RESUMEN

Objetivo Este estudio evalúa la seguridad y la eficacia del sistema Rezūm® en los pacientes con disfunción eréctil (DE) con y sin prótesis peneana inflable (PPI). Materiales y métodos Se trata de una revisión retrospectiva de los pacientes con DE tratados con Rezūm® por un único cirujano durante 12 meses. De cada paciente se obtuvo la edad, la presencia de PPI, el número de medicamentos para la hiperplasia prostática benigna, la puntuación internacional de síntomas prostáticos (IPSS), el índice de calidad de vida (QOL) de la IPSS, la tasa de flujo máximo (Qmáx) en la uroflujometría y la tasa de flujo promedio (Qavg) en la uroflujometría antes y después del tratamiento con Rezūm®. Se utilizaron pruebas T para 2 muestras independientes con objeto de comparar las características preoperatorias y postoperatorias entre los pacientes con y sin PPI. Se realizó una regresión lineal para identificar los factores asociados con el Qmáx o Qavg postoperatorio. Resultados Se identificaron un total de 17 pacientes con DE sometidos al sistema Rezūm®, incluyendo 11 pacientes con una PPI. La mediana de seguimiento tras el tratamiento con Rezūm® fue de 65 días. No hubo diferencias significativas en cuanto a los datos demográficos y las características clínicas basales entre los pacientes con y sin PPI. El Qmáx postoperatorio (10,9 frente a 9,8ml/s; p=0,04) y el Qavg (7,5 frente a 6,0ml/s; p=0,03) fueron significativamente mayores en los pacientes con PPI en comparación con los pacientes sin PPI. No hubo factores asociados con el Qmáx o el Qavg postoperatorio en la regresión lineal. Dos pacientes sin PPI resultaron en retención urinaria, mientras que en los pacientes con PPI no se produjeron complicaciones. Conclusión Rezūm® es un procedimiento seguro y eficaz para realizar en pacientes con DE, especialmente en aquellos con una PPI. Los pacientes con PPI pueden experimentar un incremento mayor en los parámetros de uroflujometría en comparación con los pacientes con DE sin PPI (AU)

Purpose This study evaluates the safety and efficacy of Rezūm™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). Materials and methods This was a retrospective review of ED patients who underwent Rezūm™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmáx), and uroflowmetry average flow rate (Qavg) before and after Rezūm™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmáx or Qavg. Results A total of 17 patients with ED who underwent Rezūm™ were identified, including 11 patients with an IPP. The median follow-up after Rezūm™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmáx (10.9ml/s vs. 9.8ml/s, P=.04) and Qavg (7.5ml/s vs. 6.0ml/s, P=.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmáx or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. Conclusion Rezūm™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP (AU)

Asunto(s)

RESUMEN

Inflatable penile prosthesis (IPP) remains the gold standard for the surgical treatment of refractory erectile dysfunction; however, current literature to aid surgeons on how best to counsel patients on their postoperative inflated penile length is lacking. The aim of this study was to identify preoperative parameters that could better predict postoperative penile length following insertion of an IPP. Twenty men were enrolled in a prospective study examining penile lengths before and after IPP surgery. Patients with Peyronie's disease were excluded from this analysis. Baseline preoperative characteristics, including body mass index, history of hypertension, diabetes, Sexual Health Inventory for Men scores and/or prior radical prostatectomy were recorded. All patients underwent implantation with a three-piece inflatable Coloplast penile prosthesis. We compared stretched penile length to pharmacologically induced erect lengths. Postoperatively, we measured inflated penile lengths at 6 weeks and assessed patients' perception of penile size at 12 weeks. The median (±interquartile range) stretched penile length and pharmacologically induced erect penile length was 15 (±3) and 14.25 (±2) cm, respectively (P=0.5). Median post-prosthesis penile length (13.5±2.13 cm) was smaller than preoperative pharmacologically induced length (P=0.02) and preoperative stretched penile length (P=0.01). The majority of patients (70%) had a decrease in penile length (median loss 0.5±1.5 cm); however, this loss was perceptible by 43% of men. Stretched penile length and pharmacologically induced erect penile length were equally good predictors of postoperative inflated length (Spearman's correlation 0.8 and 0.9, respectively). Pharmacologically induced erect penile length and stretched penile lengths are equal predictors of post-prosthesis penile length. The majority of men will experience some decrease in penile length following prosthesis implantation; however <50% report a subjective loss of penile length.

