The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction.

The purpose of this research was to determine the prevalence of erectile dysfunction (ED) in a non-selected population using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool. In a non-institutionalized population and during a free screening program for prostate cancer (Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil), from 26 to 30 July 1998, all men who were attending were invited to complete a sexual activity questionnaire (the abridged 5-item version of the International Index of Erectile Function-IIEF-5) as a diagnostic tool for ED. The possible scores for the IIEF-5 range from 5 to 25, and ED was classified into five categories based on the scores: severe (5-7), moderate (8-11), mild to moderate (12-16), mild (17-21), and no ED (22-25). Of the 1071 men who participated in the program, 965 (90.1%) were included in this study. Of the responding men 850 were Caucasian (88%) and 115 were black (12%). The mean age of the men was 60.7 y, ranging from 40 to 90 y old. In this sample the prevalence of all degrees of ED was estimated as 53.9%. In this group of men, the degree of ED was mild in 21.5%, mild to moderate in 14.1%, moderate in 6.3%, and severe in 11.9%. According to age the rates of ED were: 40-49 (36.4%); 50-59 (42.5%); 60-69 (58.1%); 70-79 (79.4%), and over 80 y (100%) showed ED (P<0.05). The Pearson coefficients between the variables age and IIEF-5 showed a statistically significant inverse (negative) relation (r=-0.3449; P<0.05). ED is highly prevalent in men over 40 and this condition showed a clear relationship to aging, as demonstrated in other studies published. The simplified IIEF-5, as a diagnostic tool, showed to be an easy method, which can be used to evaluate this condition in studies with a great number of men.

Is there any relation between serum levels of total testosterone and the severity of erectile dysfunction?

The objective of this study was to correlate the severity of erectile dysfunction (ED) with the total testosterone serum levels (TT) in a normal population. During a screening program for the early diagnosis of prostate cancer, 1071 men aged from 40 to 90 y, were invited to answer the questionnaire of the Simplified International Index of Erectile Function (IIEF-5) as a method to diagnose and classify ED. The IIEF-5 scores ranged from 1 to 25 and the ED was classified into five groups according to the scores: severe (1-7), moderate (8-11), mild-moderate (12-16), mild (17-21) and no ED (22-25). Besides the questionnaire, all subjects had their TT serum levels determined based on the blood sample obtained between 08:00 and 10:00. The analysis of the relationship between the different degrees of ED and TT levels was then studied. Of the 1071 men, 965 were included in the study (90.1%). Eighty-eight percent of these were Caucasian and 12% black. The mean age of the population was 60.7 y. The prevalence of all degrees of ED was 53.9%. The degree of ED was mild in 21.5%, mild to moderate in 14.3%, moderate in 6.3% and severe in 11.9%. The variation of TT serum concentrations was similar (P>0.05) in the different age groups. Furthermore, the TT serum levels were not different for individuals with and without ED (P>0.05) and similar concentrations of TT was observed in the different severity degrees of ED (P>0.05). Only one (0.7%) man in the group of individual with maximal score had subnormal levels of TT. ED presented a clear association with the subjects' aging, but neither correlation between TT levels and ED, nor with its severity, could be demonstrated in the present study.

Effects of L-arginine on the kidney levels of malondialdehyde in rats submitted to renal ischaemia-reperfusion.

OBJECTIVE: To evaluate the effects of L-arginine, a nitric oxide donor, on kidney levels of malondialdehyde (MDA, a product of cellular lipid peroxidation), serum creatinine levels, and urinary volume in rats undergoing unilateral renal ischaemia-reperfusion. MATERIALS AND METHODS: Wistar rats (117) were randomly distributed into three experimental groups (of four subgroups each) in which were assessed renal cell-lipid peroxidation (kidney levels of MDA), serum creatinine levels and urinary volume. The rats underwent unilateral nephrectomy followed by contralateral renal ischaemia-reperfusion with or with no pretreatment with L-arginine (200 mg/kg) given intraperitoneally. RESULTS: Pretreatment with L-arginine caused significantly higher kidney levels of MDA than in the untreated group (P < 0.05). Furthermore, L-arginine given before surgery attenuated the increase in serum creatinine and significantly increased urinary volume in rats subjected to renal ischaemia-reperfusion (P < 0.05). CONCLUSION: L-arginine tended to be of benefit for renal function during renal ischaemia-reperfusion in rats. Pretreatment with L-arginine (200 mg/kg intraperitoneally) seems to increase the renal damage by increasing kidney levels of MDA.

