¿Cuáles son los factores que afectan la dehiscencia del glande tras la cirugía de hipospadias? / What are the factors affecting glanular dehiscence after hypospadias surgery?

Antecedentes La dehiscencia glandular (DG) es una de las principales complicaciones que se producen tras la cirugía de hipospadias. Existe un número limitado de publicaciones sobre la DG en la literatura.Objetivo Esta revisión tiene como objetivo revelar los factores que afectan la DG mediante una revisión bibliográfica.Adquisición de la evidenciaSe realizó una búsqueda literaria de artículos relacionados en la base de datos utilizando el término de búsqueda dehiscencia del glande sin establecer límite temporal ni ningún otro límite. Se incluyeron en este estudio todos los artículos relacionados con la dehiscencia del glande tras la cirugía de hipospadias. Tras recopilar la información de los textos completos, se incluyeron 71 artículos en esta revisión sistemática. Se obtuvieron los siguientes datos para la realización del estudio: la localización del meato hipospádico, el tipo de cirugía, y otros datos clínicos que se consideraron factores de riesgo de la DG. Se utilizó la prueba de X2 para comprobar las diferencias entre los distintos parámetros, considerando un valor p < 0,05 como estadísticamente significativo.Resultados Tras evaluar los 71 artículos que cumplían los criterios de inclusión, en esta revisión se detectaron 309 casos (3,48%) de DG tras 8.858 reparaciones de hipospadias. Las tasas de DG fueron significativamente altas en el caso de las reparaciones de hipospadias proximales (5%), las reparaciones en dos tiempos quirúrgicos (5%) y las reintervenciones (8,75%) (p = 0,002, 0,022 y 0,004, respectivamente). El ancho del glande de < 14 mm y de la placa uretral de < 7 mm, las cirugías de hipospadias realizadas antes de los seis meses de edad y después de la pubertad, y la anestesia de bloqueo caudal aumentaron la tasa de DG Conclusiones El aumento de la tasa de DG se asocia a cirugías de hipospadias proximales, cirugías previas fallidas (cripple) y reparación por etapas, al ancho de glande

Background Glanular dehiscence (GD) is one of the main complications after hypospadias surgery. There is a limited number of publications regarding GD in the literature.Objective The aim of this work is to reveal the factors that affect GD after a literature review.Evidence acquisitionA literature search for relevant articles was performed in database using the search term glans dehiscence without setting date range limit or any other limits. All articles related to GD after hypospadias surgery were included in this study. After collecting the information from full text articles, 71 articles were included in this systematic review. In these studies, localization of hypospadic meatus, type of surgery, and other clinical data which were thought to behave as risk factors for GD were obtained. Chi-Square test was used to evaluate the differences between the parameters, where p < 0.05 was taken as statistically significant.ResultsAfter evaluating the 71 articles that met the inclusion criteria, 309 cases (3.48%) of GD after 8858 hypospadias repairs were obtained in this review. GD rates were found significantly high for proximal hypospadias (5%), two-stage hypospadia repairs (5%) and re-do hypospadias repair (8.75%) (p = 0.002, 0.022, and 0.004, respectively). Glans width < 14 mm, urethral plate (UP) width < 7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia increased the rate of GD.Conclusions The rate of GD increases after proximal, cripple and staged hypospadias surgeries, a glans width < 15 mm and UP width < 8 mm, postpubertal surgeries, and caudal anesthesia use during surgery (AU)

What are the factors affecting glanular dehiscence after hypospadias surgery?

