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François Giuliano - One of the best experts on this subject based on the ideXlab platform.
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Anatomy and physiology of genital organs - men.
Handbook of clinical neurology, 2015Co-Authors: Pierre Clément, François GiulianoAbstract:Male sexual functions involve a number of organs and structures in genitalia whose role is to produce fertilizing gametes and to allow female-partner insemination. The testes belong to the reproductive and endocrine systems as they synthesize spermatozoa and androgens, and are under finely regulated hormonal control by the hypothalamopituitary axis. Sexual responses are controlled by a complex and coordinated interplay of both the somatic and the autonomic nervous system in multiple components of the brain, spinal cord, and relevant peripheral organs. Erectile bodies are an essential element of the penis and engorgement of the penis with blood leads to penile tumescence. Blood engorgement is due to relaxation of smooth-Muscle cells of erectile tissue and endothelium of the penile arteries. The penis gains additional rigidity when the ischiocavernosus Muscles contract. Stimuli from peripheral and/or central origins activate particular spinal nuclei, causing penile erection. Ejaculation consists of two phases, emission and expulsion, which correspond, respectively, to secretion of the different components of the semen by sex glands and forceful expulsion of semen due to rhythmic contractions of the Bulbospongiosus Muscle. A spinal generator of ejaculation integrates genital stimuli and sexual cues and, when the excitatory threshold is reached, triggers ejaculation by orchestrating the activation of autonomic and somatic pathways commanding the peripheral events of ejaculation.
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Inhibition of ejaculation by the non-peptide oxytocin receptor antagonist GSK557296: a multi-level site of action.
British journal of pharmacology, 2013Co-Authors: Pierre Clément, Jacques Bernabé, Laurent Alexandre, Sandrine Compagnie, Stewart W. Mccallum, François GiulianoAbstract:Background and Purpose Oxytocin (OT) plays a major role in the control of male sexual responses. Notably, blockade of OT receptors has been reported to inhibit ejaculation in animals. The study aimed to investigate the action of a highly selective, non-peptide OT antagonist GSK557296 in a model of pharmacologically induced ejaculation in anaesthetized rats. The site of action was assessed by investigating different delivery routes for this compound. Experimental Approach Urethane-anaesthetized Wistar rats were implanted with a cerebral ventricle cannula for i.c.v. injections or with a subdural catheter for intrathecal (i.t.) GSK557296 injections. Occurrence of ejaculation was assessed following i.v. 7-hydroxy-2-(di-N-propylamino)tetralin (7-OH-DPAT), a dopamine D3 receptor agonist. In addition, seminal vesicle pressures (SVP) and Bulbospongiosus Muscle (BS) EMG were recorded as physiological markers of emission and expulsion phases of ejaculation respectively. Key Results Highest i.v. GSK557296 dose reduced occurrence of ejaculation and increases in SVP but had no effect on BS-EMG. I.c.v. GSK557296 dose dependently inhibited ejaculation, increases in SVP and BS contractions. At spinal thoracic level, GSK557296 dose dependently inhibited ejaculation and increases in SVP but BS-EMG was impaired only with the highest dose. When delivered at lumbar level, GSK557296 dose dependently inhibited ejaculation, increases in SVP and BS contractions. Conclusions and Implications In the 7-OH-DPAT-induced ejaculation model, GSK557296 acts peripherally and centrally to inhibit ejaculation with different modalities. Blockade of brain OT receptors seems to be the most effective mechanism of action. Targeting central OT receptors with highly selective antagonist seems a promising approach for the treatment of premature ejaculation.
