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Study of 33 subjects with erectile dysfunction after undergoing pelvic surgery, who were stratified in two groups: 16 where surgery appears to have no relation with the dysfunction and 17 where surgery appears to be the cause of the condition. They were compared with 151 cases with arterial dysfunction. Mean age in the group with surgery-related dysfunction (60 +/- 9.6) is higher than in the group with no relation (51.6 +/- 6.7) (p < 0.05), and in both cases similar to the group with arterial-related impotence. Both groups have vascular risk factors, superposed to those who had arteriogenic dysfunction. All flow-rate parameters in the baseline eco-doppler, degree of erectile response after intracavitary injection and flow-rate parameters after ICI can be superposed to those found in the arterial-related impotence. This suggests the existence of a likely pre-existent arterial disease which becomes unstable after surgery as a result of the vascular and nervous lesions as well as due to psychological changes. We insist on the need to gather information prior to surgery, and in the basically vascular nature of erectile dysfunctions developed in subjects who undergo pelvic surgery.

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The Eco-Doppler technique allows a fast, non-invasive and effective study of pental vascularization. Ninety-three subjects, aged 20-66, with no vascular disease were studied: 20 healthy volunteers and 73 with psychogenic dysfunctions. All subjects underwent a baseline study, and 89 a second study after intracavitary injection (ICI) (10 papaverine and 79 PgE1). No differences were seen between both drugs. Flowmetry parameters were analyzed at rest and post-ICI. At baseline, patients with psychogenic dysfunctions showed less diastolic speed (p < 0.05), acceleration (p < 0.001) and resistance index (p < 0.05) than normal subjects. After administration of the drug, no differences were detected between both groups that formed an homogeneous sample. Subjects with no vascular disease presented arterial dilatation after ICI, the vessels appearing with thin and parallel walls, homogeneous lumen and following a straight course. Flow speed parameters experienced significant changes: systolic speed increase by 153 +/- 97% (p < 0.001) and reached 34.7 +/- 9.3 cm/s; increase of diastolic speed was lower; but flow time and acceleration also increases although not significantly due to their high variability. At 20 minutes after ICI the resistance index is 0.83 +/- 0.1, higher (p < 0.001) than that observed at rest, expressing the high intracavitary pressure that exists when full erection is achieved.

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The etiological diagnosis of an erectile dysfunction usually requires a study of penis vascularization. The arterial origin involves a high percentage of erectile dysfunctions. The eco-doppler allows to perform the study in a fast, non-invasive and effective way, providing information on the morphological aspects of arteries and flow parameters. This paper reports on a study conducted in 151 subjects, aged 27-80 years, where the cause of impotence was arterial; the existence of clinical signs of vascular deficit in other domains had already suggested the condition in a group (36 subjects), while the another group (115) had no clinical symptoms and was diagnosed through eco-doppler. 75.5% were smokers and 83.1% hypertensive. All subjects underwent a baseline study, repeated in 148 after intracavitary injection (ICI). The arteries were difficult to identify at rest, but easier after ICI, presenting morphological features which were suggestive of disease: twisted course, irregular lumen, thickened walls. Flow parameters at rest presented no differences between groups, both speed (p < 0.001) and flow time (p < 0.05) being lower than in subjects with no vascular disease. Only 25.7% reached full erection with ICI, beats being noticed in 44 (91.9%). After administration of the drug there was a significant increase in systolic speed (p < 0.001), rising to 16 +/- 4.9 cm/s vs 34.7 +/- 9.3 cm/s in subjects with no vascular disease (p < 0.001). Flow time increases after ICI, reaching 345 +/- 215 msec, less than in healthy subjects (p < 0.001). RI, highly variable at rest, does not change significantly after ICI, 0.71 +/- 0.11, lower than subjects with no disease (p < 0.001). The increases seen in flow speed are greater in subjects with no ischaemic symptomatology (p < 0.01), same as RI (p < 0.05), and reveals a better arterial response. Those who obtain full erection reach greater RI (0.77 +/- 0.13) than those without full erection (0.68 +/- 0.08) (p < 0.001).

