OBJECTIVE: To assess the association between varicocele and hypogonadism, or erectile dysfunction.
METHODS: We searched MEDLINE, EMBASE, LILACS, CENTRAL, and other sources. We included cohort, case-control, and cross-sectional studies. The primary outcome was the association between varicocele and hypogonadism, or erectile dysfunction, and the secondary outcome included semen analysis. We assessed the risk of bias with the Newcastle-Ottawa Scale. We performed statistical analysis in Review Manager 5.3 and reported information about the Odds Ratio (OR) with a 95% confidence interval. We produced a forest plot for the primary outcome.
RESULTS: We included ten studies in qualitative analysis and six studies in quantitative analysis. Most of the cross-sectional studies showed a low risk of bias, not so for the two case-control studies, which represented a high risk of bias. Most of the reports described a correlation between having varicocele and presenting low testosterone levels: the meta-analysis showed that there is a significant association between varicocele and hypogonadism (OR 3.27 95% CI 1.23 to 8.68). Regarding varicocele and erectile, only one study showed a significant difference in erectile function in comparison to varicocele patients and men without varicocele.
CONCLUSIONS: There is an association between varicocele presence and hypogonadism, although more studies are needed. Besides, not much is reported about an association between varicocele and erectile dysfunction, but impairment can occur through hormone disturbances.

Studies on sexuality in patients with chronic obstructive pulmonary disease (COPD) are scarce and have yielded conflicting results. Our aim was to determine the prevalence of erectile dysfunction (ED) and associated factors in patients with COPD.
Articles with data on ED prevalence in patients diagnosed with COPD through spirometry were searched for in the PubMed, Embase, Cochrane Library, and Virtual Health Library databases from the year of their creation until January 31, 2021. The prevalence of ED was assessed with a weighted mean of the studies. A meta-analysis was performed using the Peto fixed-effect model to evaluate the association of COPD with ED.
Fifteen studies were ultimately included. The weighted prevalence of ED was 74.6%. A meta-analysis with four studies and 519 individuals showed an association of COPD with ED (estimated weighted odds ratio 2.89, 95% CI 1.93-4.32, p<0.001), with a non-negligible degree of heterogeneity (I2 57%). In the systematic review, age, smoking, degree of obstruction, oxygen saturation, and previous health status were associated with a higher prevalence of ED.
ED is common in patients with COPD and its prevalence is higher than in the general population.

Penile prosthesis (PP) implantation is an effective option for erectile dysfunction. Although initially PP surgery was carried out in an inpatient setting, there is a growing trend to implant PP as a major ambulatory surgery (MAS). This study aimed to perform a systematic review of the literature to identify available evidence of the implantation of PP under MAS setting and go carry out a comparison between MAS and inpatient procedures.
PubMed, EMBASE, Cochrane Library and MEDES electronic databases and non-indexed supplements for scientific congresses were searched to identify articles related to the surgical implantation of PP in MAS up to February 2021. Key search terms included penile prosthesis, erectile dysfunction, ambulatory surgery, ambulatory care, and surgery.
Among 171 publications retrieved (51 PubMed, 73 EMBASE, 3 Cochrane, 2 using MEDES and 42 manual searching), 5 studies were finally selected. There were no significant differences between MAS or inpatient setting in terms of the type of device, surgical approach, or location of reservoir. Complication rates observed in both groups were similar. Implantation of PP in MAS was less expensive than inpatient surgery and was associated with acceptable patient satisfaction rates and adequate pain control.
Studies demonstrated that outpatient PP surgery can achieve similar outcomes in terms of safety and satisfaction to implantation of PP in the inpatient setting, while it could reduce costs and improve the efficiency. This research could support decision makers to extend PP surgery into the ambulatory setting.

