Testosterone, Endothelial Health, and Erectile Function

Experimental and clinical studies have reported that testosterone has a critical role in the maintenance of homeostatic and morphologic corpus cavernosum components, essential for normal erectile physiology. Although the exact mechanisms mediated by testosterone in erectile function are still under investigation, recent research has suggested an important role in the regulation of endothelial cell (EC) biological functions. Besides stimulating the production of EC mediators, testosterone is also thought to promote the vasculogenic reendothelialization process, mediated by bone marrow-derived endothelial progenitor cells. Additionally, testosterone seems to modulate other erectile tissue components, including trabecular smooth muscle cells, nerve fibers, and tunica albuginea structure, all essential for the erectile process. This paper summarizes current data regarding testosterone-induced cellular and molecular mechanisms that regulate penile tissue components, focusing particularly on the role of testosterone in endothelial health and erectile function

Mecanismos moduladores da regeneração e diferenciação da glândula supra-renal : A Esteroidogénese num modelo de autotransplante

Dissertação de Doutoramento em Medicina apresentada à Faculdade de Medicina da Universidade do PortoO autotransplante da glândula supra-renal do rato permite evidenciar os fenómenos de regeneração e diferenciação do tecido adrenocortical, na ausência de tecido medular. Este modelo envolve a colocação de fragmentos da glândula no plano entre a pele e músculo da região dorsal, com base num procedimento tecnicamente simples e de fácil reprodução, proporcionando um excelente método para o estudo da arquitectura e função adrenocorticais.Utilizando estudos morfológicos, bioquímicos, autoradiográficos e imunohistoquímicos, obtivemos dados na tentativa de esclarecer alguns destes achados após o autotransplante.Foi efectuada a análise dos enxertos adrenocorticais desde o início dos fenómenos proliferativos até à regeneração completa. Os estudos em microscopia de luz e electrónica permitiram observar as alterações evidenciadas nas células glandulares assim como no tecido conjuntivo envolvente. Estudos autorradiográficos utilizando 3H-timidina mostraram uma expressão preponderante nas células glandulares subcapsulares. Foram ainda efectuados doseamentos hormonais plasmáticos de aldosterona e corticosterona, bem como a actividade da renina.A endotelina-1, peptídeo de origem vascular, tem vindo a revelar-se como factor relevante nos processos de diferenciação celular, e o seu papel na estimulação da secreção de aldosterona no rato já foi demonstrado. O seu estudo como factor regulador local na estrutura e função da zona glomerulosa mereceu especial atenção no tecido adrenocortical autotransplantado. Uma vez que os estudos morfológicos utilizando a microscopia óptica convencional revelam dificuldades na correcta identificação dos tipos celulares adrenocorticais regenerados, utilizámos um método com maior poder descriminativo para melhorar a análise das alterações celulares observadas. IZAb, um anticorpo monoclonal que reage com um antigénio (IZAg), localizado apenas na zona supra-renal interna, permitiu efectuar estudos imunohistoquímicos interessando à expressão zonal. ..

Role of oxidative stress-induced systemic and cavernosal molecular alterations in the progression of diabetic erectile dysfunction

Background Erectile dysfunction (ED) is a prevalent complication of diabetes, and oxidative stress is an important feature of diabetic ED. Oxidative stress-induced damage plays a pivotal role in the development of tissue alterations. However, the deleterious effects of oxidative stress in the corpus cavernosum with the progression of diabetes remain unclear. The aim of this study was to evaluate systemic and penile oxidative stress status in the early and late stages of diabetes. Methods Male Wistar streptozotocin-diabetic rats (and age-matched controls) were examined 2 (early) and 8 weeks (late) after the induction of diabetes. Systemic oxidative stress was evaluated by urinary H2O2 and the ratio of circulating reduced/oxidized glutathione (GSH/GSSG). Penile oxidative status was assessed by H2O2 production and 3-nitrotyrosine (3-NT) formation. Cavernosal endothelial nitric oxide synthase (eNOS) was analyzed by quantitative immunohistochemistry. Dual immunofluorescence was also performed for 3-NT and α-smooth muscle actin (α-SMA) and eNOS–α-SMA. Results There was a significant increase in urinary H2O2 levels in both diabetic groups. The plasma GSH/GSSG ratio was significantly augmented in late diabetes. In cavernosal tissue, H2O2 production was significantly increased in late diabetes. Reactivity for 3-NT was located predominantly in cavernosal smooth muscle (SM) and was significantly reduced in late diabetes. Quantitative immunohistochemistry revealed a significant decrease in eNOS levels in cavernosal SM and endothelium in late diabetes. Conclusions The findings indicate that the noxious effects of oxidative stress are more prominent in late diabetes. Increased penile protein oxidative modifications and decreased eNOS expression may be responsible for structural and/or functional deregulation, contributing to the progression of diabetes-associated ED

