[Transumbilical single-incision laparoscopic ureterolithotomy]. / Ureterolitotomía laparoscópica con incisión única transumbilical.

INTRODUCTION: laparoendoscopic single-site surgery (LESS) using transumbilical access and conventional laparoscopic instruments is a very attractive alternative to perform ureterolithotomy for ureteral stone with failed endourological management. MATERIAL AND METHOD: a 29-year-old woman presented with chronic right lumbar pain and a 1.2 cm impacted calculus localized at transition of abdominal to pelvic ureter. Semi-rigid ureteroscopy had failed to fragment the stone and shockwave lithotripsy was not available. Double-J ureteral catheter had been inserted preoperatively. We performed a transumbilical single-incision laparoscopic ureterolithotomy. Three conventional trocars were inserted in a single semi-circular umbilical incision. Right colon was detached and the ureter was identified. Calculus was extracted and the ureteral incision was closed with intracorporal sutures. RESULTS: ureterolithotomy was successfully completed, with all the operative steps performed transumbically. Operative time was 180 minutes. No single-port device or articulating and bent instruments were utilized. Estimated blood loss was less than 50 mL. No intraoperative, access-related and postoperative complications took place. The duration of hospitalization was 24 hours and scarless appearance was observed on postoperative day 15. CONCLUSION: transumbilical single-incision laparoscopic ureterolithotomy is feasible and safe. This approach offers an inherent cosmetic advantage and few postoperative discomfort. Additional experience and continued investigation are warranted.

Ureterolitotomía laparoscópica con incisión única transumbilical / Transumbilical single-incision laparoscopic ureterolithotomy

Introducción: la cirugía laparoendoscópica por puerto único (LESS) con incisión transumbilical empleando instrumental laparoscópico convencional es una alternativa atractiva para la realización de ureterolitotomía de cálculo ureteral con tratamiento endourológico fallido. Materiales y métodos: una mujer de 29 años se presenta con dolor crónico en la zona lumbar derecha y un cálculo impactado de 1,2cm, localizado en el punto de transición del uréter abdominal al pélvico. Una ureteroscopia semirrígida no consigue fragmentar la piedra y no se dispone de litotricia por ondas de choque. Se inserta catéter ureteral doble J anteriormente a la intervención. Realizamos una ureterolitotomía laparoscópica con incisión única transumbilical. Se insertan tres trócares convencionales en una incisión umbilical semicircular, se desprende el colon derecho y se identifica el úreter. Se extrae el cálculo y la incisión ureteral se cierra con suturas intracorporales. Resultados: se completa con éxito la ureterolitotomía con todos los pasos operatorios realizados transumbilicalmente. La duración de la intervención fue de 180 minutos. No se empleó ningún instrumento articulado o arqueado. La pérdida de sangre estimada fue de menos de 50ml. No hubo ninguna complicación interoperatoria o postoperatoria relacionada con la incisión. La estancia en el hospital fue de 24 horas y se observó un aspecto sin cicatriz el día 15 postoperatorio. Conclusión: la ureterolitotomía laparoscópica con incisión única transumbilical es viable y segura. Este abordaje ofrece ventajas cosméticas inherentes y pocas molestias postoperatorias. Se requiere de experiencia adicional e investigación continuada (AU)

Introduction: laparoendoscopic single-site surgery (LESS) using transumbilical access and conventional laparoscopic instruments is a very attractive alternative to perform ureterolithotomy for ureteral stone with failed endourological management. Material and method: a 29-year-old woman presented with chronic right lumbar pain and a 1.2cm impacted calculus localized at transition of abdominal to pelvic ureter. Semi-rigid ureteroscopy had failed to fragment the stone and shockwave lithotripsy was not available. Double-J ureteral catheter had been inserted preoperatively. We performed a transumbilical single-incision laparoscopic ureterolithotomy. Three conventional trocars were inserted in a single semi-circular umbilical incision. Right colon was detached and the ureter was identified. Calculus was extracted and the ureteral incision was closed with intracorporal sutures. Results: ureterolithotomy was successfully completed, with all the operative steps performed transumbically. Operative time was 180minutes. No single-port device or articulating and bent instruments were utilized. Estimated blood loss was less than 50mL. No intraoperative, access-related and postoperative complications took place. The duration of hospitalization was 24hours and scarless appearance was observed on postoperative day 15. Conclusion: transumbilical single-incision laparoscopic ureterolithotomy is feasible and safe. This approach offers an inherent cosmetic advantage and few postoperative discomfort. Additional experience and continued investigation are warranted (AU)

Successful birth after injection of frozen human oocytes with frozen epididymal spermatozoa.

