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Francesco Montorsi

Publications and source records attributed to Francesco Montorsi.

17 recordsLinked to original sources
PubMed2026

Paediatric penile length: a systematic review and meta-analysis.

OBJECTIVE: To assess geographical variation in stretched penile length among prepubertal boys and evaluate temporal trends over the past two decades, as defining reference values for genital organ size remains crucial for early identification of development disorders. METHODS: The PubMed, Cochrane and Scopus databases (no deadlines for publishing were imposed) were searched according to the Preferred Reporting Items for Systematic Review and Meta-analyses statement. Five authors independently extracted individual participant data and assessed the risk of bias. Studies with quantitative penile lengths were included; those involving congenital malformations were excluded. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (registration number CRD42022335643). RESULTS: A total of 55 studies from 2000 to 2024 were evaluated, including data from 31&#x2009;915 boys. Pooled mean stretched penile length estimates were 3.07&#x2009;cm (95% confidence interval [CI] 2.88-3.26&#x2009;cm) for the 1-week-old boys, 3.73&#x2009;cm (95% CI 3.53-3.93&#x2009;cm) for the 1-year-old boys, 4.69&#x2009;cm (95% CI 4.49-4.88&#x2009;cm) for the 2-5&#x2009;year-old boys, and 5.43&#x2009;cm (95% CI 5.20-5.66&#x2009;cm) for the 5-10&#x2009;year- old boys. When comparing data from the 2000s to the 2020s, stretched penile length decreased by 16.2% (from 3.46 to 2.90&#x2009;cm), 16.3% (from 4.17 to 3.49&#x2009;cm), 21.5% (from 5.31 to 4.17) and 26.2% (from 6.46 to 4.77&#x2009;cm) in the 1-week-old, 1-year-old, 2-5-year-old and 5-10-year-old boys, respectively. Subgroup analysis for those aged >2&#x2009;years showed significant variations by geographical region (P&#x2009;<&#x2009;0.001). CONCLUSIONS: The present study observed large variations in penile length across geographical regions and among prepubescent boys of different ages, while also suggesting a possible decline over the past two decades.

Humans↗
PubMed2003

Brain activation patterns during video sexual stimulation following the administration of apomorphine: results of a placebo-controlled study.

OBJECTIVES: To evaluate the in vivo effect of apomorphine sublingual versus placebo on cortical and subcortical brain activation during video sexual stimulation. METHODS: Ten patients with psychogenic erectile dysfunction and six potent controls underwent functional magnetic resonance of the brain during video sexual stimulation after the administration of either apomorphine sublingual 4mg or placebo following a randomized, double blind design. Functional magnetic resonance sessions were performed with a 7-day interval. RESULTS: In potent controls, viewing erotic versus neutral films induced bilateral activations in a network of occipito-parietal and temporal inferior regions, in dorsolateral and premotor frontal cortex, in anterior temporal limbic areas and the thalamus, which were comparable to the patient activations during erotic stimulation in the placebo condition. However, a striking difference was found in patients, who demonstrated a significant and extended activation in the cingulate gyrus, frontal mesial and frontal basal cortex, bilaterally, in comparison with potent controls. These activated neural systems were modulated by apomorphine administration which produced a picture that was similar to the one seen in potent controls. In patients with spychogenic erectile dysfunction apomorphine sublingual caused an increase in the extension of the activated networks, plus additional activation foci in subcortical and deep structures, namely in the nucleus accumbens, hypothalamus and mesencephalon: this activation was greater than that seen with placebo. Interestingly, a down-regulation in the frontal basal and temporal limbic cortex was present as shown by a decrease of functional magnetic resonance imaging signal reflecting a deactivation of these regions. CONCLUSIONS: Apomorphine significantly enhances the activation of cortical and subcortical brain function during video sexual stimulation. Patients with psychogenic erectile dysfunction may have an underlying functional abnormality of the brain acting as a previously unrecognised aetiological factor.

Administration, Sublingual↗
PubMed2003

Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease.