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Differences in the Spinal Command of Ejaculation in Rapid Ejaculating Rats
The journal of sexual medicine, 2009Co-Authors: Aren J. Borgdorff, Anne-sophie Rössler, Pierre Clément, Jacques Bernabé, Laurent Alexandre, François GiulianoAbstract:ABSTRACT Introduction It has been hypothesized that lifelong premature ejaculation is part of a biological variation in the intravaginal ejaculation latency, but what causes this variation remains poorly understood. Aim The aim of this study is to elucidate whether variations in ejaculation latencies in an experimental rat model for premature ejaculation are linked to differences in the spinal command of ejaculation. Main Outcome Measures Electrical microstimulation of the spinal generator for ejaculation revealed an accelerated expulsion phase in rapid ejaculating rats. Methods Adult male Wistar rats were categorized as “sluggish,”“normal,” or “rapid” ejaculators on the basis of their ejaculation frequency in sexual mating tests. One to three weeks after selection, males were urethane anesthetized and electrically microstimulated in the spinal generator for ejaculation, evoking ejaculation. Bulbospongiosus Muscle electromyographic and intraluminal vas deferens pressure were measured simultaneously, representing, respectively, the expulsion and emission phase in ejaculation. Results Electrical microstimulation of the spinal generator for ejaculation evoked ejaculation in “sluggish” (N = 9), “normal” (N = 13), and “rapid” (N = 11) ejaculating rats. Vas deferens contraction (emission phase) was evoked at different stimulation strengths, but response properties were not statistically different between “sluggish,”“normal,” and “rapid” ejaculator rats. Bulbospongiosus Muscle contractions (expulsion phase) following microstimulation was significantly accelerated in “rapid” rats as compared with “sluggish” and “normal” rats. The total duration of Bulbospongiosus Muscle contractions remained unchanged between the three ejaculator groups. Conclusions Our results provide the first scientific evidence supporting a neurophysiological difference between “rapid,”“normal,” and “sluggish” ejaculators, expressed as an accelerated expulsion phase in “rapid” ejaculator rats. This bridges the gap between a sexual behavior trait and the spinal command of ejaculation. Borgdorff A, Rossler A-S, Clement P, Bernabe J, Alexandre L, and Giuliano F. Differences in the spinal command of ejaculation in rapid ejaculating rats. J Sex Med 2009;6:2197–2205.
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Role of the Neurokinin‐1 Receptors in Ejaculation in Anesthetized Rats
The journal of sexual medicine, 2009Co-Authors: Pierre Clément, Jacques Bernabé, Laurent Alexandre, Magali Peeters, Miguel Laurin, François GiulianoAbstract:ABSTRACT Introduction Several lines of evidence indicate a role for substance P in the control of ejaculation, although its mode of action needs to be clarified. Aim The effects and sites of action of a selective antagonist for the substance P-preferred receptor (neurokinin-1 receptor subtype; NK1) were investigated in a pharmacological model of ejaculation. Methods Ejaculation was induced in anesthetized rats by intracerebroventricular (icv) delivery of the dopamine D3 receptor preferring agonist 7-hydroxy-2-(di-N-propylamino)tetralin (7-OH-DPAT). The effects of the selective NK1 antagonist RP67580 on 7-OH-DPAT-induced ejaculation were measured following intraperitoneal (ip), icv, or intrathecal (it) (third lumbar spinal segment; L3) administration. Main Outcome Measures Intraseminal vesicle pressure (SVP) and electromyogram of the Bulbospongiosus Muscle (BS) were recorded as physiological markers of emission and expulsion phases of ejaculation, respectively. Results Upon ip, icv, or it administration, RP67580 significantly reduced the occurrence of ejaculation elicited by 7-OH-DPAT. A mild decrease in the occurrence of SVP and BS responses was observed in rats treated ip with RP67580, whereas only SVP responses were moderately affected following icv or it administration. Conclusion These results show the multilevel regulation of 7-OH-DPAT-induced ejaculation by NK1 receptors. Clement P, Peeters M, Bernabe J, Laurin M, Alexandre L, and Giuliano F. Role of the neurokinin-1 receptors in ejaculation in anesthetized rats. J Sex Med 2009;6:126–134.
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brain oxytocin receptors mediate ejaculation elicited by 7 hydroxy 2 di n propylamino tetralin 7 oh dpat in anaesthetized rats
British Journal of Pharmacology, 2008Co-Authors: Pierre Clément, Jacques Bernabé, Laurent Alexandre, M Peeters, Pierre Denys, François GiulianoAbstract:Background and purpose: The involvement of the neuropeptide oxytocin in the control of male sexual responses is documented although its exact mechanisms of action, and especially the site(s) of action, are not fully delineated. In order to clarify this issue, we tested the effects of a peptide oxytocin antagonist delivered through different routes on sexual responses elicited, in anaesthetized male rats, by i.c.v. 7-hydroxy-2-(di-N-propylamino) tetralin (7-OH-DPAT), a dopamine agonist, preferentially active on D3 receptors. Experimental approach: Seminal vesicle pressure (SVP) and Bulbospongiosus Muscle (BS) electromyograms were recorded as physiological markers of emission and expulsion phases of ejaculation respectively and intracavernosal pressure (ICP) was monitored as a physiological marker of erection. Key results: When injected i.v., the oxytocin antagonist did not impair 7-OH-DPAT-induced SVP and ICP responses while BS burst frequency was diminished. When delivered i.c.v., the oxytocin antagonist dose-dependently inhibited occurrence of 7-OH-DPAT-induced sexual responses. When delivered intrathecally (i.t.) at the level of the 6th lumbar (L6) segment, but not the 13th thoracic (T13) segment, the oxytocin antagonist reduced the duration of BS responses and the occurrence of ejaculation without impairing ICP responses. Conclusions and implications: Brain oxytocin receptors mediate male sexual responses elicited by i.c.v. 7-OH-DPAT in anaesthetized rats whereas L6 spinal oxytocin receptors only impair the occurrence of ejaculation. Peripheral oxytocin receptors are marginally involved in 7-OH-DPAT-induced sexual responses. These findings should be considered for the development of potential pharmacological treatment of premature ejaculation in man. British Journal of Pharmacology (2008) 154, 1150–1159; doi:10.1038/bjp.2008.176; published online 12 May 2008
Waleed Shabana - One of the best experts on this subject based on the ideXlab platform.
