Evaluating medical treatment of impotence.

The nocturnal penile tumescence study, bulbocavernosus reflex latency time, and ultrasonic blood flow studies have made possible a more objective determination of the success or failure of various means used to treat impotence. A group of 60 patients with a history of impotence and flat nocturnal penile tumescence readings were selected for evaluation. Thirty were diabetic and 30 had idiopathic impotence. These patients were treated with a vasodilator, told to stop smoking for six weeks, or both. The results indicate that greater than one third of the patients were able to have intercourse and show NPT activity after treatment. Our study indicates that there is a select group of diabetics, as well as patients with idiopathic impotence, who may respond to medical management.

Vascular factor in erectile failure among diabetics.

Clinical, sexual, and laboratory evaluations were made on 47 impotent diabetics. All patients were given a Doppler PAPS examination and a neurologic assessment of the penis (BCRL and/or CMG). Nerve conductivity tests of the legs were also administered to most patients. The groups were classified as to whether they were insulin or noninsulin dependent. Abnormalities of penile arterial flow were detected in 95.7 per cent of all the patients. Penile arterial occlusions without associated penile neuropathies occurred in 61.7 per cent. Penile neuropathies were found in 34 per cent, and all were associated with varying degrees of penile arterial obstruction. Diabetics who were dependent on insulin showed a high frequency of vascular pathologies and a 12 to 15 per cent higher rate of penile neuropathies than the group not dependent on insulin. Our study suggests that obstruction of penile arteries is the primary factor in erectile dysfunction of diabetics. Those impotent diabetics without any overt penile nerve damage might be good candidates for revascularization procedures.

Red cell surface antigen and its relationship to survival of patients with transitional cell carcinoma of the bladder.

We studied 73 patients with transitional cell carcinoma of the bladder seen from 1967 to 1973. The red cell antigen test was done in a controlled blind study to determine if tumor behavior can be predicted by this test. Our results do not substantiate the findings of other investigators who have reported excellent correlation. We did not find statistical evidence that loss of antigen could be equated to a poor prognosis. We noted that patients in group O gave the weakest reaction and that this test had to be done in a modified fashion in tumors from these patients. It also was noted that as individuals age they tend to lose the red cell antigen. There is no doubt that this test, as reported in the literature, is a great advance in the study of bladder cancer. Further refinement in technique and more data are needed to substantiate its accuracy in predicting the behavior of bladder cancer.

A study of 48 cases of incidental carcinoma of the prostate followed 10 years or longer.

We reviewed 48 cases of incidental carcinoma treated conservatively. Patients with poorly differentiated, multiple foci or with well differentiated, multiple foci had a poor prognosis, whereas those with well differentiated, few foci (1 to 3) had a good prognosis. We believe that patients with multiple foci (poorly or well differentiated) should be treated aggressively, either by radical prostatectomy or radiotherapy. However, we recommend conservative treatment for patients with well differentiated, few foci.