OBJECTIVES: The aim of this study was to assess erectile dysfunction prevalence, time of onset and association with risk factors in patients with acute chest pain and angiographically documented coronary artery disease. METHODS: 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease were assessed using a semi-structured interview investigating their medical and sexual histories, the International Index of Erectile Function and other instruments. RESULTS: Patient mean age was 62.5+/-8 years (range 33-86 years). Mean duration of symptoms or signs of myocardial ischaemia prior to enrollment in the study was 49 months (range 1-200). Coronary angiography showed 1-, 2- and 3-vessel disease in 98 (32.6%), 88 (29.3%) and 114 (38%) patients, respectively. The prevalence of ED among all patients was 49% (147/300). Erectile dysfunction was scored as mild, mild to moderate, moderate and severe in 21 (14%), 31 (21%), 20 (14%), and 75 (51%) of patients, respectively. There was no significant difference between patients with ED (n=147) or without ED (n=153) as far as clinical and angiographic characteristics were concerned. In the 147 patients with co-existing ED and CAD, ED symptoms were reported as having become clinically evident prior to CAD symptoms by 99/147 (67%) patients. The mean time interval between the onset of ED and CAD was 38.8 months (range 1-168). There was no significant difference in terms of risk factor distribution and clinical and angiographic characteristics between patients with the onset of ED before vs. after CAD diagnosis. Interestingly, all patients with type I diabetes and ED actually developed sexual dysfunction before CAD onset (p<0.001). CONCLUSIONS: Our study suggests that a significant proportion of patients with angiographically documented coronary artery disease have erectile dysfunction and that this latter condition may become evident prior to angina symptoms in almost 70% of cases. Future studies including a control group of patients with coronary artery disease and normal erectile function are required in order to verify whether erectile dysfunction may be considered a real predictor of ischemic heart disease.

Adult↗
PubMed2003

Peyronie's disease: a review.

PURPOSE OF REVIEW: This review is aimed to summarize the most recent findings about this topic, by reviewing the literature published in 2002 and 2003 regarding the epidemiology, pathophysiology, diagnosis and treatment of Peyronie's disease. RECENT FINDINGS: Although many aspects in pathophysiology, diagnosis, medical and surgical treatment of Peyronie's disease still remain under debate, recent interesting advances have been made regarding the different aspects of this condition. Topical and systemic medical therapies have been associated with varying degrees of results, depending on modalities and timing of the treatment itself. A wide range of surgical modalities have been recently developed, although the ideal surgical procedure especially in case of severe and complex curvature does not seem to be reached yet. Furthermore this condition is often associated with psychological distress that could be responsible for performance anxiety, leading to improvement of abnormalities in erectile functioning eventually associated with Peyronie's disease. SUMMARY: Peyronie's disease consists of an acquired penile deformity caused by the formation of fibrous plaques within the tunica albuginea, leading to bio-mechanical and vascular abnormalities. In the last decade numerous advances have been made regarding pathophysiology, diagnosis and treatment of this condition, allowing for improved patient clinical prognosis. Nevertheless, although improvements in medical and surgical therapies have substantially increased the successful patients' outcome rate, Peyronie's disease is still not completely understood and its treatment remains often frustrating for the practicing urologist. Clinical presentations of this disease include penile deformities or shortening during erection, painful erection, palpable plaque or induration throughout the length of the penile shaft and erectile dysfunction.

Humans↗
PubMed2003

Sildenafil in erectile dysfunction: a critical review.

