Nocturnal erections, differential diagnosis of impotence, and diabetes.

In this study it is shown that monitoring of nocturnal penile tumescence (NPT) is an objective method for determining the erectile status of patients who complain of impotence. The characteristics of 11 diabetic patients with abnormal NPT, 11 patients with normal NPT and no medical disorders, and 11 normal men are presented. Also described are several sociodemographic characteristics of the first 100 patients undergoing an NPT evaluation as part of a screen for patients seeking implantation of a penile prosthesis. It is suggested that NPT monitoring should be a component of the differential diagnosis procedure for every patient who complains of impotence and that it provides a tool for the concentrated study of the mechanisms of erection and impotence.

Nocturnal penile tumescence and diagnosis in diabetic impotence.

The authors conducted a study of nocturnal penile tumescence (NPT) in 35 diabetic men, aged 33 to 70, who complained of impotence and in 35 age-matched control subjects. EEGs and other measurements showed that the diabetic men as a group exhibited significant reductions in the total amount of NPT and in the amount and frequency of full erection, thus suggesting that impotence in this cohort was organogenic. Although NPT monitoring represents an advance over the less precise traditional procedures for the differential diagnosis of impotence, the authors stress the need for more research in this area.

Impotence and blood pressure in the flaccid penis: relationship to nocturnal penile tumescence.

Evaluations of nocturnal penile tumescence (NPT) and penile blood pressure were performed on (1) a group of nondiabetics with normal NPT, (2) a group of nondiabetics with abnormally diminished NPT, and (3) a group of diabetics with abnormally diminished NPT. The 12 subjects in each group complained of impotence. Analysis of blood pressure data taken before the NPT evaluation suggests the possibility of selective low arterial blood pressure in impotent patients who show no obvious signs of other vascular disorders.

Management of neurogenic impotence with inflatable penile prosthesis.

The inflatable penile prosthesis was used to manage impotence of neurogenic origin secondary to spinal cord injury. The female partners were also interviewed. Analysis of the results indicated that this was an eminently satisfactory method of managing this distressing complication of spinal cord injury. Both men and women indicated satisfaction with the prosthesis. The incidence of complications was the same as in those patients with non-neurogenic impotence. Erosion of the prosthesis due to pressure necrosis of denervated tissue did not occur.

Ureteroileal anastomosis: new antirefluxing technique.

A case report of a new surgical technique of antirefluxing ureteroileal anastomosis is described. Also reviewed are previous antirefluxing ureterointestinal anastomoses.

Iatrogenic chordee following insertion of inflatable penile prosthesis.

Chordee deformity is a rare complication following insertion of the inflatable penile prosthesis through a penoscrotal incision. The deformity occurs as a result of failure to inflate and deflate the device and to maintain the penis against the abdomen in the immediate postoperative period. When this occurs it can be corrected by incision of the fibrous scar and replacement with synthetic graft material.

Experimental evaluation of bladder closure techniques.

Two methods of bladder closure have been evaluated in dogs. A conventional two-layer closure including the mucosa and a single layer running horizontal mattress extramucosal closure have been compared. Observations including adequacy of healing, strength of scar, degree of inflammatory reaction, dna degree of bladder adhesions have been made. The extramucosal running horizontal mattress closure appears to approach the ideal bladder closure.

Experience with inflatable penile prosthesis.

Prosthesis surgery for management of erectile impotence has become an increasingly important aspect of urology. The inflatable penile prosthesis (IPP) provides the impotent patient with a controllable, natural-appearing and physiologically functional penis. Major modifications in the prosthesis and in the surgical implantation technique have been made since its initial introduction. In this article we present a histologic review of the IPP and our ten-year experience with it.

Ultrastructural analysis of human penile corpus cavernosum. Its significance in tumescence and detumescence.

The erectile tissue from 15 normal and impotent male patients was studied by electron microscopy to determine if any ultrastructural features could contribute to the basic understanding of the physiology of penile erection and detumescence. It was found that the endothelium lining the cavernous lacunae contained both contractile elements and Weibel-Palade bodies which have a possible role in vasoconstriction. Within the trabeculae of the cavernous body there was an abundance of elastin as well as oxytalan and elaunin fibers around bundles of smooth muscle. With these elements affording an anchorage system for contraction of smooth muscles within the trabeculae, an alternate contraction of smooth muscles and endothelium could account for the erectile and detumescent states.

Evaluation of AMS 800 artificial sphincter for continent urinary diversion using intestinal loops.

The AS 800 artificial urinary sphincter was implanted around the isolated intestinal bowel loops in 22 New Zealand rabbits. Pressure flow studies, microangiography, and histopathology were evaluated. The results demonstrated the potential application of the AS 800 in creating continent urinary diversion.

Cystometry. (2). Central nervous system organization of detrusor reflex.

Micturition is a brain stem reflex dependent on the integrity of reticulospinal and sensory pathways in a manner similar to respiration and blood pressure regulation. The detrusor reflex which is evoked by bladder distention and may appear in the normal cystometrogram is a result of the integrity of the circuit. Interruption of the spinal cord pathways of this loop by trauma or by spinal cord tumors results in abolition of detrusor reflex. Partial interruption results in an uninhibited detrusor reflex.

