Chronic inhibition of nitric-oxide synthase induces hypertension and erectile dysfunction in the rat that is not reversed by sildenafil.

STUDY TYPE: Aetiology (case control) Level of Evidence 3b OBJECTIVE To evaluate the effect of N(G)-nitro-L-arginine methyl ester (L-NAME)-induced hypertension (HT) on erectile function in the rat and determine if the phosphodiesterase (PDE)-5 inhibitor, sildenafil, can reverse the effects of nitric oxide (NO) deficiency, as HT is a risk factor for erectile dysfunction (ED) and the NO synthase (NOS) inhibitor L-NAME induces NO-deficient HT. MATERIALS AND METHODS: Thirty-six adult Sprague-Dawley male rats were divided into three groups, i.e. a control, L-NAME-HT (40 mg/rat/day in the drinking water for 4 weeks), and sildenafil-treated L-NAME-HT (1.5 mg/rat/day sildenafil, by oral gavage concomitantly with L-NAME). The erectile response expressed as a ratio of intracavernosal pressure (ICP)/mean arterial pressure (MAP), evaluated after electrical stimulation of the right cavernous nerve. The isometric tension of corpus cavernosum smooth muscle (CCSM) was measured in organ-bath experiments. NOS expression was determined immunohistochemically for neuronal (n)NOS and by Western blot analysis for endothelial (e) and inducible (i) NOS protein. cGMP levels were evaluated by enzyme-linked immunosorbent assay. RESULTS: The erectile response was diminished in the HT group. Nitrergic and endothelium-dependent relaxation was reduced, while the relaxation response to sodium nitroprusside and contractile response to phenylephrine were not altered in CCSM from L-NAME-treated rats. HT rats showed decreased expression of nNOS, whereas eNOS and iNOS protein expression was increased. Sildenafil partly restored endothelial and molecular changes in CCSM from HT rats, but did not reverse the decreased erectile response, even as cGMP levels returned to normal levels. CONCLUSIONS: Sildenafil treatment did not correct the ED in L-NAME-treated HT rats. Under sustained high blood pressure, up-regulation of PDE5 expression failed to reverse the depletion of neuronal NO and/or impaired nNOS activity. However, endothelium-dependent relaxation was restored. Drug targeting of neuronal dysfunction might delay the onset of ED in HT.

Sex and the infertile male.

Infertility is a major stressor in life and can cause disturbances in both sexual and marital relationships. The following review focuses on sexual function in men who are diagnosed with infertility. The impact of the diagnosis of infertility on male sexuality, including related diagnostic procedures and specific infertility treatments, is scrutinized in light of current scientific literature.

Does stone dimension affect the effectiveness of ureteroscopic lithotripsy in distal ureteral stones?

OBJECTIVE: To investigate whether stone dimension is a restrictive factor for ureterorenoscopic procedures. MATERIALS AND METHODS: A group of 416 patients who had undergone ureterorenoscopic pneumatic lithotripsy (URS-PL) for lower ureteral stones between January 1999 and June 2006 in our clinic had been evaluated retrospectively. Two hundred and seventy (270, 64.9%) patients were men and 146 (35.1%) were women. The mean age of the patients was 36.61 (+/- 12.43) years. Patients were grouped according to stone dimension; 193 patients with stones smaller than 1 cm being group 1 and 223 patients with stones > or = 1 cm in dimension being group 2. Stone-free rate, operative time and rate of complications of the groups were compared. Pearson's correlation test, chi2 test, Fischer's exact test and Student's t-test were used for the statistical analysis. The p value was accepted as being meaningful if p < 0.05. RESULTS: For group 1, the mean operative time was 39.19 (+/- 18.33) min. Proximal stone migration in five and false passage formation in three patients was observed. Three patients were stone-free after a second session of URS-PL. The cumulative stone-free rate was 97.4% (188/193). For group 2, the mean operative time was 48.5 (+/- 11.31) min. About 208 (93.27%) patients were stone-free after the first session and an additional eight patients became stone-free after the second session of URS-PL. False passage, ureteral perforation, ureteral avulsion and stricture were observed in four, six, one and one patients, respectively. No proximal stone migration was observed. The cumulative stone-free rate was 96.86% (216/223). CONCLUSIONS: The effectiveness of ureterorenoscopy (URS) in the treatment of distal ureteral stones was independent of stone dimension. However, the operative time was longer and the rate of perforation was higher in stones with a diameter > or = 1 cm. On the other hand, the migration rate was higher in stones < 1 cm in diameter. Generally speaking, there was no meaningful effect of stone dimension on complication rates.

