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A 44-year-old man with Trisomy 21 and Eisenmenger's syndrome underwent surgery due to a life-threatening scrotal hernia, containing the bladder, bilateral hydroceles and part of the sigmoid colon. Joint venture plastic and urologic surgery was performed with reposition of the bladder and sigmoid colon into the abdominal cavity, bilateral inguinal hernial mesh repair, left sided orchiectomy, excision of bilateral hydroceles and excision of a major part of the scrotum and recreation of the original anatomy of the penis and scrotum. This Case presents a successful outcome achieved as the patient after one-step-surgery was left to normal condition., (© 2021 The Authors.)

Objectives: Third line treatment of urge urinary incontinence (UUI) and/or reduced bladder capacity is bladder augmentation. The aim of this study was to investigate whether clam enterocystoplasty (CECP) was an efficient treatment for patients who were refractory to conservative treatments of UUI and small functional bladder capacity and secondly if there was a difference in outcome in patients with neurogenic and non-neurogenic bladders. Methods: We evaluated 118 patients retrospectively treated in the period 2006-2018 at a single university hospital. Data were collected retrospectively. Patient groups were compared with Wilcoxon signed-rank test and Fisher's exact test. Results: Overall, 76% became continent with 92% using clean intermittent self-catherization (CISC) of patients with neurogenic bladder, 82% became continent and 100% were using CISC, whereas of patients with non-neurogenic bladder 64% became continence and 77% were using CISC. The median overall improvement of capacity was 296.5 mL (IQR: 142-440), 310 mL (186-467) in the neurogenic group and 214 mL (IQR: 126.8-361.5) in non-neurogenic ( p  = 0.01). Conclusion: CECP is an efficient treatment in UUI and reduced bladder capacity. Difference in outcome was seen with neurogenic patients having a bigger functional capacity and a higher rate of continence compared to the non-neurogenic.

Objectives: This study investigates the effect of urinary division in patients with bladder pain syndrome (BPS) refractory to conservative treatment. This study aimed to identify pre-operative predictive factors regarding the surgical outcome in patients undergoing urinary diversion with or without cystectomy (CX). Methods and patients: This study included 30 patients with BPS treated with a urinary diversion in the period from 2002-2017 at a single university hospital. The surgical procedure was selected on an individual basis, including both continent and non-continent diversions and primary procedure with or without concomitant CX. Pre- and post-operative data were registered retrospectively through medical chart review. Results: Eight patients were treated with primary CX and eight had secondary CX within a short time following urinary diversion (1.45 years in median), mainly due to persisting pain. However, more than half the patients were successfully treated with urinary diversion alone throughout the follow-up period (estimated 58% after 12 years). Nine patients were prior to surgery diagnosed with Hunner's lesions, and these had significantly greater pain relief compared to the remaining 21 patients ( p  = 0.02). The higher success rate of the bladder-preserving procedure was suggested in patients older than 48 years ( p  = 0.09) with less pain pre-operatively, estimated by less than three opioids prior to the procedure ( p  = 0.01). Conclusions: Surgical treatment with urinary diversion should be taken into consideration for refractory BPS, especially patients diagnosed with Hunner's lesions. These results support a bladder-preserving strategy unless the patient is young or has severe treatment refractory pain pre-operative.

Background: A syringocele is a cystic dilation of the ducts from the bulbourethral glands located in the bulbous part of the male urethra. It is a rare condition primarily reported in children and young adults. The objective was to evaluate the diagnostic pattern and management strategy in patients of all ages diagnosed with syringocele. Methods: A retrospective review of patients with syringocele in the period 2004-2018 was performed. Age at diagnosis, primary symptoms, the diagnostic modalities used, treatments and effects were registered. Results: In the period, 19 patients with syringoceles were identified, eight children and 11 adults. The majority of the patients presented with obstructive voiding symptoms. All patients underwent cystourethroscopy. Supplementary diagnostics as voiding cystourethrography, retrograde urethrography, uroflowmetry, magnetic resonance imaging or transrectal ultrasonography were used inconsistently. Sixteen of the patients underwent marsupialization, one child underwent open excision and two patients were managed conservatively. Three of the children were re-operated on with endoscopic marsupialization. One of the adult patients did not respond to marsupialization and was treated with and vesico-appendico-cutaneostomy. Discussion: A review of the case reports published in the period 1996-2018 was performed and compared to these results. This review found 77 cases, 50 children and 27 adults. The reported symptoms, diagnostics and treatments were in line with the findings of this study. Conclusions: Based on these findings and the literature it is recommended that syringoceles should be diagnosed by cystourethroscopy and urethrography. Patients with symptomatic syringoceles should be offered treatment. First line treatment is endoscopic marsupialization.

