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039 Immunohistochemical Characterization of a Spinal Cord Generator of Ejaculation in Human
S18
WMSM 2016 Abstracts
guidelines, utilization of single and multimodal therapies may improve ejaculatory latency times, thus improving the sexual experience and quality of life (QoL) of men with RE and their partners. In Canada, paroxetine is used off label an oral treatment, as dapoxetine (which is available worldwide and is, for example, on the NHS list of treatments in the UK) is not approved by Health Canada. Other options include couples therapy, behavioural modification, topical anesthetics, other oral off-label agents and use of condoms. The novel delivery lidocaine spray for premature ejaculation (Promescent) is available overthe-counter, and we assess efficacy in this difficult to treat group. Methods and Materials: Promescent, a novel lidocaine-only eutectic formulation enabling increased absorption of the anesthetic through the skin (refer to US patents 8507561 and 8563616) is available as an OTC product and was utilized in 20 consecutive men for treatment of refractory RE. All men had been treated for RE previously with at least two different modalities for a minimum of two years, and followed clinically through treatment their failures. The goal was to determine “reallife” success, as defined by patient and partner satisfaction with treatment and continued use of the specific treatment. Results: Eleven of 20 men continue to use Promescent at six months after initiation, with an initial response rate of 14/20. Two men ceased use due to partner or patient note of medication odor. One patient is without a partner, but continues to utilize with self-stimulation. 9/11 are in heterosexual relationships, 2/11 MSM. There has been no report of diminution of treatment effect after 6 months in the 11/20 group. Six of 20 found no improvement or improvement insufficient to continue treatment. Conclusions: In men with refractory RE, Promescent offers a greater than 50% opportunity for meaningful improvement in sexual function, as evidenced by continued usage at 6 months. Given the negative impact on QoL by RE, Promescent is a safe and potentially effective option for these men. Partner acceptance of treatment is high with minimal side-effect induced termination of treatment. Disclosure: Work supported by industry: no.
Clinical observations strongly suggest that a spinal neuronal organization commanding ejaculation exists in man that can be activated in spinal cord injured patients by penile vibratory stimulation despite disruption of cerebral connections. In the rat, a spinal generator of ejaculation (SGE) in 3rd and 4th lumbar (L3-L4) segments has been identified which is notably characterized by the presence of a variety of markers including receptors and neuropeptides onto the constituting neurons immunoreactive for galanin. Objective: An immunohistochemical study was conducted to identify in human lumbar spinal cord neuronal organization that shares similarities with the rat SGE. Material and Method: Post-mortem men and women (n¼3 each) spinal cord specimens were processed for immunodetection of galanin neurons, which distribution was 3D reconstructed. Co-expression with galanin of the molecular markers of the rat SGE (androgen and neurokinin-1 receptors, cholecystokinin, gastrin-releasing peptide, met-enkephalin) was assessed using confocal microscopy. Results: Galanin neurons were mostly located between L2 and L5 segments in medial lamina VII, with a maximum within L4. Three dimension reconstruction of spinal cord sections showed that galanin neurons were grouped into single columns bilaterally to the central canal. Galanin neurons were found in greater number in men than in women specimens indicating sexual dimorphism. In addition, a vast majority of L3-L4 galanin neurons were immunoreactive for cholecystokinin, gastrinreleasing peptide, met-enkephalin, androgen and neurokinin-1 receptors. Conclusion: A neuronal organization has been evidenced in human lumbar spinal cord that is closely similar to the rat SGE providing greater insight into the spinal control of ejaculation and potential pharmacological targets for the treatment of ejaculatory disorders. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
039
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IMMUNOHISTOCHEMICAL CHARACTERIZATION OF A SPINAL CORD GENERATOR OF EJACULATION IN HUMAN Chéhensse, C.1; Facchinetti, P.1; Bahrami, S.2; Andrey, P.3; Soler, J.M.4; Chrétien, F.5; Bernabé, J.6; Clément, P.6; Denys, P.2; Giuliano, F.2 1 INSERM-Université de Versailles Saint Quentin en Yvelines, France; 2Raymond Poincaré hospital-INSERM-Université de Versailles Saint Quentin en Yvelines, France; 3INRA-Université Pierre et Marie Curie Paris, France; 4Bouffard Vercelli Centre, France; 5Institut Pasteur-Saint-Anne Hospital, France; 6 Pelvipharm-INSERM-Université de Versailles Saint Quentin en Yvelines, France
THE MINIMALLY INVASIVE NO TOUCH (MINT) PENILE IMPLANT, THE FIRST 150 CONSECUTIVE CASES Katz, D.J.1; Love, C.1 1 Men’s Health Melbourne, Australia Objectives: The minimally invasive infrapubic inflatable penile implant procedure was developed by Dr. Perito with the aim of minimising operative time and post-operative morbidity. Dr Eid has also demonstrated a significant reduction in post- operative infections with his No-Touch technique. We have developed a new technique that combines key aspects of these 2 approaches to create a minimally invasive, no-touch (0 MINT0 ) technique for penile prosthesis insertion. We theorised that the MINT J Sex Med 2017;14:S1-S131