Sildenafil citrate (Viagra) is a potent orally active cGMP-specific phosphodiesterase type 5 (PDE5) inhibitor that is effective as a peripheral conditioner in the treatment of male erectile dysfunction (ED) of organic, psychogenic or mixed aetiology. Sildenafil is the first effective oral agent in the management of ED that has had a revolutionary impact on management of ED. The present review has been subdivided into five major sections. Based on the most recent peer-reviewed publications, the first section is aimed at critically evaluating PDE5 selectivity as well as the pharmacokinetics and pharmacodynamics of the drug, mainly to assess the best doses for each group of patients (i.e. adult and elderly men). Effectiveness in a broad spectrum ED population is the subject of the second section of the review, principally reporting post-marketing company-independent results. Safety and tolerability are the key concerns of the third section, with a broad consideration of the most commonly reported adverse events. Special attention has been paid to the cardiovascular safety of the drug, chiefly outlining the positive and potentially protective cardiac effects of sildenafil. Moreover, the impact of sildenafil in special patient populations is considered, namely in men complaining of diabetes mellitus, depression, neurological disorders, renal failure and those who have undergone a radical prostatectomy. Sildenafil and the ageing male has been especially underlined. Finally, the review covers a few new potential applications of sildenafil in ED patients with regard to high-dose treatment and combination therapy. The review ends with several considerations regarding the direct and/or indirect impact of sildenafil over quality of life and quality of partnership.

Adult↗
PubMed2003

Sildenafil citrate for treatment of erectile dysfunction in men with type 1 diabetes: results of a randomized controlled trial.

OBJECTIVE: In the 5-10% of diabetic men with type 1 diabetes, erectile dysfunction (ED) may be a particularly common and unwanted complication. This is the first study focusing exclusively on the effects of sildenafil in men with type 1 diabetes and ED. RESEARCH DESIGN AND METHODS: A total of 188 patients were entered into a double-blind, placebo-controlled, parallel-group, flexible-dose study and were randomized to receive sildenafil (25-100 mg; n = 95) or placebo (n = 93) for 12 weeks. Efficacy was evaluated using questions three (Q3; achieving an erection) and four (Q4; maintaining an erection) from the International Index of Erectile Function (IIEF), a global efficacy question (GEQ; "Did treatment improve your erections?"), and a patient event log of sexual activity. RESULTS: Improvements in mean scores from baseline to end-of-treatment for IIEF Q3 (35.7 vs. 19.9%) and Q4 (68.4 vs. 26.5%) were significant in patients receiving sildenafil compared with those receiving placebo (P = 0.0001). Moreover, the percent of improved erections (GEQ, 66.6 vs. 28.6%) and successful intercourse attempts (63 vs. 33%) was significantly increased with sildenafil compared with placebo. Improvements in sexual function were seen irrespective of the degree of ED severity. Adverse events were generally mild to moderate in severity, with headache (20 vs. 8%), flushing (18 vs. 3%), and dyspepsia (8 vs. 1%) reported more often in the sildenafil than in placebo-treated patients. CONCLUSIONS: Treatment with sildenafil for ED was effective, resulting in an increased percentage of successful attempts at intercourse, and was well tolerated among men with type 1 diabetes.

Adult↗
PubMed2002

The ageing male and erectile dysfunction.

Erectile dysfunction (ED) is common in the ageing man and reliable therapies are needed. The pathophysiology of erectile dysfunction in this patient group mainly includes chronic ischaemia, which triggers the deterioration of cavernous smooth muscle and the development of corporeal fibrosis. The assessment of the ageing man with erectile dysfunction who seeks medical treatment should include a thorough medical and sexual history, a systemic and focused physical examination and selected blood tests. An extensive discussion of the various therapeutic options should follow in order to allow the patient to identify the most suitable alternative. Oral drug therapy represents a safe and efficacious option for most elderly patients.

Aging↗
PubMed2002

A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation.