Long-term results of penile vein ligation for erectile dysfunction due to cavernovenous disease.

PURPOSE: We now know that outflow restriction is essential for maintaining a rigid erection, which can be achieved after satisfactory smooth muscle relaxation. The aim of this study was to assess retrospectively the efficacy of penile vein surgical ligation in patients with a follow-up of at least 3 years. MATERIALS AND METHODS: Thirty-two men with impotence due to cavernovenous occlusive disease underwent penile vein ligation for management of organic erectile dysfunction. Cavernovenous occlusive disease was diagnosed by gravity cavernosometry. RESULTS: Long-term evaluation revealed sustained potency without adjunctive therapy in only 7 patients (21.87%). Twenty-five patients (78.12%) did not show any improvement in the erectile mechanism. Associated complications included penile shortening in 4 (12.5%), hypoesthesia of the glans area in 2 (6.25%), and Peyronie's disease in 1 (3.2%). CONCLUSION: Based on these data, we conclude that the long-term success of penile vein ligation is poor.

Experience with early catheter removal after radical retropubic prostatectomy.

PURPOSE: We tested the hypothesis that early catheter removal may be accomplished safely after radical prostatectomy. MATERIALS AND METHODS: Cystography on postoperative day 4 or 5 in 42 of 67 consecutive patients who underwent radical retropubic prostatectomy revealed no extravasation in 30 and the urethral catheter was removed (group 1). The control group included 25 patients who did not undergo cystography, and the catheter was removed 14 days postoperatively (group 2). RESULTS: Immediate and late continence was achieved in 14 (46.7%) and 25 (83.3%) cases in group 1, and in 8 (32%) and 22 (88%) cases in group 2, respectively (p>0.05). Catheterization was performed easily without any endoscopic or surgical procedure in 2 patients (6.7%) in group 1 who presented in urinary retention after catheter removal. Wound infection and pelvic abscess developed in 1 case (3.3%). There were no late complications. In group 2 urinary retention developed in 1 patient (4%), wound infection in 1 (4%) and hematuria in 1 (4%). Two patients (8%) had late vesical neck contracture at 4 and 10 months, respectively, which required urethrotomy in 1. In 1 patient (4%) a stricture in the anterior urethra was dilated. CONCLUSIONS: Our study shows that early catheter removal may be accomplished safely in most patients after radical retropubic prostatectomy, and was not associated with a higher complication rate.

Is there any association between Peyronie's disease and serum collagen markers?

Several theories regarding the pathogenesis of Peyronie's disease have been investigated under many clinical conditions. We have investigated the association of Peyronie's disease with the most common markers of collagen disease. Several serum markers of collagen disease (mucoproteins, C-reactive protein, antinuclear antibody, rheumatoid factor, lupus erythematosus cells, proteinograms) of 30 patients with Peyronie's disease were compared with those obtained from 30 patients, matched for age, with other urological conditions unrelated to the penis. Mucoproteins were altered in 66.7% of patients of the Peyronie's disease group and in 46.7% of the control patients (P>0.05). C-reactive protein was altered in 23.3% of the Peyronie's disease patients and in 13.3% of the control patients (P>0.05). Antinuclear antibody (ANA) was reactive in 16.7% of the tested group and in 6.7% of the control group (P>0.05). The rheumatoid factor was elevated in 6.7% of the patients from both groups (P>0.05). LE cells were normal in all the patients in our study. No statistical significance between the two groups was found in the protein electrophoresis test. Only the Waaler-Rose test (rheumatoid hemagglutination test) was statistically significant in our study (P<0.05). We have not found any significant association between the serum markers of collagen diseases in patients with Peyronie's disease, except the rheumatoid hemagglutination test (Waaler-Rose).

