Penile implants in the treatment of organic impotence.

OBJECTIVE: To evaluate the reliability and safety of penile implants in the treatment of organic impotence at the Saudi Aramco - Dhahran Health Center. METHODS: A series of 108 cases of organic impotence that underwent 125 penile implantation procedures between 1988 and 1997 was reviewed. The follow-up period ranged between 6 months and 10 years. The mean age was 57.9 years (range 26-76). The prostheses used were AMS (American Medical System) inflatable (92 cases) and malleable (16 cases). RESULTS: There were no complications in 86 patients, (80%) who had functioning prostheses all through the follow-up period. Revision of the implants was required in 13 patients (14%). The causes of revision were severe infection, intolerable pain from an oversized malleable prosthesis, and dysfunction of the inflatable prostheses. Removal of the implant was necessary in severe infection, intolerable pain, and extrusion of the prosthesis. All 9 patients (8%) had inflatable prostheses and refused a second implant. There was no single mortality among our series. The overall procedure complications involved 26 out of 125 procedures (21%). It was shown that malleable penile prostheses have significantly lower procedure complications than the inflatable ones (p<0.05). CONCLUSION: Penile implants are reliable and safe modality of treatment for organic impotence with acceptable morbidity.

Penile implants in the treatment of organic impotence.

OBJECTIVE: To evaluate the reliability and safety of penile implants in the treatment of organic impotence at the Saudi Aramco - Dhahran Health Center. METHODS: A series of 108 cases of organic impotence that underwent 125 penile implantation procedures between 1988 and 1997 was reviewed. The follow-up period ranged between 6 months and 10 years. The mean age was 57.9 years (range 26-76). The prostheses used were AMS (American Medical System) inflatable (92 cases) and malleable (16 cases). RESULTS: There were no complications in 86 patients, (80%) who had functioning prostheses all through the follow-up period. Revision of the implants was required in 13 patients (14%). The causes of revision were severe infection, intolerable pain from an oversized malleable prosthesis, and dysfunction of the inflatable prostheses. Removal of the implant was necessary in severe infection, intolerable pain, and extrusion of the prosthesis. All 9 patients (8%) had inflatable prostheses and refused a second implant. There was no single mortality among our series. The overall procedure complications involved 26 out of 125 procedures (21%). It was shown that malleable penile prostheses have significantly lower procedure complications than the inflatable ones (p<0.05). CONCLUSION: Penile implants are reliable and safe modality of treatment for organic impotence with acceptable morbidity.

Laparoscopic varicocelectomy for infertility. An initial report from Saudi Arabia.

OBJECTIVE: To evaluate laparoscopic varicocelectomy for the treatment of infertility in Saudi males. METHODS: Between January 1992 and July 1994, laparoscopic varicocele repair was performed at Saudi Aramco Dhahran Health Center, in 48 patients, 8 for pain and 40 for infertility. RESULTS: The 8 patients with pain improved postoperatively. As for those with infertility, 63% had an improved sperm count and 66% showed increased sperm motility. Thirty percent had no change in motility or count. CONCLUSION: Laparoscopic varicocelectomy is a simple and safe technique with good results and can be performed as day surgery with early return to normal activity.

Laparoscopy for the impalpable testes. Initial experience of one center.

Twenty three patients with impalpable tests underwent diagnostic laparoscopy in our hospital between 1988 and 1991, in an attempt to evaluate this modality of investigation. Four of them had bilateral undescended, i.e. total of 27 tests, 12 on the right side and 15 on the left. Eight patients were adults, age between 23 and 38, average 30 years, 15 were children, age between 1 and 9, average 5 years. Twenty testes were intraperitoneal (74%), 6 intracanalicular (22.2%) and one absent (3.8%). Thirteen testes were removed and 2 were diagnostic only, the rest had successful orchiopexy. No operative or postoperative morbidity. Laparoscopy was diagnostic in all cases, assisted in planning the surgical procedure in 21 testes and saved one patient the surgical incision. Laparoscopy is a safe procedure, has a definite role in the management of impalpable testes, for diagnosis and planning of surgery. Future prospects of operative laparoscopy needs to be developed and evaluated.

Congenital midureteral strictures.

A case is reported of a fifteen-year-old female with left midureteral congenital stricture and a contralateral single blind-ending ureter with a small atrophic right kidney. The possible etiology is presented.

Effect of skeletal muscle relaxants on bladder smooth muscle.

The present study was conducted to determine the effects of skeletal muscle relaxants on contractions of bladder smooth muscle. Rat, rabbit and human bladder muscle strips were incubated in a 50 ml. organ bath filled with physiological salt solution, aerated with 95 per cent O2, 5 per cent CO2 and maintained at 37C. Contractions were induced both electrically and with acetylcholine. Contractile strength was measured before and after 30 to 70 minute incubations with diazepam (0.25 to 1.0 microgram./ml.), dantrolene sodium (4 micrograms./ml.) or baclofen (4 micrograms./ml.). Neither baclofen nor dantrolene sodium had any effect (p greater than 0.3) on electrically or acetylcholine-induced contractions in any of the 3 species tested but diazepam potentiated both electrically induced (115 per cent of predrug contractile strength, p less than 0.05) and acetylcholine-induced (122 per cent of predrug contractile strength, p less than 0.01) contractions of rat, but not rabbit or human, bladder muscle. In rabbits diazepam significantly reduced maximal bladder pressures in vivo (p less than 0.05) but had no effect on bladder capacity. Dantrolene sodium had no effect on rabbit bladder pressure or capacity in vivo. While diazepam is thought to exert its effects on skeletal muscle through CNS inhibition, these results suggest that diazepam may affect rat but not rabbit or human bladder smooth muscle directly.