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Bulbospongiosus Muscle sparing urethroplasty versus standard urethroplasty a comparative study
Urology, 2019Co-Authors: Ehab Elkady, Tamer Dawod, Mohamed Teleb, Waleed ShabanaAbstract:OBJECTIVE To compare outcome of Muscle and nerve-sparing bulbar urethroplasty with standard bulbar urethroplasty as regard ejaculatory dysfunction and postvoid dribbling. METHODS This prospective randomized study included 50 patients with bulbar urethral stricture underwent urethroplasty over a period of 5 year. All patients were operated by ventral onlay buccal mucosal graft urethroplasty and randomly divided into 2 groups. Group I (n = 25) was operated by standard bulbar urethroplasty. Group II (n = 25) was operated by bulbar urethroplasty with preservation of Bulbospongiosus Muscle and nerve. Postoperative follow-up was performed at 1-, 6-, and 12-month and annually thereafter. Urethrography was done at 1-month, while uroflowmetry was performed at 6- and 12-month. Urethrography was indicated if Qmax <14 mL/sec. Success was defined as normal voiding without any auxiliary procedures. RESULTS Success rate was 88% and 92% in Group I and II, respectively. Urethral sacculation was not detected in any patient in either group. One patient from Group I was complicated by urinary extravasation after catheter removal and required re-catheterization for another 1week. One patient in each group was complicated by postoperative wound infection managed by antibiotics. Postvoid dribbling was the complaint of 9 patients in Group I and 1 patient in Group II, while semen sequestration was present in 10 and 2 patients in Group I and Group II, respectively. Significant differences were observed between the 2 groups as regard postvoid dribbling and ejaculatory dysfunction. CONCLUSION Bulbar urethroplasty with Bulbospongiosus Muscle and nerve-sparing seems to be a safe and effective alternative for standard bulbar urethroplasty.
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Bulbospongiosus Muscle Sparing Urethroplasty Versus Standard Urethroplasty: A Comparative Study
Urology, 2018Co-Authors: Ehab Elkady, Tamer Dawod, Mohamed Teleb, Waleed ShabanaAbstract:OBJECTIVE To compare outcome of Muscle and nerve-sparing bulbar urethroplasty with standard bulbar urethroplasty as regard ejaculatory dysfunction and postvoid dribbling. METHODS This prospective randomized study included 50 patients with bulbar urethral stricture underwent urethroplasty over a period of 5 year. All patients were operated by ventral onlay buccal mucosal graft urethroplasty and randomly divided into 2 groups. Group I (n = 25) was operated by standard bulbar urethroplasty. Group II (n = 25) was operated by bulbar urethroplasty with preservation of Bulbospongiosus Muscle and nerve. Postoperative follow-up was performed at 1-, 6-, and 12-month and annually thereafter. Urethrography was done at 1-month, while uroflowmetry was performed at 6- and 12-month. Urethrography was indicated if Qmax
Eduardo Solsona Narbon - One of the best experts on this subject based on the ideXlab platform.