BACKGROUND: Glanular dehiscence (GD) is one of the main complications after hypospadias surgery. There is a limited number of publications regarding GD in the literature. OBJECTIVE: The aim of this work is to reveal the factors that affect GD after a literature review. EVIDENCE ACQUISITION: A literature search for relevant articles was performed in database using the search term glans dehiscence without setting date range limit or any other limits. All articles related to GD after hypospadias surgery were included in this study. After collecting the information from full text articles, 71 articles were included in this systematic review. In these studies, localization of hypospadic meatus, type of surgery, and other clinical data which were thought to behave as risk factors for GD were obtained. Chi-Square test was used to evaluate the differences between the parameters, where p < 0.05 was taken as statistically significant. RESULTS: After evaluating the 71 articles that met the inclusion criteria, 309 cases (3.48%) of GD after 8858 hypospadias repairs were obtained in this review. GD rates were found significantly high for proximal hypospadias (5%), two-stage hypospadia repairs (5%) and re-do hypospadias repair (8.75%) (p = 0.002, 0.022, and 0.004, respectively). Glans width <14 mm, urethral plate (UP) width <7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia increased the rate of GD. CONCLUSIONS: The rate of GD increases after proximal, cripple and staged hypospadias surgeries, a glans width <15 mm and UP width <8 mm, postpubertal surgeries, and caudal anesthesia use during surgery.

A rare penetrating injury through the axilla caused by stilt pole in a Bajau Laut boy.

An 8-year-old child of Bajau Laut descent (a stateless tribe in Eastern Borneo and the Sulu archipelago) presented following a fall, with penetrating injury through the axilla caused by a stilt pole, exiting at the supero-anterior aspect of the left shoulder. Due to the lack of comprehension of modern medical treatment and poor language skills, the parents refused to consent for detailed radioimaging studies, nor surgical removal and exploration in the operating theatre. The removal of retained stilt pole was done in casualty area in Hospital Tawau, followed by local exploration under sedation and local analgesia. Despite the horrific injury, there was no limb-threatening neurovascular injury sustained. Management of such injury in the nomadic Bajau Laut population provides valuable insight and about the challenges and decisions of management.

Los parámetros espermáticos significativos que empeoran están asociados con la hipotrofia testicular en pacientes con varicocele de alto grado / Significant worsening sperm parameters are associated to testicular hypotrophy in patients with a high grade varicocele

Objetivo: Investigar la relación entre el volumen testicular y los parámetros seminales en pacientes con varicocele izquierdo de alto grado unilateral. Material y métodos: Ciento ochenta y siete pacientes que tenían varicocele izquierdo de alto grado de entre 19 y 25 años fueron incluidos en este estudio. Todos los pacientes se sometieron a una evaluación estándar, incluyendo historia clínica y examen físico. Se calculó la diferencia de porcentaje de volumen testicular entre los testículos derecho e izquierdo. Los pacientes fueron divididos en los siguientes 3 grupos: grupo 1 (n = 72) diferencia de volumen testicular < 10%; diferencia de volumen testicular 10-20% grupo 2 (n = 74); y diferencia de volumen testicular > 20% grupo 3 (n = 41). Resultados: La media de edad y el IMC de los pacientes fueron de 21,5 años y 23,1 kg/m2, respectivamente (p = 0,596, p = 0,943). Se compararon los parámetros seminales y los volúmenes testiculares de los 3 grupos. Se descubrió que el recuento total de espermatozoides móviles, porcentaje de espermatozoides móviles y porcentaje de espermatozoides de morfología normal eran menores en el grupo 3 (p = 0,011, p = 0,012, p = 0,029, respectivamente). Se encontró que los volúmenes testiculares medios para el testículo izquierdo y derecho eran 15,2 cm3 y 17,7 cm3 (p < 0,001), respectivamente. No se encontraron diferencias significativas en los volúmenes testiculares derechos entre los grupos (17,4, 17,7 y 18,1 cm3; p = 0,573). Conclusiones: Un varicocele testicular izquierdo de alto grado se asocia con hipotrofia testicular ipsilateral y paralela a los parámetros del esperma empeorado

