Surgical Complications in En Bloc Renal Transplantation.

En bloc pediatric transplantation (EBPT) began with the aim of increasing the donor pool due to the existing high demand for donors. At its inception, it was considered a type of suboptimal transplantation due to its association with a high incidence of vascular, urologic, and immunologic complications. The main objective of this study was to update information on EBPT with the largest case series that exists on a worldwide scale. In a retrospective study, the results obtained from brain-dead donors (BDDs; n = 770) were compared to those of EBPT (n = 100) from January 1990 to December 2012. The median of follow-up was 12.8 years (interquartile range 8.1 to 17.2). The variables collected for analysis were demographic factors (age and sex of recipients, age and weight of donors), renal function, graft survival, recipient survival, surgical complications (thrombosis, lymphocele, urologic complications, and renal artery stenosis and need for revascularization with angioplasty and/or stents). Subsequently in a second analysis, we studied the association between graft survival, thrombosis, angioplasty, stents, and appearance of lymphoceles with the different factors that were considered to be related in accordance with published literature and our own experience. Graft loss due to surgical complications was more frequent in EBPT than in BDD (15% vs 2.2 % in BDD; P < .001), and interstitial fibrosis and tubular atrophy were more frequent in BDD (13% vs 2%; P < .001). EBPT offers a good survival rate after overcoming the possible surgical complications that may arise.

Robot Assisted Radical Prostatectomy in Kidney Transplant Recipients. Our Clinical Experience and a Systematic Review.

INTRODUCTION: Radical prostatectomy is a more skillful procedure in kidney graft recipients. Robotic surgery can provide a useful minimally invasive tool. OBJECTIVES: The study aims to evaluate the robotic-assisted laparoscopic prostatectomy (RALP) in kidney transplant recipients, describing intra/postoperative complications, renal and oncological outcomes. METHODS: This is a retrospective study conducted in a single institution of 84 RALP. Four of them were kidney transplant recipients. Side of the renal graft, clinical stage, intra/postoperative events, operating time, creatinine levels before/after intervention and oncologic follow-up were recorded. A systematic review of the literature was performed. RESULTS: Aged 61.25 ± 7.76 years, interval between renal transplantation and RALP: 10 ± 3.16 years. Mean prostate specific antigen: 7.1 ± 2.8 ng/ml, 2 patients were cT1c and 2 cT2a. Preoperative biopsies: Gleason score 3 + 3 in 3 patients, 3 + 4 in 1 patient. Charlson comorbidity index mean was 4.82 ± 0.82. No intra/postoperative events were reported. Mean operating time: 196 ± 20.8 min. Positive surgical margins: 2/4 patients. Pathological analysis: Gleason 3 + 4 in 2 patients and Gleason 3 + 3 in the others 2. A patient developed a bladder neck sclerosis. No differences between pre/postoperative creatinine. Three patients are free of biochemical recurrence and 1 patient required adjuvant radiotherapy. CONCLUSION: RALP in renal transplant recipients is a safe and feasible technique for localized prostate cancer. No difference in oncological outcomes and no impairments on renal function were found.

Factores determinantes de la satisfacción del paciente con el tratamiento para la disfunción eréctil / Determining factors in patient satisfaction with erectile dysfunction treatment

