Erectile dysfunction in patients with chronic hepatitis C virus infection.

BACKGROUND AND STUDY AIMS: Hepatitis C virus (HCV) infection is a major public health problem worldwide and in Egypt. Several studies have suggested that chronic HCV infection may be associated with erectile dysfunction (ED) in men. The aim of our study was to detect the prevalence of ED among male patients with chronic HCV infection. PATIENTS AND METHODS: The study included 150 male patients with chronic HCV infection (124 patients with chronic hepatitis and 26 patients with HCV-associated liver cirrhosis). The Child-Pugh score was used to assess the severity of cirrhosis. An Arabic validated version of the five-item International Index of Erectile Function (IIEF-5) was used to detect the presence and severity of ED. RESULTS: The patients' age ranged from 20 to 80 years with mean age±standard deviation (SD; 50±17.19) years. The prevalence of ED among patients with chronic HCV infection was found to be 29.3%. The prevalence was significantly higher in cirrhotic as compared to chronic hepatitis patients (p<0.001) and the average ED score was significantly lower in patients with liver cirrhosis than in those with chronic hepatitis. There was a highly significant relation between the severity of ED and the severity of liver disease. There was a significant negative correlation between serum bilirubin and ED score and a significant positive correlation between serum albumin and ED score in patients with liver cirrhosis. CONCLUSION: About 30% of patients with chronic HCV infection were found to have ED; so, given the high prevalence of HCV infection in Egypt, chronic HCV infection may be considered in the differential diagnosis of ED. There was a highly significant relation between the severity of ED and the severity of liver disease and the majority of patients with liver cirrhosis proved to be suffering from ED, which may be related to the associated hypoalbuminaemia.

Human testicular arterial supply: gross anatomy, corrosion cast, and radiologic study.

OBJECTIVE: To study human testicular arterial supply. DESIGN: Prospective. SETTING: Academic setting. PATIENT(S): Forty fresh male cadavers. INTERVENTION(S): Gross anatomy of 20 cadavers, corrosion casting of 10, and radiography of 10. MAIN OUTCOME MEASURE(S): Testicular vascular supply, course, branching, and anastomosis. RESULT(S): The testicular artery descends bilaterally in a straight course (85%) and in a convoluted course (15%). There were three sites of terminations: along the upper pole of the mediastinum testis (78.8%), giving terminal branches (16.2%) or descends without division (5%). Four patterns of termination were found, but in the majority (69.7%) it terminates as upper and lower polar branches. The cremasteric artery arises from the inferior epigastric artery and terminates close to the lower end of the testis, anastomosing with the lower polar branch of the testicular artery. The artery of the vas arises from the inferior vesical artery, terminates by several capsular branches close to the mediastinum testis, anastomosing with branches of the testicular artery along the mediastinum testis. CONCLUSION(S): The testis gets its arterial supply mainly from the testicular artery supplemented with the cremastric artery and the artery of the vas. The testis has rich vascular areas in the upper polar, mediastinum testis, and posterolateral segments.

Intracavernous sodium nitroprusside (SNP) versus papaverine/phentolamine in erectile dysfunction: a comparative study of short-term efficacy and side-effects.

OBJECTIVE: The aim of our work is to evaluate the efficacy of intracavernous sodium nitroprusside (SNP) in management of erectile dysfunction (ED) in a clinical comparative study with papaverine/phentolamine in ED patients. METHODS: The study included 40 patients with ED divided into two groups. Group I include 20 patients receiving intracavernous (30 mg papaverine + 1 mg phentolamine) followed 1 week later by intracavernous 300 microg SNP. Group II included 20 patients receiving the same regimen of group I but with intracavernous SNP first followed by papaverine/phentolamine 1 week later. All patients were assessed clinically for their response and any developing complications. RESULTS: The numbers of good and poor responders were not statistically significant (P > 0.05) among the two groups. The mean erectile duration of SNP was similar to bimix (P > 0.05). No side-effects whether local or systemic occurred with SNP while priapism and local penile pain were recorded with bimix solution. CONCLUSIONS: Intracavernous pharmacotherapy is still a reliable method both for diagnosis and for treatment of ED. While preliminary results of our study show a potential of SNP to be an effective and safe intracavernous agent, long-term self-injection clinical trials are needed before large-scale usage is recommended.

Intracavernous chlorpromazine versus phentolamine: a double-blind clinical comparative study.

INTRODUCTION: Intracavernous pharmacotherapy is one of the most common treatment modalities of erectile dysfunction (ED). There are different drugs that are used for intracavernous injection including papaverine, phentolamine, prostaglandins E1, phenoxybenzamine, and moxisylate. AIM: The aim of this study is to evaluate the efficacy of chlorpromazine as an intracavernous vasoactive agent alone or with other drugs. METHODS: This study was performed on 50 patients presenting to our department complaining of ED. Patients were divided into three groups according to the type of intracavernous drug injected. Group A included 20 patients who received an intracavernous injection of 1 mL bimix (30 mg papaverine + 1 mg phentolamine) followed a week later by intracavernous test dose using a 1 mL mixture of papaverine and chlorpromazine (30 mg papaverine + 2.5 mg chlorpromazine). Group B included 20 patients who received an intracavernous injection of 1 mL trimix (30 mg papaverine + 1 mg phentolamine + 10 microg PGE1). A week later they received another intracavernous test dose using a 1 mL mixture of papaverine, PGE1, and chlorpromazine (30 mg papaverine + 2.5 mg chlorpromazine + 10 microg PGE1). Group C included 10 patients who received various intracavernous injections of chlorpromazine in doses 1 mg, 2 mg, 5 mg, and 10 mg. RESULTS: There was no significant difference in erection response and erection duration between phentolamine and chlorpromazine. Prolonged erection occurred in two patients of group B and postural hypotension occurred in three patients of group C. CONCLUSION: Chlorpromazine can be used as an intracavernous vasoactive agent; it is similar to phentolamine in efficacy and short-term side effect profile.