Objective: To investigate the relationship between testicular volume and semen parameter sin patients with unilateral high grade left varicocele. Material and methods: One hundred eighty seven patients who had left high grade varicocele aged 19-to-25 years were included in this study. All patients underwent a standard evaluation, including medical history and physical examination. The percentage testicular volume difference between the right and left testicles was calculated. The patients were divided into the following three groups; Group 1 (n = 72) testicular volume difference < 10%, testicular volume difference 10%-20% Group 2 (n = 74) and testicular volume difference > 20% Group 3 (n = 41). Results. The mean age and BMI of the patients were 21.5 years and 23.1 kg/m2, respectively (P = .596,P = .943). The semen parameters and testicular volumes of the three groups were compared. The total motile sperm count, percentage of motile sperm, percentage of normal morphology sperm were found to be lower in Group 3 (P = .011, P = .012, P = .029 respectively). The mean testicular volumes for the left and the right testis were found to be 15.2 cm3 and 17.7 cm3 (P < .001), respectively. No significant difference was found in the right testicular volumes between groups (17.4, 17.7 and 18.1 cm3, P = .573). Conclusions: A high grade left testicular varicocele is associated with ipsilateral testicular hypotrophy and parallel to worsened sperm parameters

Significant worsening sperm parameters are associated to testicular hypotrophy in patients with a high grade varicocele.

OBJECTIVE: To investigate the relationship between testicular volume and semen parameter sin patients with unilateral high grade left varicocele. MATERIAL AND METHODS: One hundred eighty seven patients who had left high grade varicocele aged 19-to-25 years were included in this study. All patients underwent a standard evaluation, including medical history and physical examination. The percentage testicular volume difference between the right and left testicles was calculated. The patients were divided into the following three groups; Group 1 (n=72) testicular volume difference <10%, testicular volume difference 10%-20% Group 2 (n=74) and testicular volume difference >20% Group 3 (n=41). RESULTS: The mean age and BMI of the patients were 21.5 years and 23.1kg/m(2), respectively (P=.596, P=.943). The semen parameters and testicular volumes of the three groups were compared. The total motile sperm count, percentage of motile sperm, percentage of normal morphology sperm were found to be lower in Group 3 (P=.011, P=.012, P=.029 respectively). The mean testicular volumes for the left and the right testis were found to be 15.2cm(3) and 17.7cm(3) (P<.001), respectively. No significant difference was found in the right testicular volumes between groups (17.4, 17.7 and 18.1cm(3), P=.573). CONCLUSIONS: A high grade left testicular varicocele is associated with ipsilateral testicular hypotrophy and parallel to worsened sperm parameters.

Effect of tempol, a membrane-permeable radical scavenger, on mesenteric blood flow and organ injury in a murine cecal ligation and puncture model of septic shock.

BACKGROUND: Interventions that reduce the generation or the effects of reactive oxygen species exert beneficial effects in a variety of models of septic shock. We investigated the effect of tempol, a low-molecular-weight membrane-permeable radical scavenger, on mesenteric blood flow and organ injury in a murine cecal ligation and puncture (CLP) model of septic shock. MATERIALS AND METHODS: Forty-four Swiss albino mice were anesthetized with chloral hydrate (400 mg/kg, i.p.) and subjected to CLP (except for the sham-operated animals). The animals were divided randomly into 4 groups: the 1st group was sham operated (sham-operated group, n = 10); the 2nd group underwent CLP and was injected with saline (CLP + saline group, n = 12); the 3rd group was sham operated and treated with tempol (10 mg/kg, i.p., sham-treated + tempol group, n = 10); the 4th group underwent CLP and was treated with tempol (10 mg/kg, i.p., CLP + tempol group, n = 12). Mesenteric arterial blood flow (MABF) was measured by Doppler ultrasound. Poly(adenosine 5'-diphosphate-ribose) polymerase (PARP) activity was examined in the liver, lung, and kidneys. RESULTS: In the CLP + saline group, the MABF was significantly lower than in the sham-operated group (p < 0.001). After tempol administration, MABF values significantly increased (p < 0.05). We observed significantly stronger PARP-positive staining in the lungs and kidney glomeruli in the CLP + saline group than in those of the sham-operated group (p(lung) = 0.0148, p(glomeruli) = 0.0025). A marked reduction in PARP activity was found in the lung and kidney glomeruli of the CLP + tempol group (p(lung) = 0.0026, p(glomeruli) = 0.0085). There was no significant effect of CLP on PARP activity in the liver and kidney tubuli (p(liver) > 0.05, p(tubuli) > 0.05). CONCLUSION: Tempol improved MABF in a CLP-induced septic shock model. Although tempol could not prevent the activation of PARP in the liver and kidney tubuli, it did attenuate PARP activation in the lung and kidney glomeruli.