Cystometry: III. Cystometers.

Cystometers may employ either fluid (water) or gas (air or carbon dioxide) as the distending medium. The operation of air and carbon dioxide cystometers is described, and a comparison is given of the various systems currently in use.

Cystometry. V. Bladder sensation.

Bladder sensation is an important variable in cystometry. Sensory complaints are a valuable portion of the history which may be further defined and documented by the cystometric examination.

Women's satisfaction with partners' penile implant. Inflatable vs noninflatable prosthesis.

We evaluated 49 women whose sexual partners were organically impotent and subsequently received either an inflatable or noninflatable penile prosthesis. The women comprised three groups, based on the type of prostheses their partners had received: inflatable (n = 34), noninflatable (n = 11), and a double implant group (n = 4). The comparisons made were (1) dimensions of sexual satisfaction, (2) emotional stability, (3) satisfaction with the prosthesis, and (4) relationship changes. Two special questionnaires and the Derogatis Sexual Functioning Inventory were utilized in this evaluation. Women in the inflatable prosthesis group were found to be significantly more satisfied with the quality of their sexual relations and with their partner's prosthesis than were the women in the noninflatable prosthesis group. There apparently is a general advantage to women whose partners have received an inflatable prosthesis compared with the noninflatable alternatives.

Inflatable and noninflatable penile prostheses: comparative follow-up evaluation.

This evaluation was conducted with 63 men who were organically impotent and subsequently received either an inflatable penile prosthesis (n = 43), a noninflatable penile prosthesis (n = 14), or both in succession (n = 6). The patient groups were compared for sexual satisfaction, sexual activity, mental status, complications, satisfaction with prosthesis, and relationship changes. The methods of evaluation were the Derogatis Sexual Functioning Inventory and two unstandardized questionnaires. Significant differences were found between the two patient groups: inflatable prosthesis recipients report being more sexually satisfied, more satisfied with their implant, experiencing less psychiatric distress, having a more rapid postsurgical recovery, more sexually active, and experiencing more positive changes in relationships with their partners than do recipients of a noninflatable prosthesis. The data suggest that the inflatable prosthesis may be a more favorable choice for most individuals than noninflatable devices.

Outpatient implantation of penile prostheses under local anesthesia.

Penile implantation can be accomplished safely under local anesthesia on an outpatient basis. This reduces cost and should be considered more frequently than the current practice. The techniques and routines for performing penile implantation under local anesthesia are described.

The use of the artificial sphincter in the treatment of urinary incontinence in the female patient.

Data analysis of my experience with the implantation of the artificial sphincter shows an overall success rate of 84 per cent. These results are in 139 females ranging from 5 to 84 years of age. The surgery is difficult primarily because the urethral-vaginal septum is not a surgical plane. Even partial injury to these tissues can lead to failure with erosion of the device into the urethra or vagina. The use of a new surgical instrument, the "cutter clamp" (see Fig. 8) is expected to improve results because of the precision it offers in dissecting around the bladder neck. Infection occurred in 4 of 139 patients, or 3 per cent. In one infected patient, the cuff eroded into the urethra. The infection rate may actually be higher because infection might account for some of the other erosions that occurred. Once erosion occurs, secondary infection can obscure the fact that the device was contaminated at the time of the original implantation. The use of a surgical isolation bubble system may lower both the incidence of infection and erosions in the future. The relief to the totally incontinent female by the artificial sphincter cannot be overestimated. The patients are very grateful, especially because most have undergone multiple treatment methods in an effort to cure their incontinence. The effectiveness of the device, barring infection or erosion, is evident by a success of 91 per cent of such patients being socially continent and 66 per cent being completely dry.

The artificial urinary sphincter. Experience in adults.

The author's experience and results of implanting the artificial sphincter into 406 adults from June 1972 through March 1988 are reviewed. The early experience in which the device was pressurized by means of valves has been compared with later experience with the device whose pressure is controlled by means of a balloon. The degree of continence has been assessed according to the model of the device, the etiology of the incontinence, the location of the cuff, and the pressure that was chosen. The patients have been grateful to achieve an improved quality of life with social urinary continence brought about by improvements in the prosthesis. Additional improvements in the fitting of the cuff might bring even better results.

Scanning electron microscope observations on third-instar Gasterophilus nasalis (Diptera: Oestridae).

Scanning electron microscope observations studied the morphology of 3rd-instar Gasterophilus nasalis (L.). Distinctive features are illustrated in a sequence of 16 micrographs, bearing indications of structures considered of special interest. The morphology of G. nasalis is compared with that of other larval bot flies.

[Development of an implantable artificial urinary sphincter (author's transl)]. / Entwicklung eines implantierbaren künstlichen Blasenverschlussmechanismus

Fifteen years experience with investigations of the neurologic aspects of lower urinary tract function has produced a therapeutic rationale that includes utilization of prosthetic devices in selected patients. Development of an implantable artificial sphincter evolved as a necessity for restoring urinary continence became apparent. The experimental design of animal models and the technologic methods in device development are herein described.