Prevalence of erectile dysfunction and its correlates in Egypt: a community-based study.

We evaluated the prevalence of erectile dysfunction (ED) in a cross-sectional community-based random sample of Egyptian men. ED was correlated with the socioeconomic status, risk factors and quality of life. Married men in Ismailia province were interviewed at home. Data were processed for 805 men with mean age of 43.58 y (s.d. 11.03). There is a fair correlation between ED and increasing age (< or = 0.001). Males with complete ED comprised 13.2% of the sample, 26% of men in their 50s, 49% of men in their 60s and 52% of those 70 y or older. The state of better erection correlated fairly with sexual desire and sexual satisfaction (< or = 0.01). ED was associated with living in rural areas and lower socioeconomic level (< or = 0.01), with smoking, diabetes, heart disease, hypertension, liver disease, arthritis, peptic ulcer and renal disease (< or = 0.05). ED was negatively associated with good quality of life (< or = 0.001). These results indicate that ED is a common problem among married Egyptian men.

Storage detrusor pressure in bilateral hydroureteronephrosis.

OBJECTIVES: To determine the detrusor pressure (P(det)) during the storage phase associated with upper urinary tract (UUT) dilatation. SUBJECTS AND METHODS: Twenty-seven patients with bilateral hydroureteronephrosis, neither due to organic obstruction nor vesicoureteral reflux, were included. Water cystometry was done according to the recommendations of the International Continence Society [Abrams P., et al.: Scand J Urol Nephrol 1988(suppl 114):5-19]. P(det) at 25, 50, 75 and 100% of bladder capacity was determined using the tag function of a computerized urodynamic system. RESULTS: The age of the patients ranged from 16 to 81 years; 3 were females and 6 had renal insufficiency. In these 27 patients, high P(det) >15 cm H2O was sustained throughout the storage phase in only 11% of patients, and at 50 and 75% of bladder capacity in 44 and 88% of patients. About half (13/27) of the patients had a P(det) <40 cm H(2)O at capacity. Patients with renal insufficiency had a mean P(det) higher and more sustained over the storage phase compared to patients with normal renal function. The mean P(det) at all measured bladder volumes was significantly higher than in a control group of patients without hydroureteronephrosis. CONCLUSION: A P(det) >15 cm H(2)O but not necessarily 40 cm H2O, sustained for part of the storage phase but not necessarily throughout the whole storage phase, was associated with UUT deterioration. A higher and more sustained P(det) during the storage phase was associated with renal insufficiency.

Quantitative and qualitative assessment of flowmetrograms in patients with prostatodynia.

