Comparison of transrectal ultrasonography and transrectal ultrasonography-guided seminal vesicle aspiration in the diagnosis of the ejaculatory duct obstruction.

OBJECTIVE: To compare transrectal ultrasonography (TRUS) and TRUS-guided seminal vesicle aspiration in the diagnosis of ejaculatory duct obstruction (EDO). DESIGN: A retrospective case-controlled study comparing the findings of TRUS and TRUS-guided seminal vesicle (SV) aspiration. SETTING: Clinics of Urology and Radiology. PATIENT(S): Seventy patients with suspected EDO (complete in 10, partial in 60 patients) on clinical evaluation. INTERVENTION(S): Each SV was punctured transrectally using a 20-gauge Chiba needle within 2 hours after ejaculation. MAIN OUTCOME MEASURE(S): In SV aspirates, greater than three sperm per high-power microscopic field was considered a positive result for EDO. RESULT(S): Fifty-five (78.6%) patients had evidence of EDO on diagnostic TRUS. However, obstruction on TRUS was confirmed in 49.1% (27 of 55) of the patients with SV aspiration. Higher sperm positivity rates were achieved in patients with SV dilation (11 of 13, 84.6%) and prostatic midline/ED cyst (12 of 16, 75.0%). Stepwise logistic regression analysis revealed that the incidence of SV dilation was significantly higher, whereas that of chronic inflammatory findings in the prostate was significantly lower in the positive SV aspirate group. CONCLUSION(S): TRUS alone is not a reliable tool for the diagnosis of EDO. For this reason, SV aspiration should be used as an adjunctive technique in patients with SV dilation or a prostatic midline/ED cyst to confirm the diagnosis before surgery.

The clinical characteristics of Peyronie's patients with notching deformity.

INTRODUCTION: Peyronie's patients with notching deformity represent a small percentage of disease population, and the features of these patients have not been well established yet. AIM: To analyze the characteristics of Peyronie's patients with notching deformity. MAIN OUTCOME MEASURES: Peyronie's patients with notching deformity were compared with those with other type of penile deformities with regard to clinical features. METHODS: During a 13-year period, a total of 703 patients with Peyronie's disease were evaluated at our institution. The patients were divided into two groups: group I consists of Peyronie's patients with notching deformity (N = 89) and group II patients with any other kind of penile curvature (N = 614). The clinical characteristics, presence of co-morbidities including diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hypertension, and ischemic heart disease, erectile status, and penile deformities were compared between the two groups. RESULTS: Pure notching deformity was detected in 12.6% (N = 89) of the patients. The mean age of men was 53.1 +/- 10.2 and 52.7 +/- 10.7 years in groups I and II, respectively, (P = 0.8). The leading presenting symptom was erectile dysfunction (68.5%), followed by penile deformity (51.6%), and pain on erection (17.9%) in group I, while it was penile curvature (77.1%), erectile dysfunction (54.6%), and pain on erection (14.4%) in group II. In group I, 27 patients (30.3%) were diagnosed during a standard evaluation for erectile dysfunction. Hypertension was significantly higher in group I (25.8%) than in group II (15.4%) (P = 0.022); whereas hypercholesterolemia was more common in group II (P = 0.008). There was no significant correlation between the presence or the number of co-morbid conditions and the presence of the notching deformity. Combined injection and stimulation test revealed a diminished erectile capacity in 46.1% of the patients in group I, while it was 31.7% in group II (P = 0.008). In group I, 62.9% had unilateral notching deformity, 34.8% had hourglass deformity, and 2.2% had combined hourglass and notching deformity. Overall, the notching deformity was localized in the distal penile shaft in 50.5%, proximal shaft in 40.4%, and mid-shaft in 8.9% of the patients in group I. CONCLUSIONS: In this large-scale series, pure notching deformity was detected in about one-tenth of patients with Peyronie's disease. Patients presented at the first half of the sixth decade of life and more than half of the patients were in the acute phase of the disease. The most common presenting symptom was erectile dysfunction. The notching deformity was more frequently localized at the base and tip of the penis.

Surgical treatment of Peyronie's disease: a critical analysis.

OBJECTIVE: The present paper reviews surgical treatment alternatives for patients with Peyronie's disease using knowledge obtained from the contemporary literature. METHODS: : All aspects of surgical treatment for Peyronie's disease were examined on the basis of MEDLINE database researches. RESULTS: Surgical treatment should be delayed until the acute inflammatory phase has resolved and should be considered in patients with deformity that impairs sexual function. Currently, surgical treatment alternatives are reconstructive surgery by either lengthening the concave side (incision and grafting) or shortening the convex side (Nesbit procedure or plication) of the penis, and implantation of penile prosthesis with or without incision of the plaque. PD patients with good erectile capacity are candidates for reconstructive surgery. Meanwhile, implantation of penile prosthesis with or without remodeling should be considered for patients without adequate erectile capacity. CONCLUSIONS: The aim of the surgical treatment in Peyronie's disease is to correct the deformity while preserving or improving erectile capacity of the penis. Appropriate treatment options should be individualized according to the patients' expectations and erectile capacity.

Effects of extra-corporeal shock waves on penile hemodynamics and histopathology in rats.

AIM: To study the effect of extra-corporeal shock wave (ESW) on the penile hemodynamics and histopathology in rats. METHODS: Adult male Sprague-Dawley rats were divided at random into 3 groups. ESW application was performed with a Siemens Lithostar with the rats under anesthesia lying prone on the balloon probe. Rats in Group I received a total of 1000 shocks at 18 kV and immediately underwent hemodynamic evaluation performed by direct electrostimulation of the cavernous nerve and measurement of intracavernous pressure (ICP). Rats in Group II received 3 times 1000 shocks at 18 kV at weekly intervals and hemodynamic evaluation was performed 1 month after the last ESW application. Group III served as the control. Histopathological examinations of penile tissues were done on Masson's trichrome and hematoxylin and eosin stained sections. RESULTS: Penile hemodynamic evaluation showed a trend toward a diminished mean maximal ICP, duration of erection, ICP during the plateau phase and maximal ICP/ blood pressure ratio in Group I, although there was no significant significance. The mean latency period in Groups I and II was prolonged. Petechial bleeding within tunical layers and small foci of hemorrhage within the corpora cavernosa were observed in Group I. However, histopathological examination failed to reveal any significant differences between the groups in terms of smooth muscle content, tunical thickness, organization of collagen bundles and elastic fiber-lattice framework. CONCLUSION: ESW has certain damaging effects on the penis.