Neurogenic autonomic dysfunction (NAD) is underdiagnosed, and it is likely in patients, who have orthostatic hypotension and symptoms from multiple organ systems as well as abnormal results from a neurological examination. A clinical and neurophysiological examination of the autonomic nervous system combined with a standardised paraclinical evaluation should be performed. NAD may be present in neurodegenerative disorders, vitamin deficiency, toxicity, infection, and in paraneoplastic, metabolic, hereditary and immune-mediated conditions.

Neurogenic autonomic dysfunction (NAD) and polyneuropathy occur in common conditions like diabetes and alcoholism. However, it can also be seen in rare diseases like in this case report of amyloid light-chain amyloidosis: primary amyloidosis. A 56-year-old man presented with polyneuropathy, a sympathetic dysfunction causing orthostatic intolerance, syncope, parasympathetic dysfunction and involvement of the enteric nervous system. The report illustrates, that routine screening can be insufficient in diagnosing amyloidosis. NAD and polyneuropathy without clear aetiology may require a multidisciplinary elucidation of more rare diseases.

Objective: This study aimed to evaluate the efficacy of treatment for incontinence due to neurogenic detrusor overactivity (NDO) and idiopathic detrusor overactivity (IDO) with onabotulinumtoxinA (BoNT-A) at Aarhus University Hospital, Skejby, Denmark., Materials and Methods: The data were collected retrospectively by systematic review of the patient records from March 2003 to May 2012. Patients treated with BoNT-A over the age of 18 years were included. Treatment indication, diagnosis, adverse events, treatment interval, duration of effect and effect grade were registered. Follow-up data were collected by a telephone interview 4 weeks after treatment., Results: The study identified 219 patients, who received a total of 657 treatments during the period. Full effect of the treatment was experienced in 71%, intermediate effect was seen in 16% and low effect in 3%. There was no difference in effect duration between the IDO and NDO groups. The most common adverse event was the need to perform clean intermittent self-catheterization; 27% of all patients experienced this. Urinary tract infections were reported in 5% of procedures and significant haematuria in 1%. These findings correspond with the results of other published studies., Conclusion: BoNT-A is a safe and effective treatment for incontinence in IDO and NDO.

Contralateral testis biopsy in patients with unilateral testis germ cell cancer is a controversial topic. We present a case of a young male who develops a second testis germ cell cancer despite negative biopsy 30 months earlier. A review of the newest studies and the Scandinavian and European guidelines concerning contralateral testis biopsy is performed.

Objective: The aim of this study was to present experience with ureteral reconstruction using the Yang-Monti technique with reconfigured ileal segments., Material and Methods: Between 2006 and 2010, five patients underwent complete unilateral ureteral substitution with the Yang-Monti technique, whereby short segments of ileum were incised paramesenterically, joined and transversely tubularized to form a neoureter of suitable length and cross-sectional diameter to bridge large ureteral defects. The causes of the ureteral defects were strictly iatrogenic. Two of the five patients were reconstructed acutely, while the others were repaired after 3-5 months with a nephrostomy diversion in the intervening period., Results: Four of the five patients had patent neoureters, while one sustained a stricture, necessitating permanent double-J stenting. Mean follow-up was 41 months (range 13-62 months). Split renal function for two of the patients was markedly reduced but notably with no elevation in creatinine or apparent loss of renal function. Three of the five patients had immediate postoperative urinary leakage at the proximal anastomosis, necessitating drainage, prolonged double-J stenting and/or nephrostomy diversion., Conclusion: In cases of ureteral defects deemed too extensive for traditional reconstruction techniques such as the psoas hitch and/or Boari flap, the technique demonstrated here, using reconfigured ileal segments, is a viable alternative to nephrectomy and autotransplantation. Acute reconstruction within 24 h after the ureteral lesion is also feasible. In general, care must be taken to avoid urinary leakage, particularly at the proximal anastomosis, which may result in prolonged hospitalization and double-J stenting. The protocol should include frequent follow-up to avoid long-term loss of renal function.