Introducción: La disfunción eréctil (DE) se asocia a estados depresivos, de ansiedad y pérdida de autoestima, empeorando la calidad de vida del paciente. El presente estudio tuvo por objetivo, identificar y evaluar los aspectos más relevantes para el paciente en relación con la satisfacción con el tratamiento para la DE, analizar cuales de éstos tienen mayor impacto sobre la autoestima y la satisfacción con diferentes aspectos de la vida Métodos: Estudio epidemiológico, transversal, multicéntrico y observacional. Se incluyeron hombres españoles mayores de 18 años en tratamiento para la DE con cualquier fármaco oral, al menos 4 semanas antes del comienzo del estudio. El coeficiente de correlación de Pearson fue calculado entre los aspectos importantes para el paciente al valorar su satisfacción con el tratamiento (preguntas 4 a 11 del 'Erectile Dysfunction inventory of treatment satisfaction', EDITS) y la satisfacción con el tratamiento (pregunta 1 EDITS), lasubescala de autoestima del cuestionario 'The Self-esteem and Relationship' (SEAR) y el cuestionario 'Fugl-Meyer life satisfaction CheckList' (LISAT-8). Resultados: Se incluyeron un total de 1.646 pacientes. Los aspectos de mayor relevancia en relación con la satisfacción con el tratamiento para la DE, fueron: duración de los efectos (r=0,7311 p≤0,0001), rapidez de acción del fármaco (r=0,7088 p≤0,0001), confianza en poder mantener relaciones sexuales (r=0,7021 p≤0,0001) y satisfacción de la pareja (r=0,692 p≤0,0001). Los aspectos que mayor impacto tuvieron sobre la autoestima fueron: duración de los efectos (r=0,6254 p≤0,0001) y confianza en poder mantener relaciones sexuales(r=0,6372 p≤0,0001). Los aspectos que mayor impacto tuvieron sobre la mejora de diferentes aspectos de la vida (LISAT-8) fueron: facilidad de uso (r=0,4372 p≤0,0001) y rapidez de acción del fármaco (r=0,4131 p≤0,0001).Conclusión: Los aspectos relevantes en la satisfacción con el tratamiento fueron también los que más influían en la autoestima y la vida afectiva del paciente (AU)

Introduction: Erectile dysfunction (ED) is associated with depression, anxiety and loss of self-esteem, deteriorating patient’s quality of life. The present study aimed, to identify and evaluate key factors influencing patient’s satisfaction with ED treatment. To analyze which of them have a greater impact on patient’s self-esteem and satisfaction with different aspects of life. Methods: The approach used was a multicentre, cross-sectional, epidemiological, observational study. The study group consisted of Spanish men over 18 years of age who received oral drug treatment for ED for at least 4 weeks before the study began. Pearson’s correlation coefficient was calculated from the important aspects for the patient to assess his satisfaction with treatment ('Erectile Dysfunction Inventory of Treatment Satisfaction' (EDITS) questions 4-11) and overall satisfaction with treatment (EDITS question 1), the self-esteem subscale of the 'Self-esteem and Relationship' (SEAR) questionnaire, and the'Fugl-Meyer Life Satisfaction Check List' (LISAT-8) questionnaire. Results: A total of 1,646 patients were included. The most significant factors in connection with satisfaction with treatment for ED were; duration of the effects (r=0.7311 p≤0.0001), speed of action of the drug (r=0.7088 p≤0.0001), confidence in the ability to have sexual relations (r=0.7021 p≤0.0001) and partner satisfaction (r=0.692 p≤0.0001). The factors which had greatest impact on self-esteem were duration of the effects (r=0.6254 p≤0.0001) and confidence in the ability to have sexual relations (r=0.6372 p≤0.0001). The factors with the greatest impact on improvement in quality of life (Lisat-8 questionnaire) were: ease of use (r=0.4372 p≤0.0001) and speed of action of the drug (r=0.4131 p≤0.0001).Conclusion: The factors which most influenced satisfaction with the treatment were also those which had most impact on the patient’s self-esteem and emotional life (AU)

[Determining factors in patient satisfaction with erectile dysfunction treatment]. / Factores determinantes de la satisfacción del paciente con el tratamiento para la disfunción eréctil.