The efficacy of sildenafil in different etiologies of erectile dysfunction.

PURPOSE: The aim of this study was to evaluate the efficacy of sildenafil and success of treatment in particular etiological causes in erectile dysfunction lasting more than 3 months. MATERIAL AND METHODS: A total of 141 patients between 27 and 78 years old without any cardiac compromise, despite controversial, which precludes sildenafil (Viagra) treatment, were included in this study. All patients had only International Index of Erectile Capacity Form (IIEF) for pre-treatment evaluation and 50 mg sildenafil was started. Patients were assessed monthly for 6 months thereafter. Erectile capacity changes were questioned by IIEF on each follow-up and 100 mg sildenafil was given in patients without a response and monthly follow-up was scheduled. All patients had SMA-12, hormonal analyses and penile colour Doppler ultrasonography during the treatment course. The difference between IIEF score of each patient was displayed by Paired-t test and p-values less than 0.05 was applied as significant. RESULTS: The average beginning IIEF score of 141 patients was 11.80 +/- 0.47 [6-22], and increased to 20.70 +/- 0.62 [6-30] after a month of 50 mg sildenafil treatment. The mean increase was 75.4% and found to be significant (p = 0.000, p < 0.05). The average IIEF scores were recorded as 22.57 +/- 0.69 after 3, and 22.12 +/- 0.24 after 6 months. There was no difference between these values and 2nd month controls (P3 month = 0.5675, P6 month = 0.6138, p > 0.05). A positive response was recorded in 102 patients (72.3%) and 39 (27.7%) patients were unresponsive. Doubled doses of sildenafil (100 mg) was effective in additional 17 patients. After overall treatment, 119 (84.4%) patients had benefit from sildenafil. Penile Doppler ultrasonography displayed arterial insufficiency in 79 (56.03%), veno-occlusive dysfunction in 14 (9.93%), mixt vascular pathology in 14 (9.93%) patients. Normal ultrasonographic findings in 32 patients (22.7%) were classified as psychogenic dysfunction. Among the organic causes, sildenafil was found to be most effective in arterial insufficiency group. CONCLUSION: Sildenafil is a successful management modality in erectile dysfunction with minimal pre-treatment evaluation. As far as etiological causes concerned, sildenafil was found to be most effective in arterial insufficiency group and psychogenic group. The efficacy of sildenafil treatment has not been changed with the treatment time, since IIEF scores were stable during follow-up controls.

Effect of seminal plasma calcitonin levels on sperm mobility.

This study investigated the effect of the seminal and blood plasma calcitonin levels on the sperm motility in idiopathic infertile patients. The number of sperm cells and their motility were evaluated in the spermiograms of 52 idiopathic infertile patients. The levels of seminal plasma calcitonin were studied with double antibody technique using a DPC kit. Fifty-two patients were divided into 2 groups according to the motility rates of sperm and 20 healthy volunteers were assigned to a control group. The difference between the groups was evaluated by using Kruskall-Wallis and Mann-Whitney U tests, and the correlation of seminal and blood calcitonin levels with sperm motility were determined. The difference in motility rates between the 3 groups was statistically significant (p = .000, p < .05). Blood plasma calcitonin levels were in normal ranges in all cases and no significant difference was found among the 3 groups (chi2 = 2.7219, p = .2589, p > .05). While sperm motility was correlated with seminal calcitonin levels (r = .8581), blood calcitonin levels did not show a correlation with sperm motility rate (r = -.0265). Moreover, there was no correlation between seminal and blood plasma levels of calcitonin (r = -.0010). Motility rates decreased in the patients with low seminal calcitonin levels and seminal calcitonin levels had a significant effect on sperm motility.

Short-term histopathologic effects of different intracavernosal agents on corpus cavernosum and antifibrotic activity of intracavernosal verapamil: an experimental study.