Introduction: Endothelium-derived relaxing factors such as nitric oxide (NO), prostanoids, and endothelium-derived hyperpolarizing factor (EDHF) are thought to play an important role in vasodilation of penile arteries., Aim: The present study investigated the mechanisms involved in flow- and acetylcholine-induced vasodilation in penile arteries, and whether acetylcholine- and flow-mediated vasodilation is altered in Zucker diabetic fatty (ZDF) rats, a model of type 2 diabetes. Moreover, it was addressed whether enhanced myogenic tone may explain impaired flow-evoked vasodilation in arteries from ZDF rats., Methods: Penile dorsal arteries obtained from lean control and ZDF rats were suspended in a pressure myograph, and flow- and acetylcholine-evoked vasodilation was measured as changes in arterial diameter., Main Outcome Measure: Changes in penile arterial diameter., Results: Incubation with an inhibitor of NO synthase, asymmetric dimethyl-L-arginine (ADMA), and of cyclooxygenase, indomethacin, reduced acetylcholine but not flow-evoked vasodilation in penile arteries, while both responses were abolished by endothelial cell removal. Iberiotoxin, a blocker of large-conductance calcium-activated K+ (BK(Ca) ) channels, inhibited flow-evoked vasodilation. Flow-evoked vasodilation was reduced in arteries from ZDF rats in the absence, but not in the presence, of indomethacin plus ADMA. Elevation of intraluminal pressure increased myogenic tone, which was reduced in arteries from ZDF rats., Conclusion: The present findings show that flow evokes endothelium-dependent EDHF-type vasodilation involving BK(Ca) channels in penile arteries. Flow-evoked vasodilation is reduced and only of EDHF-type in penile arteries from type 2 diabetic rats suggesting modulation of this pathway may restore endothelial function and preserve erection in diabetes., (© 2012 International Society for Sexual Medicine.)

The prevalence of stress urinary incontinence after prostatic surgery for benign disease is 0-2% and 5-35% after surgery for malignant disease. After radical prostatectomy for prostate cancer spontaneous improvement of stress incontinence occurs up to 1 year after surgery. Medical treatment with doloxetine (a serotonine-noradrenaline-reuptake inhibitor) and minimal invasive treatments like urethral bulking and male sling procedures are only effective against minor stress incontinence. Implantation of artificial urethral sphincter prosthesis remains gold standard for effective treatment and lasting effect.

Dry gangrene of the penis due to ischaemia is a rare condition. In cases previously reported in the literature, the aetiology was end-stage renal failure in combination with severe arteriosclerosis and diabetes mellitus. We present herein two cases of dry gangrene of the penis with two different aetiologies.

Objective: To evaluate the satisfaction level of patients and partners after implantation of a Mentor Alpha-1 inflatable penile prosthesis (IPP) for the treatment of erectile dysfunction (ED)., Material and Methods: A questionnaire was sent to 46 patients who had been operated on for ED with implantation of a Mentor Alpha-1 IPP. The investigation was designed to evaluate patient and partner satisfaction., Results: Eighty-five percent of the questionnaires were returned. Sexual desire had not changed but the quality of sexual activity had significantly improved. Acceptance by the partner was good. Overall satisfaction among both patients and partners was high. In total, 95% of patients said that they would recommend the procedure to other patients in the same situation., Conclusions: Patient and partner satisfaction with the Mentor Alpha-1 IPP was high, with the exception of the minority of patients who experienced unacceptable complications. Infection and mechanical failure are important risks which patients should be informed of before agreeing to implantation surgery.

Objective: To evaluate the complications and prosthesis survival associated with implantation of the Mentor Alpha-1 inflatable penile prosthesis (IPP) for the treatment of erectile dysfunction (ED)., Material and Methods: Between August 1995 and March 2003, 65 patients underwent implantation of a Mentor Alpha-1 IPP at the Urological Departments of Skejby or Aalborg University Hospitals. Patient data were obtained retrospectively from medical files., Results: The follow-up period ranged from 1 to 96 months (median 48.5 months). Twenty-one patients (32%) experienced complications that required revision. The majority of complications consisted of mechanical problems, but infection was also a large contributor to the complication rate. Seven patients (11%) had the prosthesis permanently removed due to infection. Kaplan-Meier estimates of the 5-year prosthesis survival rates with and without successful revisions due to complications were 88% and 63%, respectively., Conclusions: The Mentor Alpha-1 IPP is an efficient treatment for ED in situations where less invasive therapy has failed. The risk of infection or mechanical failure must not be ignored. Patients should be informed of this risk before agreeing to implantation surgery.