INTRODUCTION: Erectile dysfunction (ED) is associated with depression, anxiety and loss of self-esteem, deteriorating patient's quality of life. The present study aimed, to identify and evaluate key factors influencing patient's satisfaction with ED treatment. To analyze which of them have a greater impact on patient's self-esteem and satisfaction with different aspects of life. METHODS: The approach used was a multicentre, cross-sectional, epidemiological, observational study. The study group consisted of Spanish men over 18 years of age who received oral drug treatment for ED for at least 4 weeks before the study began. Pearson's correlation coefficient was calculated from the important aspects for the patient to assess his satisfaction with treatment ("Erectile Dysfunction Inventory of Treatment Satisfaction" (EDITS) questions 4-11) and overall satisfaction with treatment (EDITS question 1), the self-esteem subscale of the "Self-esteem and Relationship" (SEAR) questionnaire, and the "Fugl-MeyerLife Satisfaction Check List" (LISAT-8) questionnaire. RESULTS: A total of 1,646 patients were included. The most significant factors in connection with satisfaction with treatment for ED were; duration of the effects (r=0.7311 p < or = 0.0001), speed of action of the drug (r=0.7088 p < or = 0.0001), confidence in the ability to have sexual relations (r=0.7021 p < or = 0.0001) and partner satisfaction (r=0.692 p < or = 0.0001). The factors which had greatest impact on self-esteem were duration of the effects (r=0.6254 p < or = 0.0001) and confidence in the ability to have sexual relations (r=0.6372 p < or = 0.0001). The factors with the greatest impact on improvement in quality of life (Lisat-8 questionnaire) were: ease of use (r=0.4372 p < or = 0.0001) and speed of action of the drug (r=0.4131 p < or = 0.0001). CONCLUSION: The factors which most influenced satisfaction with the treatment were also those which had most impact on the patient's self-esteem and emotional life.

[The persistence of the müllerian duct]. / Persistencia del conducto Mülleriano.

OBJECTIVE: To report two rare cases of persistent müllerian duct syndrome. METHODS/RESULTS: Two patients with normal chromosome studies (46, XY) are presented. The radiological evaluation showed structures compatible with those of the müllerian duct. These structures were completely excised with excellent results. The histological findings confirmed the clinical diagnosis. CONCLUSIONS: Persistent müllerian duct syndrome is a rare form of male pseudohermaphroditism that presents difficulties in making the differential diagnosis from other conditions with a different etiopathogenesis and that are not completely defined.

[Arterial priapism. Resolution following embolization with autologous thrombus]. / Priapismo arterial. Resolución tras embolización con coágulo autólogo.

OBJECTIVE: To report our experience with the management of arterial priapism by embolization. METHODS: Two patients with arterial priapism secondary to perineal trauma are described. Diagnostic evaluation included intracorporal blood gas, echo Doppler and selective pudendal arteriographic assessment. Treatment was by selective autologous embolization. RESULTS: Detumescence was achieved and control follow-up evaluation at 12 and 24 months demonstrated normal erectile function. CONCLUSIONS: In our view, selective embolization is an effective treatment for arterial priapism arising from perineal trauma.

[Ureteral iatrogenic disease of obstetric-gynecologic origin]. / Yatrogenia ureteral de origen obstetro-ginecológico.

OBJECTIVE: To review our experience in the diagnosis and management of ureteral injuries secondary to obstetric and gynecologic procedures. METHODS: During the last 25 years, 42 patients were treated at our center for iatrogenic ureteral injuries (45 renal units) associated with obstetric and gynecologic procedures, principally hysterectomy via the abdominal approach (29 cases). The injury was diagnosed in the immediate postoperative period in 21 of the 42 cases. Surgical management was frequently by ureteroneocystostomy. Patient follow-up ranged from 3 months to 11 years. RESULTS: Good results were obtained in 83.3% of the cases. CONCLUSIONS: Ureteral injuries detected intraoperatively should be immediately repaired. For those diagnosed postoperatively, management by retrograde or antegrade catheterization and/or US or CT-guided percutaneous nephrostomy should be attempted before performing surgery.

[Incidence of tumors in renal transplant patients. Is there a changing tumor pattern in these patients?]. / Incidencia de neoplasias en pacientes con trasplante renal. Está cambiando el patrón de neoplasias en estos pacientes?

