1,721,176 research outputs found
Late-onset hypogonadism (LOH): Incidence, diagnosis, and short-term effects
No full textLate-onset hypogonadism (LOH) is a condition that affects an estimated 10% of men aged > 50 years and up to 20% of men aged > 60 years. Characterized by a measurable deficiency in serum testosterone levels, LOH is sometimes referred to as testosterone deficiency, or androgen deficiency in the ageing male (ADAM). There are a number of distinct physical, psychological, and sexual symptoms associated with LOH. The diagnosis of LOH is made on the basis of these presenting symptoms, accompanied by the biochemical establishment of low serum testosterone levels. Symptoms such as fatigue, sleep disturbance, short-term memory loss, changes in body composition, irritability, depression, a decrease in libido, and erectile dysfunction can compound to adversely affect patient quality of life and health status. This paper describes how to recognize and diagnose LOH and considers its short-term impact on patient health and well-being. (c) 2005 Elsevier B.V. All rights reserved
Management of Disastrous Complications of Penile Implant Surgery
No full textRationale: Penile Prosthesis Implantation (PPI) is the definitive treatment for Erectile Dysfunction not responsive to conservative management strategies. Furthermore, it is a staple of surgical treatment of severe Peyronie's Disease (PD) and phallic reconstruction. Expert implantologists occasionally face disastrous complications of penile implant surgery which can prove to be very challenging. In this article we present a selected number of case reports which exemplify this kind of situations and discuss management strategies while also commenting on plausible aetiologies. Patients’ concerns: The first case describes a PPI performed in end-stage fibrotic corpora after multiple instances of implantation/explant. The second and third cases show two diametrically opposed approaches to the management of glans necrosis after PPI in post-radical cystectomy patients. The fourth case describes the history of a diabetic patient suffering from glandular, corporal and urethral necrosis after a complicated PPI procedure. The fifth case reports the surgical treatment of a case of recurring PD due to severe scarring and shrinking of a vascular Dacron patch applied in a previous operation. Diagnosis: Complication diagnosis in all patient was mainly clinical, intra- and postoperative, with Penile Color Doppler Ultrasonography performed when needed in order to demonstrate penile blood flow. Interventions: The patients underwent complex surgical procedures that addressed each specific complication. Complex penile implants with fibrosis-related complications, penile prosthesis explant with and without surgical debridement of necrotic areas, penile prosthesis explant with necrotic penile shaft and urethral amputation with perineostomy, and complex corporoplasty with scar tissue excision and patch application with PPI were performed in the five patients. Outcomes: Penile anatomy and erectile function with PPI was achieved in 4 out of 5 patients. 1 of 5 patient is scheduled to undergo a total phallic reconstruction procedure at the time of this writing. Lessons: Management of disastrous complications of penile implant surgery can be very challenging even in expert hands. In-and-out knowledge of possible PPI and PD complications is required to achieve an acceptable outcome. Bettocchi C, Osmonov D, van Renterghem K, et al. Management of Disastrous Complications of Penile Implant Surgery. J Sex Med 2021;18:1145–1157
Pedicled pubic phalloplasty in females with gender dysphoria
No full textOBJECTIVE:
To describe a novel phalloplasty technique and to study the results and complications in female patients with gender dysphoria.
PATIENTS AND METHODS:
Between 1989 and 2000, 85 female-to-male transsexual patients had a phalloplasty fashioned from suprapubic abdominal wall flap that was tubed to form the phallus, and which incorporated the neourethra made from a pedicled tube of labial skin. The complete neourethral reconstruction was in one stage in 32 patients and in two in 48; five patients did not wish to have the neourethra fashioned.
RESULTS:
The cosmetic appearance of the phallus was considered good in 68% of the patients. The major complications (in 60 patients) were related to the neourethra (75%) with stricture formation (64%) and/or fistulae (55%) predominating. This complication rate was significantly less (P < 0.001) when the neourethra was created in two stages. Once the neourethra was completed, patients were then offered both penile and testicular prostheses. Sexual intercourse was possible with no prosthesis in 16 patients.