G-spot: Fact or Fiction?: A Systematic Review

ABSTRACT: Introduction: The G-spot, a putative erogenous area in the anterior vaginal wall, is a widely accepted concept in the mainstream media, but controversial in medical literature. Aim: Review of the scientific data concerning the existence, location, and size of the G-spot. Methods: Search on Pubmed, Pubmed Central, Cochrane, clinicaltrials.gov and Google Scholar from inception to November 2020 of studies on G-spot's existence, location and nature. Surveys, clinical, physiological, imaging, histological and anatomic studies were included. Main Outcome Measure: Existence, location, and nature of the G-spot. Results: In total, 31 eligible studies were identified: 6 surveys, 5 clinical, 1 neurophysiological, 9 imaging, 8 histological/anatomical, and 2 combined clinical and histological. Most women (62.9%) reported having a G-spot and it was identified in most clinical studies (55.4% of women); in 2 studies it was not identified in any women. Imaging studies had contradictory results in terms of its existence and nature. Some showed a descending of the anterior vaginal wall, that led to the concept of clitourethrovaginal complex. In anatomic studies, one author could systematically identify the G-spot, while another group did not find it. Studies on innervation of the vaginal walls did not systematically identify an area with richer innervation. Conclusion: The different studies did systematically agree on the existence of the G-spot. Among the studies in which it was considered to exist, there was no agreement on its location, size, or nature. The existence of this structure remains unproved.Vieira-Baptista P, Lima-Silva J, Preti M, et al. G-spot: Fact or Fiction?: A Systematic Review. Sex Med 2021;9:100435

Síndrome metabólica e disfunção eréctil - avaliação de parâmetros clínicos e hemodinâmicos

Objetivos Calcular a prevalência de fatores de risco cardiovascular, incluindo a síndrome metabólica (SM), numa série de doentes portugueses com disfunção erétil (DE) e quantificar o impacto individual e agregado dos mesmos, nos parâmetros hemodinâmicos e no grau de severidade reportada. Material e métodos Estudo de uma série de 408 doentes com DE seguidos em consulta de Urologia, no período 2008-2010. A SM foi definida pelos critérios propostos pela National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), tendo sido quantificadas as variáveis hipertensão arterial (HTA), intolerância a glicose (IG), hipertrigliceridemia (HTG), diminuição de HDL e obesidade central, sob a forma dicotómica. O estudo hemodinâmico foi efetuado por eco-doppler peniano dinâmico (D-PCDU) e a avaliação da severidade da DE recorrendo ao questionário International Index of Erectile Function 5-questions (IIEF-5). Resultados Verificou-se uma prevalência elevada de HTA (46,3%), IG (36,0%), HTG (24,8%), diminuição de HDL (22,3%) e obesidade central (41,2%). A prevalência de SM foi de 26,5%. O IIEF-5 e o pico de velocidade sistólica (PSV) apresentaram medianas de 12,0 e 34,0 cm/s, respetivamente. As análises multivariadas revelaram a HTA e a IG como fatores independentes influenciando negativamente o valor do PSV (p = 0,002) e o score do IEEF-5 (p = 0,010), respetivamente. Conclusão Enfatiza-se a elevada prevalência de fatores de risco cardiovascular numa população de doentes com DE, assim como a forte associação independente da HTA ao agravamento dos parâmetros hemodinâmicos da função erétil.Objectives To estimate the prevalence of cardiovascular risk factors, including metabolic syndrome (MS), in a series of Portuguese patients with erectile dysfunction (ED) and to quantify their individual and aggregate role regarding penile hemodynamics and degree of ED severity. Material and methods A cross-sectional study of 408 patients seen in the Urology Department of Hospital Sao João (Portugal) within the period 2008-2010 was performed. MS was defined in accordance with the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. For this purpose, we used the dichotomized variables: hypertension (HTA), glucose intolerance (GI), hypertriglyceridemia (HTG), decreased HDL cholesterol and central obesity. Penile hemodynamics were measured using the dynamic penile color Doppler ultrasound (D-PCDU) and ED severity was assessed with the International Index of Erectile Function-5 questions (IIEF-5). Results There was high prevalence of HTA (46.3%), GI (36.0%), HTG (24.8%), decreased HDL (22.3%) and central obesity (41.2%). Prevalence of MS was 26.5%. The median of IIEF-5 and peak systolic velocity (PSV) was 12.0 and 34.0 cms, respectively. Multivariate analysis revealed HTA and GI as independent factors decreasing the value of PSV (p = .002) and the score IEEF-5 (p = .010), respectively. Conclusion We emphasize the high prevalence of cardiovascular risk factors in a population of patients with ED as well as the strong independent association between AHT and hemodynamic worsening of erectile function

