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Objectives To evaluate, in a retrospective, single-center trial, our open prostatectomy outcomes and complications in the past 12 years to emphasize the feasibility of open prostatectomy for large prostates. Methods A total of 1193 patients underwent open prostatectomy from 1995 to 2007. We retrospectively analyzed the data from 664 patients who had preoperative, operative, and postoperative data available. Results The mean patient age was 67.5 years (range 52–86). The mean preoperative prostate-specific antigen value was 9.6 ng/mL (range 1.65–45.6). The mean prostatic weight was 88.7 g (range 45–324) and was significantly different for the 1995–2001 and 2002–2007 groups (73.6 vs 98.2 g, respectively). Of the 664 patients, 208 (31%) had had an indwelling catheter before surgery. The average International Prostate Symptom Score was 21.7 (range 13–32) preoperatively and 10.6 (range 8–18) postoperatively (P

Introduction Erectile dysfunction (ED) is a common complication of diabetes mellitus (DM). However, efficacy and/or long‐term satisfaction with most of those ED treatment options have been suboptimal. Aim In this study we try to evaluate the effect of aggressive treatment and DM regulation on the erectile function in men with DM‐induced ED (DMED). Methods Eight type 1 and 17 type 2 diabetic subjects were included into the study. All patients had a measurement of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1 c ) levels, and completed three sessions of consecutive nights using the RigiScan Plus monitoring device before and after blood sugar control. Also International Index of Erectile Function (IIEF) questionnaire scores were obtained before and after blood sugar control. Results Significant improvement was noted in FPG and HbA1 c levels throughout the treatment period ( P P > 0.05). Conclusion We suggest that there are probably other factors than aggressive treatment and DM regulation for treating DMED, and probably we must consider preventive strategies with pharmacological agents to prevent progressive decrease in erectile function in diabetic patients. Akand M, Yaman O, Gursoy A, Erdogan MF, and Anafarta K. The effect of diabetes mellitus treatment and good glycemic control on the erectile function in men with diabetes mellitus‐induced erectile dysfunction: A pilot study. J Sex Med 2006;3:344–348.

Skrotal kalsinozis (SK) skrotum derisinde cok sayida kucuk kalsifik nodullerle karakterli, nadir goru- len iyi seyirli bir hastaliktir. Noduller zaman icinde sayica ve boyut olarak artis gosterir. Hastalar genellikle uzun seneler bu hastalikla yasarlar ve kozmetik kaygilari disinda doktora basvurmazlar. Lezyonlarin histopatolojik incelemesinde, dermisde karakteristik amorf homojen kalsiyum depolanmalari iceren globuler bazofilik noduller ve bunlari cevreleyen histiositik dev hucrelerin eslik ettigi kronik granulomatoz inflamasyon izlenir. SK gelisimine ait bircok hipotez ortaya atilmistir. Bunlarin en populer olanlari epitelyal kist zemininde gelismis distrofik kalsifikasyon teorisi ile idyopatik etyoloji teorisidir. Bu yayinda, tesbit edildigi andan itibaren 3 ay gibi kisa bir surede hizla buyuyen skrotal nodullere sahip 51 yasinda bir SK hastasi sunmaktayiz. Skrotal eksizyon materyelinin histopatolojik incelenmesinde, tipik SK lezyonlarina eslik eden 3 adet kucuk epitelyal kist ile bir kenarinda epitel komponenti iceren 1 adet kalsifik nodul izlenmistir. Bulgularimiz, kalsifik nodullerin epidermal kistlerin distrofik kalsifikasyonu ile gelistigi tezini destekler nitelikte olup, histopatolojik tablonun lezyonun yasina gore degistigi anlasilmaktadir. Nodullerin zaman icinde sayisinin artmasi altta yatan nuks eden bir patolojinin varligini dusundurmektedir. Bulgularimiz, bu hazirlayici faktorun epitelyal kistler oldugunu dusundurmustur. SK’de farkli safhalardaki lezyonlarin birlikte bulunmasi, siklikla kronik donemde eksize edilmeleri nedeniyle de lezyonlarda epitelyal komponent izlenememesi sasirtici bir bulgu olmamalidir.

