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BackgroundWhile premature ejaculation (PE) is a common and disturbing sexual dysfunction in men, current available treatment modalities have limited efficacy and low treatment adherence.AimTo assess the feasibility, safety, and efficacy of the vPatch, a miniaturized on-demand perineal transcutaneous electrical stimulation device for treating PE.MethodsThis prospective bicenter international first-in-human clinical study consisted of 2 arms, was sham controlled, and had a randomized double-blind design. In terms of statistical power calculation, 59 patients aged 21 to 56 years (mean ± SD, 39.8 ± 9.28) with lifelong PE were included. During the initial visit, intravaginal ejaculatory latency time (IELT) was measured over a 2-week run-in period. Eligibility was confirmed in visit 2, based on IELT values, medical and sexual history, and patients’ individualized sensory and motor activation thresholds during perineal stimulation with the vPatch. Patients were randomized to the active (vPatch) and sham device groups in a 2:1 ratio, respectively. The vPatch device’s safety profile was determined by comparing the incidence of treatment-emergent adverse events. During visit 3, IELTs, Clinical Global Impression of Change scores, and Premature Ejaculation Profile questionnaire outcomes were recorded. Primary end points assessed vPatch device efficacy as mean change in geometric mean IELT; each person was compared with himself, with and without the device, and the sham group was compared with the active group.OutcomesOutcomes included changes in IELT and Premature Ejaculation Profile before and after treatment, last visit Clinical Global Impression of Change scores, and vPatch safety profile.ResultsOf 59 patients, 51 completed the study: 34 in the active group and 17 in the sham group. The baseline geometric mean IELT significantly increased from 67 to 123 seconds (P Clinical ImplicationsTherapeutic use of the vPatch during coitus may become an on-demand, noninvasive, and drug-free treatment for PE.Strengths and LimitationsTo our knowledge, this is the first rigorous study investigating whether transcutaneous electrical stimulation during coitus could improve the symptoms of men with lifelong PE. The study is limited by the small number of patients, the exclusion of patients with acquired PE, the short-term follow up, and the use of a device based on a theoretic mechanism of action.ConclusionWe demonstrated the possibility to treat lifelong PE by prolonging coitus on demand, using electric stimulation of ejaculation muscles with the vPatch.Clinical trial registration: NCT03942367 (ClinicalTrials.gov).

Introduction: Andrological emergencies include a wide array of acute genital injuries which require immediate care from the specialist. Missing or delaying treatment often results in permanent loss of function or, in some cases, loss of the affected organ itself.Evidence acquisition: A comprehensive bibliographic search of PubMed database with up-to-date existing reviews and case reports was performed.Objective: This chapter aims to review major andrological emergencies with peculiar attention to clinical presentation and practical management in order to provide the specialist with reliable information to keep in mind when confronting these challenging occurrences.

BackgroundHyaluronic acid (HA) has demonstrated clinical benefits for the treatment of Peyronie’s disease (PD); however, there are no reports that documented long-term outcomes. The aim of the current study is to illustrate the clinical outcomes after 2 years of follow-up in patients who received HA for PD.MethodsFrom January 2015 to December 2018, we enrolled 244 patients affected by PD in this multicenter non-randomized clinical study, as previously reported. Patients received intralesional HA (Group A) or verapamil (Group B). Follow-up was undertaken after 3 months, 1 year, and 2 years. International Index of Erectile Function (IIEF-5), PC, and visual analogue scale (VAS) were collected.ResultsAmong the whole cohort, 125 patients were included in Group A and 119 in Group B. As PC, the median curvature was 25.0° at 3 months [interquartile range (IQR), 15.0–30.0] (p=0.45) and was maintained at 1 (p=0.87) and 2 years of follow-up (p=0.90) (Group A), while it was 30.0° (IQR, 20.0–35.0) (p=0.67) at 3 months and was stable at 1 (p=0.77) and 2 years of follow-up (p=0.80) (Group B). For VAS score, the median change in Group A was −4.0 (IQR, −4.0, −5.0, pConclusionsWe reported clinical efficacy of intralesional HA in patients with PD after 2 years of follow-up by slightly improving penile curvature (PC) and bother of the disease. These results should be considered during the counseling of the patients especially regarding the lack of worsening over time.