Combination of intralesional verapamil and oral antioxidants for Peyronie's disease: a prospective, randomised controlled study.

The aim of this study was to evaluate the efficacy of the association of intralesional verapamil (ILV) injection with oral antioxidants compared with ILV monotherapy in patients with early onset of Peyronie's disease (PD) at 12-week follow-up. Group A (n = 52) received ILV 10 mg weekly for 12 weeks, while group B (n = 53) received ILV 10 mg weekly for 12 weeks + antioxidants orally one tablet once a day for 3 months. The main efficacy outcomes were the change in plaque size (PS), penile curvature (PC), visual analogue score (VAS), IIEF-15 and IIEF-15 subdomains. Both groups showed significant improvement from baseline to week 12 relative to PS and PC, while group B also in IIEF-15 score (mean difference: 5.51, P < 0.01) and VAS (mean difference: -2.71, P < 0.01). No significant differences were observed between both groups in PS and PC. Finally, both groups showed significant increase in orgasmic function (IIEF-OF) and overall satisfaction (IIEF-OS), while group B showed significant improvement also in intercourse satisfaction (IIEF-IS). Significant differences were found relative to IIEF-OF, IIEF-IS, IIEF-OS and VAS scores in the group B compared with group A. Patients affected by PD may benefit from combination treatment with ILV and oral antioxidants thanks to the improvement in IIEF-OF, IIEF-IS and IIEF-OS at 12 weeks.

Diagnosing erectile dysfunction: instruments for the study of smooth muscle relaxation.

Complete cavernosal smooth muscle relaxation is the pre-requisite for the reliability of every evaluation of the integrity of the corporal veno-occlusive system. Such evaluation is needed whenever reaching a diagnostic conclusion on the haemodynamic status of a given patient is clinically relevant. Clinical challenges that a laboratory evaluation of veno-occlusive integrity face comprise both the induction of complete smooth muscle relaxation, and the possibility to monitor it. This article will review the relevant aspects of normal range values of veno-occlusive function, existing strategies aimed to promote complete smooth muscle relaxation, and available techniques to monitor the cavernosal smooth muscle status.

[Semeiotic flowmetry in complex varicocele]. / Semeiotica velocimetrica nel varicocele complesso.

The Authors report on their specific experience on the funicular Doppler veocimetry, regarding the varicocele. In particular we enhance the semeiological spects of the C.W. Doppler velocimetry in the sub-clinical varicocele, in the bilateral one and in the characterization of the spermatic and cremasteric refluxes, and of the external pudenda vein. The Authors stress the utility of the definition of the amount of the reflux, so achieving an integration with the existing classification by degrees, that as it is now days expressed, it seems, to regard the elapsed time and the quantity of reflux caused by the Valsalva manoeuvre. In the practical velocimetry those elements have not been proved to have a parallel increment. Lastly, we report on some cases of veno-spermatic refluxes, uniquely observed in the clynostatism, along with a missing orthostatism. Moreover the Authors believe that some of these hemodynamical consideration could be revisited.

A new technique for end-to-end ureterostomy in the rat, using an indwelling reabsorbable stent.

The restoration of the continuity of the urinary tract represents one of the major problems in rat renal transplantation. End-to-end ureterostomy is the most physiologically effective technique; however, it involves noteworthy technical difficulties because of the extremely thin caliber of the ureter in the rat and the high incidence of postoperative hydronephrosis. We describe a new technique for end-to-end ureterostomy in the rat, where the use of an absorbable ureteral stent is recommended. A 5-0 plain catgut thread is used as a stent. The anastomosis is performed under an operating microscope at X 25-40 magnification with interrupted sutures of 11-0 Vicryl. The use of the indwelling stent facilitates the performance of the anastomosis and yields optimal results. The macroscopical, radiological, and histological controls in a group of rats operated on with this technique showed a very high percentage of success with no complications, a result undoubtedly superior to that obtained with conventional methods.

Microsurgical one-stage repair of hypospadias with a rectangular transverse dorsal preputial vascularized skin flap.

A microsurgical technique for one-stage repair of hypospadias using a rectangular transverse dorsal preputial island skin flap is presented. The use of optical magnification, atraumatic technique, and microsurgical instruments allows a vascularized preputial skin flap to be raised and isolated on the dorsum of the penis and then rotated ventrally and tubulized into a neourethral channel. The meatus of the new urethral channel lies at the tip of the glans. Cover for the penis is simply obtained and does not require a longitudinal row of sutures. The need to remove the distal stenotic portion of the urethra and to correct any degree of chordee is outlined and emphasized. Good cosmetic and functional results demonstrate the efficacy of such a technique.