The reported sex and surgery satisfactions of 28 postoperative male-to-female transsexual patients.

From 1980 to July 1997 sixty-one male-to-female gender transformation surgeries were performed at our university center by one author (A.M.). Data were collected from patients who had surgery up to 1994 (n = 47) to obtain a minimum follow-up of 3 years; 28 patients were contacted. A mail questionnaire was supplemented by personal interviews with 11 patients and telephone interviews with remaining patients to obtain and clarify additional information. Physical and functional results of surgery were judged to be good, with few patients requiring additional corrective surgery. General satisfaction was expressed over the quality of cosmetic (normal appearing genitalia) and functional (ability to perceive orgasm) results. Follow-up showed satisfied who believed they had normal appearing genitalia and the ability to experience orgasm. Most patients were able to return to their jobs and live a more satisfactory social and personal life. One significant outcome was the importance of proper preparation of patients for surgery and especially the need for additional postoperative psychotherapy. None of the patients regretted having had surgery. However, some were, to a degree, disappointed because of difficulties experienced postoperatively in adjusting satisfactorily as women both in their relationships with men and in living their lives generally as women. Findings of this study make a strong case for making a change in the Harry Benjamin Standards of Care to include a period of postoperative psychotherapy.

The correlation between the new RigiScan plus software and the final diagnosis in the evaluation of erectile dysfunction.

PURPOSE: The computer generated recordings for 2 nights in 40 patients studied with the RigiScan device were reevaluated using the new RigiScan Plus software to test its value in improving the discrimination between psychogenic and organic erectile dysfunction. MATERIALS AND METHODS: Each man was evaluated for erectile dysfunction with a detailed medical and sexual history, physical examination, biothesiometry, plethysmography, 2 nights of ambulatory RigiScan monitoring and a psychological evaluation that usually included a private interview with the sexual partner. At the conclusion of evaluation each patient was broadly classified as having organic or psychogenic erectile dysfunction. The RigiScan reports were initially independently analyzed without the investigator's knowledge of the final diagnosis by determining the single best erectile event, with a minimal cutoff value of 60% erection for 5 minutes as necessary to be considered normal and the sum of measurements from the 2 nights. The original reading and final diagnosis were correlated. At this point the data were processed with the new RigiScan Plus software using 2 new measurements: 1) rigidity activity units and 2) tumescence activity units at the base and tip of the penis, and the results were correlated with the final diagnosis. RESULTS: Evaluation of the single best event again showed that tip rigidity was the best single predictor if the diagnostic criteria were modified to 70% tip rigidity for 5 minutes with an estimate of correct classification of 92.5%. Nearly the same accuracy was obtained by base single event rigidity, tip rigidity and base tumescence activity units (each 90%). The summary analysis of all erectile events during the 2 nights of evaluation that had a low correlation with the final diagnosis using the original software showed that the best overall predictor of final diagnosis was tip tumescence activity units (92.5%), followed by base rigidity and tumescence activity units (each 90%). CONCLUSIONS: The RigiScan Plus software introduced 4 new parameters that facilitate interpretation of the RigiScan data. The new software did not improve the correlation with the final diagnosis compared to the subjective single best event analysis but added new objective parameters, measured and displayed by the software, that facilitate use of the data by the physician.

[Detailed evaluation of sexual function after radical prostatectomy: is patient satisfaction correlated with the quality of erections?]. / Evaluation détaillée de la fonction sexuelle après prostatectomie radicale: la satisfaction des patients est-elle corrélée à la qualité des érections?

INTRODUCTION: Post radical prostatectomy potency rates, quantified on the basis of physician survey, have ranged up to 80%. Physician derived potency data, however, may not be representative of true post-prostatectomy potency rates or more importantly may not accurately portray patients' post-operative sexual satisfaction. We conducted a pilot study combining physician derived and patient derived subjective data with objective measures of erectile function. MATERIALS AND METHODS: Eleven men, mean age of 59 years, who were treated with nerve sparing radical retropubic prostatectomy formed the study group. Initially, the patients responded to a physician directed telephone survey on sexual status. Potency was then objectively assessed utilizing Rigiscan testing on two consecutive evenings. Lastly, the patients completed a validated short questionnaire directed to obtain a patients' subjective perception of sexual function. RESULTS: All the patients responded to the first part of the study by informing the physician that they were sexually active or potent after radical prostatectomy. Of these 11 patients, however, only 2 (18%) were mostly satisfied with their sex life according to the quality of life questionnaire. Rigiscan testing revealed that 8 of the 11 patients had nocturnal erections which were adequate for vaginal penetration. Of the 5 patients who stated that they were mostly dissatisfied with their sexual functioning, 3 had objective evidence of adequate erectile ability as documented by Rigiscan. Three of the four patients who were ambivalent with respect to their sexual function also demonstrated objective evidence of normal erectile activity. CONCLUSION: Although a patient may inform his care provider that he is sexually active or potent, he may not be satisfied with his present level of sexual functioning. In addition, we observed that some dissatisfied patients do have normal Rigiscan patterns indicating that a percentage of patients who are not happy with their level of sexual function after radical prostatectomy may have a psychogenic component to their problem.