WMSM 2016 Abstracts
guidelines, utilization of single and multimodal therapies may improve ejaculatory latency times, thus improving the sexual experience and quality of life (QoL) of men with RE and their partners. In Canada, paroxetine is used off label an oral treatment, as dapoxetine (which is available worldwide and is, for example, on the NHS list of treatments in the UK) is not approved by Health Canada. Other options include couples therapy, behavioural modification, topical anesthetics, other oral off-label agents and use of condoms. The novel delivery lidocaine spray for premature ejaculation (Promescent) is available overthe-counter, and we assess efficacy in this difficult to treat group. Methods and Materials: Promescent, a novel lidocaine-only eutectic formulation enabling increased absorption of the anesthetic through the skin (refer to US patents 8507561 and 8563616) is available as an OTC product and was utilized in 20 consecutive men for treatment of refractory RE. All men had been treated for RE previously with at least two different modalities for a minimum of two years, and followed clinically through treatment their failures. The goal was to determine “reallife” success, as defined by patient and partner satisfaction with treatment and continued use of the specific treatment. Results: Eleven of 20 men continue to use Promescent at six months after initiation, with an initial response rate of 14/20. Two men ceased use due to partner or patient note of medication odor. One patient is without a partner, but continues to utilize with self-stimulation. 9/11 are in heterosexual relationships, 2/11 MSM. There has been no report of diminution of treatment effect after 6 months in the 11/20 group. Six of 20 found no improvement or improvement insufficient to continue treatment. Conclusions: In men with refractory RE, Promescent offers a greater than 50% opportunity for meaningful improvement in sexual function, as evidenced by continued usage at 6 months. Given the negative impact on QoL by RE, Promescent is a safe and potentially effective option for these men. Partner acceptance of treatment is high with minimal side-effect induced termination of treatment. Disclosure: Work supported by industry: no.
Clinical observations strongly suggest that a spinal neuronal organization commanding ejaculation exists in man that can be activated in spinal cord injured patients by penile vibratory stimulation despite disruption of cerebral connections. In the rat, a spinal generator of ejaculation (SGE) in 3rd and 4th lumbar (L3-L4) segments has been identified which is notably characterized by the presence of a variety of markers including receptors and neuropeptides onto the constituting neurons immunoreactive for galanin. Objective: An immunohistochemical study was conducted to identify in human lumbar spinal cord neuronal organization that shares similarities with the rat SGE. Material and Method: Post-mortem men and women (n¼3 each) spinal cord specimens were processed for immunodetection of galanin neurons, which distribution was 3D reconstructed. Co-expression with galanin of the molecular markers of the rat SGE (androgen and neurokinin-1 receptors, cholecystokinin, gastrin-releasing peptide, met-enkephalin) was assessed using confocal microscopy. Results: Galanin neurons were mostly located between L2 and L5 segments in medial lamina VII, with a maximum within L4. Three dimension reconstruction of spinal cord sections showed that galanin neurons were grouped into single columns bilaterally to the central canal. Galanin neurons were found in greater number in men than in women specimens indicating sexual dimorphism. In addition, a vast majority of L3-L4 galanin neurons were immunoreactive for cholecystokinin, gastrinreleasing peptide, met-enkephalin, androgen and neurokinin-1 receptors. Conclusion: A neuronal organization has been evidenced in human lumbar spinal cord that is closely similar to the rat SGE providing greater insight into the spinal control of ejaculation and potential pharmacological targets for the treatment of ejaculatory disorders. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
039
040
IMMUNOHISTOCHEMICAL CHARACTERIZATION OF A SPINAL CORD GENERATOR OF EJACULATION IN HUMAN Chéhensse, C.1; Facchinetti, P.1; Bahrami, S.2; Andrey, P.3; Soler, J.M.4; Chrétien, F.5; Bernabé, J.6; Clément, P.6; Denys, P.2; Giuliano, F.2 1 INSERM-Université de Versailles Saint Quentin en Yvelines, France; 2Raymond Poincaré hospital-INSERM-Université de Versailles Saint Quentin en Yvelines, France; 3INRA-Université Pierre et Marie Curie Paris, France; 4Bouffard Vercelli Centre, France; 5Institut Pasteur-Saint-Anne Hospital, France; 6 Pelvipharm-INSERM-Université de Versailles Saint Quentin en Yvelines, France
THE MINIMALLY INVASIVE NO TOUCH (MINT) PENILE IMPLANT, THE FIRST 150 CONSECUTIVE CASES Katz, D.J.1; Love, C.1 1 Men’s Health Melbourne, Australia Objectives: The minimally invasive infrapubic inflatable penile implant procedure was developed by Dr. Perito with the aim of minimising operative time and post-operative morbidity. Dr Eid has also demonstrated a significant reduction in post- operative infections with his No-Touch technique. We have developed a new technique that combines key aspects of these 2 approaches to create a minimally invasive, no-touch (0 MINT0 ) technique for penile prosthesis insertion. We theorised that the MINT J Sex Med 2017;14:S1-S131