OBJECTIVE: To analyze the incidence of tumors in renal graft recipients, the course, treatment and its effect on the graft and patient. METHODS: We conducted a retrospective and prospective study on 477 renal transplants performed at our hospital from 1980 to 1996. The tumor type, course and possible tumor-related factors (immunosuppression, age, sex, graft rejection, virus) were analyzed. RESULTS: 57 tumors were found; 41 patients had at least one tumor. The most common were skin, renal and lung cancer. Age, sex and immunosuppression were found to be tumor-related factors in renal transplant recipients. CONCLUSIONS: Patients undergoing renal transplantation are at a higher risk for developing a tumor, above all in the older male patients. A relationship was found for immunosuppression, the number of drugs received and the number of rejection episodes. Furthermore, the tumor pattern in these patients is different from the usual pattern.

[Neurobiology of ejaculation and orgasm disorders]. / Neurobiología de las alteraciones de la eyaculación y orgasmo.

OBJECTIVE: To determine the neurologic alterations of patients with ejaculatory and orgasmic disorders. METHODS: A study of the neuroandrologic profile was performed in eight patients; 6 presented an ejaculation, one premature ejaculation and one presented an orgasm. The neuroandrologic profile consisted in performing selective electromyography of the bulbocavernosus muscle, recording of the S2-S4 evoked potentials, evoked somatosensory potentials of the pudendal nerve, electromyography of the smooth cavernous muscle (SPACE), sympathetic skin response and cystometry. RESULTS: The sympathetic lesion was more frequent in the cases with an ejaculation (four cases; 66%); a pudendal efferent lesion was demonstrated in one case (17%) and a suprasacral lesion in one case (16%). A pudendal afferent lesion was observed in the two cases with premature ejaculation (100%). Both cases with an orgasm had a pudendal afferent lesion (100%) and one of them also presented a sympathetic lesion (50%). CONCLUSIONS: An ejaculation appears to be caused by sympathetic, motor pudendal or suprasacral lesion. An altered perception of genital sensations due to lesion of the afferent pudendal pathway appears to be present in premature ejaculation. An orgasm could be ascribed to an alteration of the pudendal sensibility or to the absence of ejaculation.

[Sarcomatoid renal carcinoma]. / Carcinoma renal sarcomatoide.

OBJECTIVE: To analyze the pathological and clinical features of a variant of renal carcinoma: sarcomatoid renal carcinoma. METHODS: Of 316 patients diagnosed as having a renal tumor from 1975 to 1995, 11 (3.5%) with a pathological diagnosis of sarcomatoid renal carcinoma were analyzed. The clinical history, biological data and diagnostic imaging findings of these patients were reviewed. All patients had undergone surgical exploration. RESULTS: All the tumors showed a double cellular population, with a fusiform component. Histological analysis showed a high grade and stage tumor. Ten patients died from the disease, the mean survival rate was 9 months (range 2-48) following diagnosis. CONCLUSIONS: Sarcomatoid carcinoma of the kidney is uncommon and can be occasionally difficult to distinguish from sarcoma. It has a worse prognosis than other variants of renal carcinoma.

[Neurobiology of erectile dysfunction in multiple sclerosis]. / Neurobiología de la disfunción eréctil en la esclerosis múltiple.

OBJECTIVE: To analyze the neurological alterations responsible for impotence in multiple sclerosis. METHODS: We conducted a pharmacologic erection test and a neuroandrologic profile study in 11 patients with multiple sclerosis and impotence. This study consisted in: bulbocavernosus EMG, S2-S4 evoked potentials, somatosensory potentials of pudendal nerve, electromyography of cavernous smooth muscle (SPACE), sympathetic skin response (SSR) and cystometry. RESULTS: The most frequent neurological lesion was complete suprasacral (7 cases; 64%) and parasympathetic (7 cases; 64%) lesions. The parasympathetic lesions were of the upper motor neuron type in 6 of the 7 cases (86%). Peripheral autonomic [sympathetic in 2 cases (18%); parasympathetic in 1 case (9%)] and pudendal lesions (3 cases; 27%) were also observed. CONCLUSIONS: The main cause of impotence in multiple sclerosis could be ascribed to a suprasacral lesion. Some cases also present peripheral autonomic lesions.