A couple (female 31, male 42 years old) with infertility due to obstructive azoospermy returned to the clinic in order to attempt pregnancy using their frozen oocytes and epididymal sperm cells, which had been cryopreserved at the time of a previous IVF attempt. Two days before the scheduled transfer, eight oocytes were thawed; 5/8 (63%) oocytes survived and 4/5 (80%) oocytes fertilized after intracytoplasmic sperm injection (ICSI) with the previously frozen epididymal spermatozoa. All four fertilized ova cleaved (100%). On day 2 after thawing, four embryos were transferred; three with two cells (grade II) and one with three cells (grade III). Hormonal support for the established pregnancy was maintained with oestradiol and progesterone orally until 12 weeks of gestation, and the patient was delivered by Caesarean section at 40 weeks of gestation; the baby boy weighed 3025 g, and measured 51 cm, with Apgar of 10 in the 1st and 5th min. The cryopreservation and warming protocol used for this study yielded very favourable results, comparing well with reports in the literature. This case report demonstrates that it is possible to obtain high rates of oocyte survival following thawing and high rates of fertilization after ICSI, with viable development of the resulting embryos.

The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction.

The purpose of this research was to determine the prevalence of erectile dysfunction (ED) in a non-selected population using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool. In a non-institutionalized population and during a free screening program for prostate cancer (Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil), from 26 to 30 July 1998, all men who were attending were invited to complete a sexual activity questionnaire (the abridged 5-item version of the International Index of Erectile Function-IIEF-5) as a diagnostic tool for ED. The possible scores for the IIEF-5 range from 5 to 25, and ED was classified into five categories based on the scores: severe (5-7), moderate (8-11), mild to moderate (12-16), mild (17-21), and no ED (22-25). Of the 1071 men who participated in the program, 965 (90.1%) were included in this study. Of the responding men 850 were Caucasian (88%) and 115 were black (12%). The mean age of the men was 60.7 y, ranging from 40 to 90 y old. In this sample the prevalence of all degrees of ED was estimated as 53.9%. In this group of men, the degree of ED was mild in 21.5%, mild to moderate in 14.1%, moderate in 6.3%, and severe in 11.9%. According to age the rates of ED were: 40-49 (36.4%); 50-59 (42.5%); 60-69 (58.1%); 70-79 (79.4%), and over 80 y (100%) showed ED (P<0.05). The Pearson coefficients between the variables age and IIEF-5 showed a statistically significant inverse (negative) relation (r=-0.3449; P<0.05). ED is highly prevalent in men over 40 and this condition showed a clear relationship to aging, as demonstrated in other studies published. The simplified IIEF-5, as a diagnostic tool, showed to be an easy method, which can be used to evaluate this condition in studies with a great number of men.

Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in Brazilian and Mexican men.

A 12-week, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of flexible-dose sildenafil citrate (Viagra) treatment (25, 50 or 100 mg) in Brazilian and Mexican men with erectile dysfunction (ED) of broad-spectrum etiology. Efficacy was assessed on the basis of responses to the 15-item International Index of Erectile Function (IIEF) questionnaire, completed at baseline and after 12 weeks of treatment. At end point, mean scores for all IIEF domains of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) were significantly (P<0.0001) higher in the sildenafil group (n=109) than in the placebo group (n=105). These findings confirm the significant increases in frequency of penetration and frequency of maintained erections reported previously. Sildenafil treatment was well tolerated. The most common adverse events were headache and flushing. In conclusion, sildenafil is a well-tolerated and effective treatment for ED of broad-spectrum etiology in Latin American men.

Is there any relation between serum levels of total testosterone and the severity of erectile dysfunction?