Objectives: Epidemiologic data indicate that erectile dysfunction (ED) is a significant problem among men worldwide. However, data do not exist for Turkish men. This study was conducted to determine the prevalence and sociodemographic, medical, and lifestyle correlates of ED in Turkey. Methods: Information was gathered via physician-conducted interviews using a validated questionnaire. Respondents self-rated their ED as "none," "minimal," "moderate," or "severe". Bivariate and multivariate analyses were performed on data from a stratified random sample of 1982 men aged ≥40 years to quantify the associations between ED and potential covariates. Results: The age-adjusted overall prevalence of ED in Turkey was 69.2% (mild 33.2%, moderate 27.5%, severe 8.5%) and increased with age, as did severity of ED. When we consider moderate+severe ED cases, the prevalence is 36%. In a multivariate model, increased prevalence of moderate or severe ED was significantly associated with age, residence in eastern Turkey; low educational level; unemployment; or underlying diabetes, hypertension, depression, prostate problems or lower urinary tract symptoms. Conversely, residence in southern Turkey, alcohol consumption, physical activity, and higher income were significantly associated with decreased prevalence. Conclusions: ED affects a high proportion of Turkish men aged ≥40 years, is correlated with a number of serious medical conditions and the frequency increases with age.

Purpose: Nocturnal penile tumescence monitoring was compared to cavernosal smooth muscle content in 48 cases of erectile dysfunction.Materials and methods: Pre-operatively nocturnal penile tumescence rigidity (NPTR) testing, colour Doppler sonography and if needed pharmaco cavernosometry-cavernosography were evaluated in 48 impotent patients before surgical intervention. The 40 patients whom all those diagnostic tools were abnormal constituted the first group. In the remaining 8 patients, which constitutes the second group, NPTR testing were normal but the other tests were abnormal. 10 potent patients with congenital penile curvature constituted the third group. Cavernous biopsies were obtained during the surgery and biopsies stained immunohistochemically to quantify smooth muscle cells (SMC) by anti-desmin and anti-SMA.Results: We observed statistical significant difference of corporeal SMC content with regard to first Vs second group and first Vs third group (p 0.05).Conclusion: NPTR testing appears to correlate well with corporeal SMC, which is the key structures of erection. We think that with taking into the consideration of its specific reservations, NPTR testing is still one of the best non-invasive tool in the differential diagnosis of erectile dysfunction.

Objectives. To determine the effect of experimental hypercholesterolemia on the ultrastructure of cavernosal smooth muscle cells, endothelial cells, elastic fibers, and collagen content, which are the key structures fundamental for erection. Methods. Forty-two New Zealand white rabbits were divided into a control group (group 1, n = 7, fed a standard diet), a hypercholesterolemia group (group 2, n = 20, fed a diet containing 1% cholesterol for 8 weeks), and a reversibility group (group 3, n = 15, fed a 1% cholesterol diet for 8 weeks, then switched to a standard diet for 4 weeks). Blood samples were obtained for lipid determination before and after the study. The cavernosal tissues were obtained at the end of 8 weeks for groups 1 and 2 and at the end of 12 weeks for group 3 and immunohistochemical examinations of these cells were performed. Results. Immunohistochemical analysis revealed that hypercholesterolemia produces marked and reversible decreases in the cavernosal content of smooth muscle cells, endothelial cells, and elastic fibers and increases the content of collagen 3 and 4. Conclusions. Our findings suggest that hypercholesterolemia in this animal model affects the percentage of staining for smooth muscle actin, endothelial cells, elastin, and collagen 3 and 4. However, since this effect is temporary depending on the blood cholesterol levels, it might not alter the erectile function.

