Prospective comparison of topical minoxidil to vacuum constriction device and intracorporeal papaverine injection in treatment of erectile dysfunction due to spinal cord injury.

OBJECTIVE: To compare the effectiveness of topically applied 2% minoxidil to that of intracorporeal injection therapy and vacuum constriction devices for the treatment of erectile dysfunction in the spinal cord injured (SCI) male. METHODS: Eighteen SCI men, aged nineteen to sixty-five years (median age, 29), and level of injury C7 to L3 (15 thoracic level) were prospectively evaluated. All patients were able to achieve only a poorly sustained reflex erection that was inadequate for satisfactory intercourse. No patient had suffered erectile dysfunction prior to his SCI. In each patient, 1 mL of a 2% minoxidil solution was applied as an aerosol spray to the glans penis. The erectile response was compared to that obtained with a vacuum constriction device (VCD) and intracorporeal papaverine injection. In each case, the subjective assessment by both the patient and the physician, as well as objective results of penile base rigidity as measured by the RigiScan DT Monitor Device, were recorded. RESULTS: Papaverine increased rigidity at the base of the penis by a median 77 percent (range, 30-100%). The VCD increased rigidity by a median 57 percent (range, 30-80%). Minoxidil induced no change in rigidity (range, 0-15%). No complications were observed for any method of inducing tumescence. CONCLUSIONS: Papaverine and VCD proved to be effective means of establishing penile erection in male SCI patients. Both subjective and objective erectile responses to minoxidil were poor. Nevertheless, the principle of topical therapy is an attractive alternative to existing modalities. Further investigation is warranted.

Contact neodymium:yttrium-aluminum-garnet laser ablation of the external sphincter in spinal cord injured men with detrusor sphincter dyssynergia.

OBJECTIVES: The purpose of this study was to determine the efficacy and safety of contact neodymium:yttrium-aluminum-garnet (Nd:YAG) laser external sphincterotomy as an alternative treatment of detrusor-external sphincter dyssynergia (DESD). METHODS: Twenty-two spinal cord injured men with video-urodynamically verified DESD underwent external urinary sphincter ablation using the contact Nd:YAG laser. Three patients with bladder neck obstruction required concurrent contact laser bladder neck incision. Preoperative urodynamic parameters of voiding pressure, bladder capacity, and residual urine were compared with those obtained 1 year postoperatively. RESULTS: Each procedure was performed with the Nd:YAG contact laser set at 40 to 50 W, with a total accumulated energy of 23,800 to 60,000 J for each patient. The mean duration of surgery was 45 +/- 21 minutes. Bladder voiding pressure decreased from 87 +/- 23 preoperatively to 47 +/- 11 cm H2O at 12 months (P < 0.01). Residual urine volume decreased significantly, from 122 +/- 77 to 33 +/- 19 mL at 12 months (P < 0.01), and bladder capacity remained unchanged at 174 +/- 84 and 230 +/- 92 mL (P = 0.57). Three patients were found to have recurrent sphincter obstruction 1 year after laser sphincterotomy. Two patients experienced complications associated with condom catheter urinary drainage and returned to the use of an indwelling catheter. One patient experienced diminished reflex erectile function postoperatively. No patient required blood transfusion. No deleterious effects on renal function or symptoms of autonomic dysreflexia were noted. CONCLUSIONS: External urinary sphincter ablation using the contact Nd:YAG laser compares favorably with electrosurgical techniques.

The invention of the modern uroflowmeter by Willard M. Drake, Jr at Jefferson Medical College.

The uroflowmeter is perhaps the most important and certainly the most commonly used urodynamic instrument currently employed in urologic practice. The modern uroflowmeter was invented by Willard M. Drake, Jr., in 1946 at the Jefferson Medical College. The original manuscript, entitled "The uroflometer: an aid to the study of the lower urinary tract," appeared in Journal of Urology in 1948. Drake obtained a US patent for the device, entitled "Uroflometer," in 1953. The flowmeter, originally manufactured by van Beek Industries, was more recently manufactured and distributed by Grewe Plastics. Drake is now retired and living in Nacogdoches, Texas.

