Unilateral unitary inflatable penile prosthesis to correct impaired tumescence and severe penile deformity resulting from traumatic rupture of 1 corpus cavernosum.

Nonsurgical management of a penile fracture can result in penile deformity due to plaque, and impaired tumescence due to corporeal fibrosis and altered erectile hemodynamics. We describe the correction of penile deformity and impaired tumescence by extensive resection of corporeal fibrosis and insertion of a unilateral unitary inflatable prosthesis. A possible role is proposed for correcting penile angulation secondary to unilateral disease using a unilateral unitary inflatable penile prosthesis.

Love and sex after 60: how to evaluate and treat the sexually-active woman.

In the medical evaluation of older female patients with sexual problems, you need to assess the woman's psychological state, as well as her physical condition. An important question to ask is whether her level of sexual activity is satisfactory to her. Women's early sexual experiences, in some cases including childhood sexual abuse, impact greatly on their sexuality in later life. When sexual problems are related to the menopause, customized hormone replacement therapy is the treatment of choice. Other clinical factors that impact on older women's sexuality include urinary incontinence, breast surgery, and hysterectomy.

Love and sex after 60: how to evaluate and treat the impotent older man. A roundtable discussion: Part 2.

In the medical evaluation of older men with erectile dysfunction, obtain a detailed history to determine whether the dysfunction is organic or psychogenic. Determine if there are underlying pathologic processes--most notably vascular diseases--or other factors responsible for the dysfunction, such as medications or nerve or arterial damage from surgery. Lifestyle changes in mid-life (regular exercise, a low-fat diet, and smoking cessation) increase a man's chances of remaining potent as he grows older. Treatments for impotence include injection therapy, vacuum devices, and implants. Each therapy has advantages and disadvantages, and the informed patient plays an important role in choosing the therapy that is right for him.

Diabetes-related impotence in the elderly.

Because many elderly men with chronic illnesses such as diabetes have multiple causes contributing to their impotence and may still retain an interest in sexual activity, those who still are unable to adequately perform sexually after treatment of their medical problems should be informed of the alternative methods of treatment of their impotence or alternative methods of sexual fulfillment and gratification and, when necessary, should be offered supportive counseling and psychotherapy.

Diagnostic evaluation of impotence.

A multispecialty approach to diagnosis of impotence is the most appropriate, because many factors may be at work. The expertise of professionals in the fields of urology, sex therapy, psychiatry, family practice, internal medicine, endocrinology, neurology, radiology, sleep evaluation, and vascular surgery may be needed to ascertain the correct organic or psychogenic cause in some cases.

Treatment alternatives for impotence.

More than 10 million men in the United States are chronically impotent. Fortunately, significant advances have been made in psychotherapy, pharmacologic management, arterial and venous surgery, penile prosthesis implantation, and use of external devices so that most find a satisfactory solution. After their dysfunction is sufficiently evaluated and the most appropriate treatment option is applied, most men achieve erectile capability sufficient for intercourse.

OmniPhase penile prosthesis: delayed bilateral central cable breakage.

The OmniPhase* penile prosthesis is a new mechanically activated penile implant. The prosthesis can be alternatively flaccid and rigid depending on the tension of a supporting central cable. We report a case of delayed bilateral central cable breakage with subsequent loss of penile rigidity.

Diabetes-related impotence and its treatment in the middle-aged and elderly: Part II.

Primary care treatment of diabetes-related impotence frequently revolves principally around patient referral and counseling. Sex or marital counseling or psychotherapy has a moderately high success rate for patients with psychogenic impotence. However, penile prosthesis implantation in properly selected patients with irreversible diabetic impotence has a final success rate, in terms of patient and partner satisfaction, of approximately 90%. Intracorporal self-administered papaverine alone or in combination with phentolamine has a limited role in producing erections satisfactory for intercourse.

Diabetes-related impotence and its treatment in the middle-aged and elderly: Part I.

Diabetes-related impotence is commonly noted within 10 years of the onset of diabetes. It is frequently due to microangiopathy and is associated with symptomatic neuropathy. Careful history-taking, physical examination, laboratory tests, and frequently, sophisticated diagnostic tests are indicated in the evaluation of these patients. Nocturnal penile tumescence and rigidity testing has become the gold standard of noninvasive evaluation.

Interstitial irradiation of carcinoma of the prostate with 125iodine and simultaneous extraperitoneal pelvic lymphadenectomy in 32 patients: trials, tribulations and possible triumphs.

A series of 32 patients with carcinoma of the prostate who underwent 125iodine interstitial irradiation to the prostate and simultaneous extraperitoneal pelvic lymphadenectomy was reviewed. The patients were segregated into 3 groups: group 1-patients with early localized low grade disease, group 2-patients with advanced localized high grade disease and group 3-patients with early localized high grade disease and those with advanced localized low grade disease. Owing to the high degree of predictability of the absence or presence of pelvic lymph node metastasis in patients in groups 1 and 2 and the morbidity associated with superficial pelvic lymphadenectomy we do not advocate this procedure in these patients. However, we advocate pelvic lymphadenectomy in patients in group 3 because of the unpredictability of lymph node metastasis. Furthermore, our data indicate that 1) the morbidity of the combined procedures is relatively low, with no patients becoming incontinent and only 12.5 per cent becoming impotent, 2) 125iodine interstitial irradiation of the prostate after transurethral prostatectomy is safer in terms of postoperative complications than is radical prostatectomy and 3) while superficial pelvic lymphadenectomy is not an innocuous procedure it generally is safe and, at times, an important diagnostic staging procedure.