Importance of axial penile rigidity in objective evaluation of erection quality in patients with erectile dysfunction--comparison with radial rigidity.

INTRODUCTION: The aim of this prospective study was to evaluate the usefulness of measurement of axial penile rigidity, compared with radial penile rigidity. PATIENTS AND METHODS: Twenty-two patients, aged 21-75 years old (a mean of 50), with erectile dysfunction underwent axial penile rigidity measurements by the digital inflection rigidometer (DIR) as well as radial penile rigidity measurements by the RigiScan Plus during intracavernous pharmacological erection testing. RESULTS: A significant correlation was recognized between axial rigidity, and radial rigidity at the tip (p = 0.0024) and base (p = 0.0098) of the penis. In 10 patients, the DIR revealed axial rigidity of 550 g or more, and they also had radial rigidity of 60% or more at the tip and base. In 14 and 17 subjects, radial rigidity of 60% or more was observed at the tip and base, respectively. Four of the former 14 and 7 of the latter 17 had axial rigidity <550 g. CONCLUSIONS: A RigiScan results of radial rigidity of 60% or more should be interpreted cautiously and not necessarily regarded as normal.

[The efficacy of portable 3-dimensional ultrasound scanning device (Bladder Scan BVI6100) for measurement of residual urine volume--comparison with transabdominal ultrasound estimation].

In 177 patients, we evaluated the efficacy of a portable 3-dimensional ultrasound scanning device (Bladder Scan BVI6100) in measurement for residual urine volume, compared with transabdominal ultrasound estimation, using values measured by urethral catheterization as actual values. A high correlation was demonstrated between values measured by BVI6100 and actual values. Error rates of the values measured by BVI6100 male mode, female mode and transabdominal ultrasound estimation to actual values were 42.7 +/- 32.6, 50.6 +/- 63.3 and 65.8 +/- 43.7%, respectively. The error rate of the values measured by BVI6100 female mode was significantly higher than that by BVI6100 male mode or transabdominal ultrasound estimation. Irrespective of patient sex, the error rate of the values measured by BVI6100 in male mode was significantly lower than that in female mode. Therefore, BVI6100 male mode was considered to be a useful alternative for measurement of residual urine with accuracy similar to that of transabdominal ultrasound estimation.

Hand-assisted laparoscopic radical cystoprostatectomy and urethrectomy with ileal conduit construction.

INTRODUCTION: Hand-assisted laparoscopy was first performed in the 1990s by inserting the surgeon's finger or hand through a small tight wound. Although leakage of gas from the incision initially limited the usefulness of the technique, the hand-assisted procedures have advanced extensively since the introduction of the hand-assisted laparoscopy port. Laparoscopic procedure has only rarely been applied to radical cystoprostatectomy. Favorable reports for laparoscopic radical prostatectomy encouraged us to attempt a cystoprostatectomy under hand-assisted laparoscopy. PATIENT: The patient was a 70-year-old male with an invasive bladder tumor and no distant metastasis. Informed consent for undergoing hand-assisted laparoscopic radical cystoprostatectomy and ileal conduit construction was obtained. METHODS AND RESULTS: The bladder was dissected free and extracted whole through the incision for the hand port. The bilateral ureters and a loop of small intestine were withdrawn through the same incision. An ileal segment was isolated and small intestine continuity was recovered. Each ureter was anastomosed to one extreme of the ileal segment that was then reintroduced into the abdomen. The stoma was constructed through the right side port without additional incision. No intraoperative complications were observed. Recuperation was unusually quick and painless, and few postoperative analgesics were needed. CONCLUSIONS: Hand-assisted laparoscopic cystoprostatectomy and urinary diversion could provide the advantage of decreased postoperative morbidity without the long operation time and technical difficulty of a strictly laparoscopic procedure.

[The efficacy of Gosyajinkigan for pollakisuria].

We investigated the efficacy of Gosyajinkigan in 20 patients with prostatic disease, in whom pollakisuria was not improved by treatment with drugs for lower urinary tract symptoms. Four and 8 weeks after treatment, the urinary frequency was significantly improved during both daytime and night. The efficacy rates for diurnal frequency and nocturia were 45% and 65%, respectively. The International Prostate Symptom Score (IPSS) was decreased 4 weeks after treatment, and the parameters of uroflowmetry, the residual urine volume and quality of life score were improved 8 weeks after therapy. It was concluded that Goshajinkigan was effective for pollakisuria with prostatic disease, and the administration of the agent for 8 weeks or longer was needed to improve lower urinary tract symptoms.

Relationship between penile hemodynamic parameters assessed by color Doppler ultrasonography and penile rigidity recorded by the RigiScan Plus.

OBJECTIVE: We studied the relationship between penile hemodynamic parameters assessed by color Doppler ultrasonography and penile rigidity estimated by objective measurement. PATIENTS AND METHODS: A total 37 patients with erectile dysfunction were examined. After intracavernous injection of 20 microg prostaglandin E1, we measured their penile hemodynamic parameters in the cavernous arteries by color Doppler ultrasonography. Simultaneously, the RigiScan Plus device was used for real-time evaluation of penile rigidity. Hemodynamic parameters were correlated with penile rigidity. RESULTS: Peak systolic velocity and resistive index were significantly correlated with penile tip (r = 0.54, r = 0.72, respectively) and base (r = 0.55, r = 0.76, respectively) rigidity; there was no significant correlation between end-diastolic velocity and penile rigidity. CONCLUSIONS: Peak systolic velocity and resistive index were strongly correlated with penile rigidity in patients with erectile dysfunction during intracavernous pharmacological testing. The resistive index in particular appeared to be the most valid parameter for assessment of penile rigidity.