Functional urethral closure with pubovaginal sling for destroyed female urethra after long-term urethral catheterization.

OBJECTIVE: To assess the pubovaginal sling as therapy for correction of the destroyed female urethra secondary to long-term indwelling Foley catheter management of neurogenic vesical dysfunction. METHODS: Fourteen women with neurologic disease and a patulous and nonfunctioning urethra underwent pubovaginal sling functional urethral closure. The purpose of the procedure is to achieve a dry perineum. Greater tension is applied to the sling suspension for urethral closure than is normally used to ensure continence for patients exhibiting intrinsic sphincter dysfunction without neurogenic vesical dysfunction. RESULTS: Two patients with adequate bladder capacity and compliance underwent only a pubovaginal sling suspension. They were subsequently managed with intermittent catheterization. In 5 patients, a sling operation in conjunction with enterocystoplasty was accomplished. In 5 patients, a sling procedure with an ileocystostomy and a cutaneous urostomy (bladder chimney) was utilized. In 2 patients, suprapubic tube drainage was established at the time of pubovaginal sling placement. All patients have achieved continence, without the need for absorbent pads, with follow-up time of six to sixty months (mean, 24 months). Abdominal wall herniation has not developed in any patient. CONCLUSIONS: The pubovaginal sling cured incontinence and has resulted in a dry perineum with few problems. The sling procedure may be superior to transabdominal or transvaginal bladder neck closure without the risk of fistula formation.

Comparison of bladder rupture pressure after intestinal bladder augmentation (ileocystoplasty) and myomyotomy (autoaugmentation).

OBJECTIVES: To compare the risk of bladder rupture of bladder augmentation using ileocystoplasty versus that of autoaugmentation with myomyotomy in a rat model. METHODS: Bladder rupture pressure and volume of three groups of female Sprague-Dawley rats were determined by cystometry. The first group of 11 rats had undergone ileocystoplasty using a detubularized 1 -cm segment of ileum. A second group of 9 rats had undergone autoaugmentation with myomyotomy. One month after surgery the animals were studied cystometrically to determine the bladder rupture pressure, then killed. A third group, consisting of 10 nonoperated rats, was studied and served as controls. RESULTS: Nonoperated, control rat bladders were able to sustain 154 +/- 43 mm Hg pressure and 2.5 +/- 2.0 mL volume prior to bladder rupture. Conventional ileocystoplasty was noted to increase bladder capacity to 4.0 +/- 1.9 mL, but decrease rupture pressure to 111 +/- 49 mm Hg. Myomyotomy resulted in a mean bladder rupture volume of 1.2 +/- 0.4 mL, with a rupture pressure of 101 +/- 13 mm Hg. The rupture pressure after myomyotomy is significantly lower than that of the native bladder (P < 0.001), whereas the rupture volume after myomyotomy is significantly lower than either after the ileocystoplasty or with the native bladder (P < 0.001). Bladder rupture occurred at the augmented ileal bladder dome in 7 of 11 ileocystoplasty animals and at the anastomotic suture line in 4 animals. Bladder rupture occurred at the area of bladder diverticulum in all 9 myomyotomy animals. Among controls, no specific site pattern of bladder rupture was noted. CONCLUSIONS: Bladder augmentation with myomyotomy increases vulnerability to urinary extravasation, evidenced by a significantly reduced rupture pressure and bladder volume at rupture when compared to the native bladder.

Neurogenic vesical dysfunction.

Women with neurogenic vesical dysfunction are prone to the development of urologic complications. These patients require diagnostic evaluation including the use of urodynamic study, imaging, and often endoscopy. These studies ultimately determine whether medical management or surgical intervention will minimize the long term risk of urologic complications. Proper definitive treatment of this patient group effectively enhances quality of life and patient satisfaction.

