In the last decade, many novel minimally invasive surgical techniques within benign prostatic hyperplasia (BPH) surgery were developed to reduce postoperative complications that often discourage ...patients from pursuing BPH surgery.
To assess perspective of future and past international BPH surgery patients regarding their postoperative complications, namely erectile and ejaculatory function.
A survey was distributed randomly to 2 groups of BPH patients: one with 149 patients having undergone surgery in the last 2 years (group A), and the other cohort of 151 men seriously considering BPH surgery in the next year (group B). This survey consisted of 20 questions that assessed patients' motivating factors for undergoing elective BPH surgery and their perspectives regarding the potential postoperative complications attributed to BPH surgery.
The perspective of future and past international BPH surgical patients towards the preservation of their erectile and ejaculatory functions was assessed with the help of a survey.
Results indicated that in general BPH surgery patients considered the maintenance of erectile (95%, n = 284) and ejaculatory function (92%, n = 276) to be important preoperative considerations, regardless of their age. Patients aged 50–59 years were most concerned with the permanent impact on sexual function and patients aged >60 years were most concerned with urinary incontinence. In patients aged >70 years, 66% (n = 43) and 62% (n = 40) of the respondents indicated that maintaining erectile and ejaculatory function was important, respectively.
Patient-centered care needs to be implemented in order to address the importance that past and future BPH surgery patients hold toward the maintenance of their postoperative sexual function.
In the group of patients having previously undergone BPH surgery, the possibility of recall bias should be taken into account when interpreting the study's findings. However, maintaining sexual function was also important for the group of patients seriously considering surgery in the next year suggesting that these considerations are not solely due to recall bias. Additionally, the results were limited by the small sample size of participants in groups A (n = 149) and B (n = 151).
It was found that past and future BPH surgery patients attribute a significant importance toward the maintenance of their sexual function. Although novel approaches with better sexual outcomes such as Rezum and UroLift for prostates <80 mL, and Aquablation for any size prostate are available, more research is needed to investigate their long-term effects on sexual function before they can be recommended to patients.
Bouhadana D, Nguyen D-D, Zorn KC, et al. Patient Perspectives on Benign Prostatic Hyperplasia Surgery: A Focus on Sexual Health. J Sex Med 2020;17:2108–2112.
Coronavirus disease 2019 (COVID-19) pandemic caused unprecedented restrictions in outpatient services and surgical practices in urology as in other medical branches as well as in all areas of life.
...To investigate whether there have been variations in the presentations of male patients with sexual and reproductive health problems to the outpatient urology clinics during the COVID-19 pandemic and to understand the underlying factors for these variations, if any.
Male patients aged ≥18 years who presented to the outpatient urology clinics in 12 centers across Turkey from February 1, 2020 to June 1, 2020 were retrospectively evaluated. The patients were divided into 2 groups: those who presented to the outpatient clinic from February 1, 2020 to March 11, 2020 comprised the “pre–COVID-19 pandemic period” group, whereas those who presented to the outpatient clinic from March 12, 2020 to June 1, 2020 comprised the “COVID-19 pandemic period” group and compared with each other.
The main outcome of this study was the number and diagnose of patients presented to urology outpatient clinics.
Andrological problems were detected in 721 of 4,955 male patients included in the study. During the COVID-19 pandemic period, there was a significant increase in andrological diagnosis in these patients compared with the pre–COVID-19 pandemic period (n = 293 17% vs n = 428 13.2%, P < .001, respectively). Similarly, there was a statistically significant increase in the number of patients diagnosed with male reproductive or sexual health problems during the COVID-19 pandemic period (n = 107 6.2% vs n = 149 4.6%, P = .016 and n = 186 10.8% vs n = 279 8.6%, P = .013, respectively). The number of patients diagnosed with erectile dysfunction during the pandemic was also significantly higher than the pre–COVID-19 pandemic period (n = 150 8.7% vs n = 214 6.6%, P = .008).
Presentations to the outpatient urology clinics owing to andrological problems markedly increased during the pandemic period. Although these problems are of multifactorial origin, psychogenic factors are also considered to significantly trigger these problems.
Duran MB, Yildirim O, Kizilkan Y, et al. Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study. Sex Med 2021;9:100292.