PURPOSE: We compared the efficacy of paroxetine alone and combined with sildenafil in patients complaining of premature ejaculation. MATERIALS AND METHODS: Enrolled in this study were 80 consecutive potent men 19 to 47 years old (mean age 34) with premature ejaculation but without any obvious organic cause. Pretreatment evaluation included a history, self-administration of the International Index of Erectile Function (IIEF) questionnaire, physical examination and the Meares-Stamey test to exclude genital tract infection. The initial 40 patients received 10 mg. paroxetine daily for 21 days and then 20 mg. as needed, that is 3 to 4 hours before planned sexual activity, for 6 months (group 1). The other group of 40 men received 10 mg. paroxetine daily for 21 days and then 20 mg. as needed plus 50 mg. sildenafil as needed, that is 1 hour before planned sexual activity, for 6 months (group 2). Patients were followed 3 and 6 months after beginning therapy and were evaluated using several general assessment questions, IIEF and ejaculatory latency time. RESULTS: Mean ejaculatory latency time +/- SE in group 1 was 0.33 +/- 0.04, 3.7 +/- 0.10 (p <0.01) and 4.2 +/- 0.03 (p <0.01) minutes at baseline, 3 and 6-month followup, while in group 2 it was 0.35 +/- 0.03, 4.5 +/- 0.07 (p <0.01) and 5.3 +/- 0.02 (p <0.001) minutes, respectively. When improvement in ejaculatory latency time was compared in the 2 groups, group 2 results proved to be significantly greater (p <0.05). Baseline, and 3 and 6-month mean intercourse satisfaction domain values of the IIEF were 9, 11 and 11 (p = 0.09, not significant), and 9, 11 and 14 (p <0.05) in groups 1 and 2, respectively. Group 2 patients reported significantly greater intercourse satisfaction than those in group 1 (p <0.05). At baseline, 3 and 6 months there was a mean of 0.9 +/- 0.1, 1.7 +/- 0.3 (not significant) and 2.5 +/- 0.3 (p <0.01) coitus episodes weekly in group 1, and 1 +/- 0.2, 2.3 +/- 0.3 (p <0.01) and 3.2 +/- 0.1 (p <0.001) in group 2, respectively. Group 2 patients reported a significantly higher number of coitus episodes weekly (p <0.05). Side effects in the 40 group 1 cases included anejaculation in 1 (2.5%), gastrointestinal upset and/or nausea in 5 (12.5%), headache in 4 (10%) and decreased libido in 2 (5%). Side effects in the 40 group 2 cases included anejaculation in 1 (2.5%), headache in 8 (20%), gastrointestinal upset and/or nausea in 6 (15%) and flushing in 6 (15%). Group 2 patients reported significantly more headaches (p <0.01) and flushing episodes (p <0.001) than those in group 1. After 6 months of treatment 33 men (82.5%) in group 1 and 36 (90%) in group 2 were willing to continue therapy (not significant). CONCLUSIONS: Paroxetine combined with sildenafil appears to provide significantly better results in terms of ejaculatory latency time and intercourse satisfaction versus paroxetine alone in potent patients with premature ejaculation. However, combined treatment is associated with a mild increase in drug related side effects.

Adult↗
PubMed2002

A 4-year update on the safety of sildenafil citrate (Viagra).

Clinical studies have demonstrated that sildenafil citrate (Viagra) is an effective and well-tolerated oral treatment for erectile dysfunction. Despite its established safety profile, concern about its cardiovascular safety persists among some physicians and the general public. This concern has stemmed primarily from sporadic reports of adverse events published in the literature and sensationalized by the media. However, the only absolute contraindication for sildenafil is concurrent use of nitrates. Because sildenafil has been on the market for 4 years and under clinical investigation for even longer, we can now evaluate its long-term safety in men who have been taking the drug for several years. We review this issue from 3 perspectives. First, we reassess the overall safety profile of sildenafil by reviewing the initial controlled clinical trials and open-label studies. We present new data from patients who have been exposed to sildenafil for up to 4.5 years. We also evaluate the results from independent postmarketing studies. Second, we review the cardiovascular-specific results from the clinical trials, long-term extension, and postmarketing studies. Lastly, we review the specific effects on the visual system based on findings from studies conducted during drug development and post marketing.

Cardiovascular System↗
PubMed2002

Guidelines on erectile dysfunction.

The introduction of new oral therapies has completely changed the diagnostic and therapeutic approach to erectile dysfunction. A panel of experts in this field have developed guidelines for clinical evaluation and treatment based on the review of available scientific information.