Tamoxifen versus placebo in the treatment of Peyronie's disease.

PURPOSE: We evaluated the effects of oral tamoxifen and placebo in patients with Peyronie's disease. MATERIALS AND METHODS: We selected 25 patients with Peyronie's disease who did not have calcified plaque for treatment in the andrology outpatient clinic. A medical history was obtained, and physical examination, penile x-ray, penile ultrasound and pharmacologically induced erection with prostaglandin E1 were performed. Patients were randomly divided into group 1--those who received 20 mg. tamoxifen twice daily for 3 months and group 2--those who received placebo for the same period. The same evaluations were done 4 months later and results were compared. Qualitative (chi-square test) and quantitative (Student's t test) results were analyzed using the Yates correction factor with p <0.05 considered significant. RESULTS: Pain subsided in 66.6 and 75% of the patients treated with tamoxifen and placebo, respectively (p >0.05). In groups 1 and 2 a reduction in the penile deformity was noticed by 46.1 and 41.7% of the patients (p >0.05), and a decrease in plaque size was noticed by 30.7 and 25%, respectively. On the other hand, objective measurements did not reveal any difference in plaque area or curvature angle. CONCLUSIONS: This study did not show significant improvement in pain, curvature or plaque size in patients with Peyronie's disease who were treated with tamoxifen compared with those treated with placebo.

Endoscopic suspension of the prolapsed vaginal dome.

Complete prolapse of the vaginal dome post hysterectomy is uncommon. However, complications such as urinary incontinence, recurrent urinary infections, and ureteral obstruction leading to anuria and loss of renal function may result. A modified technique for endoscopic suspension of the bladder neck and vaginal prolapse, performed in six patients, is presented. The positive results achieved after a 64-month of follow-up suggest that this procedure is another safe alternative to correct vaginal prolapse and its complications.

Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction.

PURPOSE: We evaluated men with organic erectile dysfunction treated with placebo and high dose oral yohimbine hydrochloride. MATERIALS AND METHODS: We selected 22 patients with organic erectile dysfunction (mean age 58 years) for treatment in the andrology outpatient clinic. These patients had been previously undergone neurological, vascular, hormonal and psychological testing, and were treated during an equal period of 30 days with placebo and daily single dose oral 100 mg. yohimbine. The response to treatment was evaluated via a questionnaire that comprised the outcome items of complete--normal penile rigidity enabling vaginal penetration, partial--erection improved but not sufficiently for appropriate vaginal penetration, none--no improvement and worse--erection deteriorated. The patients consented to treatment after being told of the severe adverse effects that might occur. RESULTS: The most common side effects were anxiety, increase in cardiac frequency, increased urinary output and headache but in no case was treatment discontinued. Of the patients 3 (13.6%) and 12 (54.5%) reported complete or partial response to treatment, respectively. However, statistical analysis disclosed no significant difference when yohimbine was compared to placebo (p < 0.05). CONCLUSIONS: Oral 100 mg. single dose daily yohimbine promotes no improvement in patients with organic erectile dysfunction.

Atropine role in the pharmacological erection test: study of 228 patients.

PURPOSE: We determined the efficacy of atropine sulfate combined with papaverine hydrochloride, prostaglandin E1 and phentolamine mesylate in the pharmacological erection test. MATERIALS AND METHODS: A total of 230 consecutive patients with erectile dysfunction was randomized for pharmacological erection test and received an intracorporeal combination of 50 mg. papaverine hydrochloride, 10 micrograms. prostaglandin E1, 0.2 mg. phentolamine mesylate and 0.075 mg. of atropine sulfate (group 1), or the same combination without atropine sulfate (group 2). Erectile response was evaluated subjectively and by intracorporeal pressure measurement. RESULTS: In group 1, 40 patients (35.1%) showed only tumescence, and 22 (19.3%) had poor erection. In group 2, 45 patients (39.5%) had tumescence and 17 (14.9%) poor erection. In both groups 52 patients (45.6%) had rigid erection. There was no statistically significant difference regarding erectile response and intracorporeal pressure. CONCLUSIONS: The addition of atropine sulfate did not improve results of the pharmacological erection test when combined with 50 mg. papverine hydrochloride, 10 micrograms, prostaglandin E1, and 0.2 mg. phentolamine mesylate.