The objective of this study was to correlate the severity of erectile dysfunction (ED) with the total testosterone serum levels (TT) in a normal population. During a screening program for the early diagnosis of prostate cancer, 1071 men aged from 40 to 90 y, were invited to answer the questionnaire of the Simplified International Index of Erectile Function (IIEF-5) as a method to diagnose and classify ED. The IIEF-5 scores ranged from 1 to 25 and the ED was classified into five groups according to the scores: severe (1-7), moderate (8-11), mild-moderate (12-16), mild (17-21) and no ED (22-25). Besides the questionnaire, all subjects had their TT serum levels determined based on the blood sample obtained between 08:00 and 10:00. The analysis of the relationship between the different degrees of ED and TT levels was then studied. Of the 1071 men, 965 were included in the study (90.1%). Eighty-eight percent of these were Caucasian and 12% black. The mean age of the population was 60.7 y. The prevalence of all degrees of ED was 53.9%. The degree of ED was mild in 21.5%, mild to moderate in 14.3%, moderate in 6.3% and severe in 11.9%. The variation of TT serum concentrations was similar (P>0.05) in the different age groups. Furthermore, the TT serum levels were not different for individuals with and without ED (P>0.05) and similar concentrations of TT was observed in the different severity degrees of ED (P>0.05). Only one (0.7%) man in the group of individual with maximal score had subnormal levels of TT. ED presented a clear association with the subjects' aging, but neither correlation between TT levels and ED, nor with its severity, could be demonstrated in the present study.

Effects of the chronic use of finasteride on testicular weight and spermatogenesis in Wistar rats.

OBJECTIVE: To evaluate spermatogenesis in rats chronically exposed to finasteride, as the recent use of finasteride in young men to prevent hair loss has raised concerns about chronic use and fertility. MATERIALS AND METHODS: Male Wistar rats (4 months old) were selected and divided into two groups. Group 1 (17 rats) received a finasteride suspension of 2 mg/kg/day in saline solution, 5 days/week for 10 months; group 2 (eight rats of the same age) were treated with placebo for the same period. At the end of the exposure the testes were weighed and processed for histological analysis. Spermatogenesis was evaluated as the mean number of seminiferous tubules with and without spermatozoids in their lumen, in five random fields on the same slide. Student's t-test was used to assess differences in the groups. RESULTS: In group 1, the mean (sd) weight of the testes was 1.55 (0.29) g and in group 2 1.58 (0.34) g (P>0.05). The histological analysis showed a mean of 13.35 (1.66) seminiferous tubules per field and 1.20 (3.30) tubules with no spermatozoids in group 1; in group 2 the respective values were 13.53 (1.46) and 0.06 (0.14) (P>0.05). CONCLUSION: Finasteride had no detectable effects on the quantitative and qualitative analysis of spermatogenesis in rats.

Beneficial effect of alpha-tocopherol in renal ischemia-reperfusion in rats.

We evaluated the effects of alpha-tocopherol (vitamin E) on the products of lipid peroxidation and serum creatinine levels in a rat model of renal ischemia-reperfusion. The animals were submitted to sham operation or renal ischemia-reperfusion, and they were pretreated with alpha-tocopherol or the vehicle saline. In four groups, we analyzed the lipid peroxidation products by measuring malondialdehyde and chemiluminescence levels. In the other three groups, we studied the serum creatinine levels after the procedures. In our study, the pretreatment with alpha-tocopherol reduced significantly the lipid peroxidation of renal cells and renal dysfunction induced by renal ischemia-reperfusion in rats.

Role of the L-arginine/nitric oxide pathway in renal ischaemia-reperfusion in rats.

OBJECTIVE: To study the role of the L-arginine/nitric oxide (NO) pathway during renal ischaemia-reperfusion in rats. DESIGN: Randomised experimental study. SETTING: Teaching hospital, Brazil. ANIMALS: 97 male Wistar rats randomly assigned to 4 groups for the assessment of renal dysfunction and to 6 groups for the assessment of the oxidative stress induced on renal cell membranes by ischaemia-reperfusion. INTERVENTIONS: The animals underwent sham-operation or renal ischaemia-reperfusion (n = 9 each) with or without pretreatment with L-arginine (a NO donor) or L-NAME (N(omega)-nitro-L-arginine methyl ester--an inhibitor of NO production) (n = 10 each). MAIN OUTCOME MEASURES: Serum creatinine concentrations and oxidative stress by chemiluminescence initiated by the tert-butyl hydroperoxide technique. RESULTS: Renal ischaemia-reperfusion significantly worsened renal dysfunction and increased oxidative stress in the ischaemia-reperfusion group after 24 and 96 hours of reperfusion compared with the control group (p < 0.05). Pretreatment with L-NAME slightly but not significantly increased serum creatinine concentrations after 24 and 96 hours of reperfusion together with activity of reactive oxygen species during renal ischaemia-reperfusion. L-arginine also significantly protected renal function and reduced the increment in the amount of chemiluminescence induced by giving L-NAME during 24 and 96 hours of reperfusion (p < 0.05). CONCLUSION: The L-arginine/NO pathway seems to have a slightly protective effect on the kidney after renal ischaemia-reperfusion injury in rats. These results need to be confirmed by studies in human beings.

