Objective criteria in the long-term evaluation of penile venous surgery.

Caverno-venous leakage is a frequent cause of impotence and, since venous network resection gives poor results, a study was performed to evaluate the prognostic factors of this surgical procedure. A total of 23 patients underwent surgery for caverno-venous leakage. With a minimum followup of 1 year, 12 patients had normal erections for sexual intercourse. No significant difference was observed in patient age or maintenance flow rates between the responders and nonresponders. Objective quantification of the percentage of smooth muscle cells using computerized image analysis after immunohistochemical staining (desmin antidesmin) for smooth muscle cells on cavernous biopsies performed during the operation allowed us to differentiate significantly between the 2 groups. All responders had greater than 29% smooth muscle cells. Biopsy of the cavernous body with quantification of the different intracavernous structures seems to be a prognostic factor in selecting impotent patients for vascular reconstruction.

Penile extensibility: to what is it related?

Penile extensibility is the difference between the length of the flaccid penis and the penis submitted to a maximal constant traction. This measurement has been proposed for use as a new potential diagnostic method to assess intracavernous fibrosis. To determine the value of this method we measured penile extensibility before and after removing the skin and cavernous tissue in 17 cadavers and 4 patients undergoing penile implantation. In all cases a cavernous tissue biopsy was performed and the percentages of the different structures were objectively quantified by computer analysis. The extensibility decreased with patient age but it was not influenced by removal of the skin and/or cavernous tissue. No correlation was observed between decreased extensibility and the increase in fibrotic elements in the penile tissue. Penile extensibility seems to reflect the elasticity of the tunica albuginea, which is the limiting factor and cannot be an expression of fibrosis of the corpora cavernosa.

Vascular impotence: focal or diffuse penile disease.

Using computerized image analysis the percentage of smooth muscle fibers was measured in several biopsies of the penis from 10 cadavers and 5 patients with vascular impotence. No significant difference was observed between the proximal and distal areas, and/or between the peripheral and central areas in 1 corpus cavernosum, and between the 2 corpora cavernosa for each patient or cadaver. The percentage of smooth muscle fibers was less in impotent patients in comparison with the cadavers, in which the erectile status was not known, and this reduction occurred throughout both cavernous bodies. Vascular impotence is a diffuse penile disease. Therefore, a cavernous body biopsy can be used to study the penile structure in the assessment of vascular impotence.

[Stenosis of the renal artery as a cause of acute renal insufficiency after transplantation]. / La sténose de l'artère rénale comme cause d'insuffisance rénale aiguë aprés une transplantation.

Eight cases of kidney transplant recipients that developed acute renal failure are described. Arterial renal stenosis was responsabilised for the ARF. One patient was submitted to transluminar angioplasty without success and then operated. This technique was the successful treatment in another patient. Four patient were submitted to surgical correction as first therapeutic approach. Two patients received no specific treatment. From the six treated patients five had good evolution.