Multiple sclerosis (MS) is one of the most frequent diseases of the central nervous system and usually occurs at the age when people would be expected to be in the prime of their sexual lives. ...Clinicians working in this field commonly concentrate on the classical neurological deficits and often overlook symptoms that seriously affect the quality of life, such as sexual dysfunction (SD). Sexual functioning of MS patients remains poorly understood.
The aim of this study was to assess the prevalence of SDs, their relationship with demographic factors, and sexual quality of life in men with multiple sclerosis (MS).
Sixty‐seven patients from the National Multiple Sclerosis Center were interviewed, completed the questionnaires, and underwent neurological assessment.
Primary outcome measures included the International Index of Erectile Function (IIEF), the Sexual Quality of Life Questionnaire (SQoL), and the Expanded Disability Status Scale (EDSS).
The most common complaints were erectile dysfunction (52.9%), decreased sexual desire (26.8%), and difficulties in reaching orgasm (23.1%) or ejaculation (17.9%). The severity of SD had a clear impact on sexual quality of life, especially in the domains of erectile function and intercourse satisfaction. However, neither IIEF nor SQoL scores were correlated with age, time since onset of MS symptoms, or EDSS scores. Only 6% of the patients had ever discussed their concerns with a medical professional or undergone sexual therapy.
SD is highly prevalent but commonly overlooked in MS patients and has a significant impact on their sexual quality of life. The data support a multifactorial etiology of SD in MS. More focus on SD and use of appropriate screening tools in clinical practice with MS patients are recommended. Lew‐Starowicz M and Rola R. Sexual dysfunctions and sexual quality of life in men with multiple sclerosis. J Sex Med 2014;11:1294–1301.
The goal of this study was to investigate the association between serum oestradiol levels and clinically significant erectile dysfunction in a cohort of men presenting for andrological evaluation. ...Retrospective review was conducted of patients that presented to a urologist with practice in andrology over an 18‐month period. Patients completed the Male Sexual Health Questionnaire and had serum total testosterone and oestradiol measurements prior to 10:30 a.m. via immunoassay. t Tests, chi‐square tests and multivariate logistic regression were used to compare clinical characteristics between those with adequate erectile function (erection scale score > 2) vs. clinically significant erectile dysfunction (erection scale score ≤ 2). Among 256 patients, average age was 49 years (SD 15), average serum oestradiol was 22.3 pg/ml (SD 10.6), and average serum total testosterone was 465.9 pg/ml (SD 206.3). On multivariate logistic regression, serum oestradiol was associated with clinically significant erectile dysfunction (OR 1.52 per SD increase, 95% CI 1.11–2.09, p = 0.009) when controlling for serum total testosterone, age, body mass index and smoking status. These results warrant future studies on the utility of measuring serum oestradiol in patients with erectile dysfunction and the use of aromatase inhibitors in patients with erectile dysfunction and elevated serum oestradiol.
Serenoa repens (SR) is a plant used to treat benign prostatic hyperplasia and prostatitis. We know that SR act as a 5α-reductase inhibitor, moreover, several studies have proved that SR has ...anti-inflammatory and antioxidant properties. There is some belief among patients that SR may negatively impact male sexual function. Such belief is circulating in non-medical social networks and is perhaps maintained by patients as a result of incorrect web surfing. However, it is also possible that SR may exert a "nocebo" effect thus negatively impacting on the general well-being of patients.
The aim of this study is to investigate whether SR is causing negative effects on male sexual function.
To ascertain the effect of SR on male sexual function, we conducted a systematic review and meta-analysis, by performing an electronic database search in accordance with the PRISMA guidelines.
Out of 20 included papers, 8 papers reported comparisons of SR with placebo, and 7 studies reported comparisons of SR with tamsulosin. The standardized mean difference of changes from baseline scores of sexual function was not significantly different between SR and placebo (SMD: 0.43, 95% CI: 0.18 to 1.05; I^2 = 95%). Similarly, no significant mean differences in the Male Sexual Function-4 (MSF-4) test scores were found between SR and tamsulosin (SMD: -0.31, 95% CI: -0.82 to 0.19; I^2 = 90%).
We found no statistically significant differences between negative effects on sexual function in patients treated with SR compared to patients who received placebo. The results of our meta-analysis are similar to those of other systematic reviews. Studies are warranted to ascertain whether any such effects might occur as a result of a nocebo effect.