OBJECTIVES: To evaluate the short-term effects of different intracavernosal agents and to investigate the antifibrotic effect of verapamil combined with these intracavernosal agents. METHODS: Forty-five Sprague-Dawley rats weighing 400 to 500 g each (mean weight 435.27 +/- 13.65 g) were equally divided into nine groups (n = 5). Papaverine (group 1), alprostadil (group 2), sodium nitroprusside (group 3), and verapamil (group 4) were injected alone intracavernously in 0.2-mL doses. Verapamil combined with papaverine, alprostadil, and sodium nitroprusside in 0.2-mL doses (0.1 mL verapamil and 0.1 mL vasoactive agent) were injected in groups 5 through 7. Group 8 was kept as a control group without injection, and isotonic saline alone was injected in group 9 during the same period. The intracavernous injection was done twice weekly with a 4-day interval. At the end of the study, total penectomy and multiple liver biopsies were performed to evaluate the histopathologic effects of the vasoactive agents and to test the liver function. RESULTS: In all groups, the structure of the corpora cavernosa was well preserved generally and appeared similar to the control tissue. However, localized edema, fibrosis, macrophage infiltration, and polymorphonuclear leukocytes were found only at the injection site. Although these findings were not different from the findings in the saline and alprostadil groups, they were slightly more extensive in the papaverine and sodium nitroprusside alone groups and also in the vasoactive agent plus verapamil groups. Although mononuclear lymphocyte infiltration was found in the portal areas, advancing into the liver parenchyma, the liver function tests were within normal limits. CONCLUSIONS: We observed that intracavernous injection, except with nitroprusside, caused focal intracavernosal fibrosis and edema. We believe these effects might not be caused by just the drug, but also by needle trauma, since general fibrosis was not observed in the short term. However, nitroprusside has a severe fibrotic effect on cavernosal tissue in the short term. Moreover, intracavernous verapamil injection could not prevent the fibrosis in the short term.

New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: is it a useful test?

BACKGROUND: The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno-occlusive dysfunction. METHODS: Eighty-seven consecutive patients were allocated into three groups as psychogenic, arterial and venous erectile dysfunction after investigations. Nocturnal penile tumescence recording parameters between psychogenic and vascular erectile dysfunction and arterial and veno-occlusive dysfunction were compared. Mann-Whitney U-test, Pearson's chi2 test and correlation coefficient tests were used for statistical analysis. RESULTS: Depending on intracavernous injection, penile Doppler ultrasonography and cavernosometry tests, 37 patients (43%) had psychogenic impotence while 50 (57%) had organic pathologies. Of the 50 patients diagnosed with vascular impotence, 29 (48%) had arterial failure and 21 (42%) had veno-occlusive dysfunction. Nocturnal penile tumescence recording revealed psychogenic erectile dysfunction in 34 patients (39%) and vascular erectile dysfunction in 53 patients (61%). Nocturnal penile tumescence recording has been regarded as the gold standard and, in our series, it showed 90.6% sensitivity and 88.2% specificity in differentiating the cause of erectile dysfunction. Values of rigidity activity unit and tumescence activity unit were significantly higher in patients with psychogenic impotence (P < 0.001), when compared with vascular impotence. In patients with a vascular cause, no difference was found between arterial failure and veno-occlusive dysfunction with regard to tip tumescence activity unit, base tumescence activity unit, tip rigidity activity unit, base rigidity activity unit and erection time (P > 0.001). However, patients with arterial failure had less erection than patients with veno-occlusive dysfunction (P < 0.001). CONCLUSION: New recording parameters of nocturnal penile tumescence can differentiate organic and psychogenic erectile dysfunction more precisely. However, these recording parameters cannot distinguish subgroups with a vascular cause of erectile dysfunction.

The efficacy of alfuzosin treatment in patients with prostatism.

