Intracavernosal papaverine injection test for the diagnosis of erectile dysfunction, experience in 1180 patients

To evaluate the intracavernosal papaverine injection test as diagnostic tool for patients having erectile dysfunction. 1180 patients suffering erectile dysfunction were classified according to the etiology based on history and clinical assessment into three groups. Group [A], included 324 cases having primary psychogenic impotence, Group [B] included 676 patients having impotence with associated risk factors and Group [C] included 180 patients having secondary impotence without obvious cause. A bolus dose of 30 mg papaverine was injected intracorporealy in all studied patients. Color Doppler sonography was done for patients having negative papaverine test to confirm the diagnosis. Papaverine intracavernosal injection test was positive in 82% [266 cases] of Group A, 37% [250 cases] of Group B and 59% [106 cases] of Group C. Priapism was developed in 5% [18 cases], 5.3% [36 cases] and 4.5% [8 cases] of Groups A, B, and C, respectively. Negative papaverine test is valuable in impotent patients having associated risk factors [Group B], as it was negative in 63% [426 cases] of them. Color doppler sonography confirmed the diagnosis in 86% [369 cases] of them as they having arteriogenic, venogenic or mixed vasculogenic impotence. In-Group C, it was negative in 41% [74 cases] and the color Doppler sonography confirmed the diagnosis of vasculogenic impotence in 60.5% [45 cases]. In-Group A, negative papaverin test was found in 18%, [58 cases], while color doppler sonography was normal in 95% [55 cases] of them and venous leakage was found in only 5% [3 cases]. Intracorporeal papaverine injection is a good positive test to rule out major arterial insufficiency or veno-occlusive dysfunction. However, a negative papaverine test is valuable in patients having associated risk factors or those without obvious cause for their impotence. But not in patients having psychogenic impotence

Management of 62 cases of priaplsm following intracavernosal injection of papaverine

Priapism induced by intracavernous injection of vasoactive drugs is uncommon and easily managed. It could be treated by puncture of the corpora and injection of alpha-adrenergic drugs or by surgical intervention. The aim of this study is to find an easy uncomplicated and less invasive method for treatment of patients developed post injection priapism. Out of 1180 impotent patients injected with papaverine intracavernosally as an office test. 62 cases [5.3%] developed priapism. Eighteen cases of them had primary psychogenic impotence while 44 cases had secondary impotence and a possible organic cause for their impotence. Conservative treatment was attempted in all cases during the first 24 hours. Priapism resolved spontaneously with conservative treatment in 38.9% [7 out of 18] of patients having psychogenic impotence and in 15.9% [7 out of 44] of patients having secondary impotence and possible organic cause for their impotence. So conservative treatment alone was effective in about 22.5% [14 out of 62] of all patients. After 24 hours aspiration of the corpora was done using two butterfly gauge No. 15 needles each one was fixed into one corpous cavernosum at the mid penile shaft. The amount of aspirated blood differed according to the patient response, untilcomplete detumesence achieved, and it ranged between 150 and 350cc. This method resulted in aspiration of a relatively large amount of blood from the corpora washing the drug [papaverine] out of the corporeal tissue and avoids the injection of vascontrictors into the corpora with its possible sequelae on cardiac or hypertensive patients. Subcutaneous hematoma developed in 5 cases and they were treated conservatively. After 2 weeks all psychogenic cases regained their normal potency while patients having secondary impotence their potency returned to the preinjection baseline

Two years follow-up of patients with asymptomatic simple renal cysts

The kidney is one of the most common sites in the body for cysts. The incidence of asymptomatic simple renal cysts ranged between 11.9% in one series up to 14% in another series of patients. The aim of this study is to follow up patients with asymptomatic renal cysts to evaluate the natural history and development of complications over 2 years follow up. The study included 131 patients, twelve cases had no sufficient period of follow up [lost follow up]. The remaining 119 patients [69 males and 50 females] ranging in age from 25-75 years were followed up at 3 months interval for a period ranging from 9-24 months [mean 16.8 +/- 04 months]. The patients were followed up by clinical history, examination, urine analysis, blood urea, serum creatinine and abdominal Ultrasonography. The results revealed that the cyst size increased with time but there was no significant difference between mean size of the cyst at presentation and at the follow up visit [P. value 0.34]. there is no change in the number of cysts and no cyst complications observed over the follow up period

Neodymium: yag laser coagulation of the prostate in surgical risk patients

Transurethral Neodymium:YAG laser coagulation of the prostate gland was used to treat benign prostatic hyperplasia in 36 surgical risk patients, who had either significant lower urinary tract symptoms or urinary retention. The mean International Prostate Symptom Score [IPSS] decreased from 26.8 to 9.6, then increased to 14.2. The mean maximum flow rate [Qmax] increased from 8.3 to 15.1 ml/s and then decreased to 10.6 ml/s. The average residual urine volume [PVR] decreased from 139.3 to 65 ml, then increased to 87.5 ml at 12th and 60th months, respectively. Catheters were removed after seven days. Seven out of the 36 patients required re-catheterization within the first visit. Repeated interference was needed in 12 of the 36 patients. From the results obtained it was concluded that, aggressive Nd:YAG laser prostatectomy is safe and effective for high surgical risk patients with obstructive prostates and produces good results that are sustained for up to two years. On the contrary, the durability of this procedure is significantly decreased after three years with high incidence of re-treatment rate