The epidemiology of erectile dysfunction.

During the last two decades, significant advances have been made in the understanding of male sexual dysfunction. Concomitantly, a marked increase in both clinical and research activity in the field of male erectile dysfunction has led to a better evaluation and more treatment options. The prevalence and incidence are dependent on the definitions used, the diagnostic tolls, and the treatment options. Using standard definitions as suggested by the NIH Consensus Conference and improving our diagnostic and treatment options will have a major impact on the epidemiology of ED. A summary of the risk factors for ED is presented in Table 3. Still more epidemiologic research is essential to further understand the distribution as well as the prevalence of ED in certain ethnic groups, chronic conditions, and as a result of surgery and trauma. These studies will help us improve our diagnostic skills as well as our therapeutic options.

Penile revascularization.

Penile revascularization surgery to correct penile vascular insufficiency has undergone several modifications since its introduction. Further improvement in the surgical success rate will be achieved with improved understanding of erectile physiology, diagnostic methodology, and both microsurgical and radiological techniques.

Reestablishment of male sexual function and appearance 23 years after alligator induced traumatic orchiectomy and penile lacerations.

We report a case of traumatic sexual dysfunction and genitalia deformity successfully treated with dorsal vein excision, spongiolysis, rotational flaps, split thickness skin grafts, testicular prosthesis implantation and penile autologous fat augmentation 23 years after an alligator attack resulted in amputation of the testes and half of the scrotum, and denudation of the penis with corpus cavernosum to spongiosum fistula formations.

Male erectile dysfunction assessment and treatment options.

Until the early 1970s impotence was believed to be primarily a psychological disorder. The treatment usually consisted of empiric testosterone administration and psychotherapy, that were often ineffective. The introduction in the early 1970s of penile implants changed the treatment options and at the same time ushered in the modern era of male sexual medicine. Clinical as well as laboratory research improved significantly the diagnosis and treatment options of the impotent man. Today the man with a sexual problem has a much better chance of proper diagnosis and effective treatment.

Surgical management of long urethral strictures.

A total of 25 patients with a long urethral stricture involving the bulbomembranoprostatic urethra underwent excision of the afflicted region via the perineal approach with end-to-end anastomosis. Liberation of the distal urethra provided sufficient length for anastomosis without tension of the healthy urethra. Satisfactory results were obtained in 23 of the 25 patients without any functional disturbance of sphincter control.

Sports hematuria.

Strenuous exercise makes extraordinary demands. The transition from rest to intensive physical activity can cause pathological changes in various organs, particularly in the urinary tract. Hematuria (microscopic or macroscopic) is one of the abnormalities commonly found after sports activity. This phenomenon can occur in noncontact sports (such as rowing, running and swimming) as well as in contact sports (boxing, football and so forth). The pathophysiology can be either traumatic or nontraumatic. Renal trauma and/or bladder injury due to repeated impact of the posterior bladder wall against the bladder base can cause vascular lesions and consequently hematuria. There are 2 mechanisms of nontraumatic injury. 1) Vasoconstriction of the splanchnic and renal vessels occurs during exercise in order that blood can be redistributed to the contracting skeletal muscles, thus causing hypoxic damage to the nephron. This results in increased glomerular permeability which would favor increased excretion of erythrocytes and protein into the urine. 2) A relatively more marked constriction of the efferent glomerular arterioli results in an increased filtration pressure, which favors increased excretion of protein and red blood cells into the urine. It must be noted that sports hematuria differs from other conditions that may cause reddish discoloration of the urine due to physical exercise, such as march hemoglobinuria and exercise myoglobinuria. In the latter 2 abnormalities there is excretion of hemoglobin and myoglobin molecules in the urine and not whole blood or intact red blood cells. Sports hematuria usually has a benign self-limited course. However, coexisting urinary tract pathological conditions should be excluded carefully.

[A rare pelvic tumor].

Splenosis consists of the autotransplantation of splenic tissue following splenic trauma. Unlike hypersplenism, to which it is not related, it does not usually result in any clinical manifestation. It is usually discovered incidentally during operation years after splenic trauma. A benign tumor is found which may or may not be histologically identical with normal splenic tissue, and may or may not be functional. We present a 52-year-old man with a pelvic mass thought to be malignant. Work-up, including CT scan, 99m Tc colloid scintigraphy and 99m Tc-labeled heat-denaturated erythrocyte scintigraphy revealed pelvic splenosis. This case highlights the fact that a pelvic tumor after emergency splenectomy may represent splenosis.