Urodynamics of spinal cord injury.

Historically, urologic complications have been the major source of morbidity and mortality among spinal cord injured (SCI) patients. All SCI patients should undergo urodynamic evaluation, with the initial urodynamics study done after the patient is beyond the spinal-shock phase. Management of the urinary tract in SCI individuals should be based on urodynamic principles and findings rather than on the neurologic history.

Spermatogenesis in early and chronic phases of experimental spinal cord injury in the rodent model.

A rodent model was used to study the degree and dynamics of potential spermatogenic alterations during both acute and chronic phases after experimental spinal cord injury (SCI). Sexually mature Sprague-Dawley rats underwent controlled impact SCI by exposure of the thoracic spine, T-10 laminectomy, and intraoperative somatosensory-evoked potential latency and amplitude. A 50 gm-cm SCI was produced in 35 experimental subjects. Sham surgery was performed on 16 control subjects through exposure of the dura without weight drop. SCI was verified by obliteration of the somatosensory-evoked potential following injury and subsequent neurologic assessment (modified hindlimb Tarlov scale) 4 weeks after injury. Flow cytometry with acridine orange as the DNA probe was used to measure potential spermatogenic alterations in testicular cell development and integrity of epididymal sperm chromatin structure between 2 and 20 weeks following SCI. Flow cytometric analysis revealed that nine of the 35 SCI animals demonstrated altered spermatogenesis; it is not clear whether these effects are specific or nonspecific stress related. These responder animals contributed to dramatic differences in relative percent testicular haploid cells (spermatids) and concurrent differences in percent diploid cells at 2, 4, 8, 12, and 16 weeks. Percentages within the three spermatid populations (round, elongating, and elongated) also differed at these time points. The sperm chromatin structure assay (SCSA) revealed significant epididymal sperm nuclear structure differences at 2, 4, and 12 weeks (P < 0.001). These findings are in concordance with our clinical observations of spermatogenesis in spinal cord injured men and suggest that significant spermatogenic deficit may occur, even in the early phase of injury.

Prospective comparison of external sphincter prosthesis placement and external sphincterotomy in men with spinal cord injury.

The effectiveness and complications of the treatment of detrusor-external sphincter dyssynergia (DESD) and voiding pressure > 60 mm H2O using an endoluminal urethral sphincter prosthesis (Urolume) were compared with those of conventional external sphincterotomy in 46 men with spinal cord injury (SCI) (mean age 34 years; range 18-58 years). Twenty-six patients elected the Urolume, and 20 chose sphincterotomy. The age and level and duration of SCI were similar in the two groups. Follow-up ranged from 6 to 20 months. After prosthesis placement, voiding pressure dropped from 88 +/- 29 cm H2O to 38 +/- 22 cm H2O at 6 months (n = 23) and 35 +/- 16 cm H2O at 12 months (n = 18) (P < 0.001). The residual urine volume fell from 180 +/- 145 mL preoperatively to 85 +/- 125 mL at 12 months (P < 0.001), while the maximum cystometric capacity remained constant (P = 0.75). External sphincterotomy achieved similar statistically significant decreases in voiding pressure and residual urine volume, and bladder capacity was maintained. The preoperative and follow-up urodynamic measures were similar in the two groups. Prosthesis placement was associated with a significantly shorter operation (P = 0.001) and length of hospitalization (P = 0.01), a lower hospitalization cost (P = 0.01), and less bleeding (change in hemoglobin concentration) (P = 0.01) than external sphincterotomy. The complications of stent insertion were device migration (n = 4) and secondary bladder neck obstruction (n = 2). One patient with continuing reflux required bilateral ureteral implantation. The complications of sphincterotomy were bleeding necessitating transfusion (n = 2), recurrent obstruction (n = 2), and erectile dysfunction (n = 1). The sphincter prosthesis is as effective as sphincterotomy in the treatment of DESD, while being technically easier, less morbid, and less expensive.