Adult↗
PubMed2002

Vestibular flap urethroplasty for strictures of the female urethra. Impact on symptoms and flow patterns.

INTRODUCTION: To assess the impact on subjective symptoms and flow patterns of a new surgical technique designed to correct strictures of the female distal urethra and urethral meatus. MATERIALS AND METHODS: Seventeen patients (mean age 41.2 years) with symptomatic strictures of either the distal urethra or the urethral meatus entered the study. Patients reporting an AUA score >20, a diagnosis of bladder outlet obstruction according to the Abrams-Griffiths nomogram and the Schaefer linPURR diagram, urethral calibration <20 F and radiologic evidence of the stricture, were considered eligible for surgery. A pedicled flap isolated from the vaginal vestibule was anastomosed with two longitudinal running sutures along the two edges of an opened urethra. RESULTS: In all cases, diffuse fibrosis of the urethral wall was demonstrated at histological examination. Mean (+/- SE) preoperative and 12-month follow-up results were as follows: AUA score 25.2 +/- 2.1 vs. 8.4 +/- 1.2 (p < 0.0001); peak flow rate (ml/s) 13.2 +/- 1.2 vs. 36 +/- 1.5 (p < 0.0001); detrusor pressure at Q(max) (cm H(2)O) 45 +/- 5 vs. 17 +/- 3; residual urine volume (ml) 120 +/- 5 vs. 20 +/- 5 (p < 0.0001). Fifteen patients (88%) showed an unobstructed Abrams-Griffiths nomogram and a Schaefer linPURR diagram postoperatively. All but 2 cases (88%) could be calibrated at 28 F postoperatively and showed a normal urethral lumen at voiding cystourethrography. Complications were never noted. CONCLUSIONS: Female patients with symptomatic strictures of the distal urethra or urethral meatus may be treated efficaciously and safely with vestibular flap urethroplasty. Although this technique must be performed under optical magnification it is easy to perform and is not associated with complications.

Adolescent↗
PubMed2002

[Diagnostic value of ultrasound-guided anastomotic biopsies in patients with high PSA (> or = 0,4 ng/ml) after radical prostatectomy].

OBJECTIVES: The authors report their experience on the use of a high number of biopsies for the diagnosis of a vesicourethral anastomosis tumor recurrence in patients who underwent radical prostatectomy with a PSA elevation. METHODS: Sixty-five patients with PSA > or = 0.4 ng/ml after radical prostatectomy received 6 to 8 transrectal ultrasound (TRUS) guided biopsies of the vesicourethral anastomosis. RESULTS: The biopsy scheme with 6 random anastomotic biopsies plus additional biopsies through TRUS detectable lesions was able to diagnose a local recurrence in more than 60% of the cases. In presence of a post-operative PSA < 1.0 ng/ml and in absence of ultrasound detectable or palpable lesions a local neoplastic recurrence was detected in 58% of the cases. In presence of a palpable or ultrasound visible lesions, the detection rate increases to 80% of the cases.

Biopsy↗
PubMed2002

Phosphodiesterase inhibitors for the treatment of erectile dysfunction.

The key event in penile erection is relaxation of the cavernous smooth muscle. As phosphodiesterases (PDEs) are key enzymes of the signaling pathway, knowledge about cavernous PDEs is of major importance in understanding the effects and side-effect profile of new and selective pharmacological agents for erectile dysfunction. Experimental studies revealed that gene transcripts of 14 different PDE isoenzymes are present in human cavernous tissue. Of these, PDE3 and 5 have the most prominent functional role. The effects and side effects of clinically available PDE5 inhibitors can be explained both by the distribution pattern of these two isoenzymes in various tissues, by direct inhibition of PDE5 and indirect inhibition of PDE3 in various tissues, and by the putative selectivity for a cavernous-specific PDE splice variant.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed2002

[Role of ultrasonography-guided prostatic biopsy of hypoechoic areas associated with systematic biopsies in patients with normal and high PSA levels].