BACKGROUND: The prevalence of sexual dysfunction (SD) in men with multiple sclerosis (MS) is reported variously in different studies. The most common form of SD in these patients is erectile dysfunction (ED). The goal of this systematic review and meta-analysis is to determine the pooled prevalence of SD and ED in men suffering from MS.
METHODS: We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, and gray literature (references of references, and congress abstracts) up to 14th November 2020.
RESULTS: We found 3163 studies by primary search, 2246 were included after deletion of duplicates. Finally, 29 studies were included for meta-analysis. A total of 3349 patients were evaluated. The pooled prevalence of SD was 66% (95% CI: 64%-69%). The pooled prevalence of erectile dysfunction was 49% (95% CI: 47%-50%).
CONCLUSIONS: Sexual dysfunction is a prevalent complication of MS in male patients which should be considered by clinicians.

Orchalgia is a common andrological disorder and usually results from pathognomonic change of testes and regional structures. However, responsible cause is still unknown in more than one-fourth of patients.
We report two men who initially suffered an acute, isolated orchalgia and posteriorly complicated with paraparesis. They had previous history of prostate cancer and cervical myelitis. The urological examination was negative in both of them. Finally, prostate cancer metastasis and recurrent myelitis at T2/3 level was identified, respectively. Although their orchalgia progressively subsided, their urological, sexual and neurological dysfunction persisted.
In the literature, the responsible pathology of spinal orchalgia was exclusively found below T10 level, frequently delaying affirmative diagnosis. Therefore, a thorough evaluation of spinal cord above T10 level should be alerted for idiopathic orchalgia with a pre-existing history or risk of spinal cord disorder and a negative urological examination.

OBJECTIVE: Over 50% of elderly men and 70% of male cardiac patients suffer from erectile dysfunction (ED). Although pharmacotherapy is effective and safe, it only brings a short-term improvement and may cause side effects. Low energy shock-wave therapy (LESWT) is a promising causative modality for the treatment of ED. The evidence is still limited with different results obtained using different devices. The aim of this work was to evaluate evidence from randomized controlled trials regarding the efficacy of LESWT generated by an electrohydraulic unit for the treatment of ED.
METHODS: A systematic review of the literature was conducted in PubMed on May 20th, 2018 and supplemented by a Google search of grey literature, as well as a hand search of the bibliographies of retrieved articles. Out of 34 studies, 5 studies on 354 patients were included in the quantitative synthesis.
RESULTS: The studies evaluated an abridged International Index of Erectile Function (IIEF-5), the Erectile Hardness Scale (EHS) and Flow-Mediated Dilatation (FMD). The meta-analysis revealed that LESWT improved the IIEF-5 score (mean difference: 5.16; 95% CI, 1.39-8.93; p=0.0073) and EHS score (risk difference:0.72; 95% CI, 0.73-0.80; p<0.001). Reporting of FMD was inconsistent and not analyzed. The meta-analysis of studies conducted with electrohydraulic devices showed greater benefits to patients in comparison to the meta-analyses of heterogeneous studies conducted using various devices for generating shock waves.
CONCLUSIONS: Evidence exists that LESWT generated with an electrohydraulic unit is effective. Further research is needed in order to evaluate this method in different patient populations and for the long-term.
UNASSIGNED:  Más del 50% de los hombres ancianos y más del 70% de hombres con enfermedades cardiacas sufren de disfunción eréctil (DE). Aunque la farmacoterapia es efectiva y segura, solo conlleva una mejoría temporal y puede causar efectos secundarios. La terapia con ondas de choque de baja energía (OCBE) es una técnica prometedora para el tratamiento de la DE. La evidencia es aún limitada con resultados diferentes obtenidos con aparatos diferentes. El objetivo de este trabajo es evaluar la evidencia de ensayos randomizados en relación a OCBE generado con unidades electrohidráulicas para el tratamiento de la DE.MÉTODOS: Una revisión sistemática de la literatura fue conducida en PubMed el 20 mayo 2018 y suplementada por la búsqueda de Google en literatura gris. También se hicieron búsquedas individuales de artículos. De 34 estudios, 5 estudios en 354 pacientes fueron incluidos para la síntesis cuantitativa.
UNASSIGNED: Los estudios evaluaron abridged International Index of Erectile Function (IIEF-5), Erectile Hardness Scale (EHS) y Flow-Mediated Dilatation (FMD). El metanálisis reveló que OCBE mejoró el score de IIEF-5 (diferencia media: 5,16; 95% CI, 1,39-8,93;p=0,0073) y EHS score (diferencia de riesgo: 0,72;95% CI, 0,73-0,80; p<0,001). Los reportes de FMD fueron inadecuados y no se analizaron. El metanálisis de estudios conducidos con aparatos electrohidráulicos demostró mayores beneficios a pacientes en comparación con el metanálisis de estudios heterogéneos conducido utilizando varios aparatos generadores de ondas.
UNASSIGNED: La evidencia demuestra que OCBE generado por una unidad electrohidráulica es efectiva. Es necesaria más investigación para poder evaluar este método en diferentes poblaciones de pacientes y para el largo plazo.