Premature ejaculation: current and future treatments.

Premature ejaculation (PE) is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration (FDA). Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.

The clinical characteristics of Peyronie's patients with notching deformity.

INTRODUCTION: Peyronie's patients with notching deformity represent a small percentage of disease population, and the features of these patients have not been well established yet. AIM: To analyze the characteristics of Peyronie's patients with notching deformity. MAIN OUTCOME MEASURES: Peyronie's patients with notching deformity were compared with those with other type of penile deformities with regard to clinical features. METHODS: During a 13-year period, a total of 703 patients with Peyronie's disease were evaluated at our institution. The patients were divided into two groups: group I consists of Peyronie's patients with notching deformity (N = 89) and group II patients with any other kind of penile curvature (N = 614). The clinical characteristics, presence of co-morbidities including diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hypertension, and ischemic heart disease, erectile status, and penile deformities were compared between the two groups. RESULTS: Pure notching deformity was detected in 12.6% (N = 89) of the patients. The mean age of men was 53.1 +/- 10.2 and 52.7 +/- 10.7 years in groups I and II, respectively, (P = 0.8). The leading presenting symptom was erectile dysfunction (68.5%), followed by penile deformity (51.6%), and pain on erection (17.9%) in group I, while it was penile curvature (77.1%), erectile dysfunction (54.6%), and pain on erection (14.4%) in group II. In group I, 27 patients (30.3%) were diagnosed during a standard evaluation for erectile dysfunction. Hypertension was significantly higher in group I (25.8%) than in group II (15.4%) (P = 0.022); whereas hypercholesterolemia was more common in group II (P = 0.008). There was no significant correlation between the presence or the number of co-morbid conditions and the presence of the notching deformity. Combined injection and stimulation test revealed a diminished erectile capacity in 46.1% of the patients in group I, while it was 31.7% in group II (P = 0.008). In group I, 62.9% had unilateral notching deformity, 34.8% had hourglass deformity, and 2.2% had combined hourglass and notching deformity. Overall, the notching deformity was localized in the distal penile shaft in 50.5%, proximal shaft in 40.4%, and mid-shaft in 8.9% of the patients in group I. CONCLUSIONS: In this large-scale series, pure notching deformity was detected in about one-tenth of patients with Peyronie's disease. Patients presented at the first half of the sixth decade of life and more than half of the patients were in the acute phase of the disease. The most common presenting symptom was erectile dysfunction. The notching deformity was more frequently localized at the base and tip of the penis.

Surgical treatment of Peyronie's disease: a critical analysis.

OBJECTIVE: The present paper reviews surgical treatment alternatives for patients with Peyronie's disease using knowledge obtained from the contemporary literature. METHODS: : All aspects of surgical treatment for Peyronie's disease were examined on the basis of MEDLINE database researches. RESULTS: Surgical treatment should be delayed until the acute inflammatory phase has resolved and should be considered in patients with deformity that impairs sexual function. Currently, surgical treatment alternatives are reconstructive surgery by either lengthening the concave side (incision and grafting) or shortening the convex side (Nesbit procedure or plication) of the penis, and implantation of penile prosthesis with or without incision of the plaque. PD patients with good erectile capacity are candidates for reconstructive surgery. Meanwhile, implantation of penile prosthesis with or without remodeling should be considered for patients without adequate erectile capacity. CONCLUSIONS: The aim of the surgical treatment in Peyronie's disease is to correct the deformity while preserving or improving erectile capacity of the penis. Appropriate treatment options should be individualized according to the patients' expectations and erectile capacity.