Objectives. To evaluate the role of polytetrafluoroethylene (Gore-Tex) as a ureteral substitute in dogs after resection of a 5 to 8-cm-long middle segment. Methods. Five mongrel dogs underwent resection of the middle segment of the left ureter and segmental replacement of the resected part with segments of Gore-Tex over a double-J catheter. The double-J stents were removed at 21 days and the dogs were evaluated by excretory urography and abdominal ultrasonography 12 weeks after surgery. They were then killed and the ureters and the kidneys examined both grossly and microscopically. Results. There was radiologic evidence of advanced hydronephrosis on the left side in all 5 dogs. Grossly, the left kidneys showed marked pelvic and proximal ureteral dilatation and atrophy of parenchyma. Severe stricture at the anastomotic sites and marked fibrous tissue around the prostheses were found. No cellular lining was found in the Gore-Tex lumen. Conclusions. There is no potential for ureteral replacement by Gore-Tex tube graft.

Several surgical techniques have been applied for the treatment of cavernosal venous leakage, sufficient enough to create erectile dysfunction. In light of the variable success rates, we report our experience with deep dorsal penile vein arterialization for the management of severe cavernosal venous leakage.Twenty-four impotent patients with venous leakage were treated by the Virag-II type of end-to-end anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally. Diagnostic evaluation included color flow Doppler sonography before and after intracavernous 60 mg papaverine injection and dynamic cavernosometry/ cavernosography, which indicated veno-occlusive dysfunction in 28 patients. Revascularization was technically possible in 24 of the patients, although in 4 anastomosis could not be achieved due to the poor quality of the inferior epigastric artery.Five patients had early occlusion in the immediate postoperative period and 4 had late occlusion within 8 months. Potency was improved initially in 9 (38%) of the 24 patients in whom successful anastomosis had been achieved, with longer term improvement in 6 (25%) of 24 who realized restoration of erectile potency as defined by clinical investigations. The mean follow-up was 24 months (range 3-36 months).We believe that anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally in cases of venous leakage results in a low success rate due probably to a pancavernosal alteration in corporal tissue compliance.

Corpora cavernosa of 4 impotent patients with arterial pathology and 6 with venous insufficiency were studied by electron microscopy. The findings in all of the smooth muscle samples were the following: pronounced thickening of the basal lamina; marked reduction of contractile myofilaments and electron dense bodies; finger-like cytoplasmic projections; increase in mitochondria with swelling and aggregation; huge protrusions of nuclear membrane into the cytoplasm; increased proportion of interstitial matrix to smooth muscle cells. These were more marked in the dark than in the light cells, which was considered as the beginning of degeneration. Another finding was degenerative changes in the endothelial cell lining of the sinusoids, especially denudation, fragmentation and marked thickening of the basal lamina. Severity of the symptoms did not change in any of the patients with different pathologies. So, we can assume that the pathological alterations may be due to chronic penile vascular insufficiency or vice versa.

Penile prosthesis was implanted for erectile impotence of mainly organic origin in 104 patients. The AMS Dynaflex penile prosthesis was inserted in 39 cases, the AMS Malleable 600 prosthesis in 61 and the AMS Ultrex Plus prosthesis in 4. In 1 patient receiving a malleable prosthesis both rods had to be removed owing to erosion into the urethra and reimplantation was performed at the same operation. Only 1 patient who underwent implantation of the Dynaflex device had mechanical failure that necessitated surgical revision. After implantation of the new prosthesis both patients had satisfactory intercourse. One Dynaflex penile prosthesis, implanted into a juvenile-onset diabetic, became infected and required removal. Another complication was secondary to spontaneous erosion (noninfected) in 1 patient with malleable prosthesis who suffered loss of only one rod and who is still satisfied with the result. The overall complication rate in our series has been approximately 4%. The rest of the patients report satisfaction with the ability to move the penis voluntarily permitting normal sexual activities as well as normal appearance in the flaccid position. According to our experience, careful preoperative assessment from the views of both patient and device selection along with patient education, and strictly obeying the rules of sterility during implantation and applying systemic and local antimicrobial prophylaxis are essential in obtaining a successful result in prosthesis implantation for the individual patient.