OBJECTIVE: Alfuzosin, a quinazoline derivative, is a selective alpha-la adreneceptor antagonist with further selectivity for the alpha-1 adrenoceptors of the lower urinary tract and lesser affinity for vascular alpha-1 adrenoceptors. The present study evaluates the efficacy of alfuzosin in a group of the patients with prostatism. METHODS: Eighty-two patients with lower urinary tract symptoms aged from 55 to 76 years (mean age 62.36 +/- 6.4) were enrolled in the study. The patients were evaluated by blood pressure measurement, digital rectal examination, serum total and free prostate specific antigen (PSA) determinations by Tandem R-Assay with the reference range of 0.0 to 4.0 ng/ml, international prostate symptom score (IPSS), volume measurement by transrectal prostate ultrasound, blood biochemistry, uroflowmetry, postvoiding residual urine (PVRU) assessment. The patients treated with alfuzosin 2.5 mg three times a day for 3 months were re-evaluated by blood pressure measurement, IPSS, urine flow rate (UFR) and PVRU assessment in the 2nd week and in the 6th week, and by blood pressure measurement, IPSS, blood biochemistry, serum total and free PSA determinations, UFR and PVRU assessment in the 3rd month. Statistical analysis was performed using student-t test, and p value was considered significant when less than 0.05. RESULTS: Although IPSS significantly decreased in the 2nd week of the treatment compared to pre-treatment value, it reached a maximum decrease in the 6th week of the treatment. There were statistically significant difference between in the 2nd week IPSS value and the 6th week IPSS value. However, no difference was seen between the 6th week IPSS value and the 3rd month IPSS value. No significant difference was observed between pre-treatment values and the 2nd week values regarding UFR and PVRU. Peak flow rate and PVRU significantly changed in the 6th week of the treatment and they reached maximum change in the 3rd month. Difference was also significant between the values in the 6th week of the treatment and those in the 3rd month of the treatment. According to the blood biochemical analysis, total and free PSA levels before and after the treatment, there were no significantly difference. Additionally, alfuzosin had no effect on blood pressure. Before, during and after the treatment, blood pressure did not change significantly. CONCLUSION: Present study showed that symptomatic improvement with alfuzosin treatment began in the 2nd week, reaching the maximum level in the 6th week whereas urodynamic parameters began to improve in the 6th week and reached the maximum level in the 3rd month with no effect on blood pressure and blood biochemical test.

Comparison of the efficacy of fluoxetine alone vs. fluoxetine plus local lidocaine ointment in the treatment of premature ejaculation.

OBJECTIVE: The present study compares the efficacy and side effects of fluoxetine alone vs. fluoxetine plus local lidocaine ointment in the treatment of premature ejaculation. METHODS: Forty-three patients suffering from premature ejaculation were studied. The exclusion criteria were erectile dysfunction, loss of libido, alcohol and substance abuse, mental retardation, diabetes mellitus, thyroid disease, hypotension, previous use of these drugs and urogenital infections. The patients' ages ranged from 19 to 48 years (mean age 28 +/- 1.6). They had regular sexual lives. They had normal psychiatric consultation and the Glombock Rast Sexual Satisfactory Test (GRISS) psychiatric test were in accordance with premature ejaculation. RESULTS: The patients were assigned to two groups. Twenty-six patients, aged 21 to 36 years (mean age 27), received only fluoxetine 20 mg/day (1 capsule) for a week which was later increased to 40 mg/day (2 capsules). Seventeen patients, aged 19 to 48 years (mean age 31), were given fluoxetine 20 mg/day plus local application of lidocaine ointment. The patients and partners were re-evaluated 8 weeks after the treatment. The results were classified as unsuccessful, improvement and cure. The chi-square test was used for statistical analysis. In the fluoxetine group, 8 (30.8%) patients cured, 11 (42.2%) showed improvement and there were 7 failures (26.9%). In the combination treatment group, 9 (52.9%) patients cured, improvement was observed in 5 (29.4%) and failure in 3 (17.6%). Side effects in group I were observed in 6 patients (23%) and in 5 (29.4%) in group II. There were no statistical differences between the two groups according to the side effects (p > 0.01). No patients were excluded from the study due to side effects. CONCLUSION: The combination of fluoxetine plus local application of lidocaine ointment was found to be more effective than fluoxetine alone in the treatment of premature ejaculation. However, the results should be confirmed in further studies with a placebo group to rule out the placebo effect.

