Incidentally diagnosed Peyronie's disease in men presenting with erectile dysfuntion

The aim of this study was to analyze characteristics of patients with Peyronie's disease (PD) diagnosed during a standard evaluation for erectile dysfunction (ED) and compare them with patients presenting with the classical complaints of PD. During a 10-y period, a total of 448 patients were evaluated at our two outpatient clinics, directed by the same author (AK). They were divided into two groups: group I consisted of patients, who presented with only ED and were unaware of their penile deformity, and group II consisted of patients with the classical features of the disease. The clinical characteristics, penile deformities, erectile status and the presence of comorbidities were determined in the two groups. Of 448 Peyronie's patients, 16% (n=71) were detected during diagnostic work-up for ED. In this group of patients, ED was the presenting symptom for a mean period of 31.3+/-9.7 months. The mean age of men was 57.54+/-8.75 and 52.21+/-10.27 y in groups I and II, respectively (P=0.0001). The mean degree of deformity was 31.5+/-12.66 degrees in group I and 41.16+/-19.14 degrees in group II (P=0.0001). In group I (n=71), 69% (n=49) of the patients had a poor erectile response to the combined injection and stimulation (CIS) test. Also, in this group, the mean degrees of deformity in CIS-positive and -negative patients were 27.05+/-12.50 and 33.80+/-12.03 degrees , respectively (P=0.033). Diabetes mellitus (40%) was the leading comorbidity in group I, while at least one comorbidity was observed in 73% of the cases (P=0.001). A remarkable percent of Peyronie's patients (16%) were detected during a standard evaluation for ED. This study analyzed, for the first time, the frequency and the characteristics of incidentally diagnosed Peyronie's patients who presented with only ED. Our data indicate that one should always consider the possibility of PD in older patients with diabetes, presenting with only ED.

Role of inhibitor deficiency in urolithiasis. I. Rationale of urinary magnesium, citrate, pyrophosphate and glycosaminoglycan determinations

Between October 1988 and March 1990, 173 urinary stone patients (average age 38.3 years) were evaluated metabolically, especially with regard to urinary magnesium, pyrophosphate (Ppi) citrate and glycosaminoglycans (GAG). 25 healthy subjects served as controls. Inhibitory deficiency was found to be the most frequent causal factor in our series, with an incidence of 48.7% in first-time stone formers and 51.08% in recurrent urolithiasis (p less than 0.1). Deficient citrate levels were present in 46.56%, hypomagnesiuria in 24.4%, hypopyrophosphaturia in 10.7% and deficient GAG in 2.7% of the patients. Deficient urinary Ppi was seen in only 2.7% of the stone formers as the only metabolic defect, while deficient GAG was never the only causal factor. All 4 inhibitors showed no correlation with age, sex, activity of stone disease, stone weight and burden. There were no statistically significant differences with controls. We think that routine metabolic evaluation must be performed both in recurrent patients and first-time stone formers and must include urinary citrate and Mg determinations in every case. Urinary Ppi should be determined in selected cases and GAG determinations are irrational.

Voiding difficulties in the female: prevalence, clinical and urodynamic review

The urodynamic questionnaires of 600 consecutive female patients attending a urodynamic clinic with a variety of urologic symptoms were reviewed. Investigations consisted of independent uroflowmetry and either twin-channel subtracted cystometry or videocystourethrography with synchronous bladder pressure and urine flow recordings. Urodynamic evidence of voiding difficulty was defined as a repeated peak flow rate of less than 15 ml/sec or more than 200 ml of residual urine. One hundred ninety-five patients complained of voiding difficulties; this was substantiated in only 87. An additional 12 patients had no symptoms suggestive of impaired voiding, but had urodynamic evidence of voiding difficulty. Symptoms of voiding difficulty were found to be unreliable. Neurologic disease was a significant etiologic finding. Uroflowmetry was advised for patients who were to undergo suprapubic surgery for incontinence or radical pelvic surgery.