OBJECTIVE: The aim of the study is to evaluate the need to perform directed biopsies to hypoechoic areas at transrectal ultrasound associated with a prostatic mapping in patients with normal and elevated levels of PSA. MATERIALS AND METHODS: Since January 1987, 517 consecutive patients (mean age: 65.5 +/- 5.2 yrs) underwent selective prostatic biopsies of hypoechoic areas and systematic sextant biopsies with 10 samples in patients with a prostatic volume < 60 g and 12 samples in prostatic volume > 60 g. RESULTS: The median PSA value was 7.2 +/- 4.6 ng/ml (SD). 52% of the patients had a positive digital rectal examination. Cancer was detected in 47% of the patients (245/517), in 18% (14/78) of patients with PSA level < 4.0 ng/ml, in 42% (109/256) with PSA level from 4 to 10 ng/ml, in 66% (122/183) with PSA > 10 ng/ml. The PSA value was statistically higher (PSA = 14.9 +/- 17) in patients with positive prostatic biopsies compared to patients with negative biopsies (PSA = 8.5 +/- 8.3 ng/ml) (p > 0.0001). The PPV (positive predictive value) of the hypoechoic lesions was 36% (187/517). Cancer was detected only in directed biopsies of the hypoechoic areas regardless of PSA value in the 20% of patients (49/245). Sextant biopsies were positive with negative directed biopsies in 24% (58/245) of the patients, while both directed and sextant biopsies were positive in 56% (138/245) of the patients. COMMENTS: The hypoechoic lesion is the prostatic area in which prostatic cancer is most likely to be located in spite of the fact that the PPV of a hypoechoic area is less than 40%. The combination of sextant and lesion-directed biopsies maximizes the detection rate using the lowest possible number of biopsy cores. In the case of a TRUS visible lesion, the optimal number and placement of added systematic biopsies is yet to be defined. Due to the multifocality of prostate cancer, in the future, it is probable that, by adding more biopsies to the sextant standard scheme, the necessity of biopsying single small hypoechoic lesions will no longer be necessary.

Aged↗
PubMed2002

[Role of prostate fossa ultrasonography in the diagnosis of local recurrence after radical prostatectomy in case of PSA failure].

OBJECTIVES: The aim of this study is to verify the diagnostic accuracy of transrectal ultrasound (TRUS) of vesico-urethral anastomosis in patients with PSA elevation (> or = 0.2 ng/mL) after radical prostatectomy, who received 4-6 random anastomotic biopsies of the prostatic fossa plus additional biopsies directed to TRUS detectable lesions. MATERIAL AND METHODS: Since 1992 up to now, 102 patients (mean age: 68.3 +/- 5.4 years) with PSA elevation after radical prostatectomy underwent TRUS of the vesico-urethral anastomosis and 4-6 TRUS-guided random biopsies plus 1-2 additional biopsies directed to TRUS detectable lesions. Pathologic stage was B (ASS classification) in 60% of cases, C in 36% and D in 4% (patients without hormonal treatment who underwent TRUS-guided biopsy because of TRUS detectable or palpable lesion). RESULTS: The mean PSA at biopsy time was 2.1 +/- 4.6 (SD) ng/mL (range: 0.2-31.6 ng/mL) with median PSA of 0.9 ng/mL. DRE was positive in 37% of cases, while TRUS was positive in 73%. Recurrent adenocarcinoma was detected in 51% of all patients and in 45% (26/57) of patients with PSA < 1.0 ng/mL. TRUS sensitivity was higher (80%) than DRE (50%), but specificity was lower (37% vs 81%). The positive predictive value of TRUS detectable lesion was 60%. TRUS sensitivity and specificity increase with PSA elevation and sonographic aspects of prostatic fossa are statistically correlated with histology when PSA > 1.2 ng/mL. CONCLUSIONS: TRUS of the vesico-urethral anastomosis seems to be more sensitive but less specific than DRE for prostatic cancer local recurrence. More than half of TRUS detectable lesions is positive at biopsy. TRUS and TRUS-guided biopsy accuracy are directly correlated with PSA elevation.

Aged↗