Intracavernosal drug-induced erection therapy versus external vacuum devices in the treatment of erectile dysfunction

OBJECTIVES

To determine if there is a significant difference between intracavernosal self-injection and external vacuum devices when compared directly for satisfaction, effectiveness and side-effects.

PATIENTS AND METHODS

Fifty men were randomised into two groups and received either instruction on the use of the Osbon ErecAid system or self-injection therapy. After 15 uses, each group completed a questionnaire detailing efficacy, satisfaction and side-effects, and then changed to the other modality after appropriate instruction. A questionnaire was completed by study participants and their sexual partners after using both methods. Patients were followed for 18-24 months using telephone interviews.

RESULTS

Forty-four patients (mean age 62.3 years, range 38-84) completed the study. Patients and their partners reported a superior quality of erections with the injection method but the difference did not reach statistical significance. The ability to attain orgasm and the overall satisfaction of the patient and partner with the sexual experience was significantly better when using injections. Side-effects were similar between the modalities. Subgroups analysed for age, duration and aetiology of impotence showed that younger patients (< 60 years), those with a shorter duration of impotence (< 12 months) and those impotent secondary to radical prostatectomy strongly favoured injection therapy (P < 0.05). Overall, of the 44 couples, the final preferences of the patients were 25 (57%), 12 (27%), six (14%) and one (2%) for the injection, vacuum device, both or neither, respectively, and of the partners were 22 (50%), 12 (27%), six (14%) and four (9%), respectively. At 18-24 months, 80% of patients were still using either the vacuum device, injections, or both.

CONCLUSION

Both the vacuum device and injections are effective treatment modalities for impotence and are associated with good long-term success. Overall, there was a trend favouring injection therapy over the vacuum device which was most significant in younger patients, those with a shorter duration of impotence, and those impotent secondary to radical prostatectomy.

A comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urological surgery

PURPOSE

Intermittent pneumatic compression of the calf and/or thigh effectively decreases the incidence of deep venous thrombosis and other thrombotic sequelae but clinical data comparing these modalities are currently lacking.

MATERIALS AND METHODS

A total of 90 patients undergoing major urological surgery was randomly assigned to receive calf length or thigh length pneumatic compression for antithrombotic prophylaxis. Duplex ultrasound of the lower extremities was performed preoperatively and twice postoperatively to evaluate for deep venous thrombosis. Health care providers in the operating room, recovery room and ward were asked to compare the compression systems, and a cost analysis was performed.

RESULTS

A total of 47 patients wore the thigh length sequential pneumatic sleeves and 43 wore calf length uniform compression systems. A pulmonary embolus without evidence of deep venous thrombosis was detected in 1 patient (2%) using the thigh length system. A thrombus was detected in the common femoral vein by duplex ultrasonography in 1 patient (2%) with the calf length system. Nursing personnel found the calf length sleeves easier to apply and more comfortable by patient account but they were satisfied with both systems. There was a significant cost savings with the calf length pneumatic compression system.

CONCLUSIONS

Calf and thigh length pneumatic compression systems similarly decrease the risk of deep venous thrombosis in patients undergoing urological surgery. The calf length system has the added advantage of being less expensive and easier to use.

Bilateral renal cell carcinoma in autosomal dominant polycystic kidney disease. A case report and literature review

The association of autosomal dominant polycystic kidney disease with renal cell carcinoma is infrequent. A case of bilateral renal cell carcinoma in conjunction with autosomal dominant polycystic kidney disease is presented. The discussion emphasizes pertinent diagnostic and therapeutic considerations.

Erectile dysfunction following transurethral resection of the prostate

PURPOSE

We objectively measured the incidence of erectile dysfunction following transurethral resection of the prostate.

MATERIALS AND METHODS

A total of 56 men completed a questionnaire detailing perceived sexual dysfunction, and underwent nocturnal penile tumescence testing for 3 nights before transurethral resection of the prostate and again at 3 months postoperatively.

RESULTS

Complete data were available for 40 men. No significant difference was found in penile tumescence, number of erectile events and duration of events before and after surgery. Preoperative and postoperative rigidity was statistically different, with a slight improvement after transurethral resection of the prostate (p < 0.05). A subjective decrease in quality of erection after transurethral resection of the prostate was reported in 27.5% of the patients. However, on further questioning, 63.6% of these patients equated retrograde ejaculation with decreased potency.

CONCLUSIONS

We demonstrated no decrease in objective parameters of erectile function studies following transurethral resection of the prostate. Previous estimates of impotence after transurethral prostatectomy may have been tainted by subjective patient reports equating retrograde ejaculation with erectile dysfunction.

New use of Foley catheter for precise vesicourethral anastomosis during radical retropubic prostatectomy

PURPOSE

We describe a new method of using a Foley catheter to assist vesicourethral anastomosis during radical retropubic prostatectomy.

MATERIALS AND METHODS

A total of 81 patients underwent radical retropubic prostatectomy with this technique. Followup ranged from 4 to 48 months. Peri-catheter urethrograms were performed at 3 weeks. Patients were evaluated specifically for bladder neck contracture, urinary continence and prolonged catheterization.