Aims: To investigate the feasibility of conditional short duration electrical stimulation of the penile/clitoral nerve as treatment for detrusor hyperreflexia, the present study was initiated., Methods: Ten patients with spinal cord injury, 4 women and 6 men, with lesions at different levels above the sacral micturition center had a standard cystometry performed. During a subsequent cystometry, conditional short duration electrical stimulation of the penile/clitoral nerve was performed as treatment for one or more detrusor hyperreflexic contractions., Results: In all patients, at least one contraction (mean, 7.8; range, 1-16 contractions) was inhibited by the stimulations. The mean cystometric capacity was increased significantly by conditional electrical stimulation, from 210 mL in the control cystometries to 349 mL in the stimulation cystometries (P=0.016). The maximal detrusor pressure during the first contraction in the control cystometries was mean 51 cm H(2)O, whereas the maximal pressure of the first contraction in the stimulation cystometries was reduced to mean 33 cm H(2)O (P=0.045)., Conclusions: The authors conclude that repeated conditional short duration electrical stimulation significantly increased cystometric capacity in patients with spinal cord injury. The increase was caused mainly by an inhibition of detrusor contractions. The need for a reliable technique for chronic bladder activity monitoring is emphasized, as it is a prerequisite for clinical application of this treatment modality., (Copyright 2003 Wiley-Liss, Inc.)

Objectives: To determine the efficacy and safety of fixed-dose oral sildenafil in patients with erectile dysfunction (ED) of various etiologies., Methods: In a 12-week, double-blind, randomized, placebo-controlled, fixed-dose study, 514 men (mean age 56 years) with ED were randomized to receive 25, 50, or 100 mg of sildenafil or placebo. The primary etiology of ED was determined to be organic in 32% of men, psychogenic in 25%, or mixed in 43%. Sildenafil or placebo was taken in the home setting approximately 1 hour before sexual activity, not more than once daily. Efficacy was determined by responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) of the 15-item International Index of Erectile Function (IIEF). Other measures of efficacy included the five sexual function domains of the IIEF, a global efficacy question, event log data, and a partner questionnaire., Results: Sildenafil significantly increased patients' ability to achieve and maintain erections (P <0.0001), with efficacy increasing with increasing dose. Significant improvements were also observed in the IIEF domains for erectile function, orgasmic function, intercourse satisfaction, and overall sexual satisfaction (P <0.0001). The proportion of subjects who felt that treatment with sildenafil improved their erections was significantly greater (67% to 86%) than that with placebo treatment (24%, P <0.0001). The proportion of successful attempts at sexual intercourse also increased significantly with sildenafil treatment (P <0.001). Partner responses corroborated patient reports. Sildenafil was well tolerated at the three doses studied., Conclusions: Oral sildenafil is an effective, well-tolerated treatment for ED of various etiologies.

Objective: To evaluate the outcome and complications after operative correction of sexually disabling penile angulation., Patients and Methods: Between January 1 1987 and December 31 1991, 175 patients underwent operative correction of penile angulation due to Peyronie's disease (57 patients) or congenital curvature (118 patients). Thirty two patients were treated by plication of the tunica albuginea and 143 by the Nesbit procedure. Post-operatively 91% of the patients were seen in the out-patient clinic after 3-5 months. A questionnaire sent to all patients 6-60 months after surgery was returned by 74% of the patients, and the present results are based on the most recent information obtained., Results: In the plication group good or acceptable results were obtained in 12 of 32 patients (38%) after the first operation, and in a further nine patients (22%) after a second operation. In the Nesbit group 126 of 143 patients (88%) obtained good or acceptable results after the first operation and a further seven patients (5%) reported success after a second operation. The failures in the Nesbit group were due mainly to post-operative erectile dysfunction in patients with Peyronie's disease, in contrast to the plication group where failures were primarily due to recurrence of angulation., Conclusion: Operative correction of penile curvature is a reasonably safe procedure, but should not be performed solely for cosmetic reasons. In the present retrospective study the results were better after the Nesbit procedure compared with plication of the tunica albuginea. However, a review of the literature does not give support to one operative technique over the other. This can only be clarified by performing a prospective randomized trial.

In the period February 1991 to February 1992, 12 patients underwent penile vein resection as described by Tom Lue for erectile dysfunction caused by venous leakage. The median age of the patients was 43.7 years (range 23 to 46 years). Two patients had haematoma and two had penile oedema postoperatively. Both conditions resolved spontaneously within two weeks. At the first follow up six weeks postoperatively, 10 patients were able to have normal intercourse. After six month this number had declined to eight. After a follow-up period of 18 to 30 months only four patients were able to have intercourse. One of these needed self injection with papaverin/phentolamine. Because of the poor results, penile vein resection as described by Tom Lue cannot be recommended as a routine procedure in patients with erectile dysfunction caused by venous leakage. However the operation may be relevant in younger patients with penile venous leakage, where there are no concomitant causes of the erectile failure.

