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Objective: The management of patient affected by premature ejaculation (PE) is nowadays not highly satisfactory. Here, we aimed to evaluate the tolerability and efficacy of a combination of tryptophan, Satureja montana, Tribulus terrestris, Phyllanthus emblica extracts in order to improve sexual quality of life in patients with premature ejaculation., Materials and Methods: All patients attending to 5 urological centers from January 2015 to March 2015, due to premature ejaculation were enrolled in this study. At the enrolment visit, all subjects underwent self-administered IIEF-5, Male Sexual Health Questionnaire-Ejaculation Disorder (MSHQEjD), PEDT and IELTS (calculated as mean from that perceived by partner and that perceived by patient) and underwent urological visit and laboratory examinations. All patients received one tablet per day of a combination of tryptophan, Satureja montana, Tribulus terrestris, Phyllanthus emblica extracts for 3 months (Group A). After 3 months all patients underwent follow-up visit with the same investigations that have been carried out in the enrolment visit. The results were compared with a cohort of patients enrolled in the same period in another urological center and considered as a control group (Group B). All patients in the control group underwent counseling and sexual behavioral treatment without any pharmacological compound., Results: At the follow-up analysis, significant changes in terms of IELT in the Group A (mean difference: 31.90; p < 0.05) at 3 months and versus Group B at the intergroup analysis (mean difference: 30.30; p < 0.05) were reported. In the group A, significant differences from baseline to last follow- up were observed relative to IIEF-5 (mean difference: 1.04; p < 0.05), PEDT (mean difference: -2.57; p < 0.05) and FSH (mean difference: -16.46; p < 0.05)., Conclusion: In conclusion, patients affected by PE may significantly benefit from oral therapy with a combination of tryptophan, Satureja montana, Tribulus terrestris, Phyllanthus emblica extracts in terms of IELT and PEDT scores improvement.

Objectives: The Italian Society of Andrology, i.e. "Società Italiana di Andrologia" (S.I.A.), launched on December 2014 a prospective, multicenter, monitored and internal review board approved Registry for penile implants, the "INSIST-ED" (Italian Nationwide Systematic Inventarisation of Surgical Treatment for ED) Registry. Purpose of this first report is to present a baseline data analysis of the characteristics of penile implant surgery in Italy., Material and Methods: The INSIST-ED Registry is open to all surgeons implanting penile prostheses (all brands, all models) in Italy, providing anonymous patient, device, surgical procedure, outcome, follow-up data, for both first and revision surgeries. A Registry project Board overviews all the steps of the project, and a Registry Monitor interacts with the Registry implanting surgeons., Results: As by April 8, 2016, 31 implanting surgeons actively joined the Registry, entering 367 surgical procedures in its database, that comprise: 310 first implants, 43 prosthesis substitutions, 14 device explants without substitution. Implanted devices account for: 288 three-component devices (81,3%), 20 two-component devices (5,4%), 45 non-hydraulic devices (12,3%). Leading primary ED etiologies in first implant surgeries resulted: former radical pelvic surgery in 111 cases (35,8%), Peyronie's disease in 66 cases (21,3%), diabetes in 39 cases (12,6%). Two intraoperative complications have been recorded. Main reasons for 57 revision surgeries were: device failure (52,6%), erosion (19,3%), infection (12,3%), patient dissatisfaction (10,5%). Surgical settings for patients undergoing a first penile implant were: public hospitals in 251 cases (81%), private environments in 59 cases (19%)., Conclusions: The INSIST-ED Registry represents the first European experience of penile prosthesis Registry. This baseline data analysis shows that: three-pieces inflatable prosthesis is the most implanted device, leading etiology of erectile dysfunction (ED) in patient receiving a prosthesis is former radical pelvic surgery, primary reason for revision surgery is device failure, primary settings for first penile implant surgery are public hospitals. Evaluation of penile implant impact on recipients quality of life is presently ongoing.

