Penile fracture is a rare urological emergency that may cause erectile dysfunction (ED). We analyzed the factors affecting erectile function in patients who underwent surgical repair for the management of penile fractures. Eighty-two patients who underwent penile fracture surgery in the Department of Urology, University of Gaziantep (Gaziantep, Türkiye) between January 2012 and January 2023 were evaluated. Age, body mass index, time elapsed from the incident of penile fracture to surgery, size, laterality, level of the defect, causes of fracture, presenting signs and symptoms, and relevant complications were recorded. Erectile function of the patients was evaluated preoperatively and at postoperative 3 rd and 6 th months according to the International Index of Erectile Function-5 (IIEF-5) scoring system. The factors decreasing the erection quality of the patients after surgical repair of penile fractures were investigated using IIEF-5 scoring system. Only age, defect size, and time elapsed from fracture onset to surgery were found to be effective on the occurrence of ED ( P = 0.005, P < 0.001, and P < 0.001, respectively). In the receiver operating characteristic (ROC) analysis, the cut-off values were 12.5 mm for defect size ( P < 0.001), 8.5 h for the time elapsed from fracture onset to surgery ( P = 0.036), and 40.5 years for the age of the patients ( P = 0.005). Delayed surgery, defect size, and advanced age had significant and negative effects on erectile function in cases of penile fracture. Before repair of the defect, patients should be given appropriate counseling about the possibility of ED, and early penile rehabilitation should be initiated.
Humans ; Male ; Erectile Dysfunction/epidemiology* ; Penis/surgery* ; Adult ; Middle Aged ; Risk Factors ; Postoperative Complications/etiology* ; Young Adult ; Rupture/surgery* ; Age Factors ; Aged ; Penile Erection ; Retrospective Studies

Despite surgical advancements, erectile dysfunction (ED) is a common consequence of radical prostatectomy (RP). This study aimed to evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitation program on assisted and unassisted erectile function (EF) recovery. All patients who underwent RP and at least 1 year follow-up at penile rehabilitation program in the Department of Urology, OORR Policlinico Riuniti (Foggia, Italy) were included. Treatment involved phosphodiesterase type 5 inhibitors (PDE5Is; tadalafil 20 mg, 1 tablet every other day), intracavernous injections (Caverject 5 µg, 1 vial per week), and daily use of vacuum erection devices (VEDs). Primary end point was EF recovery defined as International Index of Erectile Function-5 (IIEF-5) ≥21 with or without rehabilitation aids. IIEF-5 and prescribed treatments were prospectively collected at 3 months, 6 months, 9 months, 12 months, and 24 months. Among 570 eligible patients, 397 (69.6%) underwent rehabilitation. Patients who undergoing andro-rehabilitation were younger (65 months vs 70 months; P < 0.0001), had lower prostate-specific antigen (PSA) levels (5.9 ng ml -1 vs 6.2 ng ml -1 ; P = 0.04), and lower grade tumors ( P = 0.001) compared to the patients who did not undergo sexual rehabilitation after radical prostatectomy. Two-year EF recovery rates in patients undergoing andro-rehabilitation ranged from 75% (preoperative IIEF-5 >16) to 45% (preoperative IIEF-5 <16) with rehabilitation aids. Combination treatments (PDE5I+VEDs with or without intracavernous injections) showed the highest rates of EF recovery (up to 80% at 2 years). EF recovery without rehabilitation aids was significantly higher for patients with IIEF-5 >21 (IIEF-5 >21 [36%] vs IIEF-5 of 17-21 [18%]; P = 0.01). Subanalysis indicated a moderate benefit of rehabilitation in patients with preoperative IIEF-5 <16 who underwent bilateral nerve-sparing RP. Participation in intensive penile rehabilitation programs improves EF recovery in patients undergoing RP. Preserving the neurovascular bundles may be beneficial for patients with preoperative ED.
Humans ; Male ; Prostatectomy/rehabilitation* ; Middle Aged ; Erectile Dysfunction/drug therapy* ; Aged ; Recovery of Function ; Robotic Surgical Procedures/adverse effects* ; Phosphodiesterase 5 Inhibitors/therapeutic use* ; Penile Erection ; Tadalafil/therapeutic use* ; Prostatic Neoplasms/surgery* ; Treatment Outcome

Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms, including sexual dysfunction and infertility. However, clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear. This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction. This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores, libido, and frequency of morning erection. Of the 58 patients, 48 (82.8%) patients had sexual intercourse preoperatively. Among those 48 patients, 41 (85.4%) patients presented with erectile dysfunction. The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas (17.63 ± 0.91 vs 13.28 ± 1.43; P = 0.01). Postoperatively, the incidence of erectile dysfunction was 47.9%, which was significantly lower than that preoperatively (85.4%; P = 0.01). Twenty-eight (68.3%) patients demonstrated an improvement in erectile dysfunction. Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction. Preoperative testosterone <2.3 ng ml^-1 was an independent predictor of improvement in erectile dysfunction. In conclusion, our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma. The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.
Humans ; Male ; Prolactinoma/surgery* ; Erectile Dysfunction/etiology* ; Retrospective Studies ; Sexual Dysfunction, Physiological/complications* ; Testosterone ; Pituitary Neoplasms/pathology*

Sexual disorders following retroperitoneal pelvic lymph node dissection (RPLND) for testis tumor can affect the quality of life of patients. The aim of the current study was to investigate several different andrological outcomes, which may be influenced by robot-assisted (RA) RPLND. From January 2012 to March 2020, 32 patients underwent RA-RPLND for stage I nonseminomatous testis cancer or postchemotherapy (PC) residual mass. Modified unilateral RPLND nerve-sparing template was always used. Major variables of interest were erectile dysfunction (ED), premature ejaculation (PE), dry ejaculation (DE), or orgasm alteration. Finally, fertility as well as the fecundation process (sexual intercourse or medically assisted procreation [MAP]) was investigated. Ten patients (31.3%) presented an andrological disorder of any type after RA-RPLND. Hypospermia was present in 4 (12.5%) patients, DE (International Index of Erectile Function-5 [IIEF-5] <25) in 3 (9.4%) patients, and ED in 3 (9.4%) patients. No PE or orgasmic alterations were described. Similar median age at surgery, body mass index (BMI), number of nodes removed, scholar status, and preoperative risk factor rates were identified between groups. Of all these 10 patients, 6 (60.0%) were treated at the beginning of our robotic experience (2012-2016). Of all 32 patients, 5 (15.6%) attempted to have a child after RA-RPLND. All of these 5 patients have successfully fathered children, but 2 (40.0%) required a MAP. In conclusion, a nonnegligible number of andrological complications occurred after RA-RPLND, mainly represented by ejaculation disorders, but ED occurrence and overall sexual satisfaction deficit should be definitely considered. No negative impact on fertility was described after RA-RPLND.
Male ; Child ; Humans ; Robotics ; Quality of Life ; Retrospective Studies ; Neoplasms, Germ Cell and Embryonal/surgery* ; Testicular Neoplasms/pathology* ; Lymph Node Excision/adverse effects* ; Retroperitoneal Space/surgery* ; Erectile Dysfunction/surgery* ; Treatment Outcome

