Electrical activity of the vas deferens is it of a clinical value?

Bilateral EMG tracing of the electrical activity of the vasa deferentia in normal and pathological conditions to evaluate its diagnostic role in diagnosing the vas deferens disorders affecting ejaculation and infertility. This study included 30 young and middle aged males with normal erection and ejaculatory functions [control group]. Also included 44 young and middle aged males with infertility and ejaculatory complaints [study group]. This study group included 10 cases diagnosed as having bilateral congenital absence of vasa deferentia. 4 cases of unilateral congenital absent vas deferens, 12 cases complaining of anejaculation and 18 diabetics with good erection, but complaining of retrograde ejaculation. Both groups were subjected to bilateral simultaneous EMG recording of the vas electrical activity from the inguinal parts of both vasa deferentia. The recording was done by a double channel EMG, single potential analysis of cavernous electrical activity [SPACE], developed by Wiest. Germany, using surface electrodes. The mean age of the control group was 30.03. +/- 3.8 years [range 24-37 years]. Their EMG tracing of electrical activity of the vas deferens, revealed periodic bursts between phases of electrical silence. These bursts were of slow oscillations with high amplitude and slow frequency. The bursts had a similar configuration, amplitude and duration on both sides, in a given subject. They were synchronous on both sides. The mean duration was 12 +/- 2.6 seconds [5-16 seconds] the number of phases 5.4 +/- 1.6 and frequency 0.9 +/- 0.3 per minute. The mean amplitude was 400 uV [range 240-500 uV]. The rate of bursts varied between subjects. The study group included 44 men with a mean age of 30.35-5.9 years with no statistical difference when compared with the normal group [t=1.13, P>0.05]. This study group was divided into 4 groups: Group I: included 10 azoospermic men with clinical diagnosis of bilateral congenital absent vasa deferentia. In 9 of them [90%] the EMG tracing revealed electrical silence even when repeated. In one case [10%] the tracing revealed electrical activity like to normal group. In this case the vasa deferentia were found embedded in lipoma of the cords. Group II: included 4 cases with unilateral congenital absent vas deferens. The EMG tracing revealed complete electrical silence on the side of absent vas deferens. The other side revealed normal tracing. Group III: included 12 men who presented by anejaculation. Out of them 4 cases [33.34%] were secondary to druga buse and their tracing revealed electrical silence, 3 cases [25%] were psychogenic and their tracing revealed normal tracing, 2 cases [16.67%] were secondary to anal prolapse surgery and their tracing revealed electrical silence, one case [8.33%] due to bilateral ejaculatory duct obstruction and its tracing revealed normal tracing, another case [8:33%] was due to a congenital prostatic cyst and its tracing revealed normal tracing, a last case 8.33%], with diabetes discovered during investigation and the EMG tracing was of low voltage potentials with non-synchoronization on both sides. Group IV: included 18 diabetics, with good potency and complaining of infertility due to retrograde ejaculation, EMG tracing of the electrical activity of the vasa deferentia revealed low voltage potentials with non-synchronization of these potentials on both inguinal regions in 12 cases [66.67%], electrical silence in 4 cases [22.22%] and normal tracing in 2 cases [11.11%]. EMG of electrical activity of the vas deferens can be characterized for the normal and pathologic vasa deferentia. It is a simple, easy, non radiologic and non-invasive that can be used as a diagnostic tool in investigating the vas deferens disorders affecting ejaculation and infertility

Pubo-scrotal incision for repair of penile fractures

Fracture penis is a urologic emergency, which should be managed with prompt exploration and repair of the tunical tear. In this study we have evaluated a puboscrotal incision for the repair of penile fractures. Between Feb. 1995 till Dec. 2000, 42 cases of fracture penis were operated upon for repair using a puboscrotal incision. Patients presented at the emergency room and outpatient clinic of our department Full history, clinical examination and preoperative cavernosogram were done to all the patients to delineate the sites of Tunical tear. If urethral injury was suspected urethrography was performed. All cases included in this study presented to our department within 3-72 hours from injury. Their ages ranged from 18 to 44 years [mean 27.5 +/- 6.95 years]. Urethral injury was found in 5 cases [12%]. The follow-up of cases ranged from 12 to 34 months [average was 18 months]. The puboscrotal incision gave almost no complications in 30 cases [62.5%] and complications when happened were minimal and self-limiting. They included wound infection in one case [2.4%], residual fibrotic area in 3 cases [7.1%] minimal penile curvature in 2 cases [4.8%], painful erection during coitus in one case [2.4%], hematoma formation [small] in 2 cases [4.8%] and finally weak erection that resolved after 3 months postoperative in one case [2.4%]. In conclusion the puboscrotal incision is a good exposure of the penis with satisfactory repair of penile fractures and concomitant urethral injury. It avoids incision into markedly edematous penile skin

Venous leakage among incomplete responders to intracavernosal injection of prostaglandin E

We studied the results of 100 impotent patients, including pharmacocavernosometry and cavernosography results, who gave incomplerte or poor response to intracavernous injection of 20 mcg of progstaglandin E[1] [PGE[1]] and with normal penil/brachial index. Incomplete erection was recorded in 25 cases, tumescence in 71 cases and no response in 4 cases. out of the 25 cases with incomplete ereection, 7 cases [28%] showed no venous leakage, 14 cases [56%] showed minimal venous leakage and 3 cases [12%] showed moderate venous leakage and one case [4%] showed massive venous leakage. Out of the 71 patients who responded by tumescence, 4 cases [5.6%] showed no venous leakage, 30 cases [42.3%] showed minimal venous leakage, 24 cases [33.8%] moderate venous leakage, and 13 cases [18.3% showed massive venous leakage. Those who gave no response to intracavernosal injection of PGE[1] [4 cases], one case [25% showed moderate leakage, while 3 cases [75%] showed massive venous leakage. Statistically these results were very highly significant [X[2]= 25.1 and P< 0.001]. Thus the worse the response to intracavernous injection of prostaglandin E[1], the worse the degree of venous leakage. Equally negative poor resonse to PGE[1] intracavernosal injection does not mean venous leakage

Anatomy of penile venous drainage in impotent men during pharmacocavernosography

To identify the venous channels into which corporeal blood drains in impotent men, who have a normal arterial respones and, poor erection after 60 mg papaverine injection, pharmacocavenosography was done in sixty impotent men. Out of the sixty cases, 13 [21.71%] showed a pathologic venous drainage via a single venous system, while 47 cases [78.3%] showed combined venous leakage. The deep dorsal vein was visualized in 95 percent of cases, the proximal [cavernosal and crural veins] venous drainage in 73.3 percent, the deep dorsal and proximal veins in 20 percent and corpus spongiosum in 13.3 perecent. Pharmacocavernosography allows the formulation and institution of a therapeutic plan based on the patient's underlying pathophysiology and appropriate for the individual's case

Ultrasonographic evaluation of peyronie's

Twelve patients with Peryronie's disease were examined by 5 MHZ ultrasonography. A simple method was used instead of the water bath to faciliatate good localization and measurement of the fibrotic plaques in the area of the tunica albuginea. Calcifications can by clearly detected. Penile ultrasonography is painless, free of risk, easy to perform and yields precise morphologic picture. It is ideal for documentation and assement of the anatomic alternation in Peyronie's disease as well as in follow up of its course