Objectives To evaluate the quality of erections, ability to perform sexual intercourse, incidence of complications and satisfaction of patients using an external vacuum erection device in the treatment of erectile failure. Patients and methods Of the 61 impotent men who participated in this clinical trial, 49 used the device and were surveyed. The mean follow-up period was 12.8 months. A subjective rating scale from 1 to 10 was used to assess the patients' satisfaction with the device, where 1 indicated ‘dissatisfied’ and 10 indicated ‘very satisfied’. Results The ease of using the device, satisfaction with the quality of erections and ability to perform intercourse were given scores >5 by 88, 84 and 82% of the patients, respectively. Sixteen (33%) of the men withdrew from the trial, primarily because they were unable to achieve and maintain a full erection, or suffered conflicts in their relationship, or for reasons not related to the device. Overall, the effectiveness rate was 67%. Of 32 patients with arteriogenic impotence, 28 (88%) had satisfactory results and had an improvement in their capacity for spontaneous erections with the device. The most frequent adverse effects were blocked ejaculation, bruising or the development of ecchymosis, discomfort during pumping and discomfort from using the constriction bands. Conclusion These results suggest that the vacuum device is an effective and safe treatment for impotence of various aetiologies, especially for those patients with arteriogenic impotence.

We describe a patient with urethral stricture, contracted bladder and erectile impotence, who was successfully treated after a series of operations.

Herein, 2 cases of megacystis secondary to myenteric plexus pathology are reported. Unlike the entity of visceral myopathy, there was ganglion cell loss both in the bladder and in the colon of these 2 cases. Moreover, they did not present any gastrointestinal symptoms. Megacystis was the common pathology in these patients, whereas 1 of them suffered from unilateral vesicoureteral reflux. We could not find any similar report dealing with this phenomenon up to this time in the literature.

The mechanism and hemodynamics of penile veins in erection have long been a matter of controversy and hypotheses. With the intention to develop a new concept of venous ultrastructure in penile venous insufficiency, we studied the histopathology of 13 dorsal penile veins obtained from important patients during venous ligation because of proven venous leakage. Besides, 1 normal deep dorsal vein taken from a volunteer who underwent another type of penile operation was also examined. All sections were stained with hematoxylineosin, Gomori trichrome, periodic acid-Schiff, Gomori reticulum and Verhoeff elastic stains. All 13 veins showed some significant histological changes namely nodular hypertrophy in 7; nodular atrophy in 2, diffuse atrophy in 2, diffuse hypertrophy in 1 and minimal changes in 1. In general, the dominating histological appearance was hypertrophy of the muscular pattern and enhancement of collagenization. None of these alterations was prevalent in the normal control. The cause and the result relationship between venous leakage and the mentioned histological changes still remains a matter of debate.

Our purpose was to determine the incidence of electrocardiographic (ECG) abnormalities in patients with organic erectile dysfunction (ED) and to compare the results with an age-matched control (potent) group.A total of 218 men with ED of organic etiology formed our study group. A total of 210 age-matched men who had urologic disease other than ED served as control group. An experienced cardiologist who was blind to the primary diagnosis evaluated the ECGs in the entire group. The results were reported as either normal or abnormal according to the presence or absence of an abnormality suggestive for cardiovascular disease.The mean age of the study and control groups was 58 years (range for the study group 28-82 years and for the control group 28-80 years). Abnormal ECG rates among patients with ED and control subjects were comparable. The incidences of ECG abnormalities in the study and control groups were 21.1% and 17.1%, respectively (P = 0,298). No ECG abnormality was detected in males younger than 40 in either group.Middle-aged or older men with ED may carry potential risk for cardiovascular diseases in the absence of cardiovascular symptoms. However, patients with organic ED are not under increased risk for ECG abnormalities.