OBJECTIVES: Prostatodynia (type III-B according to the classification of the National Institute of Diabetes and Digestive and Kidney Diseases) represents a major part of all chronic prostatitis syndromes. Uroflowmetry changes in these patients were rarely described, and discrepancies exist about the prevalence of urodynamic abnormalities. The aim of this study was to describe both qualitative and quantitative flowmetrogram characteristics in these patients. METHODS: Two hundred and thirty-eight flowmetrograms from patients diagnosed as having prostatodynia and 71 flowmetrograms from control males with matched age but without lower urinary tract problems were evaluated. Two to three flowmetric analyses were done for each individual, and the best one, i.e., representing the individual's voiding and no artefact (e.g., wag artefact), was chosen. A minimal voided volume of 150 ml was required to be included. Diagnosis of prostatodynia followed the routine criteria. For all patients the postvoiding residual urine was assessed by ultrasound (Bladder Scan). Qualitative study was done according to a classification using flow-time ratio (T(Qm)/T100x100) and flow ratio (Q(ave)/Q(max)x100) for continuous flow. Interrupted flow was classified separately. Descriptive statistical analysis was used. RESULTS: The age range was 18-49 (mean +/- SD, 34.2+/-7.8) years. The symptom duration ranged from 3 to 84 (16.5+/-27.7) months. Out of 238 patients 196 had uninterrupted flow. Thirty-six patients showed interrupted flow due to external sphincter contraction < or =2 s, and 6 patients showed interrupted flow with abdominal muscle straining. Out of the 196 patients, 73 showed Q(max) >15 ml/s, and 67 showed a voided volume <200 ml. For this group the Q(max) was 13. 3+/-5.3 ml/s, Q(ave) was 7.6+/-3.0 ml/s, and the mean postvoiding residual urine was 29.9 (range 0-234) ml. Type I flowmetry pattern was present in 39.7%, type II in 38.7%, type III in 5%, type IV in 16%, and type V in 0.5% of the patients with continuous flow (see Patients and Methods). The control group showed a Q(max) of 19.5+/-3. 8 ml/s, a Q(ave) of 11.1+/-2.6 ml/s, a voided volume of 311.9+/-106. 9 ml, and a postvoiding residual urine of 14.3+/-29.3 ml/s. Pattern I was seen in 89%, pattern II in 8%, and pattern IV in 3% of the controls. CONCLUSION: Most patients with prostatodynia had abnormal flowmetry parameters, and different patterns were shown, confirming that many have urinary flow disorders. Flowmetry should be part of the prostatodynia patient diagnostic workup, as this might add to the understanding of patient problems and may help in the selection of more appropriate methods in order to define the pathophysiologic basis of the symptoms and to perform treatment accordingly.

Urinary bladder bilharziasis as a cause of impaired bladder muscle contractility.

In an attempt to evaluate the effect of bilharziasis on bladder contractility as a factor in the genesis of voiding disorders, 44 cases of bilharzial bladder neck obstruction diagnosed using traditional methods (symptomatological, radiographic, and endoscopic) were subjected to complete urodynamic evaluation (flowmetry, cystometry, pressure/flow study, and stop-flow test). Their parameters were compared with those of 28 patients with urodynamically obstructed benign prostatic hyperplasia and 8 nonsymptomatic controls. Contractility parameters (isometric detrusor pressure, maximum estimated flow rate, detrusor power at maximum flow) were calculated for the studied cases and their distribution according to the Schafer pressure/flow diagram was evaluated. Bladder biopsy including the detrusor was evaluated in all 72 patients. Poor bladder contractility associated with an extensive bilharzial effect on the detrusor muscle was found to be the major abnormality in 20 of 44 patients with presumed bilharzial bladder neck obstruction with no evidence of urodynamic outflow obstruction. We believe such a workup is essential in cases of suspected obstruction associated with bilharziasis to throw light on the pathophysiology of the voiding disorders, avoid unnecessary surgery, and provide a better prognosis.

In situ extracorporeal shockwave lithotripsy of middle and lower ureteral stones: a boosted, stentless, ventral technique.

OBJECTIVES: To assess the outcome of a boosted, stentless, ventral in situ extracorporeal shockwave lithotripsy (ESWL) of middle and lower ureteric stones using a shockwave head from the opposite side of the stone using a Lithostar Siemens lithotriptor for stones larger than average size and of longer duration in place. The purpose was to attain a high clearance rate in a short time thereby avoiding auxiliary procedures. METHODS: A prospective study of 132 patients (134 stones) with middle and lower ureteric stones >6 mm in place for more than 2 weeks were treated with a Siemens Lithostar lithotriptor in the prone position with sedoanalgesia on an outpatient basis. No stents were planned ahead of treatment. The shock head from the opposite side of the stone transversing only through the soft tissue of abdomen and pelvis was used routinely. Localization was done using fluoroscopy and snapshots and intravenous contrast was given when needed. The boosted sessions were done on day 1 (S1), day 2 (B1), day 7 (S2) and day 14 (S3) when needed or till adequate fragmentation after any session, even the first one. This procedure was evaluated at the 6th week of management or at adequate fragmentation and clearance if before that time. RESULTS: This study inlcuded 115 males and 17 females with a mean age of 47 +/- 15 and 53 +/- 11 years. Stone size defined as the longest stone diameter as measured in plain film of the abdomen was 0.75-2.6 cm with a mean of 1.1 cm. All but two stones were successfully fragmented. Only 12% needed interference for developing obstruction and/or complication during the planned treatment. 106 patients needed only S1 or B1, 20 patients needed session 2, 6 patients needed session 3. Clearance was 43% by the 2nd day, 79% by the 7th day, 94% by the 14th day and 98.5% by the end of the 6th week. CONCLUSION: For larger ureteric stones a boosted stentless ventral shockwave lithotripsy for in situ middle and lower ureteric stones gave good results with short time clearance and without unusual side effects. The ventral application of shockwave from the opposite side was found more convenient with the Siemens Lithostar lithotriptor. We recommend this approach to be the initial procedure for middle and lower ureteric stones when they are larger than average, of longer duration and/or expected to be of harder texture as an outpatient procedure under sedoanalgesia to minimize the need for auxiliary procedures.