We aimed to evaluate ten-year outcomes of penile prosthesis (PP) implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection (EPI). We identified 549 men who underwent 576 PP placements between 2008 and 2018. Univariate and multivariate analyses were used to identify potential predictors of EPI. An EPI predictive nomogram was developed. Thirty-five (6.1%) cases of EPI were recorded with an explant rate of 3.1%. In terms of satisfaction, 82.0% of the patients defined themselves as "satisfied," while partner's satisfaction was 88.3%. Diabetes (P = 0.012), longer operative time (P = 0.032), and reinterventions (P = 0.048) were associated with EPI risk, while postoperative ciprofloxacin was inversely associated with EPI (P = 0.014). Rifampin/gentamicin-coated 3-piece inflatable PP (r/g-c 3IPP) showed a higher EPI risk (P = 0.019). Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients, redo surgeries, or when a r/g-c 3IPP was used (all P < 0.03). We showed that diabetes, longer operative time, and secondary surgeries were the risk factors for EPI. Postoperative ciprofloxacin was associated with a reduced risk of EPI, while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant. After further validation, the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.
Erectile Dysfunction/surgery* ; Humans ; Male ; Patient Satisfaction ; Penile Implantation ; Penile Prosthesis ; Penis/surgery* ; Tertiary Care Centers

Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction (ED) that is refractory, unsatisfactory, or contra-indicated for other approved medical or mechanical options. In this study, we introduce the "Ghattas technique," wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder, which can increase the cylinder diameter for cases that need a larger prosthesis. All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire (IIEF-5). Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at final follow-up. The mean age of the 23 included patients was 57.9 (standard deviation [s.d.]: 11.4) years and the mean duration of ED was 8.5 (s.d.: 7.9) years. Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores (8.3 [s.d.: 3.9] vs 24.6 [s.d.: 0.6], P < 0.001). High treatment satisfaction was determined according to a mean EDITS score of 94.9 (s.d.: 9.9). The proposed Ghattas technique was safe and effective in our patients, and provides opportunity for cases that need a diameter larger than 13 mm. Further studies are needed to confirm these results.
Child ; Erectile Dysfunction/surgery* ; Humans ; Male ; Patient Satisfaction ; Penile Prosthesis ; Surgical Mesh ; Surveys and Questionnaires ; Treatment Outcome

General recommendations regarding surgical techniques are not always appropriate for all Peyronie's disease (PD) patients. Therefore, the purpose of this study was to investigate the effects of plication procedures in PD patients with severe penile curvature and the effects of early surgical correction in patients who no longer have progressive deformities. The clinical data from 72 patients who underwent plication procedures were analyzed in this study. Patients were divided into Groups A and B according to the curvature severity (≤60° or >60°) and Groups 1 and 2 according to the duration of disease stabilization (≥3 months or <3 months). At the 1-year follow-up, 90.0% (36/40) and 90.6% (29/32) patients reported complete penile straightening, and 60.0% (24/40) and 100.0% (32/32) patients reported penile shortening in Groups A and B, respectively. No curvature recurrence occurred in any patient, and no significant differences were observed in postoperative International Index of Erectile Function-Erectile Function domain (IIEF-EF), erectile pain, sensitivity, or suture knots on the penis whether such outcomes were grouped according to the curvature severity or the duration of stabilization. However, the duration from symptom onset to surgical management in Group 1 was significantly longer than that in Group 2 (mean ± standard deviation [s.d.]: 20.9 ± 2.0 months and 14.3 ± 1.2 months, respectively, P < 0.001). The present study showed that the plication procedures seemed to be an effective choice for the surgical treatment of PD patients with severe penile curvature. In addition, the early surgical treatment seemed to benefit those patients who already had no erectile pain and no longer exhibited progressive deformity.
Erectile Dysfunction/surgery* ; Humans ; Male ; Patient Satisfaction ; Pelvic Pain ; Penile Induration/surgery* ; Penis/surgery* ; Retrospective Studies ; Treatment Outcome

Erectile Dysfunction ; Humans ; Male ; Penile Induration/surgery* ; Penis ; Postoperative Period ; Retrospective Studies