Fibrolipomas are an infrequent type of lipomas. We describe a case of a man suffering from subcutaneous penile fibrolipoma, who twelve months earlier has been submitted to augmentative phalloplasty due to aesthetic dysmorphophobia. The same patient three years earlier has been submitted to three-component hydraulic penile prostheses implantation due to erectile dysfunction. After six months from removing of the mass, the penile elongation and penile enlargement were stable, the prostheses were correctly functioning and the patient was satisfied with his sexual intercourse and life. The diagnostics and surgical characteristics of this case are reported.

Erectile dysfunction, the most common male sexual disorder after premature ejaculation, with its important impact on man and partner's sexuality and quality of life is a persistent inability to obtain and maintain an erection sufficient to permit satisfactory sexual performance. Non-surgical treatments with controversial results are usually applyed before surgical treatment that has reached high levels of satisfaction. We describe a new surgical technique to implant three-pieces penile prosthesis in patients suffering from erectile dysfunction (ED) not responding to conventional medical therapy or reporting side effects with such a therapy. Implantation of an inflatable prosthesis, for treatment of ED, is a safe and efficacious approach with high satisfaction reported by patients and partners. Surgical technique should be minimally invasive and latest technology equipment should be implanted in order to decrease common complications and to obtain a better aesthetic result.

Fracture of the penis, a relatively uncommon emergency in Urology, consists in the traumatic rupture of the tunica albuginea of the corpus cavernosum. Examination and clinical history can be highly suspicious of penile fracture in the majority of cases and ultrasonography (USS) can be useful to identify the exact location of the tunical rupture, which is proximal in 2/3 of cases and therefore manageable through a penoscrotal approach. Although expensive and not readily available in the acute setting, Magnetic Resonance Imaging (MRI) may play a role in the differential diagnosis with rupture of a circumflex or dorsal vein of the penis or when the tunical rupture is not associated with tear of the overlying Buck's fascia. This form of imaging is more sensitive than USS at identifying the presence of a tunical tear. The treatment of choice is immediate surgical repair, which allows preserving erectile function and minimizing corporeal fibrosis.

Objective: Peyronie's disease (PD) is a fibrotic wound-healing condition of the tunica albuginea that results in penile deformity, curvature, hinging, narrowing and shortening, penile pain, and in some cases, erectile dysfunction (ED). Surgery remains the gold standard treatment option, ensuring the faster and trustworthy treatment. For those patients who have erectile dysfunction and PD, penile prosthesis placement with straightening procedure is the best method to solve both diseases. The aim of this article is to present the use of hydraulic penile prostheses AMS CX with Momentary Squeeze associated with a complete isolation of the neurovascular bundle in a complex case after removal of two previously implanted prostheses in a man suffering from Peyronie's disease and erectile dysfunction., Material and Method: A 50 year-old patient underwent two previous prosthetic implants in another hospital. The first implantation was performed using an infrapubic approach followed by placement of a three-component hydraulic penile prosthesis. After six months the prosthesis was removed using an infra-pubic approach and two soft prosthesis Virilis II were implanted during the same surgery. One year after the second operation we implanted a hydraulic penile prosthesis AMS CX with Momentary Squeeze after complete isolation of the neurovascular bundle, fixing the two crural tips at the same level of albuginea of the two corpora cavernosa., Result: Twelve months after surgery the penis was completely straight without penile shortening and the patient was fully satisfied with his sexual life., Conclusion: The procedure enabled a perfect alignment of the cylinders along the longitudinal axis and penile prosthetic symmetry to obtain a good penile rigidity and a perfect penile straightening.