Asunto(s)

Asunto(s)

RESUMEN

There is little question as to the efficacy of sildenafil citrate (Viagra) for the treatment of erectile dysfunction. Two years of post-marketing experience provide data which indicates that the efficacy and safety of sildenafil citrate is consistent with the data obtained in clinical trials. This paper provides an update of the clinical efficacy and safety of sildenafil collected since its market approval in March of 1998. International Journal of Impotence Research (2000) 12, Suppl 4, S62-S66.

Asunto(s)

RESUMEN

Hidden foreign bodies have been described as a rare cause of both strangulation of the glans penis and urethrocutaneous fistula. We present the case of a 30-year-old man who developed a urethrocutaneous fistula and penile shaft necrosis after a condom broke during intercourse. Neither the patient nor several physicians could identify the retained ring of condom, which had been buried under newly epithelialized skin. He underwent removal of the foreign body under general anesthesia, followed 5 months later by a formal urethrocutaneous fistula repair.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVES: To evaluate, using a long-term, prospective study, the satisfaction rate, attrition rate, and follow-up treatment of well-trained patients using an external vacuum erection device, the Osbon ErecAid System, in the treatment of mild, moderate, and severe organic erectile dysfunction. METHODS: One hundred twenty-nine patients were assessed to determine the severity and cause of their erectile dysfunction. Patients with organic erectile dysfunction who were interested in the Osbon ErecAid received the device after thorough training. Patients received a follow-up questionnaire regarding satisfaction, months of use, reasons for discontinuing, and further treatment. RESULTS: Our attrition rate was 65% overall and was lowest among patients with moderate erectile dysfunction (55%). All patients with mild dysfunction discontinued use, and a large number (70%) of patients with complete dysfunction also discontinued use. Of the patients who discontinued, most stopped treatment early (median 1 month, mean 4 months) and 63% did not seek further treatment. Thirty-five percent of patients were satisfied with the device and have continued to use it long term (mean 37 months). CONCLUSIONS: Our study showed a lower success rate than previous reports. Patients who were satisfied with the Osbon ErecAid continued to use it for long periods. Patients who were not satisfied dropped out very quickly, and many did not seek further treatment. Patients with moderate erectile dysfunction had a higher rate of success than patients with mild or severe erectile dysfunction.

Asunto(s)

RESUMEN

We report a case of penile rupture after a self-inflicted injury, which was repaired through a 4-cm midline raphe incision in the high-scrotal position. A single injury to the right lateral corpora cavernosum was identified and repaired. This incision allows for exposure of all three corporal bodies and results in excellent cosmesis. Creating artificial tumescence with intracorporal saline injection can be useful in identifying small or multiple sites of corporal injury. This may obviate the need for performing a routine degloving procedure, which results in unnecessary dissection, increased edema, and potential visible scarring of the penile skin.

Asunto(s)

RESUMEN

Electroejaculation has been successfully used for sperm procurement in anejaculatory men desiring fertility. However, electroejaculates typically have normal sperm numbers but poor motility, morphology, and functional deficiencies. Here we report the pregnancy outcome of a series of couples undergoing combined electroejaculation and in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). In all, 13 couples underwent a total of 18 cycles. The aetiologies of anejaculation included history of retroperitoneal lymph node dissection for testicular cancers, spinal cord injury and psychogenic causes. ICSI was performed on 192 oocytes, resulting in a fertilization rate of 75.5%. A total of 15 embryo transfers were performed using a total of 51 embryos. Clinical pregnancy rate, as defined by positive fetal heart rate(s) using vaginal sonography, was 55.6% per retrieval; implantation rate was 33.3% per embryo. These rates appear to be similar to those obtained in standard IVF for non-male factor infertility, or ICSI for male factor infertility. The use of ICSI for electroejaculates undoubtedly provides these couples with the highest chance of pregnancy.

Asunto(s)