Objective: Postoperative sexual and urinary dysfunctions are common in rectal cancer patients. This study was conducted to compare the short-term efficacy and the impact of surgery on urinary and erectile functions between laparoscopy and robotic-assisted total mesorectal excision (TME) with partial preservation of Denonvilliers fascia. Methods: A retrospective cohort study was carried out. Clinical data of 276 patients with low rectal cancer who underwent TME with partial preservation of Denonvilliers fascia in our department between January 2016 and March 2019, including 143 in robotic group and 133 in laparoscopic group, were analyzed. All the patients were positioned by rigid rectoscope, and the distance between the tumor and the anal verge was ≤7 cm. The urinary and erectile functions were followed up at postoperative 12-month and evaluated by IPSS score (0-7 points as mild symptoms, 8-19 points as moderate symptoms, 20-35 points as severe symptoms; the excellent rate was defined as the rate of mild symptoms) and IIEF-5 score (score ≥ 22 as no dysfunction, 12-21 as mild, 8-11 as moderate, and 5-7 as severe) respectively. Results: There were no significant differences in operation ways between the two groups (P>0.05). The operation time of the robotic group was longer than that of the laparoscopic group [(312.5±75.4) minutes vs. (273.9±65.6) minutes, t=4.514, P<0.001]. However, in patients with higher body mass index (BMI ≥25 kg/m(2)), there was no significant difference in operation time between the two groups [(309.3±78.5) minutes vs. (276.1±75.3) minutes, t=1.751, P=0.085]. The time to postoperative flatus [(1.3±0.4) days vs. (1.5±1.0) days, t=-2.037, P=0.046], defecation [1 (1-5) days vs. 1 (1-12) days, Z=-2.209, P=0.008] and liquid diet [(1.0±0.1) days vs. (1.2±0.1) days, t=3.195, P=0.002] in the robotic group were all shorter than those in the laparoscopic group. While postoperative length of hospital stay in the robotic group was longer than that in the laparoscopic group [(8.5±5.5) days vs. (7.2±3.3) days, t=2.419, P=0.016]. There were no significant differences between the two groups in intraoperative blood loss, conversion rate, morbidity of postoperative complications, positive rate of distal resection margin, positive rate of circumferential resection margin, and the number of resected lymph nodes (all P>0.05). At postoperative 12 months, none of the robotic group nor the laparoscopic group had severe urinary dysfunction, and the overall excellent rate of urinary function reached 97.6% (83/85) and 98.4% (61/62) respectively. The rate of normal and mild erectile dysfunction in the robotic group and the laparoscopic group were 92.2% (47/51) and 92.6% (38/41) respectively (P>0.05). There was no significant difference between the two groups was found regarding the urinary and erectile function (both P>0.05). Conclusions: Compared with laparoscopic, the robotic TME with partial preservation of Denonvilliers fascia has no significant differences in surgical safety and short-term efficacy. They have similar advantages in the protection of urinary and erectile function. Meanwhile the robotic surgery presents faster postoperative recovery of gastrointestinal function.
Erectile Dysfunction ; Fascia ; Humans ; Laparoscopy ; Male ; Rectal Neoplasms/surgery* ; Retrospective Studies ; Robotic Surgical Procedures ; Treatment Outcome

Peyronie's disease is a common condition resulting in penile deformity, psychological bother, and sexual dysfunction. Erectile dysfunction is one common comorbid condition seen in men with Peyronie's disease, and its presence significantly impacts treatment considerations. In a man with Peyronie's disease and significant erectile dysfunction who desires the most reliable treatment, penile prosthesis placement should be strongly considered. In some instances, such as those patients with relatively mild curvature, prosthesis placement alone may result in adequate straightening. However, many patients will require additional straightening maneuvers such as manual modeling, penile plication, and tunica albuginea incision with or without grafting. For patients with severe penile shortening, penile length restoration techniques may also be considered. Herein, we provide a comprehensive clinical review of penile prosthesis placement in men with Peyronie's disease. Specifically, we discuss preoperative indications, intraoperative considerations, adjunctive straightening maneuvers, and postoperative outcomes.
Erectile Dysfunction/surgery* ; Humans ; Male ; Penile Implantation/methods* ; Penile Induration/surgery* ; Plastic Surgery Procedures ; Suture Techniques ; Traction ; Urologic Surgical Procedures, Male/methods*