In human penile corpus cavernosum strips, pre-contracted by noradrenaline, electrical stimulation of nerves evoked non-adrenergic, non-cholinergic (NANC) relaxant responses which could be inhibited by tetrodotoxin 10(-6) M, NG-nitro-L-arginine (L-NNA) 10(-7)-10(-4) M, and oxyhaemoglobin 10(-5) M, but not by methylene blue (MB) 10(-5) M. Acetylcholine-induced relaxations were also inhibited by L-NNA 10(-4) M and oxyhaemoglobin 10(-5) M, but were unaffected by pyrogallol 10(-4) M, MB 10(-5) M, and tetrodotoxin 10(-6) M. MB 5 x 10(-4)-10(-4) M significantly reduced the responses to both electrical stimulation and to acetylcholine. Nitric oxide (NO) 10(-7)-10(-4) M and sodium nitroprusside 10(-9)-10(-4) M caused concentration-dependent relaxations. The NO-induced relaxations were inhibited by oxyhaemoglobin 10(-5) M, and the concentration-response curve for sodium nitroprusside was shifted to the right by MB 10(-5) M. The response to sodium nitroprusside was unaffected by L-NNA 10(-4) M, oxyhaemoglobin 10(-5) M, and pyrogallol 10(-4) M. In circumflex veins, pre-contracted by noradrenaline, no NANC-mediated relaxation was found in response to electrical stimulation; acetylcholine caused endothelium-dependent relaxations, which were insensitive to L-NNA 10(-4) M and oxyhaemoglobin 10(-5) M. NO and sodium nitroprusside caused concentration-dependent relaxations; the concentration-response curves for NO and sodium nitroprusside were shifted to the right by oxyhaemoglobin 10(-5) M. Removal of the endothelium left the NO- and sodium nitroprusside-induced relaxations unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

The mechanical effects of the prostaglandins PGE1, PGE2, PGF2 alpha and PGI2 were investigated in human isolated penile circumflex veins (CV) and corpus cavernosum (CC) tissue. PGE1 did not affect resting tension, while the compound produced relaxation of both CC and CV preparations after precontraction with noradrenaline (NA) 3 x 10(-6)M. PGE2 produced contraction in CC and CV preparations. After precontraction with NA, however, relaxation was induced in both tissues. PGF2 alpha induced contraction in CC and CV preparations, while no relaxant responses were seen in preparations precontracted with NA. PGI2 produced no mechanical effects in unstimulated CV preparations, whereas dose-related contraction was induced in CC tissue strips. After precontraction with NA, PGI2 showed no effect in 2 of 6 CC preparations, while relaxation was seen in 4. In CV preparations precontracted with NA, PGI2 produced relaxation. Local synthesis of prostanoids may influence resting tension and modulate NA-induced responses not only in human penile CC but also in CV smooth muscle.

The intracavernosal pressure changes induced by 3 vasodilating drugs, diazoxide, glyceryltrinitrate and verapamil were investigated during autologous extracorporeal penile blood perfusion in an experimental rabbit model. In order to separate the arterial and venous components the experiments were performed with both intact and interrupted penile arterial inflow. The major hemodynamic effect of these drugs was an increased outflow resistance from the corpora cavernosa, probably effected through relaxation of the corporal smooth muscle. However, the intracorporeal pressure responses only reflected a part of the drug-induced smooth muscle relaxation. A theory is presented, according to which the corpora cavernosa are 'accumulating' smooth muscle relaxation, without direct reflection in an increased cavernosal pressure. At the moment when sufficient smooth muscle relaxation is achieved, a sudden increase in cavernosal pressure will appear and lead to an erection. This concept was generated through an approximation of corpora cavernosa to an elastic cylinder following the elastic law of Laplace in combination with the hydrodynamic law of Poiseuilles.

In anesthesized white rabbits blood was extracorporeally circulated from the left carotid artery into the penile corporeal bodies with a constant flow rate. Corpus cavernosum pressure (CCP) responses to intracavernous injections of drugs were recorded in animals with aortic nonocclusion and aortic occlusion, respectively. Vasoactive intestinal polypeptide (VIP, 1 microgram, 5 micrograms, and 20 micrograms), dissolved in 0.5 mL volumes, induced no significant increases in CCP compared with equivalent volumes of solvent, but the peptide increased the time interval until return of CCP to steady state level. Peptide histidine methionine induced a significant increase in the maximal CCP obtained in nonocclusion, and the time interval until return of CCP to steady state levels was increased in both aortic nonocclusion and occlusion. Neuropeptide Y produced an increase in the maximal CCP in animals with aortic occlusion, and a minor increase in the time interval until return of CCP values to steady state levels in both aortic nonocclusion and occlusion. Thus, all the peptides tested were capable of influencing the smooth muscle tissues involved in penile outflow regulation.