Flexible cystoscopy during urodynamic evaluation of spinal cord-injured patients.

Eighty-one consecutive flexible cystoscopic examinations were performed on 69 patients with spinal cord injury (SCI) at the time of their urodynamic study. The indications for cystoscopy included hematuria, recurrent urinary tract infections, symptoms of bladder outlet obstruction, the presence of an intraurethral sphincter stent requiring evaluation, neurogenic vesical dysfunction requiring endourodynamic study (cystometrogram through the working port of the flexible cystoscope), or bladder calculi. Flexible cystoscopy was accomplished in all patients, whether lying supine or seated in a wheelchair (N = 16). Only 6 of 39 patients with previous episodes of autonomic dysreflexia became hypertensive during cystoscopy. When a urodynamic catheter could not be inserted, the flexible cystoscope was particularly useful in defining the urethral anatomy or obstruction and in performing endourodynamic evaluation. The only complication was the development of febrile urinary tract infection in four patients. The flexible cystoscope is a valuable tool in the urodynamic laboratory caring for patients with SCI and is effective for use in endourodynamics, especially when patient positioning or catheter placement is difficult. The procedure is well tolerated, causes minimal stimulation leading to the development of autonomic dysreflexia, and provides accurate cystometric data.

Contact laser vaporization techniques for benign prostatic hyperplasia.

Contact laser applications for the relief of bladder outlet obstruction caused by an enlarged prostate are different from the noncontact Nd:YAG laser methods. The noncontact techniques rely on coagulation necrosis or high power-density vaporization. The pure contact Nd:YAG laser allows cutting, coagulation, and vaporization of tissue with minimal penetration beyond the contact surface. In the contact laser prostatectomy technique, the laser probe directly touches and vaporizes the prostatic tissue. This results in immediate removal of the obstructing tissue, in a manner similar to the standard electrosurgical transurethral resection (TURP), and offers the patient the potential for decreased catheter time and a more rapid resolution of symptoms. Our initial experience suggests that the contact technique (contact laser ablation of the prostate or CLAP) may be better suited for the smaller prostate gland (i.e., less than 20-30 g). For prostates larger than 30 g, a newly described procedure known as coagulation and hemostatic resection of the prostate (CHRP) can be used. This method combines initial noncontact coagulation of the prostate with vaporization of a channel. The goal of CHRP is to allow more rapid removal of the catheter with a continued improvement in urine flow secondary to the coagulation effects. The contact laser is specifically designed to vaporize tissue such as the prostate and allows immediate observation of a TUR defect. Improvements in the delivery system and in the size of the contact laser probes have made CLAP a useful modality for the treatment of symptomatic benign prostatic hyperplasia.

Endoluminal ultrasonographic and histologic evaluation of periurethral collagen injection.

To determine the acute and chronic ultrasonographic and histologic characteristics of injected glutaraldehyde cross-linked collagen in an animal model in order to enhance the therapeutic efficacy of the delivery of collagen for the treatment of urinary incontinence, three different depths of endoluminal ultrasound-guided injection (submucosal, intramuscular, periadventitial) of collagen into the urethral and bladder walls in two Yucatan mini pigs were investigated. The ultrasonographic characteristics of the injected material were examined 1, 4, 8, and 12 weeks later. A separate set of collagen injections, into the dermis and intramuscular layer of the lateral thigh of the animals, was undertaken with small-parts ultrasound guidance and follow-up. The injected tissues of the bladder, urethra, and thigh were ultrasonographically and histologically examined 3 months post-injection. Acutely injected collagen appeared hypoechoic on ultrasonography, although echogenicity increased over time. Submucosally injected collagen remained contained, forming a discrete collection of the material, whereas periadventitially injected collagen dispersed immediately. The ultrasonographic appearance and size of collagen collections correlated directly with their histologic identification and measurement. Injected collagen generated little inflammatory reaction, although infiltration by histiofibroblasts and neovascularization of the injected collagen occurred. Submucosal collagen injection resulted in superior longevity compared with intramuscular injection. From the results of our study, we hypothesize that durable success with collagen injection for the treatment of urinary incontinence is attributable to histiofibroblast infiltration of the injected collagen. When injected collagen is replaced with a hypertrophic scar, long-lasting clinical success is likely. If the injected collagen is replaced with a contracted scar, however, urethral coaptation may not persist. Endoluminal ultrasonography is helpful in ensuring the accurate submucosal location of collagen injection and in avoiding dispersion of the material and should enhance therapeutic efficacy in the treatment of urinary incontinence.

