Management of erectile dysfunction in patients with ischemic heart disease by intracavernous injection of vasoactive drugs because of failure, complications or contraindication of sildenafil

The aim of the present study was to evaluate the effectiveness of intracavemous injection [ICI] of vasoactive drugs combination in patients with ischemic heart disease [IHD] and erectile dysfunction [ED] who were not proper cadidatefor treatment with sildenafil citrate. The study population included 122 selected patients with IHD and ED in whom sildenafil was not an option because of its failure, side effects, or presence of contraindication for its use. The ICI program consisted of two combinations of vasoactive drugs. The first combination [A] included a mixture of papaverine, phen-tolamine, and verapamil The second combination [B] included a mixture of the former 3 drugs plus prostaglandin El. Patients who failed to respond with the first combination were switched to the second combination. A positive response was defined as an erection sufficient for vaginal penetration and maintained till ejaculation. A positive response was achieved with combination [A] in 67 [54.9%] of the 122 patients and with combination [B] in 24 [43.6%] of the remaining 55 patients. The total success rate was [74.6%]. Patients with positive response [91 pts.] were followed-up for one year with 80 [87.9%] patients reported successjid coitus during this period. The remaining 11 patients [12.1%] dropped out of the program, 2 [2.2%] because of treatment failure, and 9 [9.9%] because of marital and health reasons. Adverse effects of ICI therapy included prolonged erection in 10 [11%], painful erection in 9 [9.9%], subcutaneous hematoma in 7 [7.7%], and plaque formation in 3 [3.3%]. We conclude that ICI ofvasoactive drugs is a good alternative for the treatment of ED in patients with IHD in whom stidenafil is not anoption

Hypospadias repair using combined tissues transfer

Purpose: Buccal mnucosa graft used successfully to treat hypospadic patient with deficient penile skin. Tunica vaginalis flap proved its usefulness in repairing recurrent urethral fistula. We evaluate the results of combining both technques in management of penile hypospadias with insufficient senile skin. Patients and Between June 96 and June 99 we treated 25 hvpospadic patients, 3 circumcised and 22 redo cases, using buccal mucosa onlay graft. Hypospadcas was anterior penile in 6 and mid penile in 19 cases. Tunica vaginalis flap was used to cover the buccel graft in the last cases. Excellent functioal and cosmetic results were achieved in [56%] of cases following the operation. The success rate raised to [84%] after management of minor complications. Minor complications in 7 patients were in the form of minor fistula [16%], mild meatal retraction [4%], meatal stenosis [16%] and mild posterior stricture [8%]. Major complications were big fistula [8%] and complete failure of the procedure [8%]. No fistula occurred in cases in whom Tuncia vaginalis graft was used. Buccal mucosa onaly graft is a suitable material in hypospadias repair. Covering the graft with tunica vaginalis flap significantly decreases the incidence of fistula. Preservation of the uiethral plate decreases the size of grafting material

Minimaly invasive therapy for localized infiltrating bladder cancer in comparison with radical cystectomy

Purpose: We analyzed the long-term results of aggressive transurethral resection plus intravesical B.C.G. for the treatment of patients with localized muscle infiltrating bladder cancer in comparison to radical cystectomy regarding its efficacy, recurrence rate, survival rate, quality of life and patient satisfaction. Patients and A total of 118 patients with locally invasive transitional cell carcinoma T2 and T3A were included in the study. Seventy two patients [group I] underwent radical cystectomy, while 46 patients [group II] treated by aggressive repeated iransurethral resection until negative biopsies of the muscle layer of the depth and periphery of the tumer bed were obtained. B.C. G. was intravesically instilled in single 6-week course [150 mg/ instillation] then monthly for one year. The avenge follow-up period of group I was 60.5 months [36 - 70] and for group II was 62 months [42 - 65]. Patients were evaluated postoperatively every 3 momhs for 2 years and then every 6 months thereafter by urine cytology, cystescopy, biopsy, ultrasonography and metastatic evaluation. A comparative non-randomized study was performed for both groups, At 5-years average follow-up, cause specific survival rates were 72.4%, 66.6%, 61.1% and 60% in group I according to the stage and grade of the tumer, while it was 68.8%, 66.4%, 58.3% and 50% in group II with no statistical significant differences [p > 0.05]. The recurrence rates ranged from 24.4% to 36.3% in group I according to the stage and grade of the tumor, while it was ranged from 26.3% to 50% in group II which an apparent increase in the recurrence rates in group II which was not significant. Bladder preservation in group II ranged from 78.9% to 66.6% at average 5-year follow-up postoperativelly. Aggressive repeated transurethral resection and B.C.G. intravesical instillation is justified when the tumor is clinically limited to the muscle layer and when all biopsies of the periphery and depth of the tumor bed show muscular tissue negative for tumor cells. This modality of treatment is effective and comparable to radical cystectomy In some selected patients with small localized infiltrating transitional cell carcinoma stage T2, T3 A. moreover, it avoids the morbidity and change in quality of lif associated with radical cystectomy

Intrauterine insemination with avarian hperstimulation for treatment of comples with unexplained infertility

Treatment of couples with unexplained infertility includes many therapeutic modalities that range from expectant management to the most sophisticated assisted reproductive techniques [ARTs] as IVF and GIFT. As such, we evaluated the clinical efficacy of ovarian hyperstimulation with intrauterine insemination [IUI] as an easy and economic method of ARTs for treatment of couples with unexplained infertility. A total of 112 couples with unexplained infertility, despite of the normal finding of the infertility diagnostic work-up, were selected for this study. The male partner was evaluated by history taking, physical examination, scrotal doppler examination for varicocele, 3 consecutive semen analysis, and hormonal profile that included FSH, LH, prolactin and testosterone. The protocol of female evaluation included history taking, clinical examination, postcoital test, hormonal assay for serum prolactin, luteal phase of serum progesterone and thyroid function test, ultrasound pelvic examination with ovarian folliculometry, hysterosalpingography, premenstrual endometrial biopsy laparoscopy and hysteroscopy. All selected couples were managed by controlled ovarian hyperstimulation in combination with IUI for up to 3 cycles. Vaginal ultrasound scan was used for monitoring of the treatment cycles. A total of 171 treatment cycles were made and 27 clinical pregnancies were achieved [25 term and ongoing pregnancies and 2 spontaneous abortions]. The total pregnancy rate was 24.1% per patient and 15.8% per treatment cycle. The successful pregnancy rate was 22.3% and 14.6% per patient and per treatment cycle respectively. Controlled ovarian hyperstimulation in combination with IUI achieved a reasonable success rate in the treatment of couples with unexplained infertility and should be offered before considering the more sophisticated and expensive assisted reproductive techniques