Management of impotence in a developing country.

Three hundred and seventy five impotent men attended our Andrology clinic between July 1988 and June 1993. Their ages ranged from 20-89 years. Associated factors were diabetes mellitus, testicular failure, trauma, venous leak and hyperprolactinaemia. We categorised them into subgroups of highly educated men with manual dexterity and financial ability but impairment of manual dexterity, financially able but illiterate men, and illiterate poor with or without manual dexterity. Penile prostheses were implanted in 15; 48 were treated with vasoactive substances; 4 with vacuum devices and two had ligation of venous leaks. However, 297 (79%) men did not get the treatment best suited for their problems and received only supplementary hormones and/or psychological reassurance. In the developing countries, the selection of the appropriate treatment modality for impotence is compounded by considerations of economic, social and educational factors.

The value of ultrasound in the evaluation of patients with blunt scrotal trauma.

Twenty-one men with blunt scrotal trauma managed in the Urology Department of Riyadh Central Hospital are presented. The decision for surgical exploration was strengthened by ultrasonic findings in six patients--four men with haematocoele and ruptured testicles and two with expanding extratesticular haematoma and normal testes. In addition, sonography revealed unsuspected intratesticular haematoma and disrupted tunica albuginea (without haematocoele) in two other cases. One case managed non-operatively developed a testicular abscess detected by ultrasound. Surgery confirmed the diagnoses in all nine cases that were explored. Thirteen patients were managed non-operatively, including six cases in whom sonography revealed contused testes. Hence, the value of ultrasound scanning in evaluating patients after blunt scrotal trauma was established. It complemented clinical findings and detected unsuspected testicular injury.

Missed urological injuries in children with polytrauma.

Fifteen children (11 boys and 4 girls) with severe injuries of the urinary tract were admitted to the Riyadh Central Hospital between 1990 and 1992. Their ages ranged from 2.5 to 12 years (mean 7.3 years), and their injuries were parts of multiple-organ trauma. Following resuscitation, every child was evaluated and staged by either intravenous urography, CT scan or ultrasonography or a combination of these. Commonly associated injuries were to the skeleton, spleen and liver. Two patients with ureteropelvic junction injuries and two girls with traumatic urethropaginal fistulas were not diagnosed. The delay in diagnosis contributed to an increase in morbidity. Despite modern radiological imaging, some severe injuries of the urinary tract can still be missed. Heightened awareness and thorough clinical examination are mandatory for early diagnosis of such injuries in children with multiple injuries.

The limitations of ultrasonography in the management of testicular abscesses.

Preoperative ultrasound images of 12 cases of testicular abscess were correlated with the clinical, operative and pathological diagnosis. No ultrasonic appearance was consistent enough to permit a confident diagnosis of abscess formation.