RESUMEN
PURPOSE: Information was collected during the first 2 years of an ongoing, prospective, multi-institutional evaluation of the Dura-II penile prosthesis. Evaluation included data on clinical outcomes and a patient satisfaction survey, and will continue for 5 years after implantation for each patient. MATERIALS AND METHODS: To date 196 patients have been evaluated. Surgical data, adverse events and information from satisfaction surveys are reported. RESULTS: At a followup of 13.4 +/- 8.4 months postoperatively, adverse events occurred in 8.2% of the patients, resulting in reoperation in 5.1%. There have been no mechanical failures. Overall satisfaction rates were 85% at 3 months, 83% at 1 year and 91% at 2 years after implantation, and levels of sexual functioning were correspondingly high. A majority of patients assigned high scores to rigidity, concealability, ability to have intercourse and erection size, although satisfaction with erection size ranked lower than the other measures. CONCLUSIONS: The Dura-II penile prosthesis provides a satisfactory result and has an acceptable level of complications associated with its use. Further followup will assess temporal changes in satisfaction rates and sexual functioning for these patients.
Asunto(s)
Disfunción Eréctil/cirugía , Prótesis de Pene , Adulto , Anciano , Anciano de 80 o más Años , Disfunción Eréctil/etiología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Prospectivos , Diseño de Prótesis , Resultado del TratamientoRESUMEN
The appearance of the prostatic fossa on transrectal ultrasound (TRUS) scans obtained after radical retropubic prostatectomy (RRP) was studied in 25 patients believed to have no tumor on the basis of their level of serum prostate-specific antigen (PSA) (< or = 0.4 ng/mL). The profile of the vesicourethral anastomosis (VUA) in the midsagittal plane was tapered in 13 patients (52%) and nontapered in 12 patients (48%). The nontapered profile was associated with incontinence in nine of 11 patients (82%) followed up for less than 12 months but in only four of 14 patients (28%) followed up beyond 1 year. In 20 patients (80%), a hypoechoic soft-tissue lesion (average volume, 1.7 cm3) was seen anterior to the VUA and indented the anterior bladder wall. The length of the urethral high-pressure zone increased with muscular contraction of the pelvic floor. Knowledge of the baseline anatomic structures depicted on TRUS scans obtained after RRP may be useful in selection of tissue for TRUS-guided needle biopsy in patients with elevated levels of PSA. The many post-surgical changes reduced the specificity of the TRUS findings.
Asunto(s)
Cuidados Posoperatorios , Prostatectomía , Uretra/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Adenocarcinoma/cirugía , Tejido Adiposo/diagnóstico por imagen , Anciano , Anastomosis Quirúrgica , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular , Músculos/diagnóstico por imagen , Pelvis/diagnóstico por imagen , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Ultrasonografía , Uretra/cirugía , Vejiga Urinaria/cirugíaRESUMEN
The anatomic appearance of the prostatic fossa on transrectal ultrasound (TRUS) scans obtained after radical retropubic prostatectomy (RRP) for carcinoma was studied in 16 patients in whom local recurrence was suspected on the basis of rising serum prostate-specific antigen (PSA) levels above 0.4 ng/mL, negative pelvic computed tomographic scans, and negative bone scans. Findings in samples obtained with ultrasound (US)-guided biopsy were compared with those in samples obtained with digitally guided biopsy (DGB); each patient was his own control. When the postoperative anatomic appearance on TRUS scans was compared with that in patients without suspected recurrence of cancer, no significant difference was seen. Needle biopsy was positive for carcinoma in eight patients (50%): US-guided biopsy, in seven patients; DGB, in five patients; and both US-guided biopsy and DGB, in four patients. US-guided biopsy has limited usefulness over DGB in patients with rising PSA levels after RRP, but use of both DGB and US-guided biopsy may maximize sensitivity. The main value of TRUS may be in accurate positioning of the biopsy needle about the vesicourethral anastomosis.
Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/cirugía , Recurrencia Local de Neoplasia/patología , Cuidados Posoperatorios , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Uretra/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Tejido Adiposo/diagnóstico por imagen , Anciano , Anastomosis Quirúrgica , Biopsia/métodos , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular , Músculos/diagnóstico por imagen , Pelvis/diagnóstico por imagen , Estudios Prospectivos , Antígeno Prostático Específico/sangre , Prostatectomía/métodos , Ultrasonografía , Uretra/patología , Uretra/cirugía , Vejiga Urinaria/patología , Vejiga Urinaria/cirugíaRESUMEN
In 2 out of 3 cases of retrograde ejaculation treatment with clomipramine hydrochloride resulted in normal ejaculation and conception. The 3rd patient was only partially helped by the drug. The mechanisms of ejaculation, the causes of retrograde ejaculation, the management of the condition and the relevant pharmacological features of the tricyclic anti-depressants are discussed.