OBJECTIVE: To determine the effectiveness and safety in the short, medium, and long term of LISWT in patients with Erectile Dysfunction who do not respond to PDE5 inhibitors.
METHODS: Clinical study, quasi-experimental cohort and systematic review following the guidelines of the Cochrane collaboration and the PRISMA writing guides. The measurement of the variables was determined as a primary outcome to the evaluation of erectile function, by means of a validated questionnaire. The baseline scale was evaluated, as well as the difference at 1, 3 and 6 months, evidenced by the possibility of maintaining an erection or responding to therapy with PDEi5. An information search was carried out from its beginning to the current date, in the databases: Medline, Embase, Central, Science Direct and Lilacs.
RESULTS: The studies found used different outcome variables to show efficacy in the follow-up: All the studies used the IIEF-EF as outcome variable in its different variations.
CONCLUSIONS: LISWT could be an effective and safe treatment in patients not responding to PDEi5. It is important to point out that the evidence is currently limited, randomized studies with greater methodological rigidity and follow-up longer than 12 months are needed in order to verify the medium and long-term effect of the application of shock waves in this group of patients.

BACKGROUND: Normal sexual functioning of both men and women, being a very complex process, is affected by numerous issues besides aging. Many factors affect the sexual function and lifestyle of the young population. In this article, we tried to review the literature to update the knowledge on benzodiazepine-related (BZD) sexual dysfunction (SD) and involved mechanisms of actions based on animal and human studies.
METHODS: Different standard websites such as PubMed were used to review the literature and keywords including benzodiazepines, sexual dysfunction, gammaaminobutyric acid A (GABAA) receptor and erectile dysfunction were used.
RESULTS: SD is one of the most common disorders in males and females which has recently been demonstrated to be associated with psychotropic medications such as antihypertensive agents, tranquilizers, antihistamines, appetite suppressants, antidepressants and anxiolytics. BZDs are among the most common psychotropic agents worldwide. SD including decreased libido, erectile dysfunction (ED) and other undesired sexual urges were observed in the patients receiving BZDs.
CONCLUSIONS: The mechanisms of action of BZDs to induce SD mainly relate to enhanced GABAA receptor function which reduces penile erection.

Prostate cancer is the second most frequently diagnosed cancer in men. The initial diagnosis is made in increasingly younger patients, so it seems to be essential to guarantee optimal functional results. We carried out a systematic search to define the functional results of each of the therapeutic options for localized prostate cancer. Radical prostatectomy generates a greater negative effect on urinary continence and erectile function compared to active surveillance and radiotherapy. Robotic surgery seems to offer better functional results, especially at the level of erectile function. Urinary and bowel symptoms are more pronounced after radiotherapy compared to other options. Patients must be warned of the possible functional results prior to choice of treatment.

OBJECTIVE: To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism (IP).
UNASSIGNED: A systematic search for the terms \"penile prosthesis\", \"priapism\", \"impotence\", \"fibrosis\", \"downsized prosthesis cylinders\", and \"patient satisfaction\" has been carried out in PubMed, EMBASE, Cochrane, SCOPUS and Science Citation Index databases.
UNASSIGNED: Cavernosal tissue damage in IP is time related. Conservative measures and aspiration with or without intracorporeal instillation of α-adrenergic agonists are usually successful in the early stages. Shunt surgery in patients remains debatable, as the lack of response to aspiration and instillation of α-adrenergic agonists indicates that irreversible changes in the cavernosal smooth muscle are likely to have already occurred. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening. Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient\'s satisfaction following surgery.