Erectile dysfunction (ED) is a common complication of diabetes mellitus (DM). However, efficacy and/or long-term satisfaction with most of those ED treatment options have been suboptimal.In this study we try to evaluate the effect of aggressive treatment and DM regulation on the erectile function in men with DM-induced ED (DMED).Eight type 1 and 17 type 2 diabetic subjects were included into the study. All patients had a measurement of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1(c)) levels, and completed three sessions of consecutive nights using the RigiScan Plus monitoring device before and after blood sugar control. Also International Index of Erectile Function (IIEF) questionnaire scores were obtained before and after blood sugar control.Significant improvement was noted in FPG and HbA1(c) levels throughout the treatment period (P0.001). However, no statistically significant difference was observed in both IIEF scores and nocturnal penile tumescence and rigidity (nptr) parameters after the dm regulation (p0.05).We suggest that there are probably other factors than aggressive treatment and DM regulation for treating DMED, and probably we must consider preventive strategies with pharmacological agents to prevent progressive decrease in erectile function in diabetic patients.

Nocturnal penile tumescence and rigidity testing (NPTR) has traditionally been performed to distinguish psychogenic from organic impotence. However, considerable lack of uniformly accepted normative data for NPTR readings makes the reproducibility of the method questionable. In this study, we try to evaluate the impact of aging as independent criteria for quality of erectile episodes. A total of 455 patients (ages 20-71 y) whose initial complaints were erectile dysfunction underwent two nights NPTR measurement with Rigiscan device. After analyzing the data, 353 men out of 455 were regarded as having normal NPTR recordings. The number of normal erectile episodes (erectile episode of penile tip rigidity greater than 60% more than 10 min duration), RAU Tip, RAU Base, TAU Tip, TAU Base, Average event rigidity of Tip (%), Average event rigidity of Base (%) and Duration of erectile episodesor =60% minute were re-evaluated with regard to five age groups (group I:30 y; group II: 30-39 y; group III: 40-49 y; group IV: 50-59 y; group V:or =60 y). The mean values of erectile episodes in the age groups were as follows: group I, 2.46; group II, 2.28; group III, 2.40; group IV, 1.58; group V, 1.27. When we analyzed the groups between themselves, we observed statistically significant difference after the age of 50 y. The mean erectile episodes in patients younger than 50 y were 2.37 (s.d.: 1.50), whereas 1.49 (s.d.: 1.15) in patients older than 50 y (P0.001). We also observed statistically significant difference at all of the above-mentioned NPTR parameters with regard to age. The results of our study showed that aging negatively influence quality of nocturnal erections especially after 50 y and we suggest that age needs to be taken into account in the diagnostic interpretation of NPTR testing.

We try to evaluate the effect of sildenafil on nocturnal penile erections of potent men. We recruited 22 potent men (eight medical students and 14 urology residents) 23-29 years old into the study. A disorder-free medical and sexual history and normal erectile functions were the only inclusion criteria. All subjects completed three sessions of consecutive nights using the RigiScan Plus device. After a first night of adaptation, night 2 recordings were their baseline values whereas they received sildenafil 100 mg on night 3. We observed statistically significant improvement with regard to those NPT parameters at the nights with sildenafil: number of erectile episodes; duration of tip rigidity >60%, RAU tip, RAU base and TAU tip (P

Nocturnal penile tumescence monitoring was compared to cavernosal smooth muscle content in 48 cases of erectile dysfunction.Pre-operatively nocturnal penile tumescence rigidity (NPTR) testing, colour Doppler sonography and if needed pharmaco cavernosometry-cavernosography were evaluated in 48 impotent patients before surgical intervention. The 40 patients whom all those diagnostic tools were abnormal constituted the first group. In the remaining 8 patients, which constitutes the second group, NPTR testing were normal but the other tests were abnormal. 10 potent patients with congenital penile curvature constituted the third group. Cavernous biopsies were obtained during the surgery and biopsies stained immunohistochemically to quantify smooth muscle cells (SMC) by anti-desmin and anti-SMA.We observed statistical significant difference of corporeal SMC content with regard to first Vs second group and first Vs third group (p0.05). However we did not observe statistically significant difference with regard to second vs third group (p0.05).NPTR testing appears to correlate well with corporeal SMC, which is the key structures of erection. We think that with taking into the consideration of its specific reservations, NPTR testing is still one of the best non-invasive tool in the differential diagnosis of erectile dysfunction.