[Urologic neoplasms in patients with renal transplantation. Experience and review of the literature]. / Neoplasias urológicas en pacientes con trasplante renal. Experiencia y revisión de la literatura.

The presence of neoplasms in patients with renal transplant in a higher frequency than in general people is known since a long time. The most frequent tumours were the skin tumours, followed by other tumours common in immunosuppressed patients. The ain of this work has been study the frequency, type, diagnosis, treatment and evolution of the urinary system tumours in patients with renal transplant and an exhaustive review of literature. We have found 11 tumours of the urinary system over 57 tumours in 41 patients, with a frequency 26.8%. 6 were kidney tumours, 3 of prostate and 3 of the bladder. We have analyzed the incidence, diagnosis, treatment and evolution of tumour and its effects on the graft. We believe that the posttransplant follow-up of the patient, overcoat in males, who have tumours in more frequency, is important for the early diagnosis.

[Renal transplant in patient older than 65 years of age]. / Trasplante renal en pacientes mayores de 65 años.

OBJECTIVE: To analyze the outcome of renal transplantation in patients more than 65 years old. METHODS: From 1991 to 1997, 83 renal transplants were performed in patients aged over 60 years at our institution; 20 of these patients were more than 65 years old. The control group comprised graft recipients under than age from the 477 cases that had undergone transplantation during the period 1980-1996. Graft donor selection was done according to standard practice. The immunosuppression protocol changed over time; 5 patients received triple therapy and another 15 patients received quadruple sequential immunosuppression therapy. RESULTS: The mean age of the recipients was 66.8 years (range 65-72); 9 patients required dialysis after renal transplantation. Patients aged over 65 years had a 94% survival at 6 months, 88% at 12 months, and 88% at 48 months, whereas the survival rates for the control group were 96%, 95% and 87% for the respective time periods. Graft survival was 95% at one month, 90% at 3 months and 74% at 48 months versus 93%, 87% and 78% for the control group. CONCLUSION: Patients more than 65 years old with chronic renal failure and who are on dialysis can benefit from renal transplantation.

[En bloc renal transplant from infant donors to adults]. / Transplante renal en bloque de donante infantil a adulto.

OBJECTIVE: To analyze the medium-term outcome of en bloc transplantation of pediatric kidneys into adult patients, including the incidence and type of surgical complications. METHODS: From November 1991 to December 1997, we performed 37 en bloc transplantation of pediatric kidneys into adult patients. The kidneys were harvested from donors less that 3 years old and/or weighing 15 kg. The mean follow-up was 24 months. Grafting was achieved by end-to-side anastomosis of the donor cava to the receptor external iliac and the aortic patch to the external iliac artery. RESULTS: Three grafts failed, probably due to hilar torsion; the remaining were initially functioning well. Seven transplant removal were performed; 6 were due to thrombosis. The actuarial graft survival was 89.1% at one month, 80.83% at 12 months and 80.83% at 24 months. CONCLUSIONS: The medium-term results of en bloc transplantation of pediatric kidneys into adult patients were excellent and demonstrate the efficacy of this type of grafts. Arterial and venous thrombosis were the most important complications, quantitatively and qualitatively.

[Neurobiology of postoperative impotence after rectal excision]. / Neurobiología de la impotencia post cirugía de exéresis rectal.

OBJECTIVE: The present study was conducted to determine the changes in the neuro-andrologic profile of patients with impotence following rectal ablative surgery. METHODS/RESULTS: The study comprised 18 patients who had undergone rectal surgery: abdominoperineal resection of the rectum (AP) in 12 cases (67%), anterior resection of the rectum (AR) in 6 cases (33%). The pharmacologic erection test was negative in 60% of the patients (56% of the AP cases and 67% of the RA cases; differences not significant). Sympathetic lesion was demonstrated in 67% of the patients (50% of the AP cases and 100% of the AR cases; significant difference). Parasympathetic lesion was demonstrated in 38% of the patients (56% of the AP and in none of the RA cases; tendency towards statistical significance). Pudendal lesion was demonstrated in 83% of the patients, although no significant differences concerning pudendal involvement were observed between both types of surgery (92% of the AP group and 67% of the RA group). The frequency of the pudendal lesion was significantly greater than the parasympathetic lesion and the sympathetic lesion tended to be significantly greater than the parasympathetic lesion in patients undergoing ablative rectal surgery. No significant differences were observed between the pudendal and the sympathetic lesion in these patients. No relationship was observed between the type of neurologic lesion and the results of the pharmacologic erection test. CONCLUSIONS: The type of neurological lesion appears to be related with the level of the rectal surgery. The sympathetic innervation would be more frequently compromised in anterior resection of the rectum. The parasympathetic innervation would be more frequently compromised in abdominoperineal resection. The pudendal innervation would be affected by both types of surgical techniques.