Histopathological studies on detrusor muscle in schistosomiasis haematobium patients with poor bladder contractility.

The electron microscopic structure of the detrusor muscle in schistosomiasis patients with poor bladder contractility as evaluated by urodynamic measures had been compared with normal detrusor muscle from non-schistosomiasis patients. In the patients with poor bladder contractility the detrusor was formed of muscle fibers which were smaller in size, widely separated by collagen and showed degenerative changes and hyalinosis. No evidence of smooth muscle hyperplasia, mitosis or fibroblastic proliferation was seen. This pathological changes in the bladder of schistosomiasis patients may explain the cause of poor contractility.

Hydrocele in filarial and non filarial patients. Histopathological, histochemical and ultrastructural studies.

Twenty biopsied material of the testicular tissue were obtained from patients with unilateral hydrocele (eight due to lymphatic filariasis and twelve of idiopathic causes). Twenty biopsies lymphatic were also obtained from the normal unaffected testes and were used as control. The data obtained from histopathological, histochemical and ultrastructural studies revealed alternation in the testicular tissue with hydrocele than in the normal control testis. In the filarial hydrocele 37.5% of the cases showed thickening of the basement membrane and fibrosis with arrest of the spermatogenesis at the level of secondary spermatocytes. In addition, 12.5% showed thickening with interstitial fibrosis. Microfilariae were seen in hydrocele fluid of 3/8 cases (37.5%). In the idiopathic hydrocele 50% of the testicular tissue showed marked collagen deposits and testicular atrophy with fibrosis and thickening of basement membrane. The second 50% of cases showed variable degree of maturation arrests. Explanation for these variations in the pathological and anatomical pictures in both types of hydrocele is suggested. In the filariasis hydrocele it is due to the inflammatory response that may subside and recurrent. In the idiopathic hydrocele, it is due to the irreversible hypoxia caused by the continuous mechanical pressure due to huge amount of hydrocele fluid resulting in irreversible degenerative process with marked fibrosis.

Detrusor morphology and pathology in relation to bladder outflow obstruction in bilharzial patients.

The light and electron microscopic structure of detrusor muscle of trabeculated urinary bladder from patients with urodynamically proved bilharzial outflow obstruction had been compared with normal detrusor muscle. In bilharzial outflow obstruction, the detrusor muscle bundles were formed of relatively smaller smooth muscle cells widely separated by dense connective tissue, fatty infiltration, bilharzial ova, inflammatory cells and hyalinosis. No evidence of smooth muscle hyperplasia, mitosis, or fibroblastic proliferation. At the level of electron microscopy. The connective tissue infiltration was proved to be microfibriles apparently in continuity of the basal lamina of the smooth muscle. These pathological changes can explain both the morphological and urodynamic changes in bilharzial urinary bladder outflow obstruction.