Ureteroscopic treatment of multiple distal-ureteral stones.

BACKGROUND AND PURPOSE: Ureteroscopic intracorporeal lithotripsy for solitary distal-ureteral stones may be considered a first-line therapy. However, few reports that mention ureteroscopic procedures for multiple ureteral stones were found in the literature. Retrospectively, we reviewed our patients who were treated by ureteroscopy for multiple distal-ureteral stones. PATIENTS AND METHODS: Fifteen patients underwent ureteroscopic pneumatic lithotripsy for unilateral multiple distal-ureteral stones. Ten patients had two stones, four patients had three stones, and another patient had five stones. The average stone number per ureteral unit was 2.44, and the average stone size was 9.7 mm (range 3-23 mm). RESULTS: Eighty percent of the patients (12/15) who had unilateral stones were stone free after the first session of ureteroscopic pneumatic lithotripsy. Two patients underwent a second ureteroscopy procedure for the remaining stone or failure of ureteral access. Overall, 93.3% of the patients (14/15) were stone free. Ureteral perforation as a major complication occurred in one patient (6.6%), who was treated by open surgery. We did not routinely use Double-J ureteral stents after ureteroscopy. Only one patient required stenting because of failure of ureteral access. Steinstrasse was observed in three patients, but it resolved spontaneously in the early postoperative period. CONCLUSION: Ureteroscopic pneumatic lithotripsy has a high success rate with few complications for the treatment of unilateral multiple distal-ureteral stones. Ureteroscopic pneumatic lithotripsy seems very effective for such stones.

Primary ureteroscopy for distal-ureteral stones compared with ureteroscopy after failed extracorporeal lithotripsy.

BACKGROUND AND PURPOSE: We reviewed our experiences with ureteroscopic pneumatic lithotripsy (URS-PL) for the treatment of distal-ureteral stones and investigated whether failed extracorporeal shockwave lithotripsy (SWL) is a limiting factor for the ureteroscopic procedure. PATIENTS AND METHODS: We retrospectively studied the medical records of 375 patients treated with URS-PL from January 1999 to September 2005 in our clinic. Of these patients, 213 were treated with URS-PL primarily (group 1), whereas the remaining 162 patients had undergone SWL unsuccessfully before URS-PL was performed (group 2). We used 9F or 9.5F rigid instruments and the Vibrolith (Elmed, Ankara, Turkey). RESULTS: In group 1, 206 patients (96.7%) were treated successfully with URS alone, as were 155 patients (95.6%) in group 2. Impacted stones were observed in 21 patients in group 1 (9.85%) and in 57 patients in group 2 (35.1%). The average operating time was 33.19 +/- 9.039 minutes in group 1 and 57.42 +/- 8.757 minutes in group 2. The stone-free rates of the two groups were significantly different on the first postoperative day, but this difference decreased to an insignificant level at the end of the first month. CONCLUSION: When SWL fails, URS-PL is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be effective for impacted stones.

Giant condyloma acuminatum.

BACKGROUND: Giant condyloma acuminatum is a warty lesion that is characterized by its large size and propensity to infiltrate into deeper tissues contrasting with its microscopically benign pattern. It is proposed that giant condyloma represents an intermediate lesion between condyloma acuminatum and verrucous carcinoma. OBJECTIVE: A primary therapeutic option of giant condyloma is radical surgery with or without adjunctive chemotherapy. Because of the tumor's large extent in this case, curative therapy would have been achieved by wide surgical excision. METHOD: We present a morphologically and histologically classic example of giant condyloma with respect to origin from common genital warts. The reason for extensive exophytic growth was due to delay in therapy because of the patient's self neglect but not due to immune deficiency. The patient was treated with wide surgical excision. RESULTS: The postoperative period was uneventful, allowing satisfactory functional and cosmetic results. CONCLUSION: This case is an interesting case because of its exceptionally huge size without any deep tissue involvement and tissue atypia. This suggests that giant condyloma is an intermediate condition that exhibits a continuous tendency for growth.