A Novel Procedure of Prepuce Reconstruction Customized to the Religious Needs of Some Individuals

Background Authors describe a novel procedure in a group of patients for prepuce reconstruction, ensuring complete glans penis coverage who had either been circumcised in childhood or had congenitally short prepuce. Methods Case records of all cases done by the novel method which involved penile degloving and maintenance of neoprepuce, with the help of de-epithelization of glans penis and a few key sutures performed over the period from January 2010 to December 2019 were reviewed retrospectively. A total of 46 patients, 32 had congenitally short prepuce and 14 had previous circumcision. Results All the patients had complete glans penis coverage. None of the patients had complications like urinary infection, meatal stenosis, collection in neoprepucial sac, balanitis, or posthitis. The mean followup was 23.24 months in 37 patients. Nine lost to followup. Conclusions The procedure is simple, gives reliable results, and is customized to the needs of the patients. It does not interfere with penile erections.

A Case Report of Sleep-Related Painful Erection Successfully Treated with Paroxetine

Sleep-Related Painful Erection (SRPE) is a rare condition characterized by recurrent, painful penile erections occurring when awakening from the Rapid Eye Movement (REM) sleep stage. The cause of SRPE is still unknown, the therapeutic strategies still in an expert-based opinion phase and there is no consensus yet. We present a case of a 23-year-old patient suffering from SRPE for 1 year, the smart bracelet which has a sleep monitoring function showed his sleep was fragmented by awakenings at the end of all the REM period. Several treatments such as tamsulosin and highfrequency hyperthermia therapy and Chinese herbal medicine did not prompt any improvement of his condition, but after taking a single daily dose of paroxetine 20mg for twelves weeks, both the frequency and intensity of SRPE gradually decreased. Even though the antidepressants to which paroxetine belongs were included as one of the abandoned treatments in recent review, in our case, paroxetine showed a long-term and stable effect on patients with SRPE, it indicates that the therapeutic effect of paroxetine on SRPE deserves further study and observation.

Genetic Factors of Nitric Oxide’s System in Psychoneurologic Disorders

According to the recent data, nitric oxide (NO) is a chemical messenger that mediates functions such as vasodilation and neurotransmission, as well as displaying antimicrobial and antitumoral activities. NO has been implicated in the neurotoxicity associated with stroke and neurodegenerative diseases; neural regulation of smooth muscle, including peristalsis; and penile erections. We searched for full-text English publications from the past 15 years in Pubmed and SNPedia databases using keywords and combined word searches (nitric oxide, single nucleotide variants, single nucleotide polymorphisms, genes). In addition, earlier publications of historical interest were included in the review. In our review, we have summarized information regarding all NOS1, NOS2, NOS3, and NOS1AP single nucleotide variants (SNVs) involved in the development of mental disorders and neurological diseases/conditions. The results of the studies we have discussed in this review are contradictory, which might be due to different designs of the studies, small sample sizes in some of them, and different social and geographical characteristics. However, the contribution of genetic and environmental factors has been understudied, which makes this issue increasingly important for researchers as the understanding of these mechanisms can support a search for new approaches to pathogenetic and disease-modifying treatment.

Intermittent penile erection in lumbar spinal stenosis: Report of four new cases and review

Background: Lumbar spinal stenosis (LSS) classically presents with intermittent neurogenic claudication. Rarely, however, it may cause unanticipated, unpleasant, involuntary, and transient penile erections without sexual stimulation along with urinary urgency and claudication. Case Description: The authors present four males with LSS whose principal symptoms were intermittent neurogenic claudication and unanticipated erections while walking, accompanied by urinary urgency. Conclusion: There is scant literature on the topic of LSS presenting with unanticipated penile erections, urinary urgency, and neurogenic claudication.

Erectile Dysfunction: Epidemiology, Physiology, and Etiologies

ED is defined as the consistent inability to achieve or maintain an erection adequate for sexual activity. It is a widely prevalent disease, affecting approximately 20 million men in the United States alone. ED rates increase as men get older; however, ED is not necessarily a normal part of aging. Early-onset ED has been a predictor of underlying cardiovascular diseases, and most clinicians now advocate for a cardiology evaluation in men with new-onset organic ED. The most common etiology of ED is a vascular disease; however, ED can be caused by diabetes, endocrinopathies, medications, chronic illness, and trauma. Psychogenic causes of ED are also common. Physiology of the penile erection is complicated; however, its comprehensive understanding is imperative to enable a proper etiologic diagnosis of ED. Blood supply to the penis originates from the hypogastric arterial system, and nitric oxide is the primary neurotransmitter involved in penile erections. The epidemiology, physiology, and etiologies of erectile dysfunction are discussed in detail in this chapter. This review contains 1 figure, 2 tables, and 50 references. Key Words: causes of erectile dysfunction, epidemiology of erectile dysfunction, erectile dysfunction, nitric oxide, phosphodiesterase-5 inhibitors, physiology of the penile erection, psychogenic erectile dysfunction, sexual dysfunction, cyclic guanosine monophosphate, detumescence.