting from the corpus cavernosum, we reviewed the relevant literature and analyzed the indications, advantages and disadvantages of different methods for the treatment of penile incarceration with a circular foreign body. RESULTS: The clamping and cutting methods were non-invasive, fast, effective, and with few complications, which could be applied to the treatment of penile strangulation at all levels. However, clamping was not desirable enough for a hard metal ring and the cutting method took a longer time and might increase the risk of unnecessary damage to the penile skin, urethra and cavernous body. Prepuce edema decompression and the thin tube-coiling method, with the advantages of minimal invasiveness, simple operation and no need of special tools, were suitable for penile strangulation injury under level 3, but might cause penile skin injury and potential postoperative erectile dysfunction. Surgical resection, as an invasive procedure, could be applied to severe penile strangulation at level 4 or 5. CONCLUSIONS The principle for the treatment of penile incarceration with a circular foreign body is to remove the foreign object as soon as possible and not to add secondary damage.
Bloodletting ; methods ; Constriction, Pathologic ; therapy ; Erectile Dysfunction ; prevention & control ; Foreign Bodies ; complications ; therapy ; Humans ; Jewelry ; adverse effects ; Male ; Penis ; blood supply ; injuries ; pathology ; Postoperative Complications ; prevention & control ; Urethra

OBJECTIVETo explore the clinical value of preserving the integrity of the bladder neck in plasmakinetic vaporization of the prostate (PKVP) in protecting the erectile function and improving the quality of life of patients with benign prostatic hyperplasia (BPH) below 60 years of age.

METHODSThirty-two patients with BPH, with a mean age of 55.4 years (range 50-60 years), were enrolled the study to undergo PKVP with Gyrus bipolar systems, in which the transverse fiber muscle area of the bladder neck were carefully preserved. The erectile function and the quality of life of the patients were evaluated with the International Index of Erectile Function (IIEF)-5 and Quality of Life (QoL) before and after the operation. Retrograde ejaculation was also observed after the operation.

RESULTSIn the 6-month follow-up, only 1 (3.13%) patient was found to have erectile dysfunction. Five patients (15.6%) reported retrograde ejaculation 3 months after the surgery, and only 3 patients (9.4%) had retrograde ejaculation at 6 months.

CONCLUSIONSPreserving the bladder neck in PKVP may protect the erectile function with BPH below 60 years of age.

Erectile Dysfunction ; prevention & control ; Humans ; Laser Therapy ; Male ; Middle Aged ; Organ Sparing Treatments ; Penile Erection ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Urinary Bladder ; Volatilization

AIMTo examine the changes in the erectile function in diet-induced obese rats and investigate the oral efficacy of DA-8159, a new phosphodiesterase type 5 (PDE5) inhibitor, on penile erection in obese rats.

METHODSThe rats were fed a high-energy diet for 12 weeks and divided into three groups: an obesity-resistant (OR) control group, an obesity-prone (OP) control group, and an OP-DA-8159 treatment (DA-8159) group. The electrostimulation-induced erectile responses were measured in all groups. The body weight, plasma cholesterol, triglyceride and glucose levels were also measured.

RESULTSIn the OP control group, the maximum intracavernous pressure (ICP) and ICP/blood pressure (ICP/BP) ratio after electric stimulation were significantly lower than those in OR control group. The corresponding area under the curve (AUC) of the ICP/BP ratio, the detumescence time and the baseline cavernous pressure were also lower than those in the OR control group, but this difference was not significant. The body weight gain, plasma cholesterol and triglyceride level in the OP group were significantly higher than those in the OR group. After administering the DA-8159, a significant increase in the maximum ICP and the ICP/BP ratio were observed. The corresponding AUCs in the DA-8159 group were also higher than those in the two control groups. Furthermore, the detumescence time was significantly prolonged after treatment with DA-8159.

CONCLUSIONThese results demonstrate that diet-induced obesity affects the erectile function in rats and these erectile dysfunction (ED) can be improved by the treatment with DA-8159, indicating DA-8159 might be a treatment option for ED associated with obesity.