Persistence of müllerian duct derivative syndrome in 2 male patients with bilateral cryptorchidism.

The persistent müllerian duct syndrome represents a rare form of male pseudohermaphroditism secondary to anti-müllerian hormone deficiency. We describe 2 cases of phenotypically male postpubertal patients with a uterus and tubes. Both patients presented with bilateral cryptorchidism, 1 was seen for gynecomastia and 1 was seen for an abdominal mass that was found to be a testicular tumor.

Congenital abnormality of corpora cavernosa and erectile dysfunction: a case report.

We report on a young man who had absence of the septum and muscle in the corpora cavernosa. He had no tumescence or erection with either the nocturnal penile tumescence test or intracorporeal injection of a combination of vasoactive drugs. No other urological or extra-urological congenital defects were found. A malleable penile prosthesis was implanted.

Prosthetic penile infection: "rescue procedure" with rifamycin.

Penile prosthetic implantation is a successful procedure for the management of male erectile impotence. However, infection remains the most serious complication requiring removal of the device. Later reinsertion can be difficult due to fibrosis and a shortened penis. We present 3 cases of penile infection with Staphylococcus epidermidis in which a new penile prosthesis was placed after 72 hours of continuous irrigation of the corpora cavernosa with rifamycin. The procedure requires judicious selection of patients and a stable clinical status.

Autoinjection of corpus cavernosum with papaverine: a practical application device.

A new device for the autoinjection of papaverine into the corpus cavernosum for the treatment of impotence is described. Its use is much easier than conventional tuberculine syringes.

Fibroma retroperitoneal gigante - relato de um caso. / Giant retroperitoneal fibroma - report of a case

Tumores primarios de retroperitonio sao raros e ha escassa literatura a respeito deles. E relatado num caso de tumor retroperitoneal gigante tratado por cirurgia

Genetic and cytogenetic studies in patients with intersexuality or infertility.

A total of 198 patients has been investigated from the genetic and cytogenetic points of view. Chromosomal aberrations were probably responsible for 8 and genic causes for 11 of the 24 cases of intersexuality. Among 96 infertile males the prevalence of abnormal karyotypes was significantly higher in azoospermic (34%) as compared to oligospermic (9%) individuals. However, if persons with hypogonadism or Klinefelter's signs are not considered, the frequency of abnormal karyotypes decreases and the difference between azoospermic and oligospermic men becomes non-significant (19% and 7%, respectively). Genic factors may be the cause of sterility in about one-fourth of these males. Chromosome causes were identified in 29 and abnormal genes postulated in 9 of the 78 sterile females. Among the more rare karyotypes found, the following were considered in more detail: 45,X/46,X,i (Yp) (observed among the intersex patients); 46,X,r (Y), and 46,XY,t(2;8) (2p12 leads to pter::8 pter) (both found among the infertile males). Y/F ratios were calculated for 47 azoospermic, 40 oligospermic and 30 control individuals; the differences between their means were statistically non-significant.

O cancer de bexiga no fumante. / Bladder cancer in smokers

Pesquisa de 130 casos de cancer de bexiga atendidos na 31a. Enfermaria da Santa Casa de Misericordia de Porto Alegre, objetivando relacionar a incidencia da doenca cancerosa com o habito de fumar. Os pacientes foram analisados quanto ao habito, idade de maior incidencia do tumor e tipo histologico. Os dados obtidos foram comparados com os de um grupo de controle, observando-se que o tabagismo e mais frequente entre os portadores de tumor de bexiga do que nos pacientes do grupo de controle. Os resultados, embora nao sejam estatisticamente significativos, sugerem uma maior incidencia de neoplasia vesical em fumantes do que em nao fumantes