There are many questionnaires for evaluating erectile and ejaculatory function. These were used interchangeably among the studies included in this review and therefore the data were heterogeneous. ...Nevertheless, sexual function may be affected to certain degrees depending on disease severity and the urethroplasty technique used.
The degree of change in erectile (EF) and ejaculatory function (EjF) according to validated questionnaires following anterior urethroplasty and different techniques is unclear.
To investigate the evidence on EF and EjF evaluated via validated questionnaires following anterior urethroplasty.
A systematic review (PROSPERO ID: CRD42021229797) of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The PubMed and CENTRAL databases were searched on February 1, 2021, with an updated search performed on December 1, 2021. Studies evaluating EF and/or EjF using validated questionnaires in men aged ≥18 yr following anterior urethroplasty were included.
Overall, 29 studies (two randomised and 27 nonrandomised) were included. The questionnaire most commonly used to evaluate EF and EjF was the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ), respectively. The incidence of postoperative erectile dysfunction (ED) was 0–38% and the mean change in EF score according to the IIEF ranged from −4.0 to 2.5. The incidence of postoperative ejaculatory dysfunction (EjD) was 7.7–67% and the mean change in EjF score according to the MSHQ-EjD was 0.7–7.0. Meta-analyses revealed a mean difference of −0.87 (95% confidence interval CI −1.50 to −0.23; p = 0.008) in IIEF-EF score and 1.77 (95% CI 0.61–2.93; p = 0.003) in MSHQ-EjF score following anterior urethroplasty.
EF and EjF may be affected following anterior urethroplasty and men should be counselled appropriately. Owing to the variation in questionnaires and cutoff scores used, EF and EjF outcomes following different urethroplasty techniques are heterogeneous, with limited data from randomised controlled trials. An agreement on questionnaires and cutoff scores should be established to allow consistent reporting. Future research should aim to investigate best approaches for minimising sexual dysfunction.
Surgical repair of the urethra (urethroplasty) used to treat narrowing of the urethra (urethral stricture) may affect erectile and ejaculatory function. Different questionnaires and definitions are used to evaluate sexual function, so it is hard to compare data. The degree of disruption can be affected by different techniques and the severity of disease.
Male adolescents' sexual and reproductive health needs often go unmet in the primary care setting. This report discusses specific issues related to male adolescents' sexual and reproductive health ...care in the context of primary care, including pubertal and sexual development, sexual behavior, consequences of sexual behavior, and methods of preventing sexually transmitted infections (including HIV) and pregnancy. Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, performing an appropriate examination, providing patient-centered and age-appropriate anticipatory guidance, and delivering appropriate vaccinations. Pediatricians should provide these services to male adolescent patients in a confidential and culturally appropriate manner, promote healthy sexual relationships and responsibility, and involve parents in age-appropriate discussions about sexual health with their sons.
Air pollution, either from indoor (household) or outdoor (ambient) sources, occurs when there is presence of respirable particles in the form of chemical, physical, or biological agents that modify ...the natural features of the atmosphere or environment. Today, almost 2.4 billion people are exposed to hazardous levels of indoor pollution, while 99% of the global population breathes air pollutants that exceed the World Health Organization guideline limits. It is not surprising that air pollution is the world's leading environmental cause of diseases and contributes greatly to the global burden of diseases. Upon entry, air pollutants can cause an increase in reactive oxygen species (ROS) production by undergoing oxidation to generate quinones, which further act as oxidizing agents to yield more ROS. Excessive production of ROS can cause oxidative stress, induce lipid peroxidation, enhance the binding of polycyclic aromatic hydrocarbons (PAHs) to their receptors, or bind to PAH to cause DNA strand breaks. The continuous and prolonged exposure to air pollutants is associated with the development or exacerbation of pathologies such as acute or chronic respiratory and cardiovascular diseases, neurodegenerative and skin diseases, and even reduced fertility potential. Males and females contribute to infertility equally, and exposure to air pollutants can negatively affect reproduction. In this review, emphasis will be placed on the implications of exposure to air pollutants on male fertility potential, bringing to light its effects on semen parameters (basic and advanced) and male sexual health. This study will also touch on the clinical implications of air pollution on male reproduction while highlighting the role of oxidative stress.
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