[Neuroandrologic considerations in impotent patients with Peyronie's disease]. / Consideraciones neuroandrológicas en pacientes impotentes con enfermedad de Peyronie.

OBJECTIVE: To asses the neuroandrologic profile of impotent patients with Peyronie's disease. METHODS: We conducted a pharmacological erection test and a study of the neuroandrologic profile of 13 impotent patients with Peyronie's disease. Eight patients hhad associated conditions and no associated disease was demonstrated in the remaining 5 patients. The neuroandrologic profile was based on bulbocavernous EMG, S2-S4 evoked potentials, somatosensorial potentials of pudendal nerve, cavernous smooth muscle electromyography (SPACE), sympathetic skin response, and cystometrogram. RESULTS: SPACE was altered in all the cases. In the patients with no associated disease, all other data of the neuroandrologic profile were normal. Patients with associated conditions demonstrated more alterations in all other data of the neuroandrologic profile and significant differences were observed in 7 cases. No differences in the type of alterations of SPACE were observed in 7 cases. No differences in the type of alterations of SPACE were observed between both groups. CONCLUSION: The impotence associated with Peyronie's disease could be due to an intrinsic lesion of the erectile smooth muscle.

[Analysis of pudendal nerve somatosensory evoked potentials in the diagnosis of neurogenic impotence]. / Análisis de los potenciales evocados somatosensoriales del nervio pudendo en el diagnóstico de la impotencia neurógena.

OBJECTIVE: To determine the utility of the somatosensorial evoked potentials of the pudental nerve in the diagnosis of neurogenic impotence. METHODS: 129 patients with impotence were evaluated by physical examination and neuroandrologic profile. The neuroandrologic profile was assessed by bulbocavernous electromyography, determination of S2-S4 evoked potentials, analysis of the somatosensorial potentials of the pudendal nerve, cavernous smooth muscle electromyography (SPACE), sympathetic skin response and cystometry. RESULTS: The patients with a neurologic lesion presented a significantly longer latency time of the somatosensorial potentials than those with no neurologic lesion. The sensitivity of the somatosensorial potentials was 63% and the specificity was 98%. The sensitivity could be enhanced without significantly lowering specificity by taking 49 msec as the upper limit of normal values in latency time. The determination of the voluntary anal control in the diagnosis of neurogenic impotence was found to have a high specificity (93%), but a low sensitivity (42%). CONCLUSION: The determination of the somatosensorial potentials, unlike other techniques, could allow diagnosis of lesions of the suprasacral inneveration in the evaluation of neurogenic impotence. The evoked somatosensorial potentials of the pudendal nerve and physical examination have the inconvenience of their low sensitivity in regard to the diagnosis of neurogenic lesion in impotence, mainly because some conditions only affect the peripheral autonomic innervation and the somatic element is spared.

[Evaluation of electromyography of the corpora cavernosa (single potential analysis of cavernous electric activity--SPACE) as a technique for studying impotence]. / Valoración de la electromiografía de los cuerpos cavernosos (SPACE) como técnica de estudio de la impotencia.