Functional effects of endothelin-1 (ET-1) were investigated in isolated preparations of human and rabbit corpus cavernosum (CC) and human penile circumflex veins (CV). In all preparations, ET-1 induced slowly developing, concentration-dependent contractions. The threshold concentration of ET-1 in CV was approximately 10 and 112 times lower than the threshold concentrations in human and rabbit CC, respectively. Furthermore, the contractions in CV reached a defined maximum at 10(-7) M ET-1 (-log EC50 = 9.12 +/- 0.17), whereas no maximum was obtained in CC preparations within the concentration range used (less than or equal to 3 x 10(-7) M). Pretreatment with the Ca++ channel blocker nimodipine partly reduced the ET-1-induced contractions in human and rabbit CC, but had no significant effect on CV preparations. In a Ca(++)-free medium containing the chelator ethyleneglycol-bis-(beta-aminoethylether)-N,N'-tetra-acetic acid, the contractions induced by ET-1 were reduced, but not abolished, in all preparations. The contractions induced by ET-1 are thus mediated mainly by influx of Ca++, although there seem to exist differences in the relative contribution of L-type Ca++ channels in CC and CV. Furthermore, additional mechanisms beside Ca++ influx are likely to be involved in both tissues. A high density of [125I]ET-1 binding sites was observed throughout the stroma and in the muscle layer of the deep penile artery in both human and rabbit CC. In the human CV, numerous binding sites were observed, but no clear difference between the various structures of the vessel wall could be detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Localization and functional effects of vasoactive intestinal polypeptide (VIP) and peptide histidine methionine (PHM), two peptides derived from a common precursor molecule, were investigated in isolated preparations from human penile corpus cavernosum (CC) and circumflex vein (CV). VIP- and PHM-immunoreactivity (IR) was demonstrated in both CC and CV. The concentrations of VIP-IR and PHM-IR in CC tissue were 54.4 +/- 15.3, and 42.0 +/- 7.5 pmol g-1 wet weight respectively with a VIP/PHM ratio of 1.5 +/- 0.4 (mean +/- SEM). The corresponding values for CV tissues were 28.0 +/- 7.7 and 9.6 +/- 2.6 pmol g-1 wet weight with a VIP/PHM ratio of 3.1 +/- 0.4. CC and CV displayed VIP- and PHM-IR confined to nerve fibres in close relation to bundles of smooth muscle cells and blood vessels in both tissues. In vitro, VIP and PHM had no effects in unstimulated tissue preparations. Both peptides concentration-dependently (10(-9)-10(-6) M) relaxed CC and CV preparations precontracted with 3 x 10(-6) M noradrenaline. In CC the maximum relaxant effect of VIP and PHM was 22 +/- 11% and 9 +/- 9% and in CV the corresponding values were 82 +/- 8% and 93 +/- 3% respectively. The present study supports the hypothesis of VIP and PHM as neurotransmitters and/or neuromodulators in the nervous control of penile erection.

The impact of female sex hormones on the rhythmic urethral pressure variations (UPV) was analysed based on data from one hour urethral pressure recordings from 10 healthy fertile female volunteers measured three times during the menstrual cycle and from 12 healthy postmenopausal women measured twice within two months. The mean maximum urethral pressure (mMUP) and the mean maximum urethral closure pressure (mMUCP) had a median value of 66.5 (Interquartile 58.0-86.0) and 60.0 (49.0-80.0) cm.H2O respectively in the healthy fertile females. The postmenopausal women had a significantly lower mMUP and mMUCP of 55.5 (48.5-58.5) and 43.5 (35.5-47.0) cm.H2O) respectively. Rhythmic UPV was recorded inhealthy fertile and postmenopausal women. Frequency analysis of the UPV revealed a frequency spectrum from 0.0015 to 0.035 Hz on top of which were respiration fluctuations and vascular pulsations. The UPV amplitude was related to the mMUP and increased with increasing mMUP. The parameters analysed were stable during the menstrual cycle and during menopause. Thus no difference in the UPV frequencies or amplitudes was observed between the healthy fertile and the postmenopausal women. The investigation shows that the pressure variation in urethra apparently is not modulated by female sex hormones.