Bozlu, Murat/0000-0002-8624-0149; Yaman, Onder/0000-0002-1587-0688 WOS: 000184179000018 PubMed: 12845268 Objective: We sought to quantify intracavernosal smooth muscle content (SMC), endothelial cells (EC) and elastic fibres (EF) in both potent and impotent men. We compare the results in impotent men with regard to patient age, aetiology of impotence, presence or absence of diabetes mellitus and smoking. Patients and Methods: Seventy penile biopsies were taken from 10 potent patients with congenital penile curvature (age 1724 years, mean: 21 +/- 1.16) and from 60 impotent patients (age 28-64 years, mean: 46 +/- 7.64). Biopsies were stained immunohistochemically to quantify the percentage of SMC by anti-desmin and anti-SMA, anti-CD-34 for EC and Verhoeff's histochemical staining for EF. Statistical analyses were performed by using one-way Anova after square root transformation. Results: We observed a statistically significant difference in the amounts of corporeal SMC, EC and EF with regard to the following subgroups: potent versus impotent men; men with arterial aetiology versus veno-occlusive aetiology; men under the age of 45 versus men over the age of 45; patients with diabetes mellitus versus non-diabetes mellitus, and smokers versus non-smokers. Conclusion: Quantification of intracavernosal structures appears to be important for either understanding the mechanism of impotence or deciding the appropriate treatment. Copyright (C) 2003 S. Karger AG, Basel.

Epitheloid sarcoma is a rare mesenchymal neoplasm. We had the opportunity to report a case of epithelioid sarcoma of the penis.

Objectives. To present our experience with the Dynaflex (American Medical Systems) self-contained inflatable penile prosthesis and define specific complication and patient dissatisfaction rates. Methods. From May 1990 through January 1998, 120 men underwent implantation of a Dynaflex prosthesis. The follow-up period ranged from 2 to 80 months (mean 42). Results. Specific complication rates observed after penile prosthesis implantation were as follows: prosthetic infection, 4.16%; mechanical device failure, 7.5%; and patient dissatisfaction because of inability to work the pump, 16.66%. After intensive teaching, the patient dissatisfaction rate dropped to 0.83%. The overall complication rate was 14.15%. Conclusions. With several types of penile prostheses available, Dynaflex can be regarded as an appropriate alternative with a relatively low mechanical failure rate. However, careful preoperative assessment and patient education in the use of the pump mechanism are essential to obtain a successful result.

We describe an alternative technique using color flow Doppler sonography (CFDS) for detection of vesicoureteric reflux (VUR). Twenty-one children, ages 2-16 years, were investigated for VUR using voiding cystourethrography (VCU) and CFDS. Forty-two ureterovesical junctions were studied and a total of 27 were found to be refluxing at VCU. Five of these 21 patients were operated for VUR and they were also reevaluated 3 and 6 months after the operation. With good diuresis ureteric jets could easily be detected with CFDS and if there was a reflux of urine into the ureter this could also be displayed. Afterwards, the patient was asked to urinate and if reflux into the ureter was detected, particular attention was paid to the detection of ureteral and pelvicalyceal dilatation by conventional gray-scale sonography. Taking VCU as the gold standard, CFDS revealed reflux in all cases except 1. There were 3 patients who had only one-sided reflux at VCU and bilateral reflux at CFDS examination (false-positive: 20%). Correlation of CFDS and VCU was 90, 100 and 75% in low grade, grade III and grade IV reflux, respectively. The results of CFDS correlated well with the results of VCU during the follow-up of 5 patients who had antireflux operations. As a conclusion, CFDS could be used as an adjunct to standard ultrasonography for detection of VUR.

