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Embryology, Anatomy, and Physiology of the Male Reproductive System
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
The paired ischiocavernosal muscles cover the two crura.The crura converge to form the corpora cavernosa.The corpus cavernosa (erectile tissue) consists of lacunar spaces with smooth muscle and endothelium — filled with arterial blood during an erection.
Surgical treatment of disorders of sexual development
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Rafael V. Pieretti, Patricia K. Donahoe
Clitoral resection and recession are of historical interest and no longer recommended. The goal of current techniques is to preserve sensation for future orgasms, provide an acceptable cosmesis, and avoid painful erections. A subtunical excision of the erectile tissue has been used extensively and led to newer nerve-sparing techniques. In 1999, Baskin et al. found that distribution of the sensory nerves of the clitoris, similar to the sensory nerves of the penis, is found on the dorsal aspect of the clitoris coursing under the pubis. Circumferential branches from the dorsal neurovascular bundle encircle the clitoral shaft toward the ventrum, thus making a ventral approach to the corpora most likely to avoid nerve injury. In Baskin's technique, corporal tissue proximal to the bifurcation is left intact. In cases with severe masculinization, the clitoris is too large, resembling a penis; in such cases, the authors discuss the anatomical characteristics with the parents and advise a clitoroplasty.
Anatomy and physiology
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
The vagina opens to the vaginal orifice or introitus and the external genitalia. The vaginal orifice lies between the labia minora and the urethra, and is partially occluded by the hymen. The hymen is a thin membrane; in a virgin, someone who has not had sexual intercourse, it is intact and has a small opening. Following first sexual intercourse this is ruptured and after vaginal delivery it is torn further, leaving a small amount of tissue and is known as carunculae myrtiformes. Bartholin’s glands lie on either side of the vagina and open into the vaginal canal and their secretions along with Skene’s glands lubricate the vulva and are increased in response to the erection of the clitoris, helping to facilitate vaginal intercourse. Skene’s glands are located behind the urethral meatus. The urethral meatus is the opening below the clitoris from where the urethral canal begins. The vestibule is the area which contains the vagina and urethra and is only seen when the labia minora is separated. The clitoris is 2.5 cm long and contains erectile tissue and is found at the junction of the labia minora (Figure 3.7).
Impact of chronic medications in the perioperative period: mechanisms of action and adverse drug effects (Part I)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
ED is a common syndrome in men, with 50% of men aged 40–70 years experiencing ED symptoms. The majority of men with ED related to hypertension, diabetes mellitus, spinal cord injury, and other comorbid medical conditions may successfully complete intercourse when using phosphodiesterase type 5 inhibitors (PDE5i) sildenafil, tadalafil, vardenafil, avanafil, udenafil, and lodenafil [77,78]. ED medications inhibit phosphodiesterase type 5 (PDE-5) isoform, allowing an increase in cyclic guanosine monophosphate (cGMP). This rise in cGMP is responsible for relaxing the smooth muscle cells found in arteries, arterioles, and sinusoids of the corpus cavernosum, and the filling of erectile tissue of the penis with blood, resulting in an erection. In addition, compounds, which act via cyclic adenosine monophosphate (cyclic AMP), such as prostaglandin E1 (PGE1) and vasoactive intestinal polypeptide (VIP) are also used for self-injection or topical application for the treatment of ED [78].
Low-intensity extracorporeal shockwave therapy for erectile dysfunction
Published in Arab Journal of Urology, 2021
Onder Canguven, Kareim Khalafalla, Abdulla Al Ansari
Low-intensity extracorporeal shockwave therapy (LI-ESWT) is a ‘hot topic’ in the field of ED, both in the medical community and the common media, due to widespread advertising of this treatment. From the physical point of view, a shockwave is defined by an abrupt, nearly discontinuous change in pressure and by having a velocity that is higher than the speed of sound in the medium it propagates. Alarmingly, this treatment is being offered without what many authorities believe is adequate data. The ideal patient population for LI-ESWT and defining important technical parameters (number of shocks, energy level, location of probe application, number/timing of sessions) have yet to be fully defined [3]. Moreover, the term ‘shockwave therapy’ is used loosely, and not all of the currently used machines actually generate focussed shockwaves. Terms such as ‘radial waves’, ‘acoustic waves’, ‘sound waves’, ‘radial shockwaves’, or ‘radial pulse therapy’, while synonymous with each other, are sometimes used interchangeably with shockwaves, despite, based on physics, being a different technology. It is believed that these acoustic waves carry energy, and when targeted and focussed, interact with the targeted deep tissues causing mechanical stress and micro trauma; hence, its effect on erectile tissue can be explained.
Effect of udenafil administration on postmicturition dribbling in men: a prospective, multicenter, double-blind, placebo-controlled, randomized clinical study
Published in The Aging Male, 2020
Kyungtae Ko, Won Ki Lee, Sung Tae Cho, Young Gu Lee, Tae Young Shin, Min Soo Choo, Jun Hyun Han, Seong Ho Lee, Cheol Young Oh, Jin Seon Cho, Hyun Cheol Jeong, Dae Yul Yang
According to previous studies on erectile dysfunction, the corpus cavernosum exhibits several changes as the body ages. First are morphological changes including reduced smooth muscle and increased collagen content [19]. Second, the reduced number of smooth muscle cells causes the cavernosal angioarchitecture to loosen, resulting in reduced elasticity and an increase in vascular caliber [20]. Third, proliferating cell density in the corpus cavernosum decreases and apoptotic cell density increases [21]. Previous studies have reported that continuous usage of a PDE5i for erectile dysfunction can reverse changes in erectile tissue caused by aging. Ferrini et al. reported that continuous use of sildenafil for a prolonged period (45 days) resulted in an increased number of smooth cells and decreased fibrosis in the rat penis, which was already exhibiting corporal fibrosis [22]. Another animal study showed that vardenafil increases the number of smooth muscle cells but does not alter the ratio of collagen (III:I), and that vardenafil reduces the total collagen amount in erectile dysfunction accompanied by aging [23]. Udenafil 75 mg is a long-acting drug with a half-life of 11 to 13 h. Long-acting drugs (i.e. tadalafil and udenafil) act on the aged sinusoid tissue of the corpus cavernosum and corpus spongiosum for a longer period and may improve symptoms more consistently or rapidly.