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prospective follow up study of artificial urinary sphincter placement preserving the Bulbospongiosus Muscle
Neurourology and Urodynamics, 2017Co-Authors: Argimiro Collado Serra, J Dominguezescrig, A Gomezferrer, Emilio Batista Miranda, J Rubiobriones, Eduardo Solsona NarbonAbstract:Aims Artificial urinary sphincter (AUS) AMS-800® is an effective treatment for male stress urinary incontinence. The aim of the study was to assess the long-term effectiveness and complications of artificial urinary sphincter placement preserving the Bulbospongiosus Muscle. Methods From April 2004 to March 2014, all consecutive male patients with urinary incontinence who underwent an AUS prosthesis insertion were prospectively evaluated. Surgical technique consisted of a perineal incision for cuff placement around the bulbous urethra preserving the Bulbospongiosus Muscle. Cure rate was defined as no pad use. Results A total of 82 consecutive patients (median age 68 years, range: 54-78) were prospectively evaluated (median follow-up 46 months, range: 12-135). Bulbospongiosus Muscles were preserved intact in all cases with no intraoperative complications. Postoperative complications were reported in 14 patients (1 urethral erosion). The overall cure rate (dry rate) was 76.8% and the median ICIQ-UI score improved from 18 (range: 8-21) to 4 (range: 0-17) (P < 0.001). Artificial urinary sphincter survival rate was 95.5% (95%CI 89.4-100%) at 24 months and 62.6% (95%CI 45.5-79.6%) at 60 months. The mechanical failure rate was 6.3% (median 46.1 months, range: 22.2-100.9) and urethral atrophy and/or inadequate compression rate was 9.5% (median 58.6 months, range: 39-101.4 months). Conclusions Our study suggests that placement of AUS preserving the Bulbospongiosus Muscle is technically easy and efficient, reports excellent continence rates and lower urethral erosion rates, and could delay the onset of urethral atrophy compared to other surgical procedures used for sphincter placement.
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Prospective follow-up study of artificial urinary sphincter placement preserving the Bulbospongiosus Muscle.
Neurourology and urodynamics, 2016Co-Authors: Argimiro Collado Serra, Emilio Batista Miranda, J. Dominguez-escrig, A. Gómez-ferrer, José Rubio-briones, Eduardo Solsona NarbonAbstract:Aims Artificial urinary sphincter (AUS) AMS-800® is an effective treatment for male stress urinary incontinence. The aim of the study was to assess the long-term effectiveness and complications of artificial urinary sphincter placement preserving the Bulbospongiosus Muscle. Methods From April 2004 to March 2014, all consecutive male patients with urinary incontinence who underwent an AUS prosthesis insertion were prospectively evaluated. Surgical technique consisted of a perineal incision for cuff placement around the bulbous urethra preserving the Bulbospongiosus Muscle. Cure rate was defined as no pad use. Results A total of 82 consecutive patients (median age 68 years, range: 54-78) were prospectively evaluated (median follow-up 46 months, range: 12-135). Bulbospongiosus Muscles were preserved intact in all cases with no intraoperative complications. Postoperative complications were reported in 14 patients (1 urethral erosion). The overall cure rate (dry rate) was 76.8% and the median ICIQ-UI score improved from 18 (range: 8-21) to 4 (range: 0-17) (P
Ehab Elkady - One of the best experts on this subject based on the ideXlab platform.
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Bulbospongiosus Muscle sparing urethroplasty versus standard urethroplasty a comparative study
Urology, 2019Co-Authors: Ehab Elkady, Tamer Dawod, Mohamed Teleb, Waleed ShabanaAbstract:OBJECTIVE To compare outcome of Muscle and nerve-sparing bulbar urethroplasty with standard bulbar urethroplasty as regard ejaculatory dysfunction and postvoid dribbling. METHODS This prospective randomized study included 50 patients with bulbar urethral stricture underwent urethroplasty over a period of 5 year. All patients were operated by ventral onlay buccal mucosal graft urethroplasty and randomly divided into 2 groups. Group I (n = 25) was operated by standard bulbar urethroplasty. Group II (n = 25) was operated by bulbar urethroplasty with preservation of Bulbospongiosus Muscle and nerve. Postoperative follow-up was performed at 1-, 6-, and 12-month and annually thereafter. Urethrography was done at 1-month, while uroflowmetry was performed at 6- and 12-month. Urethrography was indicated if Qmax <14 mL/sec. Success was defined as normal voiding without any auxiliary procedures. RESULTS Success rate was 88% and 92% in Group I and II, respectively. Urethral sacculation was not detected in any patient in either group. One patient from Group I was complicated by urinary extravasation after catheter removal and required re-catheterization for another 1week. One patient in each group was complicated by postoperative wound infection managed by antibiotics. Postvoid dribbling was the complaint of 9 patients in Group I and 1 patient in Group II, while semen sequestration was present in 10 and 2 patients in Group I and Group II, respectively. Significant differences were observed between the 2 groups as regard postvoid dribbling and ejaculatory dysfunction. CONCLUSION Bulbar urethroplasty with Bulbospongiosus Muscle and nerve-sparing seems to be a safe and effective alternative for standard bulbar urethroplasty.