Animal Feed ; Animals ; Diet ; Erectile Dysfunction ; etiology ; prevention & control ; Male ; Obesity ; etiology ; physiopathology ; Penile Erection ; drug effects ; physiology ; Phosphodiesterase Inhibitors ; pharmacology ; Pyrimidines ; pharmacology ; Rats ; Sulfonamides

This study was aimed to investigate the influence of coital frequency and masturbation on erectile dysfunction (ED) in Chinese patients. A total of 332 male outpatients with or without ED and volunteers were recruited from Zhongnan Hospital, Wuhan University, China. ED was assessed by using the five-item International Index of Erectile Function scale and the frequency of intercourse by patients' self-report. After adjusting for lifestyle factors and diseases-related factors, the analyses showed that coital and masturbation in a certain frequency tended to decrease the risk of ED. Men reporting intercourse once a week had lower risk of ED than those did less than once a week, with age, hyperlipidemia, hypertension, diabetes, body mass index, smoking, and drinking as covariates (P=0.67, adjusted odds ratio [OR] = 0.84; 95% confidence interval [CI]: 0.37-1.88). For those reporting coital frequency two times per week and three or more times per week, there were 63% (adjusted OR = 0.37; 95% CI: 0.18-0.77) and 85% (adjusted OR = 0.15; 95% CI: 0.07-0.35) lower risk of ED than those reporting intercourse frequency less than once per week, respectively (P<0.05). Results indicated that maintaining a regular frequency of intercourse can reduce the risk of ED for males aged among 30 to 75 years.
Adult ; Age Distribution ; Aged ; China ; epidemiology ; Coitus ; Cross-Sectional Studies ; Erectile Dysfunction ; epidemiology ; prevention & control ; Humans ; Male ; Middle Aged ; Prevalence ; Risk Assessment ; Sexual Behavior ; statistics & numerical data

OBJECTIVETo summarize the experience of radical retropubic prostatectomy (RRP) and the multi-factors which influence on the prognosis and long life quality.

METHODSFrom January 1993 to March 2005, 132 cases radical retropubic prostatectomy were performed. The patients were divided into 2 groups: the early group and recent group. Eleven items in peri-operative time and follow up results were analysed. The erection function of 78 cases were investigated with international index of erectile function 5 score. In these patients, nocturnal electrobioimpedance volumetric assessment (NEVA) were observe in 19 cases.

RESULTSComparing of the 2 groups, the index connected with operative skill changed to optimization. No one died of prostate cancer in 63 follow up patients. Nine cases showed biochemical failure with criterion as prostate specific antigen > 0.4 microg/L. Fifty patients passed urine normal post-operation in 6 months. Eight patients had stress incontinence and 5 had entire incontinence at 6 month. Four patients had vesical neck stricture. Another follow up result shows 33 (58.9%) erection function recovered in 55 bilateral nerve-sparing operation and 7 recovered in 22 of unilateral nerve-sparing operation. NEVA shows 14 cases with artery supply insufficient in whom 4 regained erection function and 5 cases vein leakage in whom no one recovered.

CONCLUSIONSThe radical retropubic prostatectomy remains the procedure of choice for the cure of localized prostatic cancer. The keys for the operation are anatomic dissection, preservation of the neurovascular bundle and good skill. These are also important for a good life quality for the patients.

Aged ; Erectile Dysfunction ; etiology ; prevention & control ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Penile Erection ; Postoperative Complications ; etiology ; prevention & control ; Prostatectomy ; adverse effects ; methods ; Prostatic Neoplasms ; physiopathology ; surgery ; Quality of Life ; Retrospective Studies ; Treatment Outcome ; Urinary Incontinence ; etiology ; prevention & control

Prostate cancer has the highest incidence among malignant tumors of the urinary system in China. Radical prostatectomy (RP) is the most effective treatment for localized prostate cancer with a good long-term prognosis. Erectile dysfunction (ED) is a common complication after RP, which seriously affects the patient's quality of life. With the rising incidence and early diagnosis of prostate cancer, the proportion of young cases of RP is increasing, and so is the importance of the treatment of post-RP ED. The restoration of erectile function after RP is closely related to the timing of penile rehabilitation as well as to pre- and intra-operative measures such as surgical strategies and methods. Common options for the treatment of post-RP ED include oral medication of phosphodiesterase type 5 inhibitors, application of vasoactive substances in the urethra or corpus cavernosum, use of vacuum erection devices, and implantation of penile prosthesis. Stem cell therapy, nerve transplantation, low-intensity extracorporeal shockwave therapy, and erythropoietin have shown great potential in penile rehabilitation after RP. At present, the stress is placed on the remission of symptoms in the treatment of ED. Stem cell therapy may reverse the cause of disease or cure ED by reversing its pathophysiological changes. A series of clinical trials of stem cell therapy are underway and have preliminarily confirmed the safety of stem cell therapy and proved that it can improve erectile function in patients with post-RP ED. This review focuses on the progress in the prevention and treatment of ED after RP.
China ; Erectile Dysfunction ; prevention & control ; therapy ; Humans ; Male ; Penile Erection ; Penile Prosthesis ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Postoperative Complications ; prevention & control ; therapy ; Prostatectomy ; adverse effects ; Prostatic Neoplasms ; surgery ; Quality of Life ; Stem Cell Transplantation ; Treatment Outcome ; Vacuum ; Vasodilator Agents ; therapeutic use