Five patients with Peyronie's disease were operated and the tissue specimens from the plaque involving the tunica albuginea and from the tunica of the unaffected contralateral side were obtained. The specimens were then subjected to histopathological examination and the findings were correlated with those of men proved not to have Peyronie's disease but operated for other reasons. In the specimen of plaque, the changes varied from collagen destruction to cartilaginous and osseous metaplasia. However, in the tunica of the contralateral side the changes such as disregularity of collagen bundles extending even to widespread focal areas, and appearance of pale, rough, eosinophilic collagen degeneration, instead of its characteristic bright birefringence, and focal mucinous degeneration were noted. Interestingly, these alterations were not observed in the specimens of normal tunica albuginea in the control group. But the existence of minimal alterations, the regularity in the apparently normal contralateral tunica albuginea specimens in Peyronie's disease implied that there was an active turnover in collagen production, and the possible factor causing collagen degeneration and so plaque formation was probably the microtraumatization of the tunica albuginea.

Color flow Doppler sonography (CFDS) has been used to evaluate the blood flow to the testes, because of its ability to visualize small vessels with low flow. A total of 39 infertile men, 18 with clinical varicocele and 21 without, were examined using CFDS to assess the clinical usefulness of this technique. In patients with varicocele, venous diameter in the pampiniform plexus was greater than 2 mm, whereas those without varicocele showed diameters of less than 1.8 mm. Of 21 patients without varicocele on physical examination, 13 were found to have reflux by CFDS. According to clinical and CFDS findings, patients were divided into five groups: varicocele negative, suspicious subclinical varicocele, subclinical varicocele, manifest varicocele with Valsalva-induced reflux, and manifest varicocele. These data suggest that the CFDS technique is a simple, sensitive and noninvasive modality for the accurate diagnosis of varicocele.

Objectives. The traditional treatment for a painful varicocele consists of conservative measures followed by varicocelectomy. We report our results with microsurgical subinguinal varicocele ligation to treat pain. Methods. From 1996 to 1999, a total of 119 men underwent subinguinal microsurgical varicocele ligation for painful varicocele. The diagnosis of varicocele was based on the findings of both physical examination and color Doppler ultrasound. Patients described pain with testicular discomfort as scrotal heaviness or a dull ache. While waiting for the operation (range 3 to 5 weeks), all the patients underwent a preoperative trial of conservative management for pain. Results. Of 119 men, 82 (69 %) were available for follow-up 3 months postoperatively. Of those 82 patients, 72 (88%) reported complete resolution of pain, 4 patients (5%) partial resolution, 5 patients (6%) no change, and 1 patient (1%) epididymal discomfort that resolved with conservative measures. Of the 9 patients with partial or no change, 2 patients had reflux recurrence as seen on color Doppler ultrasound. Conclusions. Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicocele when performed in selected patients.

In patients with adult penile curvatures the aim of treatment is to have a penis straight enough and firm enough to allow satisfactory sexual function. Several operative approaches have been used to correct this condition. Herein, we describe our experience with the evaluation and surgical treatment of 37 patients with penile curvature. When we have decided on surgery, we either preferred to elongate the ventral corpora cavernosa by interposition of a piece of dura mater (2 patients) or in most cases (the remaining 35 patients) only excised wedges of tunica albuginea at the arcs of the maximum curvature located with artificial erection (Nesbit's operation). In conclusion, our results showed that Nesbit's operation is a versatile procedure that proved to be useful for correction of penile curvatures in patients with Peyronie's disease. However, further studies and clinical trials are needed to determine if the dura mater is an alternative in the treatment of penile curvatures due to congenital aetiology.