The concentration and distribution of neuropeptide Y (NPY) within the penile corpus cavernosum (CC) and in penile circumflex veins (CV) from healthy potent males was investigated by immunochemistry and immunohistochemistry. The concentrations were assessed to 28.6 pmol/gm. (CC) and 15.8 pmol/gm. (CV) respectively. Gel filtration on CC tissue extracts demonstrated a single peak of NPY-immunoreactivity (NPY-IR) similar to synthetic human NPY. The NPY-IR was confined to nerve fibers seemingly innervating smooth muscle cells. In vitro myographic examinations demonstrated contractile activation by NPY in 2/8 CC strips and in 5/8 CV strips. The mean contractile force was 1.17 +/- 0.62 mN (18.3 +/- 15.8% of the K(+)-induced contraction) and 2.42 +/- 0.42 mN (31 +/- 12%) respectively. NPY 10(-7) and 10(-6) M displayed a potentiating effect on the response to NA 10(-9) in one of six CC and four of six CV preparations. It is suggested that NPY could add to the contractile effect of NA in detumescence and in maintenance of the resting state; contribution of NPY to the veno-occlusive mechanism at initiation of erection is another putative physiological function.

Infusion cavernosography with the object of quantitating the rate of venous drainage from the penis and localization of possible abnormities in drainage was employed as a routine investigation in examination of erectile dysfunction in 46 patients. "Infusion to obtain erection" (IOE) and "infusion to maintain erection" (IME) were determined. In five patients, IOE was found to be greater than 180 ml/minute which was considered to be diagnostic of venous leakage. Infusion cavernosography could be assessed in 31 patients. Filling of the glans with the radio-opaque medium was found before rigidity was obtained in 27 whereas, in 19 filling of the glans occurred after rigidity was obtained. No localizing fistulae were demonstrated. It is concluded that routine employment of infusion cavernosography in investigation of impotence is unnecessary. Filling of the glans with the radio-opaque medium in infusion cavernosography does not appear to be a sign of a cavernoso-spongious fistula but rather a physiological phenomenon.

We studied consecutively 46 males, median age 36 years (range 16-59), diagnosed as bladder neck dysfunction (BND) according to a urodynamic investigation. The diagnosis was based on a prolonged opening time (greater than 04 sec) in the pressure-flow investigation and absence of organic obstruction and neurologic disease. Median duration of symptoms was 24 months (range 1-240). The most frequent symptoms were poor stream (in 70%), frequency (50%) and dribbling (37%), while 30 % had nocturia, and 20% urgency, dysuria or perineal pain during voiding. Thirty-two % had one or more urinary tract infections. We found no correlation between urodynamic findings and symptomatology in terms of total symptom-score or -duration. Median opening time was 10 sec. Patients with shorter opening time were found to have significantly greater Qmax, while the rest of the parameters did not differ. Concerning single symptom-items we found a significant correlation between small bladder capacity and frequency and nocturia but no correlation between obstructive symptoms and the pressure at the bladder neck or the urethral resistance factor. Previously used classifications of BND patients on basis of micturition pressure or response to acute alpha-blockade were not found to be of use and it is concluded that future research should be directed towards a better definition of outflow resistance which then may be used both diagnostically, prognostically and as a therapeutic aid.

To prevent nocturnal erections after penile surgery a randomized, double blind trial of nocturnal intracavernous infusion of noradrenaline (10 micrograms per hour) versus placebo in 20 patients was carried out. During infusion the corpus cavernosum pressure was continuously registered. The patients made a record of nocturnal erections and associated pain. The pressure registration confirmed total absence of erections in the noradrenaline group. In the placebo group half of the patients were devoid of nocturnal erections. No signs of ischaemia was seen, but in four patients receiving noradrenaline infusion was stopped due to pain. This treatment seems effective in preventing nocturnal erections after penile surgery.

Intracavernous injection of papaverine was tested in a group of 29 patients with multiple sclerosis and erectile dysfunction. Acceptable rigidity was obtained in 27 patients of whom 23 started to use self-injections as treatment. During an observation period of 5-12 months (mean 8.5 months) a total of 297 injections (3-35 per patient) were reported and 272 injections (92%) produced rigidity in 8-480 min. One case of priapism was seen. Minor haematomas or ecchymoses were reported in 16 cases. Two patients developed penile indurations after 6 and 19 injections respectively; one of these indurations resolved spontaneously. Self-injection with papaverine was found to be a safe and well-accepted treatment of erectile dysfunction in multiple sclerosis but long term side effects need further elucidation before the treatment is to be used as a routine procedure.

