Evaluation of penile revascularization for erectile dysfunction: a 10-year follow-up.

The objective of this study was to report long-term success rates for penile revascularization (PR) and investigate factors responsible for failures. During the past 10 y, data were obtained on 52 patients who underwent PR. Surgical technique was selected according to preoperative arteriographic findings. The mean age was 28.5 y and the mean follow-up was 70.8 months. Success was defined as satisfactory intercourse without additional therapy. Overall success was 48%. Patients under 28 y showed a 73% success rate vs 23% in the older ones (P=0.0003). Nonsmokers had a 57% success compared to 29% in smokers (P=0.05). The presence of venous leak and type of procedure had an insignificant impact on success (P=0.33 and 0.23 respectively). To conclude, this curative treatment option is limited to a selective population with vasculogenic erectile dysfunction. We found that the cure rate of this procedure is maintained and long-term follow-up shows good results, especially in the young nonsmokers.

Normative values for female genital sensation.

OBJECTIVES: Neurologic disorders might be responsible for many cases of female sexual dysfunction. Yet, they are currently undiagnosed because of the lack of measurement tools to assess genital neural function. Therefore, our objective is to provide norms for sensory thresholds in the vagina and clitoris, for a wide range of patient ages. METHODS: Vaginal and clitoral warm, cold, and vibratory sensory thresholds were measured in 89 healthy paid volunteers by the method of limits. Normograms were derived from this group of healthy volunteers. An additional 61 patients were also tested, for a total of 150 individuals. Sixty-two individuals (42 healthy volunteers and 20 patients) from the total group were tested twice to provide test-to-test repeatability data across the range of clinical (normal and abnormal) responses. RESULTS: Normograms are presented, providing age-corrected upper and lower normal values, expressed as 95% confidence limits for warm, cold, and vibratory thresholds. Intertest repeatability is also reported. CONCLUSIONS: Thermal and vibratory thresholds of both the vaginal and clitoral region are clinically feasible, valid, and repeatable. These can be applied as a valuable diagnostic tool to assess neural dysfunction through sensory assessment of the female genitalia.

Logistic regression and survival analysis of 450 impotent patients treated with injection therapy: long-term dropout parameters.

PURPOSE: We report the dropout rate associated with intracavernosal self-injection for erectile dysfunction at long-term followup, and determine parameters related to dropout. MATERIALS AND METHODS: Of 2,252 impotent patients evaluated during 9 years 450 (20%) enrolled in our self-injection program. Papaverine and phentolamine were given in 53% (initial treatment), prostaglandin E1 in 21%, and papaverine, phentolamine and prostaglandin E1 (triple mixture) in 26% of cases. Average injection volume for the 3 injection types was 0.52 cc. Data were retrospectively reviewed for patient dropout versus nondropout, specifically for type of drug, volume injected, changing treatment (from 1 drug and/or dosage to another), patient age, marital status, ethnic group, impotence duration and diabetes. RESULTS: Patient age ranged from 23 to 79 years (mean age 55). Of the patients treated at least 4 months 155 (35%) dropped out of the study. Mean treatment duration was 3.5 years. Logistic regression suggested that type of drug, changing treatment during the course of therapy and dosage (volume injected) were the only significant (p <0.05) parameters influencing dropout. Papaverine and phentolamine were twice as likely to lead to dropout as triple mixture or prostaglandin E1, and injection greater than 0.5 cc was more than twice as likely to lead to dropout. Demographic, ethnic, age and etiological factors had no significant effect on the overall dropout rate. CONCLUSIONS: The effectiveness of injection therapy was an underlying factor determining the long-term dropout rate for patients with erectile dysfunction. Other parameters or combinations of parameters that may influence patient dropout remain to be explored.

The role of corpus cavernosum electromyography.

Although corpus cavernosum electromyography presents great theoretical appeal as a possible direct clinical measure of penile neurogenic function, it has still not been adopted as a routine diagnostic test in the evaluation of patients with erectile dysfunction. This is because of the considerable technical and interpretative problems associated with the method. This review covers some of the more important research and clinical papers published since its first description in 1989, with a special focus on recent advances in this field.

Cardiovascular effects of oral pharmacotherapy in erectile dysfunction.

Several drugs have been developed to treat patients with erectile dysfunction (ED). In general, patients prefer orally administered drugs. The use of these drugs (e.g. sildenafil and apomorphine) is reviewed. Because ED is a common problem in men with vascular disease it is important to assess the effect of these drugs on the cardiovascular system. The safe use of these drugs in patients with vascular disease needs to be clearly established in appropriately designed trials.

A 12 versus 6-week course of bacillus Calmette-Guerin prophylaxis for the treatment of high risk superficial bladder cancer.

PURPOSE: We examined the efficacy of a 12-week prophylactic course of bacillus Calmette-Guerin (BCG) on superficial bladder cancer. MATERIALS AND METHODS: From August 1992 until July 1994, 70 evaluable patients 41 to 80 years old (mean age 68.5) with high risk transitional cell carcinoma of the bladder were prospectively randomized to a 12-week prophylactic course of BCG (group 2) versus a traditional 6-week course (group 1). Mean followup was 28 months. RESULTS: A 70% tumor-free rate (21 patients) and mean interval of 12.9 months to recurrence were achieved in group 2 compared to 55% (22 patients) and 12.3 months, respectively, in group 1. Group 2 patients had an overall longer disease-free survival, although no statistical significance was achieved. A subgroup of patients with stage Ta cancer in whom at least 1 tumor was resected 12 month before treatment showed the most benefit from long-term prophylactic treatment in terms of disease-free survival. Side effects were only slightly more prominent in group 2, rendering the longer course fairly acceptable. CONCLUSIONS: Our findings suggest a difference for better overall results with the 12-week course of BCG. However, a larger number of patients are needed to demonstrate a statistically significant difference between the 2 groups.

Psoas abscess: case report and review of the literature.

Psoas muscle abscess is rare and presents a diagnostic challenge requiring a high index of suspicion. We report an unusual case of primary psoas abscess caused by Proteus mirabilis. Primary psoas abscess is most commonly present in children and is usually caused by Staphylococcus aureus. A total of 434 cases of psoas abscess has been reported. The subject is discussed noting the differences between primary and secondary cases, and emphasizing the importance of ultrasound and computerized tomography guided drainage of psoas abscess. A flow chart for the evaluation and management of primary and secondary abscess is presented, taking into consideration the success rate of the various methods of treatment described in the literature.