OBJECTIVE: To analyze the utility of data obtained by single potential analysis of cavernous electric activity (SPACE) in the study of impotence. METHODS: 127 patients with impotence were evaluated by neuroandrologic profile, SPACE, erection test post intracavernous injection of papaverine-phentolamine and a cystometrogram (CMG). RESULTS: The quantitative characteristics (duration, amplitude, number of phases) of the SPACE potentials were not useful in distinguishing between the different types of impotence. The qualitative characteristics (degree of activity, morphology, synchrony and coordination) during erection were significantly different between the non-neurogenic and neurogenic impotence. Significant differences were found in the qualitative characteristics (synchrony and coordination during erection) between patients with no demonstration of organic impotence and those with a negative erection test and no alterations in the neuroandrologic profile (vascular impotence). No relationship was found between the degree of activity of the SPACE and the presence or absence of voiding reflex in the CMG. CONCLUSION: SPACE is a useful technique in the study of impotence, although the interpretation of the data are more qualitative than quantitative. The CMG provides complementary data and should therefore continue to be included in the study of the neuroandrologic profile in impotence.

[Current status of the study of genital sympathetic evoked potentials in the assessment of impotence]. / Actualidad del estudio de los potenciales evocados simpáticos genitales en la valoración de la impotencia.

OBJECTIVE: To determine the usefulness of penile sympathetic skin response (PSSR) in the study of impotence. METHODS: The PSSR, hand sympathetic skin response (HSSR), filling videocystography and SPACE (single potential analysis cavernous electromyography) were performed in 39 patients referred for study of impotence. RESULTS: A relationship between not obtaining PSSR and an open bladder neck (60%) in the videocystography at filling, and between a closed bladder neck and obtained PSSR (81%) was demonstrated. The percentage of normal hand sympathetic potentials was similar for patients with obtained and not obtained PSSR. The relationship between the degree of activity of the SPACE and the type of PSSR could not be demonstrated. CONCLUSION: The determination of the PSSR allows us to evaluate the sympathetic cavernous innervation. This would obviate performing a filling videocystography in the study of the neuroandrologic profile in impotence. The information obtained by PSSR is independent of that obtained from SPACE, therefore both procedures complement each other in the neuroandrologic study of impotence.

[Assessment of sensory thresholds of the penile dorsal nerve as screening technique for neurologic lesion in impotence]. / Valoración de los umbrales sensoriales del nervio dorsal del pene como técnica de screening de lesión neurológica en la impotencia.

OBJECTIVE: The present study was conducted to determine the usefulness of the perception and stimulation thresholds of the penile dorsal nerve in the diagnosis of neurogenic impotence. METHODS: A study was conducted to determine the neuroandrologic profile in 130 patients. According to the results of the neuroandrologic profile, they were classified as patients without neurogenic impotence (44 pts.; 34%) or with neurogenic impotence (86 pts.; 66%). The perception and stimulation thresholds (expressed in milliAmperes) were determined in all patients. Furthermore, the perineal sensation was clinically tested. Both thresholds were also studied in relation to a demonstrated neurologic lesion (sympathetic, parasympathetic, afferent pudendal, efferent pudendal and suprasacral lesions). RESULTS: Assessment of the perineal sensation demonstrated a high specificity and a low sensitivity in the diagnosis of neurogenic impotence. A significant difference was observed between both groups for the perception (confidence interval of difference between the neurogenic and non-neurogenic group; from 0.02 to 4.95 mA) and stimulation thresholds (from 2.0 to 11 mA). Morever, the stimulation threshold was significantly higher in patients with alteration of the perineal sensation). Significant differences in the perception threshold were also demonstrated between patients with and without demonstration of efferent lesion, and in the stimulation threshold between patients with and without demonstration of pudendal afferent, pudendal efferent and sympathetic lesion. These differences are attributed to the presence of mixed lesions. However, given the width of the interval of normal values, it was not possible to find a useful cut-off point in both sensory thresholds. It could only be determined that the maximum value of the perception threshold in healthy subjects should be less than 9.45 mA. CONCLUSION: The sensorial thresholds of the electrical stimulation of the penile dorsal nerve and the data from the physical examination of perineal sensation are not useful for the diagnosis of neurogenic impotence. It is necessary to carry out a complete neuroandrologic profile.