Colour Doppler ultrasound hemodynamic characteristics of patients with priapism before and after therapeutic interventions.

BACKGROUND: Information in the literature on the hemodynamic characteristics of priapism, especially after therapeutic intervention, is very limited. We analyzed our colour Doppler ultrasound (CDU) studies performed for patients with various durations of priapism before and after therapeutic intervention. METHODS: We reviewed 52 CDU studies for 24 patients with priapism before and after treatment for the period 1997-2007. The duration of priapism ranged from 4 hours to 8 days. We performed 17 CDU studies in 8 patients who presented with a duration of priapism of 7 hours or less, 9 studies in 4 patients who presented with duration of priapism of more than 20 hours, 23 studies in 11 patients referred to us after they had failed prior therapeutic intervention at other institutions and 3 studies in 1 patient with priapism related to perineal trauma. RESULTS: Among the 8 patients who presented with a duration of priapism of 7 hours or less, CDU studies on presentation showed detectible cavernosal arterial flow in all except 1 study. Among the 4 patients who presented with a duration of more than 20 hours, the studies showed no detectible cavernosal arterial blood flow. We repeated CDU studies after therapeutic intervention, and they showed restoration of cavernosal arterial flow with relief of veno-occlusive status. Among the 11 patients in whom prior treatments failed before they were referred to us, CDU studies performed on presentation showed no detectible cavernosal arterial flow in 10 of the 11 patients. We performed 12 CDU studies in 8 patients after placing a penile cavernosa-dorsal vein (CD) shunt. We observed the presence of blood flow in the CD shunt, indicating its patency in all 8 patients. Some patients showed high cavernosal arterial flow (peak systolic velocity [PSV] up to 27.6 cm/s) after surgery. These patients appeared to have residual priapism of primarily arteriogenic status that improved after observation. CONCLUSION: After therapeutic intervention, CDU study is useful to assess the relief of arteriogenic and veno-occlusive status and the decision for further treatment.

Comparative analysis of pain during anesthesia and no-scalpel vasectomy procedure among three different local anesthetic techniques.

OBJECTIVES: To compare the pain during anesthesia and during the no-scalpel vasectomy procedure for local infiltration anesthesia (LIA), LIA supplemented with spermatic cord block (LIA + SCB), and no needle jet anesthesia. METHODS: Bilateral no-scalpel vasectomy was performed in 323 patients during 2007. Of the 323 patients, 65 received LIA, 29 received LIA + SCB, and 227 received anesthesia using the no-needle technique with the MadaJet device. The level of pain during anesthesia administration and the subsequent procedural pain was documented for each technique using a pain scale of 0-10. RESULTS: Pain during the LIA + SCB procedure (mean 1.7 +/- 1.6) was significantly less than the pain during LIA (mean 3.3 +/- 2.3; P < .01). No statistically significant difference was found between the levels of pain experienced during LIA + SCB and no-needle jet anesthesia (P >> .01 and P >> .05, respectively). Intraoperative pain after LIA + SCB (mean 0.64 +/- 1.2) was significantly less than the intraoperative pain after LIA (mean 2.7 +/- 2.6; P <<< .01). Also, the intraoperative pain after LIA + SCB was significantly less than the intraoperative pain after no-needle jet anesthesia (mean 2.13 +/- 2.0; P <<< .01). CONCLUSION: LIA + SCB is an effective and better method of anesthesia compared with LIA alone or no-needle jet anesthesia for reducing the pain during vasectomy. Also, no difference was found in the pain levels during anesthesia for the LIA + SCB, LIA, and no-needle anesthesia techniques.

Clinical experience and sexual function outcome of patients with priapism treated with penile cavernosal-dorsal vein shunt using saphenous vein graft.

OBJECTIVES: To assess the outcome of new penile cavernosal-dorsal vein shunt using a saphenous vein graft. Traditional surgeries for priapism have high failure rate and subsequent impotence. METHODS: We reviewed the medical records of, and administered a questionnaire and the International Index of Erectile Function to, 16 consecutive patients with priapism who had treated with the penile cavernosal-dorsal vein shunt from 1997 to 2007. Their age was 15-65 years. The duration of ischemic priapism was 32 hours to 8 days. Ten patients had previously undergone shunt surgery by other urologists. Of the 16 patients, 5 returned the questionnaires. RESULTS: Priapism resolved or was improved after surgery in all 16 patients. One patient was lost to follow-up. One pediatric patient was excluded from the analysis. One patient with nonischemic priapism continued to have sexual intercourse. Of the 13 adult patients with ischemic priapism and follow-up for < or = 6.5 years, 3 patients had no erection, 1 had very little erection, and 9 (69%) had erection. Of the 9 patients with erections possible, six had had sexual intercourse (International Index of Erectile Function score 32-70) and 3 had not; 1 had a mental disorder, 1 was in prison, and for 1, the reason was unknown. After surgery, color Doppler ultrasound studies showed a patent shunt in all patients and restoration of cavernosal arterial flow in 12 of 13 patients studied. CONCLUSIONS: A penile cavernosal-dorsal shunt appears effective for priapism. It resulted in priapism resolution even in patients who had experienced a previous failed cavernosal-glandular shunt or cavernosal-spongiosal shunt, with a high rate of sexual function preservation.

Rapid communication: pure robot-assisted laparoscopic ureteral reimplantation for ureteral stricture disease: case report.

BACKGROUND AND PURPOSE: The role of the da Vinci robot is slowly being defined in minimally invasive urologic surgery. We report its use in the management of ureteral stricture disease. CASE REPORT: A 42-year-old man with recurrent kidney stone disease was found to have a left distal-ureteral stricture. After failure of endoscopic treatment, a robot-assisted laparoscopic ureteral reimplantation was performed. The total operative time was 210 minutes. The estimated blood loss was <50 mL. There were no intraoperative or postoperative complications. Total analgesic use was 30 mg of morphine. The hospital stay was 5 days. CONCLUSION: Pure robot-assisted laparoscopic ureteral reimplantation is a safe and feasible approach to the management of ureteral stricture disease.