Beneficial effect of intranasal desmopressin for men with benign prostatic hyperplasia and nocturia: preliminary results.

The aim of this study was to determine the efficacy of intranasal desmopressin in the treatment of nocturnal polyuria in men with benign prostatic hyperplasia (BPH). Twelve men with BPH were treated with intranasal desmopressin at bedtime for nocturnal polyuria. All patients underwent video-urodynamic evaluation. The number of nocturia episodes was the dependent variable. Exclusion criteria included nephrolithiasis, active urinary tact infection, and history of myocardial infarction, congestive heart failure, and angina. Ten of 12 patients improved with the intranasal desmopressin therapy. Nocturia episodes decreased from a median of 3.6 +/- 0.5 episodes/night before treatment to 1.8 +/- 1.1 episodes/night 3 months after therapy (p = .01). The American Urological Association symptom index decreased from 19 +/- 6 before treatment to 12 +/- 6 after therapy (p = .02). Hyponatremia did not occur. We conclude that intranasal desmopressin is a promising therapy for nocturnal polyuria in selected BPH patients.

Advantages and risks of ileovesicostomy for the management of neuropathic bladder.

OBJECTIVES: To evaluate the efficacy and complications of ileovesicostomy in patients with neurogenic bladder dysfunction. METHODS: Fifteen consecutive neurologically impaired patients (8 from multiple sclerosis, 4 from spinal cord injury, 3 from other causes) with complications of previous bladder management underwent ileovesicostomy. There were 10 women and 5 men. All patients were either poor candidates for or refused continent urinary diversion or bladder augmentation cystoplasty. RESULTS: At a mean follow-up of 23.2 months, 14 of 15 patients had low-pressure urine drainage through their ileovesicostomy. Four women with documented preoperative detrusor hyperreflexia had postoperative intermittent mild urge incontinence per native urethra. They did not require any further treatment, except for oral anticholinergic drugs (oxybutynin and tolterodine). Because of persistent severe urge incontinence, 1 woman required conversion of her ileovesicostomy to an ileal conduit with concurrent cystectomy. The ileovesicostomy of another myelodysplastic man who had four failed artificial urinary sphincters in the past was also converted to an ileal conduit because of persistent urethroperineal fistula despite perineal urethral closure. Renal function was preserved in all patients. Long-term complications were stomal stenosis in 2 patients, bladder and kidney stone formation in 5, and symptomatic urinary tract infections in 3. CONCLUSIONS: Ileovesicostomy can be safely performed in neurologically impaired women and men. Severe preoperative detrusor hyperreflexia with urge incontinence appears to be a risk factor for persistent urge incontinence postoperatively in women. Continued routine urologic surveillance for infection and stones is mandatory. Ileovesicostomy is a versatile procedure for neurologically impaired patients, because it can be converted to a conventional ileal conduit if necessary. In addition, in cases of neural recovery, the ileal "chimney" can be excised and the patient's original lower urinary tract would be preserved.

Tolterodine for overactive bladder: time to onset of action, preferred dosage, and 9-month follow-up.

This is a prospective study of 28 patients who had urinary frequency (>8 times/day) and either urgency or urge incontinence (>1 time/day). After a 2-week run-in period (visit 1), the patients were started on tolterodine 1 mg twice a day (bid) (visit 2). They were followed at 4 and 8 weeks (visits 3 and 4). The patients were contacted by telephone 1 week after visit 2. Tolterodine was increased to 2 mg bid if the patient had incomplete improvement at either the initial phone call or during visit 3. Evaluation criteria were daily micturition charts including urinary frequency, nocturia, leakage episodes, average urine volume per day, and average voided volume. Tolterodine was well tolerated without side effects in 20 (80%) of 28 patients. Eight patients (20%) dropped out after enrollment because of side effects in 3, no improvement in 2, and missing visits (>1) in 3. Drug dosage in the 20 patients who tolerated tolterodine was 1 mg bid in 3 and 2 mg bid in 17 (85%). According to micturition charts, urinary frequency, nocturia, and leakage episodes decreased significantly after tolterodine treatment, whereas average urine volume per day and average voided volume did not change significantly. There were no electrocardiographic or biochemical abnormalities due to tolterodine treatment. Mean follow-up was 9.4 months. All 20 patients who tolerated tolterodine continue to take the medication without significant side effects. We conclude that tolterodine is well tolerated and effective for overactive bladders. Two milligrams bid is the dosage preferred by the majority of patients and the onset of action is seen within 1 week of treatment. Long-term compliance and efficacy are excellent, with no dropout in >9 months of follow-up.