Prevalence of Peyronie's disease in men over 50-y-old from Southern Brazil.

The pathogenesis of Peyronie's disease still remains an enigma and few epidemiological studies are available. The purpose of this study was to determine the prevalence of Peyronie's disease in males older than 50 y. From 26 to 30 July 1998, 1071 men attended the 'Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil'. In the prostate exam they also consented to be screened for Peyronie's disease. They underwent the 5-item International Index of Erectile Function (IIEF-5) questionnaire for evaluation of the erectile condition. The presence of a well-defined plaque in the penis was the diagnostic criterion for Peyronie's disease. The men were examined by five senior residents, under supervision by the staff Urologist. Men younger than 50 y as well as patients under intracavernous injection therapy for erectile dysfunction were excluded from the study. Chi2 test was used for statistical analysis. Nine hundred and fifty-four (89.1%) out of the 1071 men with a mean age of 62 y (ranging from 52 to 77) were included in the study. Peyronie's disease plaques were found in 35 men (3.67%). Eight hundred and forty-five (88.6%) were Caucasians. There was no significant statistical difference regarding age (P > 0.05). The presence of erectile dysfunction in the men with Peyronie's disease and without this condition, was 68.6% and 53.5%, respectively (P > 0.05). From this data we can conclude that the prevalence of Peyronie's disease is higher than in formerly reported studies. Further observations should be carried out in different communities and in other groups of patients in order to confirm our results.

Management of erectile dysfunction secondary to treatment for localized prostate cancer.

BACKGROUND: Management options for localized prostate cancer include radical prostatectomy, external radiation therapy, brachytherapy, and watchful waiting. Improvements in treatment techniques have resulted in fewer side effects. Nevertheless, long-term complications such as erectile dysfunction (ED) continue to affect a significant percentage of men treated for prostate cancer and can have a distressing and debilitating effect on the patient's quality of life. METHODS: The author reviews both the prevalence and the current options for the management of ED secondary to treatment for clinically localized prostate cancer. RESULTS: The ability to preserve potency after prostate cancer treatment is controversial, with reports ranging from 10%-90%. For patients complaining of impotence, efficacious alternatives are available such as oral drugs, intraurethral alprostadil, vacuum devices, intracavernous injections, and penile prostheses. CONCLUSIONS: Sexual function is an integral part of patient satisfaction and quality of life. Although ED is a frequent complication of definitive treatment of localized prostate cancer, a variety of treatment options are now available to maximize quality of life despite age and other comorbidities.

Long-term results of penile vein ligation for erectile dysfunction due to cavernovenous disease.

PURPOSE: We now know that outflow restriction is essential for maintaining a rigid erection, which can be achieved after satisfactory smooth muscle relaxation. The aim of this study was to assess retrospectively the efficacy of penile vein surgical ligation in patients with a follow-up of at least 3 years. MATERIALS AND METHODS: Thirty-two men with impotence due to cavernovenous occlusive disease underwent penile vein ligation for management of organic erectile dysfunction. Cavernovenous occlusive disease was diagnosed by gravity cavernosometry. RESULTS: Long-term evaluation revealed sustained potency without adjunctive therapy in only 7 patients (21.87%). Twenty-five patients (78.12%) did not show any improvement in the erectile mechanism. Associated complications included penile shortening in 4 (12.5%), hypoesthesia of the glans area in 2 (6.25%), and Peyronie's disease in 1 (3.2%). CONCLUSION: Based on these data, we conclude that the long-term success of penile vein ligation is poor.

Penile straightening with crural graft of the corpus cavernosum.

