Clinical experience with 180 inflatable penile prostheses.

I present my experience with 180 inflatable penile prostheses inserted in 167 patients with organic sexual impotence of 4 months to 30 years in duration. Mean age was 59.3 years. Prostheses used were AMS 700 (9), Flexiflate (14), Mentor Mark II (99), and Mentor Alpha I (58). Mean follow-up was 43.5 months. Overall complication rate was 17.8% (32 cases). In 24 cases, the complications were major (infection, malfunction, and extrusion) and necessitated reoperation. The remaining complications (8 cases) were minor (partial deviation, autoinflation), and surgical intervention was not needed. Staphylococcus epidermidis was the offending microorganism in 7 of 9 infections. In general, my results with these penile prosthesis implants suggest that they are a valid form of treatment for organic impotence.

Standardization of penile blood flow parameters in normal men using intracavernous prostaglandin E1 and visual sexual stimulation.

The evaluation of vasculogenic impotence by color flow Doppler ultrasound after injection of intracavernous vasoactive agents allows for simultaneous visualization in real time of arterial and venous blood flow. Normal arterial blood flow parameters after prostaglandin E1 injection have yet to be standardized. Our study was initiated to evaluate blood flow parameters in a normal control population after prostaglandin E1 and visual stimulation. A total of 20 healthy male volunteers 45 to 60 years old with histories of normal sexual function was selected. All volunteers were given intracavernous injections of 10 micrograms prostaglandin E1 and received concurrent visual stimulation by means of an erotic video. All patients developed rigid erections with no complications. Using color flow Doppler ultrasound measurements were done before and after prostaglandin E1 injection of right and left superficial and deep cavernous artery diameters, peak blood flow velocities and blood flow volumes. Results (mean plus or minus standard error) showed a significant increase in diameters after prostaglandin E1 in the superficial (20% increase) and deep (70% increase) penile arteries. Blood flow volume increased 3-fold for the superficial penile arteries (from 7.3 +/- 1.4 to 20 +/- 3.5 cc per minute) and 4-fold for the deep cavernous arteries (from 3.8 +/- 1 to 12.5 +/- 1.8 cc per minute). Peak blood flow velocity increased 2-fold (from 22 +/- 3 to 46 +/- 7 cm. per second) for the superficial arteries and 3-fold (from 12.5 +/- 2 to 37 +/- 5 cm. per second) for the deep cavernous arteries. These data suggest control values for normal erectile function in middle-aged men as a 70% increase in deep cavernous artery diameter, a systolic peak blood flow velocity greater than 30 cm. per second and more than 10 cc per minute of blood flow volume. With these standards the clinician may assess, design and follow treatment strategies for vasculogenic impotence.

Congenital giant hydronephrosis with unsuspected transitional cell carcinoma.

A case report of a giant congenital hydronephrosis with multiple foci of transitional cell carcinoma is presented.

Condyloma acuminatum in children.

A case of extensive venereal warts in a nine-year-old female patient is presented. Transmission, pathology, and therapy are discussed.

Critical evaluation of 1-stage cystectomy--reducing morbidity and mortality.

Although it is a major surgical effort removal of the bladder can be done with reasonable safety. In our opinion cystectomy and urinary diversion by an ileal conduit can be performed as a conjoined procedure without need for staging to reduce risks. Mortality up to 3 months postoperatively was 3.9 per cent and the major complication rate for surviving patients was 18.6 per cent. Minor complications occurred in 28.7 per cent of all patients but were treated easily. We did not note increased morbidity after radical cystectomy compared to other types of cystectomy. A higher complication rate was noted in patients who had undergone preoperative radiation treatment, and wound infection rate was higher in patients with neurogenic bladder dysfunction and chronic cystitis. The advantages of 1-stage compared to 2-stage cystectomy would include the fact that it eliminates the need for a second operation, saves considerable expense by virtue of shortened hospitalization and an earlier resumption of the patient's productivity, achieves early removal of the malignancy, decreases the chances of infection by avoiding a second laparotomy in the presence of a stoma and allows better exposure in the absence of previous ureteroileal anastomoses.

Treatment of condylomata acuminata with carbon dioxide laser.

Ten patients with condyloma acuminatum were treated successfully with carbon dioxide laser photocoagulation. There are no side effects, damage to the surrounding tissue is minimal, and, in our experience, the lesions have not recurred. It is particularly useful for lesions which are recalcitrant to other types of therapy. We now initially treat patients who have lesions in the urethral meatus with the carbon dioxide laser.