CONCLUSIONS:
The pubic phalloplasty offers an acceptable neophallus without disfiguring the donor skin site. The main complications stem from creating the neourethra and these may be reduced by a two-stage procedure
Gnrh in the treatment of hypogonadotropic hypogonadism
No full textGonadotropin-releasing hormone (GnRH) is the focus of the scientific debate for the treatment of hypogonadotropic hypogonadism. Sexual maturation and reproductive function depend on the pulsatile secretion of GnRH that are mainly congenital and may or may not be associated with other genetic anomalies or syn-dromes. Clinical manifestations include a wide range of metabolic, endocrine, and psychologic dysfunctions. The following manuscript focuses on the effects of GnRH therapy on fertility and cognitive abilities, aiming to inves-tigate the current level of evidence for this treatment regimen. Current literature has been reviewed with the aim of highlighting the key findings on these two aspects
Cryopreserved Penile Tunica Albuginea for Allotransplantation: A Morphological and Ultrastructural Investigation
Full text linkIntroduction. Peyronie's disease, a connective tissue disorder of penile tunica albuginea (TA) associated with penile deformity, curvature, pain, and erectile dysfunction, is best managed surgically, but suitable graft biomaterials are not available. Aim. To establish whether cryopreservation affects human TA in view of its use in allotransplants. Methods. The effects on TA samples of the two most widely used tissue cryopreservation methods were investigated using an ad hoc panel of histochemical, immunohistochemical, and ultrastructural tests. Apoptotic cells were evaluated using the terminal deoxynucleotidyl transferase method of end labeling (TUNEL) assay. Main Outcome Measures. Assessment of tissue integrity and arrangement of collagen and elastic fibers in thawed TA. Results. Both cryofixation methods provided TA tissue suitable for use as graft material. Significant ultrastructural changes, namely, a greater diameter of collagen fibrils, were detected in sections preserved in liquid nitrogen; nonetheless, such increase never exceeded the normal range. The comprehensive panel of assays used proved suitable to characterize the thawed tissue. Conclusion. Human TA is suitable for cryopreservation; freezing at -80°C provides better results than preservation in liquid nitrogen. Loreto C, Orlandi A, Ferlosio A, Djinovic R, Basic D, Bettocchi C, Rutigliano M, Barbagli G, Vespasiani G, Caltabiano R, Musumeci G, and Sansalone S. Cryopreserved penile tunica albuginea for allotransplantation: A morphological and ultrastructural investigation. J Sex Med **;**:**-**
Emergencies in andrology
No full textAndrological emergencies include pathological conditions of the external male genitalia which need a rapid treatment, both surgical and medical. Between them priapism and traumas represent typical situations and often need a surgical approach, while other entities such as necrotic infections have a lower incidence but unfortunately worse outcomes. Priapism is a pathological condition characterized by a full or partial erection of more than 4 h without any sexual stimulation and which is not solved by orgasm. Three subtypes of priapism are described: Ischaemic or low flow, non-ischaemic or high flow and stuttering. The first kind of priapism represents an andrological emergency and need an immediate treatment. Genital traumas can be blunt and sharp: In the first case a communication with the external exists, while in the second case the skin is generally intact. Between infections the necrotizing fasciitis of Fournier represents the most dramatic circumstance and involves the perineum and external genitalia causing disfiguring results if not recognized and treated promptly.The aim of this chapter is drawing a picture regarding diagnosis and treatment of the commonest andrological emergencies
Penile prosthesis in the treatment of erectile dysfunction: Updates in 2020
No full textPenile erection implants are considered to be the «Gold Standard» for the treatment of erectile dysfunction with an organic component that escapes pharmacological and mechanical treatment. The place of preoperative information is fundamental. It is a simple and minimally invasive surgery. Penile Erection Implants are becoming more and more a full-fledged treatment line, which can be offered at the same time as other Erectile Dysfunction treatments. In this article, we will discuss the presentation of the different implants available, the elements underlying their indication, the place of preoperative information, the mains steps of the surgical procedure, the outcomes and satisfaction rates. © 2020 Editions Medecine et Hygiene. All rights reserved
Graciloplasty for recurrent recto-neovaginal fistula in a male-to-female transsexual
No full textRectovaginal fistula is usually a challenging condition for surgeons, but a fistula between the rectum and the neovagina in male-to-female transsexual is even more difficult to treat as it is a rare complication occurring in a patient with modified anatomy of the perineum, with heavy psychological implications for the patient. Here, we report a case of recurrent recto-neovaginal fistula in a male-to-female transsexual successfully treated by perineal graciloplasty
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