PURPOSE: We present a surgical alternative to penile straightening in Peyronie's disease that avoids penile shortening by using tissue from the crural segment of the corpora cavernosa as a graft. MATERIALS AND METHODS: We treated 7 patients with stable Peyronie's disease and satisfactory penile rigidity but significant curvature that precluded intercourse with this technique. An incision is made in the fibrous area and after stretching the gap is covered with a graft removed from the crural segment of the corpora cavernosa. RESULTS: In 6 of the 7 men straightening was satisfactory but in 1 it was not complete. No patient reported worse penile rigidity postoperatively. Donor site healing was uneventful. CONCLUSIONS: Use of tissue from the corpus cavernosum to correct penile curvature is effective. However, our results are preliminary, and long-term effectiveness and safety must be confirmed in a larger number of cases.

Experience with early catheter removal after radical retropubic prostatectomy.

PURPOSE: We tested the hypothesis that early catheter removal may be accomplished safely after radical prostatectomy. MATERIALS AND METHODS: Cystography on postoperative day 4 or 5 in 42 of 67 consecutive patients who underwent radical retropubic prostatectomy revealed no extravasation in 30 and the urethral catheter was removed (group 1). The control group included 25 patients who did not undergo cystography, and the catheter was removed 14 days postoperatively (group 2). RESULTS: Immediate and late continence was achieved in 14 (46.7%) and 25 (83.3%) cases in group 1, and in 8 (32%) and 22 (88%) cases in group 2, respectively (p>0.05). Catheterization was performed easily without any endoscopic or surgical procedure in 2 patients (6.7%) in group 1 who presented in urinary retention after catheter removal. Wound infection and pelvic abscess developed in 1 case (3.3%). There were no late complications. In group 2 urinary retention developed in 1 patient (4%), wound infection in 1 (4%) and hematuria in 1 (4%). Two patients (8%) had late vesical neck contracture at 4 and 10 months, respectively, which required urethrotomy in 1. In 1 patient (4%) a stricture in the anterior urethra was dilated. CONCLUSIONS: Our study shows that early catheter removal may be accomplished safely in most patients after radical retropubic prostatectomy, and was not associated with a higher complication rate.

Protective effect of allopurinol in the renal ischemia--reperfusion in uninephrectomized rats.

The effect of allopurinol (an inhibitor of xanthine oxidase) on oxidative stress, renal dysfunction, and histologic alterations was evaluated during the renal ischemia--reperfusion in uninephrectomized rats. Renal malondialdehyde and serum creatinine levels significantly increased after renal ischemia--reperfusion. However, the pretreatment with allopurinol demonstrated a protector effect in these parameters. Renal ischemia--reperfusion provoked a significant renal damage in the operated group. Tubular atrophy and interstitial fibrosis were attenuated by allopurinol when given prior to the surgery. In our study, allopurinol had a strong tendency to exert a beneficial effect during renal ischemia--reperfusion in uninephrectomized rats.

Is there any association between Peyronie's disease and serum collagen markers?

Several theories regarding the pathogenesis of Peyronie's disease have been investigated under many clinical conditions. We have investigated the association of Peyronie's disease with the most common markers of collagen disease. Several serum markers of collagen disease (mucoproteins, C-reactive protein, antinuclear antibody, rheumatoid factor, lupus erythematosus cells, proteinograms) of 30 patients with Peyronie's disease were compared with those obtained from 30 patients, matched for age, with other urological conditions unrelated to the penis. Mucoproteins were altered in 66.7% of patients of the Peyronie's disease group and in 46.7% of the control patients (P>0.05). C-reactive protein was altered in 23.3% of the Peyronie's disease patients and in 13.3% of the control patients (P>0.05). Antinuclear antibody (ANA) was reactive in 16.7% of the tested group and in 6.7% of the control group (P>0.05). The rheumatoid factor was elevated in 6.7% of the patients from both groups (P>0.05). LE cells were normal in all the patients in our study. No statistical significance between the two groups was found in the protein electrophoresis test. Only the Waaler-Rose test (rheumatoid hemagglutination test) was statistically significant in our study (P<0.05). We have not found any significant association between the serum markers of collagen diseases in patients with Peyronie's disease, except the rheumatoid hemagglutination test (Waaler-Rose).

Tamoxifen versus placebo in the treatment of Peyronie's disease.