RESUMEN

PURPOSE: To determine the etiology of treatment-induced erectile dysfunction among patients who underwent surgery or radiotherapy for prostatic cancer. METHODS AND MATERIALS: Ninety-eight patients were evaluated for erectile dysfunction after definitive therapy for prostate cancer with Duplex ultrasonography before and after intracorporal prostaglandin injection. Patients were classified as having arteriogenic, cavernosal, mixed (arteriogenic/cavernosal), or neurogenic impotence based upon the results of the Duplex studies. RESULTS: Among patients who underwent radical prostatectomy (RP), 31 (52%) had cavernosal dysfunction, 19 (32%) had arteriogenic dysfunction, 3 (5%) were classified as mixed, and 7 (12%) as neurogenic dysfunction. Among patients treated with radiotherapy (RT), 24 (63%) had arteriogenic dysfunction, 12 (32%) had cavernosal dysfunction, 1 (2.5%) were classified as mixed, and 1 (2.5%) as neurogenic dysfunction. A multivariate analysis identified prior RT as the only predictor of an arteriogenic etiology (p < 0.001) and prior RP as the only predictor of a cavernosal etiology (p < 0.04) for erectile dysfunction among these patients. In the RP and RT groups, the median erectile responses were 70 and 65%, respectively. Arterial peak flows < 25 cc/min predicted for a suboptimal erectile response with intracavernosal prostaglandin injections. Among 47 patients with arterial peak flows < 25 cc/min, 21 (55%) had erectile responses of < 70%, while for 51 patients with arterial peak flows > or = 25 cc/min, 31 (39%) had erectile responses of < 70% (p < 0.039). CONCLUSIONS: While the etiology of erectile dysfunction after definitive therapy for prostatic cancer is likely a multifactorial phenomenon, these data suggest that the predominant etiology among patients who undergo RT is arteriogenic and among patients who undergo RP is veno-occlussive/cavernosal pathology. This information may have implications for the design of more effective therapies to address erectile dysfunction in this patient population.

Asunto(s)

RESUMEN

PURPOSE: We identified potential predictors, a high risk period and reasons for attrition, as well as the therapeutic alternatives chosen by men who discontinued intracavernous injection. MATERIALS AND METHODS: After patients had followed the protocol of evaluation and a home trial, they were given prostaglandin E1; a triple mixture of papaverine, phentolamine and prostaglandin E1; papaverine and phentolamine, or papaverine and prostaglandin E1. Data on the 1,089 patients enrolled in the pharmacological erection program from 1988 to 1996 were retrospectively reviewed to compare characteristics of active patients and those who discontinued therapy. RESULTS: Our attrition rate was 37.6% overall and 27.5% among prostaglandin E1 users. Patients who continued active therapy remained in the program for a mean of 26 months. We could identify no risk factor for erectile dysfunction or associated condition as a risk factor for attrition. More than 50% of men who discontinued therapy did so within the first 2 months of the program but the attrition rate for the 2 years following this time was less than 10%. Among those who dropped out of therapy 52% received a penile prosthesis. CONCLUSIONS: Failure of prostaglandin E1 and triple drug therapy is the best predictor of failure of intracavernous injection. We suggest that clinicians carefully follow and counsel patients at high risk for failure about alternative treatment within the first 3 months. Remaining on intracavernous injection beyond the first 2 months is a likely predictor of long-term success, confirming intracavernous injections to be an effective long-term therapeutic option.

Asunto(s)

RESUMEN

PURPOSE: We evaluated semen quality and pregnancy rates achieved with sperm obtained by rectal probe ejaculation. MATERIALS AND METHODS: A series of 183 rectal probe ejaculation procedures performed by 1 of us (J. F. E.) on 40 anejaculatory men was reviewed. RESULTS: Motile sperm were recovered from 95% of men undergoing rectal probe ejaculation. Live births were recorded for 15 of 33 couples (45%) via intrauterine insemination (10) or in vitro fertilization (5). Three of the latter 5 pregnancies were achieved with intracytoplasmic sperm injection. CONCLUSIONS: Motile sperm are obtained from most men undergoing rectal probe ejaculation and pregnancy rates obtained with these sperm are improved by in vitro fertilization.

Asunto(s)

RESUMEN

Two patients following bladder exstrophy repair presented for final cosmetic reconstruction with the characteristic lower abdominal midline scar, bisected mons pubis, and laterally displaced labia majora. Tissue expanders were used to obtain additional skin and subcutaneous tissue. After adequate serial expansion, the expanders were removed, scar tissue excised, and primary approximation of healthy tissues performed. A tension-free closure and esthetically pleasing midline incision, mons pubis, and vulva were obtained.

Asunto(s)

RESUMEN

A possible mechanism of varicocele-induced infertility is believed to be elevation of testicular temperature. Sensitive needle thermistors were used to measure directly intratesticular and bilateral scrotal surface temperatures simultaneously in anesthetized infertile men with varicocele and control subjects. We found that intratesticular temperature is elevated significantly in humans with varicocele. In addition, we have shown that scrotal skin surface temperature is elevated in men with varicocele. Furthermore, we demonstrate that unilateral varicocele is associated with bilateral elevation of scrotal surface temperature. These findings confirm the results of animal studies revealing elevation of intratesticular temperature associated with varicocele and suggest bilateral elevation in unilateral varicocele.

Asunto(s)