Epithelioid haemangioma: a rare cause of painful erections and sleep deprivation.

Epithelioid haemangioma of the penis is a rare condition which usually presents a solid single nodule. We report a case in a 43-year-old man who presented with painful erections and sleep disturbance with two palpable penile nodules. Magnetic resonance imaging with an artificially induced erection revealed these as individual lesions, and local excision was successfully undertaken. Pathological diagnosis of epithelioid haemangioma was confirmed with positive staining for CD31. Although rare, penile epithelioid haemangioma should be considered as a differential in an atypical penile mass. Induction in of an artificial erection prior to MRI can aid diagnosis and treatment is typically with surgical excision.

Assessment of the poorly contractile or acontractile bladder in the older male in the absence of neuropathy.

Up to 30% of patients who undergo prostatectomy are left with residual symptoms. Most have persistent detrusor instability, but some have poorly contractile or acontractile bladders. Over a 2-year period, 42 neurologically normal patients were shown to have a hypocontractile or acontractile bladder on urodynamic testing; 27 had undergone outflow tract surgery. Four patients who were totally incontinent had undergone at least 2 transurethral resections. The remainder had severe frequency, urgency and nocturia. Urodynamically, all but 7 patients with poor compliance had normal filling cystometrograms, all but 8 had residual urine volumes less than 100 ml, and 26 had less than 5 ml. Thus their symptoms are difficult to explain. Apart from the insertion of an artificial sphincter in those with total incontinence, treatment did not improve any of these patients.

Duplex scanning in suspected vasculogenic impotence: a worthwhile exercise?

The value of duplex scanning in the assessment of impotence was evaluated in 146 impotent men. Scanning was by means of a Diasonics DRF 400 and penile artery measurements were taken before and after the intracorporeal injection of papaverine hydrochloride. The penile/brachial index was measured in 82 patients and its predictive value compared with the results of duplex scanning and papaverine-induced erection. On scanning evidence of good arterial inflow but poor erections, indirect evidence of venous leakage was assumed. The results showed that the deep artery responses best characterised the erectile response, with the dorsal artery being less helpful. All 37 patients with full erections following papaverine exhibited bilateral deep artery peak velocities of greater than or equal to 25 cm/s. Of the remaining 109 sub-optimal responders, 17 also has this finding; all had undergone dynamic cavernosography, with 16 exhibiting venous leakage. The penile/brachial index was found to classify 13 patients incorrectly. A critical value of deep artery response to attain erection is postulated, enabling more logical use of cavernosography. The penile/brachial index was shown to be suspect and it was concluded that duplex scanning is a useful, non-invasive method in the assessment of impotence.

Poor compliance early in filling in the neuropathic bladder.

A total of 30 patients with known neuropathy, mostly spina bifida, developed poor bladder compliance early in filling demonstrated urodynamically; 20 had bilateral hydronephrosis at the time of presentation and 5 also had severely impaired renal function. After appropriate treatment all of those with normal upper tracts or with bilateral hydronephrosis but normal renal function stabilised or improved. However, all 5 with severely impaired renal function progressed to end-stage renal failure. Poor compliance early in filling is an absolute indication for surgical intervention.

Experience with the Brindley anterior sacral root stimulator.

Brindley anterior sacral root stimulators have been implanted into 22 spinal cord injured patients from the spinal injury units in Cardiff and Sheffield. The group comprised 20 men and 2 women (15 paraplegics and 7 tetraplegics); 16 patients are using the implant, of whom 11 (68%) are continent. Of the remaining 5, 4, who empty completely, are incontinent because of inability to use the implant with sufficient frequency; 6 patients are not using their implant, though 4 are continent. Of 11 patients with detrusor/sphincter dyssynergia, sphincterotomy was necessary in 3 patients before implantation and in a further 3 after implantation. Of 4 patients with abnormal upper tracts prior to implantation, 2 resolved and 2 deteriorated, in the presence of dyssynergia; 1 patient developed hydronephrosis after implantation, having previously had normal upper tracts. Although erectile function with the stimulator was clinically adequate in 6 patients, in no patient has intercourse been achieved because of concurrent lower limb spasm.

Results of investigation of impotence in patients with overt or probable neuropathy.

The results of investigations in 50 impotent patients with neurological disease are presented. Using intracorporeal papaverine, Doppler duplex scanning, cardiovascular reflex testing and skin thermal threshold monitoring, the vascular and neurological components were assessed in each of three clinical groups with probable or overt neuropathy. These comprised spinal injury, diabetes and pelvic trauma. Anatomical detail of the penis was well seen using these techniques. In 15 patients with spinal injuries, although the aetiology was predominantly neurological, six exhibited poor flow in the deep penile arteries following injection of papaverine. This was associated with poor erections in these patients, suggesting a vascular pathology. In 27 patients with diabetes the results showed a mixed pattern. Vascular disease was almost universal, combined with varying degrees of autonomic and peripheral neuropathy, and only three had full erections with papaverine. Those with pelvic trauma (8 patients) also had a mixed picture, although some had good erections following papaverine injection. Duplex Doppler scanning of the deep penile arteries correlated with the quality of papaverine-induced erection. Thermal testing was a highly sensitive indicator of small nerve fibre dysfunction, possibly at an earlier stage than standard autonomic testing. A vascular component to impotence was shown to be common in those with neurological impairment, and may alter management.

Synthesis and microbiological activities of some monohalogenated analogs of tyrosine.

2-Chlorotyrosine and 2-bromotyrosine, as well as the previously reported 2-fluorotyrosine, were synthesized by hydrolysis of the condensation products from the appropriate benzyl bromide and ethyl acetamidomalonate and were compared with the corresponding 3-halotyrosines as growth inhibitors of Escherichia coli 9723, Streptococcus faecalis 8043 and Lactobacillus plantarum 8014. In contrast to the 2- and 3-fluorotyrosines which were equally effective as growth inhibitors, the 2-chloro- and 2-bromotyrosines were much more effective than the 3-chloro- and 3-bromotyrosines in inhibiting the growth of the three microorganisms. For each of the assay organisms, the growth inhibitions of all three 2-halotyrosines were reversed competitively in varying degrees by tyrosine.