RESULTS

Bladder neck contracture, occurred in 4.9% of the patients and 87.6% were completely continent of urine. Only 1 patient required extended postoperative catheterization.

CONCLUSIONS

Use of a Foley catheter for vesicourethral anastomosis is consistent and simple, and provided good surgical results in our experience.

Immunohistochemical localization of insulin-like growth factor binding proteins 2 and 3 in prostate tissue: clinical correlations

PURPOSE

The insulin-like growth factor system has recently been shown to have important mitogenic effects in the prostate. The system consists of 2 ligands: insulin-like growth factor types 1 and 2, which are potent mitogens for prostate cell growth, and 6 insulin-like growth factor binding proteins that modify the activity of these growth factors. Recently, changes in serum levels of insulin-like growth factor binding proteins 2 and 3 have been identified in prostate cancer patients but in vivo studies of these changes have not been previously reported.

MATERIALS AND METHODS

We performed immunohistochemical staining for insulin-like growth factor binding proteins 2 and 3 in areas of benign disease, prostatic intraepithelial neoplasia, and cancer from specimens obtained from 24 patients who underwent prostatectomy to determine changes in the quantity of these proteins with progression from the benign through the premalignant and into the malignant states. Quantification of the differences noted in the amount of insulin-like growth factor binding proteins 2 and 3 found in each of the 3 tissue types was then correlated with serum and tissue prostate specific antigen levels, pathological stage and grade of the tumors.

RESULTS

Our data indicate that as human prostate tissue progresses from the benign to the malignant state, insulin-like growth factor binding protein 2 immunoreactivity in the prostatic luminal epithelial cells increases and that of insulin-like growth factor binding protein 3 decreases. Quantification of the differences noted in binding proteins 2 and 3 among all 3 tissue types was statistically significant. However, no correlation was noted between the stage or grade of prostate carcinoma and insulin-like growth factor binding protein 2 or 3 immuno-staining intensity. Additionally, no significant correlation was found between serum or tissue levels of prostate specific antigen and insulin-like growth factor binding protein 2 or 3 immunoreactivity.

CONCLUSIONS

Our data suggest that significant changes in the insulin-like growth factor system occur with malignant transformation in the prostate. It is hoped that this system may eventually result in a better serum or tissue (from prostate biopsy) marker of malignant transformation, and/or represent a target for early therapeutic intervention to alter the growth and development of prostate cancer.

The role of cystoscopy before radical prostatectomy

OBJECTIVE

To determine the role of pre-operative cystoscopy in men undergoing radical prostatectomy for clinically localized adenocarcinoma of the prostate.

PATIENTS AND METHODS

One hundred men undergoing radical prostatectomy for clinically localized adenocarcinoma of the prostate were evaluated for coexisting bladder pathology from a retrospective review of their charts and records.

RESULTS

Four of 100 men undergoing radical prostatectomy for clinically localized prostate cancer were found to have synchronous bladder tumours. Two of these had superficial low-grade transitional cell carcinoma (TCC), one had a poorly differentiated invasive TCC and the last was found to have an inverted papilloma during radical retropubic prostatectomy. The patient with invasive disease died before the initiation of definitive therapy. The other three men are free of disease 2 years after diagnosis and treatment.

CONCLUSION

Because of the low cost and minimal morbidity of pre-operative flexible cystoscopy, we recommend that this procedure be performed on the operating table before prostatectomy. In patients with gross or microscopic haematuria, a significant history of smoking, a prior history of urothelial malignancy or symptoms of bladder outlet obstruction, cystoscopy would be best performed before surgery in an out-patient setting.

A prospective comparison of thromboembolic stockings, external sequential pneumatic compression stockings and heparin sodium/dihydroergotamine mesylate for the prevention of thromboembolic complications in urological surgery

Deep venous thrombosis and pulmonary emboli are reported to occur in up to 66% of the patients undergoing a major urological operation. Thromboembolic stockings, external sequential pneumatic compression stockings and anticoagulant agents, such as heparin sodium plus dihydroergotamine mesylate, have been suggested to decrease the risk of deep venous thrombosis and pulmonary emboli. A total of 74 evaluable patients undergoing a major urological operation was randomized to receive either thromboembolic stockings, external sequential pneumatic compression stockings, or heparin plus dihydroergotamine as prophylaxis against deep venous thrombosis and pulmonary emboli. 111Indium-labeled platelet scans, performed preoperatively and on days 1, 3 and 6 postoperatively, were used to diagnose deep venous thrombosis and pulmonary emboli. Mean patient age was 63 years and all but 1 operation was performed for neoplastic disease. Deep venous thrombosis was detected in 5 of 25 patients (20%) with thromboembolic stockings, 3 of 24 (12.5%) with external sequential pneumatic compression stockings and 2 of 25 (8%) with heparin plus dihydroergotamine. There was no difference in blood loss or complications among the groups. Although statistical significance among the treatment groups was not reached in this study, the trend to a decrease in deep venous thrombosis and pulmonary emboli with external sequential pneumatic compression stockings and heparin plus dihydroergotamine, and an absence of an increase in morbidity in these groups supports the use of these modalities to decrease the morbidity and mortality of deep venous thrombosis and pulmonary emboli.