Penile corporoplasty with Yachia′s technique for Peyronie′s disease: Single center experience with 117 patients

Introduction: Peyronie′s disease is an acquired penile deformity with a variety of presentations, caused by the formation of fibrous plaques within the tunica albuginea, leading to bio-mechanical and vascular abnormalities. The objective is to investigate the 18 years outcome of patients with Peyronie′s disease treated with penile corporoplasty (Yachia technique) in our department. Materials and Methods: One hundred and seventeen patients underwent surgical treatment for PD between 1991 and 2009 and were retrospectively evaluated. We used the Levine and Lenting′s algorithm for surgical treatment. Data was obtained from medical records, clinical evaluation, and telephone interview. Post-operative follow-up was at 6 weeks and 12 months. The mean time of follow-up was 14 months (12-19 months). Main Outcome Measures: Patient demographic, co-morbidities, erectile function, penile curvature, and surgical intervention were documented. The main outcome measures of this study are postoperative complications, surgical purpose, and patients and partner′s satisfaction rates. Results: Surgical aim was obtained in 106 patients (success rate of 94.6%). Complications occurred in 4.5% of patients, but most of these were mild. At 6 weeks, complete straightening of the penis was achieved in 57 patients (50.9%), and partial straightening which allow sexual intercourse in 49 patients (43.7%). Nine patients report gland hypoesthesia and almost all report subjective perception of penis shortening (0.5 cm to 5 cm). Twenty-two patients developed recurrent deformity at 12 months follow-up, with compromise of sexual intercourse in 7 patients. Patients′ responses to our questionnaire showed that overall 88.4% of the patients and partners were satisfied with the surgical results. Conclusion: According to the results of this long-term, retrospective study, surgical correction, using the Yachia technique, is an excellent option for patients with functional impairment from their Peyronie′s disease, especially

Testosterone Deficiency: A Common, Unrecognised Syndrome?

Context: Testosterone deficiency syndrome (TDS) is highly prevalent in ageing men. Associated symptoms may significantly impair quality of life and may affect the function of multiple organ systems. In addition, TDS may have an impact on life expectancy. Although still the subject of debate, testosterone administration may hold promise in symptomatic hypogonadal men. Objective: To present an overview of current data on TDS and treatment of hypogonadal patients with testosterone. Evidence acquisition: This manuscript is based on presentations given at a satellite symposium on TDS held at the 2nd World Congress on Controversies in Urology (CURy) in Lisbon, Portugal. Data were retrieved from recent review papers and original papers on TDS, metabolic syndrome, and erectile dysfunction (ED). Evidence synthesis: Preliminary data of the Transversal European Survey on Testosterone deficiency Diagnosis (TESTo-Dia) demonstrated that physicians need more information and education on TDS. Although there is no clear-cut testosterone threshold at which overall symptoms appear, testosterone deficiency can be associated with severe symptoms and conditions such as cardiovascular disease, diabetes, metabolic syndrome, and ED. Consequently, appropriate treatment of hypogonadal men is highly warranted. There are compelling data showing that testosterone administration does not increase the risk of prostate cancer. Moreover, treatment of testosterone deficiency appears to have a neuroprotective role. Based on these data, physicians may not withhold testosterone treatment from hypogonadal patients. Current treatment options include testosterone administration via gels, patches, capsules, or implants. A new transdermal-matrix patch appears to be safe and effective in hypogonadal men. Conclusions: Although long-term randomised controlled trials are needed, treatment with testosterone in selected symptomatic hypogonadal men may have a beneficial effect on symptoms and/or prevention of several age-related disorders. © 2009 European Association of Urology.SCOPUS: re.jinfo:eu-repo/semantics/publishe