The historical background for the use of sleep-related erections (nocturnal penile tumescence) to distinguish organogenic from psychogenic impotence is reviewed. A commercially available system for continuous, non-invasive measurement of penile tumescence and rigidity is presented.

Sixty-seven patients, aged 3-71 years, with primary hydronephrosis were operated at our department during a 5-year period. All patients had Anderson-Hynes pyeloplasty. The primary clinical result of surgery was excellent in 63 patients (94%). Of the patients with reduced renographic uptake fraction preoperatively, 38% had a significant gain 6 months after reconstruction, while only 1 patient had a reduction. There was no correlation between the outcome of reconstruction and preoperative history, degree of hydronephrosis on IVP, preoperative functional share on renography or the peroperative finding of aberrant vessels compressing the ureter. It was concluded that surgery should be undertaken on rather wide indications as reconstruction leads to stable or improved renal function regardless of preoperative symptoms or diagnostic findings.

Over a 27 months period papaverine induced erections were routinely used in the treatment of erectile dysfunction (ED). A total of 53 patients, 29 with neurogenic, 20 with arteriogenic, one with a combined arteriogenic/neurogenic ED and 4 with ED of uncertain etiology, in total used 1149 injections, of which 1069 (93%) produced erections with a rigidity sufficient for vaginal penetration. Fifteen patients discontinued treatment during the observation period. Nine patients experienced sustained erections on 16 occasions; all cases were managed by aspiration of blood and/or injection of adrenergic drugs. Penile indurations occurred in three cases, one of which resolved spontaneously. Papaverine induced erections was found to be an effective and well tolerated tool in the treatment of erectile dysfunction.

Priapism (P) may develop from unknown causes or may occur secondary to other disease or as a side effect of medication. The occurrence of pharmacologically induced erection by intracavernous injection of drugs has resulted in a number of cases of iatrogenic priapism. Priapism may be ischaemic or non-ischaemic and determination of the acid-base status in the cavernous blood may be of value in the choice of treatment. The non-ischaemic cases should be treated primarily by aspiration of blood, possibly followed by intracavernous injection of a vaso-constrictive agent, eg 15 micrograms adrenaline or noradrenaline, repeated if necessary. Cases which do not respond to this and severe ischaemic cases should be treated with glando-cavernous anastomosis.

In a sample of 29 impotent men with multiple sclerosis and erectile problems, penile arterial inflow and venous outflow were within normal limits. In 26 patients, the pudendal evoked potential (PEP) was abnormal, and eight of these also had abnormal bulbocavernous reflex (BCR). Three patients had abnormal PEP and normal BCR, and of these, two had normal and one had abnormal nocturnal erectile activity. The validity of PEP/BCR testing was supported by normal findings in six patients with MS and without erectile problems. Nocturnal erectile activity was normal in 11 patients, of whom nine had abnormal PEP and/or BCR. A high disability score corresponded poorly with both reduced sexual function, insufficient nocturnal erectile activity, and abnormal PEP and/or BCR. Intracavernous injection of papaverine gave erection in 27 patients, the dose needed to create an erection being inversely related to the level of disablement. PEP and BCR testing may be more sensitive in defining neurogenic erectile dysfunction (ED) than nocturnal erectile activity. We considered 26 of the cases to have a neurogenic cause of ED and three to have mainly a psychogenic cause.

We investigated 8 male patients, age 28-51 years, mean 35, with symptoms of bladder neck dysfunction by means of repeated water-cystometry. We made four cystometries with different patient positions and filling rates followed by a further two cystometries after an interval of 8 days. We found no difference in bladder volumes at first sensation and maximal capacity between the different investigations, irrespective of patient position and filling rate. It was concluded that data obtained by water cystometry may be regarded as absolute.

Urethral pressures are usually considered to be static and only few authors have emphasized time-related pressure changes. We conducted a study on 10 healthy male volunteers, monitoring the urethral pressures at maximal urethral closure pressure, 2.5 cm proximal (bladder neck) and 2.5 cm distal (pars bulbosa) respectively over 30 min periods. At the bladder neck only sporadic waves were seen. At maximal closure pressure almost permanent oscillations were found, the wavelengths and amplitudes showing big differences. At the pars bulbosa 2 persons showed only sporadic oscillations and in 7 we found permanent pressure variations. The pressure variations are proposed to represent peristaltic activity with the ability of expelling the last drops of urine after micturition and posing a mechanical barrier to ascending microorganisms.