Effects of transanal pelvic plexus stimulation on penile erection: clinical implications.

OBJECTIVE: To determine the ability of transanal pelvic plexus stimulation (TPPS) in inducing penile tumescence in patients with non-neurogenic erectile dysfunction (ED) and to compare the erection degree with papaverine-induced erection. PATIENTS AND METHODS: The cavernous electrical activity (CEA) in 21 men with non-neurogenic erectile dysfunction was measured during TPPS by electromyography of corpus cavernosum and the erection degree of penis (flaccid, semi-rigid, rigid) was noted. The stimulation amplitude was increased from 20 to 100 mA. All patients also underwent intracavernous papaverine injection and further CEA recordings were obtained. RESULTS: Twelve and nine patients were diagnosed with vasculogenic (VED) and non-vasculogenic ED (NVED), respectively. TPSS led to a penile erectile response in 12 patients (57%), whereas papaverine injection caused erection in 16 (76.2%) patients. The mean baseline CEA (16.9 +/- 9.1 mV) did not change with TPPS, but papaverine significantly decreased the mean CEA to 12.3 +/- 4.9 mV (P < 0.001). CEA recordings of 16 (76.2%) patients revealed a significant decrease after papaverine injection, however seven (33.3%) patients showed significant CEA decrease in response to TPPS. Both TPPS and papaverine were observed to have a higher effect in patients with NVED in terms of inducing penile erection and decreasing CEA compared to their effects in patients with VED. CONCLUSION: TPPS induces penile erection and decreases CEA for some extent, but to a lesser degree compared to papaverine. As further improvements are achieved in the methodology of TPPS, it may be a valuable method in the evaluation patients with erectile dysfunction.

Comparison of transurethral vaporization using PlasmaKinetic energy and transurethral resection of prostate: 1-year follow-up.

PURPOSE: A prospective study was conducted to evaluate the efficacy and safety of PlasmaKinetic vaporization of prostate (PKVP) relative to standard transurethral resection of prostate (TURP) in the surgical management of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Between March of 2001 and February of 2003, 75 patients aged 49 to 80 years (median 66 years) with a complaint of lower urinary-tract symptoms and a mean prostate volume of 50 +/- 6 cc were enrolled in this study. We evaluated the operating time, blood transfusion, postoperative irrigation period, and catheter-removal time. Patients were assessed at baseline and during the follow-up using the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Q(max)). RESULTS: The mean operation time for PKVP (40.3 +/- 15 minutes) was significantly shorter than that of TURP (55 +/- 11.1 minutes) (P < 0.001). The postoperative irrigation period was significantly shorter in the PKVP group (mean 6 +/- 3 hours) than in the TURP group (mean 20 +/- 8 hours) (P < 0.001). The mean catheter-removal time was significantly later after TURP (68 +/- 21 hours) than after PKVP (35 +/- 9 hours) (P < 0.001). The groups had comparable mean IPSS and Q(max) values at baseline, and both had significant improvement in these parameters after operation. For IPSS, especially at the third month after the operation, PKVP patients showed significantly greater improvement (P < 0.001). There was no difference in Q(max) values between the groups (P > 0.05). Whereas blood transfusion was necessary for two patients in the TURP group, there were no transfusions in the PKVP group. CONCLUSIONS: Because of the short operating time, smaller blood loss, shorter period of irrigation and catheterization, use of isotonic fluid, and absence of electrical current, PKVP is safe and advantageous. Although these early results have shown that this technique may be a good alternative among the minimally invasive methods for the surgical management of BPH, further studies with longer-term results are essential.

Nd:YAG laser ablation plus transurethral resection for large prostates in high-risk patients.

OBJECTIVES: To evaluate the outcome and morbidity rate of combined visual laser ablation of the prostate and transurethral resection of the prostate (TURP) in high-risk symptomatic patients with large prostates. METHODS: A total of 28 patients evaluated according to the American Society of Anesthesiologists (ASA) classification to have ASA grade 3 or greater and who had a prostate volume of 50 cm3 or greater, and peak urinary flow rate of less than 15 mL/s underwent visual laser ablation of the prostate plus TURP for severe lower urinary tract symptoms due to benign prostatic hyperplasia. The postoperative evaluation included the American Urological Association symptom score index, maximal urinary flow rate measurement, postvoid residual urine volume, and morbidity. RESULTS: The mean baseline prostate volume and duration of surgery was 85 cm3 (range 50 to 120) and 70 minutes (range 55 to 105), respectively. Surgery was performed under local and spinal anesthesia in 18 and 10 patients, respectively. No perioperative bleeding requiring transfusion or TURP syndrome developed. Urethral catheter drainage was continued for an average of 1.7 days. Only 1 patient developed irritative voiding symptoms. The postoperative follow-up period ranged from 6 to 21 months (median 11). Improvement in the evaluation parameters was noted in all cases. CONCLUSIONS: The results of our study show that visual laser ablation of the prostate plus TURP has the advantage of excellent homeostasis and lower morbidity in men with large prostates. When the patient's medical condition precludes TURP, this combination of techniques may be considered an option in such cases for symptomatic relief of obstructive urinary symptoms due to benign prostatic hyperplasia.

Predisposing factors and treatment outcome in Fournier's gangrene. Analysis of 28 cases.

OBJECTIVES: To evaluate the etiologic factors and the effects of surgical debridement and adjunctive therapies on morbidity and mortality of Fournier's gangrene. METHODS: 27 males, 1 female, a total of 28 patients with a mean age of 58 years treated for Fournier's gangrene were evaluated retrospectively. RESULTS: Predisposing factors including diabetes, alcohol abuse, paraplegia and renal insufficiency were identifiable in 54% of the patients. Etiologic origin of the gangrene was urogenital, cutaneous and anorectal in 43, 25 and 11% of the patients, respectively. The pathology was limited to genitalia in 10, extending to perineum in 8, the umbilicus in 7 and even up to the axilla in 3 patients. Suprapubic cystostomy and colostomy were necessary in 18 and 2 cases, respectively. We used hyperbaric oxygen therapy in 2 and honey in 6 patients to accelerate wound healing. A repeat debridement was necessary in 39% of the cases. Plastic surgery and grafting were done in 14 patients. Our mortality rate was 7%. CONCLUSION: Early recognition of the pathology and aggressive surgical debridement are the mainstay of the management of Fournier's gangrene. Additional strategies to improve wound healing and increase patient survival are also needed.