The management of neurogenic bladder and sexual dysfunction after spinal cord injury.

STUDY DESIGN: Review article. OBJECTIVES: To review the medical literature and comprehensively discuss the management of bladder and sexual dysfunction after spinal cord injury. SUMMARY OF BACKGROUND DATA: The physiologic alterations that accompany spinal cord injury can lead to significant bladder and sexual dysfunction. Fertility in men is also diminished. Without appropriate intervention, the above conditions can lead to significant morbidity and mortality. METHODS: Structured review of published reports obtained through a MED-LINE search and texts. RESULTS/CONCLUSION: With appropriate surveillance and management, morbidity and mortality from neurogenic bladder dysfunction can be successfully prevented. Current treatment interventions also facilitate the restoration of sexual function and fertility after spinal cord injury.

Erectile response to topical, intraurethral and intracorporal pharmacotherapy in a rat model of spinal cord injury.

In order to compare the erectile response to topical, intraurethral and intracorporal administration of vasoactive substances in neurologically intact and spinal cord injured (SCI) rats, a standard rat model of SCI using impact trauma at the level of T10 was employed, comparing the tumescence of 24 SCI and 25 control rats. Four weeks after SCI, the effect of vasoactive substances on erectile function was evaluated. Under ketamine anesthesia, the penis was exposed and intracorporal pressure (ICP) was monitored using saline infusion cavernosometry through a 24-gauge catheter inserted into one corpus cavernosum. Changes in ICP were recorded in response to the topical and intraurethral (IU) application of minoxidil (0.1 ml, 2% solution) and 2% nitroglycerin (NTG) ointment (0.1 gm), as well as the intracorporal (IC) administration of papaverine (0.0001-0.10 mg/kg). Results indicated that the mean baseline ICP was 8 +/- 5 mmHg for SCI and 9 +/- 4 mmHg for control rats. No response to topical therapy onto the undegloved penis was noted in either SCI or control rats. IU application of minoxidil to the degloved phallus developed ICP greater than that achieved with topical minoxidil; the topical application of NTG was less effective. In SCI rats, IC papaverine injection achieved an ICP of 56.9 +/- 24.3 mmHg, whereas papaverine in control rats generated an ICP of 43.5 +/- 38.8 mmHg. A greater increase in ICP at lower doses of each agent occurred in SCI than in control rats. We conclude that only the degloved phallus responded to topical vasoactive pharmacotherapy. Although both topical and IU applications of NTG and minoxidil increase ICP, tumescence was significantly less than that achieved with IC injection of papaverine. The IU application of minoxidil demonstrated significantly greater activity than other topical therapies. SCI rats displayed a supersensitive response to all modes of pharmacologic erectile therapy.

Intravesical capsaicin in neurologic impaired patients with detrusor hyperreflexia.