Electrical activity of the corpus cavernosum in denervated rats.

BACKGROUND: We evaluated the electrical activity of the corpus cavernosum after intracavernous papaverine injection in rats that had been denervated experimentally. METHODS: Twenty-four male adult Sprague Dawley rats were divided into three groups: (i) controls (n=8) (ii) unilateral cavernous nerve resection on the right side (n=8); and (iii) bilateral cavernous nerve resection (n=8). Through a suprapubic incision, the urinary bladder was retracted laterally to locate the major pelvic plexus on the lateral surface of the prostate. The major branch of the cavernous nerve, running caudally from the pelvic plexus, was isolated and excised using an operating microscope. Three weeks later, recording of the electrical activity of the corpus cavernosum (EACC) was performed by using a Neuropack-2 EMG unit (Nihon Kohden, Tokyo, Japan) and coencentric needle electrode. Changes in amplitude were evaluated before and after intracavernosal papaverine injection. The results in the flaccid state and after papaverine injection were compared by using the Mann Whitney U-test in all three groups and paired t-test between groups. RESULTS: In the flaccid penis, the mean (+/- SD) amplitude of electrical activity of the corpus cavernosum was 17.42+/-2.05, 12.42+/-1.88, 9.71+/-1.59 and 5.85+/-0.96 microV in control rats, in unilaterally denervated rats (in which the cavernous nerve was intact on the left side), in unilaterally denervated rats in which the cavernous nerve was resected on the right side and in bilaterally denervated rats, respectively. In the flaccid state, EACC is lower in the bilaterally denervated group than in the control and unilaterally nerve-resected groups (P < or = 0.05). The recording of electrical activity of the corpus cavernosum was continued for 20 min after papaverine injection. In the control group and in both groups of unilaterally denervated rats, we observed a significant decrease in the electrical activity of the corpus cavernosum in the first 5 min after papaverine injection (P < or = 0.05). However, no difference was observed in bilaterally denervated rats after injection (P > or = 0.05). CONCLUSIONS: We conclude that electrical activity of the corpus cavernosum continues after unilateral nerve injury in rats. Cross-innervation may play a role in penile innervation and corpus cavernosum electromyography shows electrical activity in denervated rats.

Pressure-flow studies: short-time repeatability.

The within and between examination variation in selected test parameters and test results in repeated pressure-flow studies was determined in a prospective study of consecutive pressure-flow examinations in 22 patients. The patients were pressure-flow tested twice within a month. Furthermore, it was evaluated whether there was a systematic change in the measured parameters during retesting. By using the Abrams-Griffiths nomogram, patients were classified as obstructed, equivocal, or unobstructed. Within and between examination variations in classification were evaluated. We found a systematic variation in P(det.Qmax) during testing, which in the absence of statistically significant systematic variations in P(det.Close) and Qmax, indicates a physiological effect of repeated pressure-flow studies, resulting in a less-obstructed second voiding. Supporting this, we found that all patients who changed group of classification of bladder outlet obstruction in the first examination shifted to a group of less obstruction, as did 66% of the patients who changed group of classification of bladder outlet obstruction in the second examination. Still, 80, respectively 85%, of the patients remained in the same group of classification of bladder outlet obstruction during retesting in the first and second examinations, respectively. Classifying the degree of bladder outlet obstruction by Qmax, P(det.Qmax), and P(det.Close) 85% of the patients reproduced their test results accurately in both examinations and taking only the first voiding in both examinations into account 95% reproduced their test results.