PURPOSE: We evaluated the effects of oral tamoxifen and placebo in patients with Peyronie's disease. MATERIALS AND METHODS: We selected 25 patients with Peyronie's disease who did not have calcified plaque for treatment in the andrology outpatient clinic. A medical history was obtained, and physical examination, penile x-ray, penile ultrasound and pharmacologically induced erection with prostaglandin E1 were performed. Patients were randomly divided into group 1--those who received 20 mg. tamoxifen twice daily for 3 months and group 2--those who received placebo for the same period. The same evaluations were done 4 months later and results were compared. Qualitative (chi-square test) and quantitative (Student's t test) results were analyzed using the Yates correction factor with p <0.05 considered significant. RESULTS: Pain subsided in 66.6 and 75% of the patients treated with tamoxifen and placebo, respectively (p >0.05). In groups 1 and 2 a reduction in the penile deformity was noticed by 46.1 and 41.7% of the patients (p >0.05), and a decrease in plaque size was noticed by 30.7 and 25%, respectively. On the other hand, objective measurements did not reveal any difference in plaque area or curvature angle. CONCLUSIONS: This study did not show significant improvement in pain, curvature or plaque size in patients with Peyronie's disease who were treated with tamoxifen compared with those treated with placebo.

Endoscopic suspension of the prolapsed vaginal dome.

Complete prolapse of the vaginal dome post hysterectomy is uncommon. However, complications such as urinary incontinence, recurrent urinary infections, and ureteral obstruction leading to anuria and loss of renal function may result. A modified technique for endoscopic suspension of the bladder neck and vaginal prolapse, performed in six patients, is presented. The positive results achieved after a 64-month of follow-up suggest that this procedure is another safe alternative to correct vaginal prolapse and its complications.

Does intratesticular testosterone administration modify the evolution of transitory testicular ischemia in pre-pubertal rats?

PURPOSE: Testicular torsion followed by ischemia results in variable degrees of infertility and until now there appears to be no effective way to recover it. Testosterone participation in the maintenance of male sexual organs and spermatogenesis led us to hypothesize that intratesticular administration could recover ischemic injury. MATERIALS AND METHODS: We divided 40 Wistar rats in 2 groups, of 20 each. One group was control and the other underwent a 120-minute testicular ischemia by means of a vascular clamp on the left spermatic cord. Each group was further subdivided in 2 subgroups. The first one was observed and the second received intratesticular testosterone 25 mg. starting on the third day after injury and during the next 7 consecutive days. Half the animals were sacrificed 30 days after injury and the remaining ones after 60 days. Weight, volume, number of seminiferous tubules, histology and spermatogenesis of the same side and contralateral testes were examined. For statistical analysis ANOVA and Fisher's tests were applied. RESULTS: It was found that testosterone was capable of acting upon volume and weight of the left testis (p=0.0001). The animals receiving intratesticular testosterone showed lower testicular weight and volume after 30 and 60 days, respectively. This subgroup also showed a higher number of seminiferous tubules, modified histology and absent spermatogenesis suggesting testicular atrophy. CONCLUSIONS: We concluded that intratesticular injection of testosterone 25 mg. once a day during 7 consecutive days after transitory testicular ischemia causes ipsilateral testis atrophy. The animals in control group showed testicular histological recovery 60 days after injury. There were no significant histological differences in the contralateral testes.

Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction.

PURPOSE: We evaluated men with organic erectile dysfunction treated with placebo and high dose oral yohimbine hydrochloride. MATERIALS AND METHODS: We selected 22 patients with organic erectile dysfunction (mean age 58 years) for treatment in the andrology outpatient clinic. These patients had been previously undergone neurological, vascular, hormonal and psychological testing, and were treated during an equal period of 30 days with placebo and daily single dose oral 100 mg. yohimbine. The response to treatment was evaluated via a questionnaire that comprised the outcome items of complete--normal penile rigidity enabling vaginal penetration, partial--erection improved but not sufficiently for appropriate vaginal penetration, none--no improvement and worse--erection deteriorated. The patients consented to treatment after being told of the severe adverse effects that might occur. RESULTS: The most common side effects were anxiety, increase in cardiac frequency, increased urinary output and headache but in no case was treatment discontinued. Of the patients 3 (13.6%) and 12 (54.5%) reported complete or partial response to treatment, respectively. However, statistical analysis disclosed no significant difference when yohimbine was compared to placebo (p < 0.05). CONCLUSIONS: Oral 100 mg. single dose daily yohimbine promotes no improvement in patients with organic erectile dysfunction.