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Corporeal vein-occlusive dysfunction (CVOD) is a frequent cause of impotence. A study with eco-doppler was conducted in 36 cases where leaking was the single cause of dysfunction and in 12 associated to arterial disease, in order to evaluate whether this technique is able to diagnose the condition. The study with eco-doppler, at rest and 20 minutes after intracavitary injection (ICI) with a vasodilating agent, shows changes in the arterial vascularization that allow to suggest the existence of venous disease: similar arterial dilation and peak systolic speed as in subjects with no disease, diastolic speed higher than the control group (p < 0.01), flow during diastole (p < 0.001) and resistance index lower than the control group (p < 0.001). All the above involve a high sensitivity (97.2%) with 81.4% positive predictive value in the diagnosis of venous conditions. Specificity, however, is low (27.3%) since some subjects with no arterial disease do not display full erection 20 minutes post-ICI. By evaluating the ecodoppler and the overall erectile response, the diagnostic ability is increased when leaking is the only cause of dysfunction, reaching a 100% positive and 91.7% negative predictive value. When etiology of the condition is both arterial and venous, the eco-doppler is unable to indicate the existence of the venous condition.

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The negative role of smoking on circulation is widespread knowledge and it has been rated as a vascular risk factor. This paper evaluates the influence of smoking on the arterial supply to the erectile tissue, establishing the flow speed parameters in cavernous arteries with eco-doppler both at rest and after intracavernous PgE1 injection. Four groups were studied: non-smokers, without arterial disease and with arterial disease of non-smoking etiology; smokers with vascular disease, and another group where smoking was the only verified etiological factor. No significant differences were detected in flow speed parameters at rest among smokers and non smokers both in individuals with preserved erectile potency or with erectile dysfunction. Following drug therapy, impotent smokers showed the worse erectile response. With regard to flow speed parameters, although the differences were not significant, it can be seen that smokers, whether potent or not, show less differential speed, flow time, and acceleration, exhibiting a certain degree of arterial rigidity. That flow speed parameters, in cases with erectile dysfunction, can be superposed in individuals with arterial-origin impotence and those where smoking is the sole risk factor, indicates that this is a factor which causes erectile dysfunction due to vascular damage, as severe as any other caused by other factors such as arteriosclerosis, diabetes, or hypertension.

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The erectil dysfunction is a common disorder in diabetic patients resulting from neurological, arterial and endocrine factors. This paper presents an eco-doppler evaluation of the arterial factor in 88 diabetics: 17 controlled with diet, 38 with oral anti-diabetic agents and 33 with insulin. Age, ranging from 23 to 70 years old, was similar in subjects controlled with diet (55.6 +/- 6.4) or anti-diabetic agents (57.6 +/- 7.9), but greater in insulin-treated subjects (46.8 +/- 10.5) (p < 0.01). Fifty-six subjects (63.6%) has nocturnal and 43 (48.9%) diurnal erections, 45 (51.1%) achieving penetration. There was 65 (73.9%) smokers, 28 (31.8%) hypertensives, and 24 (27.3%) reported stress. A baseline evaluation was performed in all cases, in 87 after I.I.C (papaverin 26 and PgL1 61), full erection being achieved in 18 cases, non-rigid erection in 15, tumescence in 50 and with no response in 4. No differences were seen by type of diabetes. The variance analysis showed no differences in the flow speed indicators among the three groups, both at rest and after I.I.C., the sample being therefore homogeneous, superposable to arterial dysfunctions and significantly lower than those of the control group (p < 0.01). We conclude that diabetes induces arterial changes which are superposable to those caused by other vascular risk factors and independent for the type of diabetes.

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Idiopathic granulomatous orchitis is a rare testicle lesion of unknown etiology. This paper illustrates 10 cases studying their presentation, location, ultrasound and histological diagnosis and therapy. A testicular injury background and self-immune reaction appear as likely causes of this entity. Differential diagnosis with testes malignant tumours can only be reached after orchiectomy and a subsequent histological examination.

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The evaluation of erectile dysfunction by popliteal and pudendal evoked potentials is not widely utilized in our country, although the foregoing has proved to be a useful technique in the evaluation of a possible neurological etiology. This study describes this simple, fast and low cost method of evaluation and reports the normal ranges. The study comprised 40 subjects; 15 were healthy volunteers and the remaining had consulted for impotence and referred antecedents suggesting a neurological etiology. The results show that a latency of 40.9 +/- 2.1 msec in P1 for the pudendal evoked potentials is normal. Concerning the popliteal evoked potentials, the normal latency for P1 is 38.07 +/- 2.8 msec.

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Among 322 cases of primary malignant renal tumours reviewed between 1969 and 1991, six were renal sarcoma (1.85%). They all presented earlier symptomatology which was not different from other renal tumours, and nephrectomy was performed in all cases, 5 of which died before 14 months. The histopathological diagnose showed two liposarcoma, two carcinosarcomas, all the others being fibrosarcomas.

