Placement of penile prosthesis during surgery for malignancies.

Insertion of either a semirigid or inflatable penile prosthesis at the completion of surgery for various malignancies was performed. Twelve men had implants and were followed at least one year with excellent results. Careful preoperative sexual counseling with the patient's spouse is recommended and adds immeasureably to the mental well-being of the patient in the postoperative period. Penile prostheses can be placed easily after radical cystectomy, radical prostatectomy (perineal or retropubic), urethrectomy, and bilateral orchiectomy. Penile prosthesis placement may also be recommended for patients with less than adequate erectile function who may be undergoing pelvic lymphadenectomy with 125I implantation for prostatic carcinoma.

Vasectomy without complication.

In a four-year period 500 outpatient vasectomies were performed by the author. Bilateral scrotal incisions were used in all cases as were metal clips to occlude the vas deferens. Operating time rarely exceeded fifteen minutes. No failures and no sperm granulomas were encountered. Complications were rare and included a single scrotal hematoma and six minor infections. Unilateral absence of the vas deferens was noted in 2 patients. The technique to be described is a simple, complication-free method of vasectomy.

Use of single J urinary diversion stents in intestinal urinary diversion.

A review of the past twenty months of intestinal-urinary diversion with use of the single J urinary diversion stents at Albany Medical Center Hospital and the Albany Veterans Administration Medical Center resulted in no ureteroileal anastomotic fistulas. Thirty-seven stented anastomoses were performed in 19 patients.

Congenital penile curvature without hypospadias.

Congenital curvature of the penile shaft without hypospadias is a rare problem that poses cosmetic and functional disability. It is caused by disparate growth of the penile corpora. Surgical repair of 7 cases is reviewed, with follow-up of two to eight years. The results of these 7 cases are added to 13 other cases reported previously. The Nesbit technique was used with the modification of (1) preserving the dorsal neurovascular bundle to avoid anesthesia and lymphedema of the glans in selected cases, and (2) intraoperative use of saline-induced erections and Allis clamp " tucks" of the tunica albuginea to insure a satisfactory repair.

Single ectopic ureter: unusual presentation in adult male.

We present a case of an unusual and late presentation of a single ectopic ureter in an adult male. The patient presented with gross painless hematuria. The left ureter draining a dysplastic kidney terminated in the ipsilateral seminal vesicle.

Management of bladder stones: should transurethral prostatic resection be performed in combination with cystolitholapaxy?

We report our institutional experience and review the literature in the management of bladder stones, with particular attention to combined cystolitholapaxy and transurethral prostatectomy. Vesical calculi are associated with obstructing prostatic hypertrophy two thirds of the time. Combined cystolitholapaxy and transurethral resection of the prostate have significant morbidity.

Use and abuse of retrograde pyelography.

Retrograde pyelography to demonstrate the renal pelvis and ureters is a common urologic procedure. Newer contrast materials and better radiographic techniques have obviated many of the previous indications for retrograde studies were independently reviewed by two urologists and a radiologist to determine if the studies were indicated, appropriately timed, informative, and complete. Our results indicate a high percentage of these examinations are incompletely performed and uninformative and could have been replaced by noninvasive studies. What constitutes a complete retrograde study and when to utilize this examination is discussed.

Penile xenon (133Xe) washout: a rapid method of screening for vasculogenic impotence.

The radioactive inert gas xenon (133Xe) is a well-established isotopic indicator used to assess vascular status in many organ systems. We employed xenon-133 to evaluate male impotence. Xenon-133 was injected subcutaneously at the level of the coronal sulcus in the detumescent state. Using the gamma camera, sequential images were obtained and computer-generated curves calculated. The clearance time for 50 per cent washout of the injected 133Xe (T1/2) was then calculated for each patient, as well as a control group. Preliminary findings indicate a correlation with such established techniques of evaluating erectile impotence as history, physical examination, penile pulse Doppler tracings, and brachial-penile blood pressure index. The xenon-133 washout study was a rapid, minimally invasive, reproducible, and cost-effective method of screening those impotent patients for vasculogenic etiology of their erectile impotence. We recommend the addition of this method to the surgeon engaged in the care of impotent males.

A double-blind, placebo-controlled evaluation of the erectile response to transurethral alprostadil.

OBJECTIVES: Previous studies have indicated that the urethra may provide an effective route for administering vasoactive medication for the treatment of erectile dysfunction. We evaluated the safety and efficacy of alprostadil administered intraurethrally at home for the treatment of this disorder. METHODS: This prospective, multicenter, double-blind, placebo-controlled study evaluated the erectile response to randomly assigned doses of transurethral alprostadil at home in 68 men with long-standing (mean 41 months) erectile dysfunction of primarily organic etiology. Patients completing the study each administered a random sequence of four different doses (125, 250, 500, and 1000 micrograms) and placebo over a 2 to 4-week period. Assessments included the couples' ability to have intercourse, patient ratings of erectile response by both categorical and visual analogue scales, penile volume measurements, and overall assessments of comfort and ease of administration. RESULTS: Overall, 75.4% (49 of 65) of study patients achieved full enlargement of the penis and 49.2% (32 of 65) achieved an erection judged by the patient to be sufficient for intercourse. In addition, 63.6% (42 of 66) of patients reported intercourse. Efficacy was similar across etiologies. The most common side effect was penile pain, which occurred in association with 9.1% to 18.3% of alprostadil administrations, depending on dose. Mean comfort ratings ranged from 79 to 87, depending on dose, where 0 = severe discomfort and 100 = comfortable; ease of administration scores were above 90 for each dose, where 0 = difficult and 100 = easy. There were no episodes of priapism in this study. CONCLUSIONS: Short-term treatment with transurethral alprostadil produced erections resulting in sexual intercourse in most patients with chronic erectile dysfunction. This therapy may be a useful treatment option for patients with erectile dysfunction.

Venous arterialization for erectile impotence.

Revascularization of the corporal bodies in arteriogenic impotence can be accomplished by means of a venous arterialization procedure as described by Ronald Virag. This surgical approach and early results are detailed in this article.

Applications of microsurgery in urology.

The applications of microsurgery in urology have increased in the decade since urologists first used such techniques. The primary uses for microsurgery in urology at first were vasovasostomy, vasoepididymostomy, and testicular autotransplantation. Penile revascularization has recently become another procedure for which microsurgery is used with increasing frequency. As more urologists learn the techniques, other urologic applications for microsurgery surely will develop.