Comparative study between audiovisualsexual stimulation test and nocturnal penile tumescence test using RigiScan Plus in the evaluation of erectile dysfunction.

INTRODUCTION: Although the nocturnal penile tumescence (NPT) test is considered the gold standard for the differential diagnosis of psychogenic versus organic erectile dysfunction (ED), concerns have recently been raised regarding the financial and time expenditure it demands. We evaluated the diagnostic efficacy of the audiovisual sexual stimulation (AVSS) test as an alternative to the NPT test. PATIENTS AND METHODS: A total of 43 patients with ED were examined. Each patient filled in an International Index of Erectile Function (IIEF) questionnaire. The evaluation of each patient consisted of AVSS and NPT tests which were performed using the RigiScan Plus. The results obtained with the two tests were compared. The patients with normal NPT patterns were presumed to have a psychogenic etiology of their ED and those with abnormal NPT patterns to have an organic etiology. RESULTS: The overall IIEF score was 32.5 +/- (SD) 9.2, and the erectile domain score was 12.2 +/- 4.5. Twenty-three patients had normal responses to the AVSS test, while 20 had abnormal responses. Twenty-two of the former 23 patients and 9 of the latter 20 patients had normal NPT patterns. Therefore, the AVSS test discriminated psychogenic ED with 71% sensitivity and 92% specificity. The overall accuracy of the test in this study was 77%. CONCLUSIONS: The AVSS test is simple, practical, and inexpensive, and its diagnostic accuracy is comparable to that of the NPT test. We conclude that the AVSS test should be the examination of choice for the primary etiological diagnosis in ED.

Telomerase activity is correlated with lower grade and lower stage bladder carcinomas.

BACKGROUND: Telomerase is a ribonucleoprotein enzyme that compensates for the progressive erosion of telomeres. The increasing interest in telomerase is motivated by the demonstration that most human carcinomas are telomerase positive. The potential use of telomerase activity in bladder carcinomas using a urine sample has been reported in several studies. However, little is known about the detection of telomerase activity in bladder carcinoma tissues. Herein, we investigate telomerase activity in bladder carcinoma tissues according to grade (G) and stage. MATERIAL AND METHODS: Telomerase activity was assayed by polymerase chain reaction enzyme-linked immunosorbent assay methods. Malignant lesions were assessed in 37 patients with bladder carcinoma and no malignant lesions were assessed in five patients with dysplasia or inflammatory bladder lesions. RESULTS: Twenty-three out of 37 carcinoma samples were telomerase-positive and one out of five control samples without carcinoma was telomerase-positive. The positive rates according to stage and grade were 83.3% for superficial and 42.1% for invasive stages and 83.3% for G1, 66.7% for G2 and 40.0% for G3. Telomerase activity was correlated with lower grade and lower stage bladder carcinomas. CONCLUSION: These results strongly suggest that reactivation of telomerase may differ between superficial and invasive bladder carcinomas and also between low grade and high grade bladder carcinomas.

Changes in male reproductive function after high altitude mountaineering.

The male reproductive functions of the members of the Masherbrum (7821 m) Expedition in 1999 were examined via semen analyses and endocrine tests. Specimens were collected from three subjects who had stayed above 5100 m for 21 to 24 days and above 6700 m for 4 to 5 days before departure and 1 month, 3 months, and 2 yr after returning from the expedition. Semen analyses showed no change in the semen volume. Sperm counts decreased after 1 month and had not recovered after 3 months, but they had recovered after 2 yr in all subjects. An increase in abnormally shaped sperm was also observed after 1 month, but had nearly recovered to the preexpedition state after 3 months. Endocrine tests revealed slightly decreased testosterone in the blood after 1 month, which had decreased still further after 3 months. The tests were completely normal after 2 yr. We suggest that a high altitude sojourn may induce reversible spermatogenic and Leydig cell dysfunction.

Snap-Gauge band compared to RigiScan Plus in a nocturnal penile tumescence study for evaluation of erectile dysfunction.

OBJECTIVE: The aim of this prospective study was to examine the ability of the Snap-Gauge band to differentiate organic from psychogenic erectile dysfunction (ED). PATIENTS AND METHODS: Nocturnal penile tumescence testing was performed on 12 patients using a Snap-Gauge band and RigiScan Plus. A total of 29 nightly examinations were evaluated. The results obtained with the two methods were compared. RESULTS: The average tumescence, average rigidity, tumescence activity units and rigidity activity units in the positive group (the group of cases in which one, two or three films of the Snap-Gauge band were broken) were each significantly greater than that in the negative group (the group of cases in which no film was broken). The Snap-Gauge band correctly diagnosed 90% of the patients with a sensitivity of 100% and specificity of 75% with respect to results obtained using the RigiScan Plus. CONCLUSIONS: The Snap-Gauge band is inexpensive compared to the RigiScan Plus and is relatively reliable. We conclude that the Snap-Gauge band can play a role in ED assessment and can function as a screening device in evaluation of ED.