Capsaicin is known to be neurotoxic for C-fiber afferents. We investigated the intravesical application of capsaicin in the treatment of detrusor hyperreflexia (DH) in seven patients (ages 23-52) with neurologic impairment. The patients were evaluated with both ice-water cystometry and formal video-urodynamic studies. Four biweekly courses of intravesical capsaicin treatment were administered using increasing concentrations (100 microM, 500 microM, 1 mM, and 2 mM). Treatment effect was monitored using a bladder diary and urodynamic evaluation one month after capsaicin treatment. Prior to treatment, six of the seven patients demonstrated a positive ice-water test and DH. Two patients were not able to complete the study due to discomfort attributed to capsaicin. Five of the seven patients completed the four courses of increasingly concentrated capsaicin. Three patients noted symptomatic improvement while two did not. The mean urodynamic bladder capacity significantly increased from 124 +/- 39 ml pre-capsaicin to 231 +/- 62 ml one month post-capsaicin in the three patients with symptomatic improvement (p < 0.05). Urodynamic testing revealed that one of the six patients with a positive ice-water test lost that response after intravesical capsaicin. Intravesical capsaicin is a novel and promising treatment for detrusor hyperreflexia in neurologically impaired patients.

Urologic manifestation of spinal cord sarcoidosis.

We present the first report of neurogenic lower urinary tract dysfunction associated with neurosarcoidosis. Urodynamic findings of detrusor hyperreflexia with detrusor-sphincter dyssynergia correlate with this patient's magnetic resonance imaging (MRI) examination which found intramedullary involvement at the mid-thoracic level.

In-vivo whole bladder response to anticholinergic and musculotropic agents in spinal cord injured rats.

The purpose of this study was to compare the effect on urodynamic parameters of anticholinergic and musculotropic agents in sham injured and spinal cord injured (SCI) rats. A standard rat SCI model induced by impact trauma was employed. Cystometrograms were performed under urethane anesthesia four weeks after SCI. Bladder capacity and voiding pressure were determined at the point of micturition monitored urodynamically and visually. The effect of oxybutynin chloride (0.01-0.1 mg/kg), propantheline bromide (0.05-0.5 mg/kg) and flavoxate hydrochloride (0.1-1.0 mg/kg) were assessed independently in sham injured and SCI rats (n = 10 in each group). Bladder capacities were 0.6 +/- 0.2 and 7.1 +/- 1.6 ml in sham and SCI rats (p < 0.01), respectively. Maximal filling pressure was 17.5 +/- 5 mmHg in sham and 25 +/- 5 mmHg in SCI rats (p < 0.05). Bladder capacity increased with all three medications. Administration of oxybutynin, propantheline and flavoxate in sham rats resulted in bladder capacities of 0.88 +/- 0.3, 0.71 +/- 0.3 and 0.8 +/- 0.2 ml, respectively (p < 0.01). In SCI rats, these drugs resulted in bladder capacities of 9.8 +/- 1.1, 7.9 +/- 1.3 and 8.8 +/- 2.0 ml, respectively (p < 0.01). No significant change in maximum filling pressure occurred. We conclude that anticholinergic and musculotropic agents caused a similar increase in bladder capacity in both sham and SCI rats. Oxybutynin enhanced bladder capacity more than propantheline or flavoxate.

Management of sphincter dyssynergia using the sphincter stent prosthesis in chronically catheterized SCI men.

This effort represents a subset analysis of the long-term Multicenter North American Trial of the UroLume sphincter stent prosthesis to determine the effect of the sphincter stent prosthesis in SCI men afflicted with detrusor-external sphincter dyssynergia (DESD) and chronically managed with an indwelling urinary catheter. Forty-one of 153 male patients in this study were evaluated urodynamically before and after placement of the sphincter stent prosthesis. Of the 41 patients, 34 (81 percent) suffered cervical-level injury while 10 patients (25 percent) had been treated previously with external sphincterotomy. Forty patients (98 percent) were troubled with recurrent urinary tract infections (UTI), with a mean of 4.6 +/- 3 episodes of UTI per year. Seven patients (17 percent) demonstrated hydronephrosis prior to stent placement. Follow-up ranged from six to 44 months. Voiding pressures decreased from a mean of 77 +/- 23 cmH2O preoperatively to 35 +/- 18 cmH2O at 12 months (n = 34) and 33 +/- 20 cmH2O at 24 months (n = 22) after stent insertion (p = 0.001). Post-void residual urinary volume decreased from 202 +/- 187 ml preinsertion to 64 +/- 69 ml at 24 months (p = 0.001) postinsertion. Maximum cystometric capacity remained constant at 201 +/- 144 ml preinsertion to 203 +/- 79 ml at 24 months (p = 0.75) postinsertion. No significant changes in any of the urodynamic parameters occurred after 24 months of follow-up between patients with (n = 10) and without (n = 31) previous external sphincterotomy. Neither hemorrhage requiring blood transfusion, obstructive hyperplastic epithelial overgrowth, stent encrustation or stone formation, nor soft tissue erosion occurred in any patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of current treatment for sexual dysfunction in spinal cord injured men in the USA model spinal cord injury centers.

