Surgical Treatment of Erectile Dysfunction and Peyronie's Disease Using Malleable Prosthesis.

PURPOSE: Peyronie's disease (PD) is a condition of middle aged men and frequently accompanied by erectile dysfunction (ED) which was attributed to penile deformity, vascular pathology and psychological components. The implantation of semi-rigid penile prosthesis allows for these patients to undergo a simple procedure aimed at correction both penile deformity and ED. The aim of this study was to investigate surgical and clinical outcomes and patient satisfaction rate at long term follow-up after semi-rigid penile prosthesis implantation (PPI) in men with PD and ED. MATERIALS AND METHODS: A total of 66 patients with mean age of 49.2 (range, 30-76) years old underwent semi-rigid PPI between 1995 and 2006. Genesis (Coloplast®) was used for implantation in a standard manner by penoscrotal approach without using any graft and remodeling technique. In all patients, dilatation of corpora was performed without any difficulty and straightening of the penis was achieved. A retrospective review of clinical database and prospective telephone survey were conducted in all patients. RESULTS: The mean follow-up time was 9.7 years (range, 6 to 17). There wasn't any clinical infection and complication during follow-up period. Fifty-nine patients were sexually active at the time of the interview. None of the patients reported residual curvature. The overall patient satisfaction was 91.5% (54 patients). Primary reasons for dissatisfaction were decreased penile length and prosthesis problems. CONCLUSION: Based on our results semi-rigid PPI is effective and easy procedure for treatment of men with PD and ED without any complication and with high patient satisfaction rate in long-term follow up period.

Management of recurrent bulbar urethral stricture-a 54 patients study with Allium bulbar urethral stent (BUS).

The Allium Bulbar Urethral Stent (BUS) is a fully covered, self-expandable, large caliber metal stent specially designed for the treatment of bulbar urethra strictures. The stent is intended for a long term use for the purpose of opening the occluded urethral passage and to allow spontaneous urination. This study objective was to evaluate the clinical efficacy of temporary placement of the Allium BUS stent. This was a prospective study in 54 men with recurrent benign urethral stricture conducted during 2009 to 2012. All men underwent an internal urethrotomy or dilatation procedure followed by an endoscopic stent placement. Clinical success was achieved in 44 (81.4%) of the 54 patients. No patient reported discomfort at the stent site. 2 stents migrated distally. 1 stent was occluded. All stents were removed in a mean time of 8.8 (range 3-18) months following implantation. This experience with the Allium BUS for treating urethral strictures suggests that it is safe and reliable treatment modality.

Coexisting papillary and clear renal cell carcinoma in the same kidney.

Renal cell carcinoma (RCC) is the most common solid lesion of the kidney. Bilateral synchronous benign and malignant renal tumors have been defined in some reports. However, unilateral concordance of malignant renal tumors is very rare and there are only a few cases that had synchronous different subtypes of malignant renal tumors arising within the same kidney. Herein, we describe a 67-year-old male patient who had clear cell RCC and papillary RCC in his right kidney that were successfully treated with radical nephrectomy. We also reviewed the pertinent literature.

Effect of cardiac resynchronization therapy on libido and erectile dysfunction.

BACKGROUND: Chronic heart failure (HF) is a common, complex clinical syndrome characterized by dyspnea, fatigue and exercise intolerance. HF patients experience decreased libido and erectile dysfunction (ED). The effects of cardiac resynchronization therapy (CRT) on libido and erectile function have not been previously evaluated. We aimed to investigate the effects of CRT on libido and ED. HYPOTHESIS: Cardiac resynchronization therapy improves libido and ED. METHODS: Thirty-one male patients with advanced HF, scheduled for implantation of a CRT device, were included in the study. Left ventricular systolic function, New York Heart Association (NYHA) class, libido, and ED were assessed before and 6 months after CRT. Libido and ED were evaluated with the Aging Male Symptoms (AMS) rating scale and internationally validated Sexual Health Inventory for Men (SHIM) questionnaire, respectively. RESULTS: At the 6-month follow-up, the mean NYHA class improved from 3.4 ± 0.5 to 2.1 ± 0.6 (P<0.001). On echocardiographic examination, an improvement in left ventricular ejection fraction (LVEF) from 18 ± 5% to 32 ± 6% was detected (P<0.001). A significant increase in mean SHIM score and a significant decrease in mean AMS were noted. Changes in SHIM and AMS scores were correlated positively with the increase in LVEF (r = 0.47, P = 0.007 and r = - 0.36, P = 0.04, respectively). Similarly, SHIM scores were correlated negatively (r = - 0.57, P = 0.001) and AMS scores were correlated positively (r = 0.73, P = 0.0001) with the improvement in NYHA class. CONCLUSIONS: CRT results in a significant improvement in libido and erectile function in patients with congestive HF. This improvement is related to the improvements in the LVEF and functional capacity. .