Peptidergic Innervation of Blood Vessels In The Urogenital System
Geoffrey Burnstock, Susan G. Griffith in Nonadrenergic Innervation of Blood Vessels, 2019
An essential part of the mechanism leading to erection is penile arterial vasodilation and relaxation of cavernous smooth muscle.37-42 Dilatation of vessels supplying the corpus cavernosum fills the organ with blood under high pressure. The most important nervous pathway mediating the relaxation is the sacral parasympathetic outflow. Pharmacological evidence indicates that the parasympathetic control of penile vasodilation during erection is mainly noncholinergic in nature.37,43 A number of other substances have been proposed as possible mediators of erection, but with the present knowledge, VIP seems to be the most suitable candidate. Thus, intracavernous injection of VIP in normal men in a dose as low as 200 pmol induces tumescence or even full erection and a significant increase in penile circumference (Figure 4).44 Simultaneously, a significant decrease in the local cavernous blood flow as evaluated by elimination of 133Xe is found. Furthermore, during erection in normal men, induced by visual sexual stimulation, the concentration of VIP in cavernous blood is increased up to 20-fold (Figure 4), while the concentration of the peptide in the peripheral circulation is unchanged.44 Although a simultaneous decrease in cavernous blood flow is observed, the VIP increase in cavernous blood is mainly due to a local release of the peptide.
Erectile Dysfunction
Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh in Male Infertility in Reproductive Medicine, 2019
Intracavernous injection (ICI) (Figure 12.3): Patients who do not respond to oral therapy may be candidates for ICI of vasoactive agents. After the ICI of the agent, an erection is achieved after 15–20 minutes. The intracavernous alprostadil (Caverject™) represents, to date, the only drug approved for ICI therapy. Alternatively, combination therapy of various agents (papaverine, phentolamine, and vasoactive intestinal peptide) may be considered in off-label settings.
The Non-Pharmacological Management of Autonomic Dysfunction
David Robertson, Italo Biaggioni in Disorders of the Autonomic Nervous System, 2019
The surgical insertion of a permanent prosthesis should be reserved for those patients in whom medications (the intracavernous injection of vasoactive drugs) or the use of external appliances fail, after adequate trial. The surgical implantation of permanent penile prostheses does require careful discussion and consideration by the patient and his physician. Obviously, a urologist experienced in the advantages and drawbacks of such therapy must be involved in the management of the patient.
Recent advances in stem cell therapy for erectile dysfunction: a narrative review
Published in Expert Opinion on Biological Therapy, 2023
Bohan Wang, Wenjun Gao, Micha Y. Zheng, Guiting Lin, Tom F Lue
Protegerou et al. (2019) conducted a pilot study to compare the efficacy of intracavernous injection of adipose-derived mesenchymal stem cells (ADMSCs) versus platelet lysate (PL) in the treatment of organic ED. Eight men were enrolled, with 5 receiving intracavernous injection of ADMSCs and 3 receiving PL alone. Adipose tissue obtained from lipoaspiration was processed to isolate stem cells, which were expanded in culture, and cells from passage 4 were suspended in 2 mL of PL for intracavernous injection. PL was obtained from 20 mL of the patient’s peripheral venous blood to obtain platelet-rich plasma (PRP), which was stored at −80°C for 48 hours and thawed for injection. The combination therapy group received 38.9 ± 14.4 × 106 ADMSCs in combination with 2.2 ± 0.3 mL of PL, while the other group received 2.3 ± 0.4 mL of PL only. The authors reported that most patients in both groups experienced increased IIEF-5 scores, morning erections, and improved peak systolic velocity, with effects lasting several months [61]. Theoretically, platelet lysate may enhance the effect of ADMSC but the combination is more invasive and costly than the allogeneic placenta or umbilical cord-derived stem cells and bioactive products. Moreover, studies with sham controls and adequately powered clinical trials are needed to determine the efficacy of this combination therapy for the ED [62].
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
This study involved subjects from five different training hospitals and was performed between December 2014 and May 2016 (IRB no. 2014-02-036). The study included 138 men aged 20 to 70 years with LUTS and an International Prostate Symptom Score (IPSS) >8. The Hallym PMD questionnaire (HPMDQ) was used to assess symptoms [12]. The questionnaire was completed by patients who experienced leakage of urine at least once every three urinations in the prior month and who were included in the final cohort (Appendix 1). The following were criteria for exclusion from the study: inability to take a phosphodiesterase-5 inhibitor (PDE5i), irregular sexual activity for over 3 months, actual or anticipated use of a different PDE5i within 2 weeks of participating in this study, and use of other erectile dysfunction treatments such as intracavernous injection. Patients who used medication that affected LUTS (i.e. α-blockers, anticholinergics, or cholinergics) for more than 1 month before study participation were allowed to participate only if they exhibited improvement and remained under regular supervision for medication management throughout the study period.
The erectile dysfunction as a marker of cardiovascular disease: a review
Published in Acta Cardiologica, 2020
Camelia Cristina Diaconu, Maria Manea, Dragos Radu Marcu, Bogdan Socea, Arsenie Dan Spinu, Ovidiu Gabriel Bratu
The evaluation may also include specific diagnostic tests, such as: nocturnal penile tumescence and rigidity test (electronic device placed on the penis over the night, which monitors the number of erections, their duration and the penile rigidity during the erections), intracavernous injection test (injection of different types of vasodilators agents into the base of the penis, that usually lead to penile tumescence within 10–15 minutes), penile duplex ultrasound, arteriography, dynamic infusion cavernosometry, cavernosography (in patients who suffer from vascular pathology associated with ED), psychological and psychiatric evaluation [2].
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