This study is a prospective multicenter cooperative survey of the evaluation and treatment of erectile dysfunction in men with spinal cord injury (SCI). Uniform database questionnaires were completed prospectively by patients seeking therapy for erectile dysfunction. Eighty-five SCI men aged 17-68 years (mean age = 26 +/- 17) were enrolled. Mean duration of traumatic SCI was 3 +/- 3.2 years (Range = 0.3-18 years). The level of injury was cervical in 20 patients, thoracic in 31, lumbar in 29 and sacral in five. Patients were fully evaluated and then counseled as to their therapeutic options. Twenty-eight chose to use a vacuum erection device (VED), 26 preferred pharmacological penile injection and five used both intracorporeal therapy and VED. The remainder were managed with marriage and sexual counseling in 10 patients, three underwent penile prosthesis placement and two used topical pharmacotherapy. Four patients used other forms of treatment and in nine no therapy was recommended. Of the patients that used pharmacologic injection only, 74 percent used papaverine as a single agent, 20 percent used papaverine with phentolamine, five percent used prostaglandin E (PGE1) alone and one percent used a mixture. Patients using injection therapy report sexual intercourse a mean of 3 +/- 3.4 times per month as compared with 5 +/- 3.2 times per month in those using VED. Five intracorporeal injection patients developed priapism while two patients using the VED developed subcutaneous bleeding and one developed penile ischemia. We conclude that although a spectrum of erectile dysfunction treatment is present among SCI centers, VED and pharmacological penile injection are by far the two most popular methods of treatment and papaverine is the most common drug. The incidence of complications is small in the model centers.

Lipogenic regulators are elevated with age and chronic overload in rat skeletal muscle.

AIM: Both muscle mass and strength decline with ageing, but the loss of strength far surpasses what is projected based on the decline in mass. Interestingly, the accumulation of fat mass has been shown to be a strong predictor of functional loss and disability. Furthermore, there is a known attenuated hypertrophic response to skeletal muscle overload with ageing. The purpose of this study was to determine the effect of 28 days of overload on the storage of intramuscular triglycerides (IMTG) and metabolic regulators of lipid synthesis in young and old skeletal muscle. METHODS: The phosphorylation and expression of essential lipogenic regulators were determined in the plantaris of young (YNG; 6-month-old) and aged (OLD; 30-month-old) rats subjected to bilateral synergist ablation (SA) of two-thirds of the gastrocnemius muscle or sham surgery. RESULTS: We demonstrate that age-induced increases in IMTG are associated with enhancements in the expression of lipogenic regulators in muscle. We also show that the phosphorylation and concentration of the 5'AMP-activated protein kinase (AMPK) isoforms are altered in OLD. We observed increases in the expression of lipogenic regulators and AMPK signalling after SA in YNG, despite no increase in IMTG. Markers of oxidative capacity were increased in YNG after SA. These overload-induced effects were blunted in OLD. CONCLUSION: These data suggest that lipid metabolism may be altered in ageing skeletal muscle and is unaffected by mechanical overload via SA. By determining the role of increased lipid storage on skeletal muscle mass during ageing, possible gene targets for the treatment of sarcopenia may be identified.