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Bulbospongiosus Muscle Sparing Urethroplasty Versus Standard Urethroplasty: A Comparative Study
Urology, 2018Co-Authors: Ehab Elkady, Tamer Dawod, Mohamed Teleb, Waleed ShabanaAbstract:OBJECTIVE To compare outcome of Muscle and nerve-sparing bulbar urethroplasty with standard bulbar urethroplasty as regard ejaculatory dysfunction and postvoid dribbling. METHODS This prospective randomized study included 50 patients with bulbar urethral stricture underwent urethroplasty over a period of 5 year. All patients were operated by ventral onlay buccal mucosal graft urethroplasty and randomly divided into 2 groups. Group I (n = 25) was operated by standard bulbar urethroplasty. Group II (n = 25) was operated by bulbar urethroplasty with preservation of Bulbospongiosus Muscle and nerve. Postoperative follow-up was performed at 1-, 6-, and 12-month and annually thereafter. Urethrography was done at 1-month, while uroflowmetry was performed at 6- and 12-month. Urethrography was indicated if Qmax
Alex J Vanni - One of the best experts on this subject based on the ideXlab platform.
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Functional Effects of Bulbospongiosus Muscle Sparing on Ejaculatory Function and Post-Void Dribbling after Bulbar Urethroplasty.
The Journal of urology, 2016Co-Authors: Ariel Fredrick, Bradley A Erickson, Kristian Stensland, Alex J VanniAbstract:Bulbar urethroplasty outcomes studies have shown low but significant rates of post-void dribbling and ejaculatory dysfunction. The Bulbospongiosus Muscle is involved with the expulsion of seminal fluid and urine from the bulbar urethra and, thus, we hypothesized that performing urethroplasty using a technique that does not split the Muscle may result in better postoperative patient reported ejaculatory function and less post-void dribbling. We performed a multi-institutional matched, case-control analysis comparing men treated with a Bulbospongiosus sparing technique to men treated with the traditional nonBulbospongiosus sparing technique. Preoperative and postoperative (3 to 12 months) ejaculatory function was assessed using the 4 ejaculatory questions of the Male Sexual Health Questionnaire short form as well as a patient perception questionnaire. Post-void dribbling was assessed using a validated urethroplasty questionnaire. A total of 25 patients who underwent Bulbospongiosus sparing urethroplasty and 25 who underwent nonBulbospongiosus sparing urethroplasty were matched by total preoperative Male Sexual Health Questionnaire score, age, and performance of excision and primary anastomosis. The Bulbospongiosus sparing and nonBulbospongiosus sparing groups had similar postoperative total Male Sexual Health Questionnaire scores (15.24 vs 15.40, respectively, p=0.90) and there were no significant postoperative questionnaire score changes in either group (Bulbospongiosus sparing 14.56 to 15.24, p=0.4; nonBulbospongiosus sparing 14.64 vs 15.40, p=0.44). Individual responses to the Male Sexual Health Questionnaire were analyzed and no statistically significant difference was found between the groups. Rates of postoperative post-void dribbling and perception of ejaculatory function were similar between the groups. Sparing the Bulbospongiosus Muscle during urethroplasty does not seem to have a significant impact on patient reported ejaculatory function or post-void dribbling compared with nonBulbospongiosus sparing urethroplasty at early followup. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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Functional Effects of Bulbospongiosus Muscle Sparing on Ejaculatory Function and Post-Void Dribbling after Bulbar Urethroplasty
The Journal of Urology, 2016Co-Authors: Ariel Fredrick, Bradley A Erickson, Kristian Stensland, Alex J VanniAbstract:Purpose: Bulbar urethroplasty outcomes studies have shown low but significant rates of post-void dribbling and ejaculatory dysfunction. The Bulbospongiosus Muscle is involved with the expulsion of seminal fluid and urine from the bulbar urethra and, thus, we hypothesized that performing urethroplasty using a technique that does not split the Muscle may result in better postoperative patient reported ejaculatory function and less post-void dribbling.Materials and Methods: We performed a multi-institutional matched, case-control analysis comparing men treated with a Bulbospongiosus sparing technique to men treated with the traditional nonBulbospongiosus sparing technique. Preoperative and postoperative (3 to 12 months) ejaculatory function was assessed using the 4 ejaculatory questions of the Male Sexual Health Questionnaire short form as well as a patient perception questionnaire. Post-void dribbling was assessed using a validated urethroplasty questionnaire.Results: A total of 25 patients who underwent bu...