Objective: Penile prosthesis implantation is the solution of choice in patients who have failed or present contraindication to the use of all conservative treatment for erectile dysfunction (ED). Overall, satisfaction rates are high, with more than 80% of patients and partners fully satisfied with cosmetic and functional result of surgery. Chronic postoperative pain, penile shortening, soft or hyposensitive glans, pencil like penis syndrome and difficulty to cycle the device represent the most common causes of patient's dissatisfaction. Satisfaction rates are better assessed with the use of validated questionnaires such as the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) The aim of our study was to analyze the long-term mechanical reliability of the AMS 700CX/CXM inflatable penile prosthesis and the patient's satisfaction rate using IIEF and EDITS questionnaire as standard reference., Materials and Methods: A retrospective case notes review of all patients who have undergone implantation of a three pieces inflatable penile prosthesis AMS 700 CX and CXR between October 1997 and December 2010. Overall, 80 patients have undergone implantation of 3 pieces inflatable penile prosthesis AMS 700 CX InhibiZone. Patients have been administered the IIEF-5 and EDITS questionnaires in combination with a non validated 9 domain questionnaire that assesses penile rigidity, sensation, orgasmic function, frequency of intercourse, impact of surgery on the quality of life, satisfaction rate., Results: Overall 10 years survival estimate according to the Kaplan Meier method of AMS 700 CX touch pump and AMS 700 CX momentary squeeze pump are respectively 77.6% and 82.5%. The median postoperative IIEF5 and EDITS score were respectively 21.46 and 73.11, which show a high level of satisfaction. 59 patients (90.8%) were able to cycle the device and were engaging in penetrative sexual intercourse., Conclusions: Penile prosthesis implantation yields excellent results in terms of cosmetic and functional outcome and therefore has a significant impact on patients' satisfaction, sex life and overall quality of life. Overall, long term reliability has been significantly improved and complication rates are low in the hands of experienced surgeons.

Aim of the Study: To evaluate with an open-label study the efficacy and safety of a complex of nutritional supplements with antioxidant activity (L-carnitine, acetyl-L-carnitine, fructose, citric acid, selenium, coenzyme Q10, zinc, ascorbic acid, cyanocobalamin, folic acid) in primary infertile patients with idiopathic astenoteratozoospermia., Methods: The study was conducted in a population of 114 infertile men (96 completed the study) diagnosed with idiopathic astenoteratozoospermia since at least 18 months. Patients orally received a formulation (Proxeed - Sigma-Tau) containing L-carnitine 145 mg, acetyl-L-carnitine 64 mg, fructose 250 mg, citric acid 50 mg, selenium 50 mcg, coenzyme Q10 20 mg, zinc 10 mg, ascorbic acid 90 mg, cyanocobalamin 1.5 mcg, folic acid 200 mcg in combination once a day for 4 months., Results: At the end of study, the mean sperm progressive motility showed a statistically significant increase from 18.3 +/- 3.8 to 42.1 +/- 5.5. Sixteen patients achieved pregnancy during the study. No significant improvement were observed for sperm density and rate of morphologically normal forms. The treatment was well tolerated., Conclusions: Carnitines in association with others functional substances can improve the most important parameters of sperm quality.

Purpose: Controversial data on ESWT (Extracorporeal Shock Wave Therapy) for the treatment of Peyronie's disease are controversial. This study was performed to access the efficacy, reliability and the side-effects of the ESWT., Materials and Methods: From 2000 to 2004, 157 patients with an average age of 58 years and with Peyronie's disease were enrolled for a conservative treatment. All 150 eligible patients were treated with ESWT, using Dornier Compact Delta II UIMS lithotripter. The median number of treatments per patient was 3.5 with the delivery of 2000 shock waves (SW) for each treatment. There was no use of anaesthesia and analgesy. An ultrasound study was made for each patient before treatment. We considered: plaque size, penis curvature, pain, penis rigidity and tumescence, sexual intercourse ability and side-effects. Median follow-up of the study was 36.9 months., Results: Average duration of the treatment was 20 minutes without relevant side-effects. With reference to the curvature, we obtained a significative reduction in 33.3% of the patients, whereas the plaque size was not statistically reduced. Regarding the pain issue we achieved good results with a reduction in more than 90% of the patients and a complete relief in 6%. The quality of the intercourse was reported slightly enhanced. No significant difference was observed in penis tumescence and rigidity., Conclusions: ESWT is a non-invasive treatment for the Peyronie's disease. Our study confirms that the best results are obtained regarding pain and less with the curvature. For the plaque size and quality of sexual intercourse the results are not satisfactory.