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Four cases with high flow priapism are described herein. Patient evaluation included intracavernal blood-gasmetry, echo Doppler, selective arteriography of the pudendal artery. Three patients had a previous history of trauma and one patient was on psychotropics. The alpha-agonist drugs and the different shunt techniques did not achieve detumescence. Two embolization procedures of the internal pudendal artery were performed with good long-term results. The other two cases achieved spontaneous detumescence. No complications or secondary erectile dysfunction were observed.

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The results obtained after treating 13 patients with low flow priapism diagnosed by cavernous gasometry, penile ecodoppler and cavernosography are explained. Seven cases of priapism (53%) developed following intracavernous injection of vasoactive drugs and had a good response to aspiration lavage and alpha-agonist medication. None of the cases needed shunt technique to achieve detumescence and all showed good evolution with regard to the erectile function. Six cases of priapism (47%) were idiopathic and they all needed some type of venous by-pass. Later, only one had normal erections.

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The study of impotentia coeundi requires separating the organic from the psychogenic cause. Arteriogenic impotence falls within the first group and has been assessed with the papaverine test, simple Doppler and arteriography. Currently, more sophisticated techniques such as the pulsed Doppler permit noninvasive assessment of the blood supply to the penile arteries. Intracavernous injection of vasoactive substances such as papaverine cause vascular changes. Evaluation of these changes permits making the diagnosis of arterial insufficiency without recurring to more invasive diagnostic techniques such as arteriography. Currently, this invasive technique is only justified in revascularization surgery but not for diagnosis. The availability of color Doppler facilitates arterial evaluation even further.

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Obstructive anuria does not necessarily show a marked dilatation of the urinary tract on evaluation with imaging techniques. A case with acute renal failure of this type is presented. We discuss why this condition is caused and how diagnosis can be made quickly. Likewise, we discuss the length of time we can defer renal diversion before rupture of the collecting system supervenes and, consequently, urinary extravasation.

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Cavernosometry and cavernosography in conjunction with artificial erection have been included in the protocol for the evaluation of sexual dysfunction in the male. The device is comprised of a volumetric infusion pump with a digital flow indicator, and the technique employed is bilateral puncture of the corpora cavernosa. Pressures are recorded by one needle while saline and contrast medium are introduced through the other. Eight males with no organic disorder were assessed for erection flow (EF) and maintenance flow (MF) to determine the normal and pathologic values for this method of evaluation. These values have a normal distribution. Calculation using formulas with a 99% reliability gave the following as pathological values: EF greater than 181 ml/min. or MF greater than 99 ml/min.

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A case of ureteral injury with urinary extravasation following aortofemoral by-pass is presented, the world bibliography of ureteral complications following aortofemoral by-pass reviewed. As possible causes of the ureteral injury of our case, a) decubitus by the dacron prosthesis and b) retroperitoneal fibrosis, are stressed. The etiology and the different methods of treatment are discussed.

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We present 8 patients treated with Dimethyl-sulphoxide, suffering from inflammatory processes of the lower, urinary tract which include: interstitial cystitis, urethral syndrome, incrustation of the prostatic cell, actinic cystitis and chronic prostatitis. All the patients have shown an improvement in their symptoms which, along with the absence of side effects and its easy administration, means that the said drug constitutes a means of therapy to be taken into account in the treatment of these inflammatory processes, following the consideration of more aggressive therapies.

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A case is presented of seminal vesicular cyst associated with kidney agenesia, ipsilateral ureter and hemitrigon; this is the 17th case presented in the world literature reviewed. A study is made of all the cases published and the authors recommend deferento-vesiculography as the best means of diagnosis and total excision of the cyst as the most effective treatment.

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A study is made of 25 patients suffering from a vesicular prostate pathology causing sterility. We have assessed the age, profession, symptoms, genital exploration and ejaculation study including the amount, pH, visocity, fructose, ascorbic acid, count, motility and morphology of the sperms and the high leukocyte reading. A seminal liquid culture has been carried out on 21 patients, alone or in association with cultures of prostate and urine secretion following prostate massaging with positive results in 16 of them (76%). Treatment was begun on 22 patients, in 13 of whom the results are known. Spermiogram readings became normal in 5 (38%) with one pregnancy; there was an associated pathology in the wife in 3 cases. As antibacterians we have basically used trimetoprim-sulphametoxazol associated with erythromycin or not and sometimes, according to the antibogram, with other antibiotics, as well as drugs to clear the prostate area. The best results were obtained in astenozoospermias. The effectiveness of the treatment was equally due to the use of TMP-SMZ on its own or along with erythromycin. The other drugs have not improved the results, except for minocyclin which megativated a sperm culture. As a preliminary result the author presented three patients with sperm infection produced by E. coli at whom the titer of antibodies in serum was investigated.

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