Congenital arteriovenous malformations in the true pelvis are extremely rare: only 7 cases have been described in male patients. We report on a patient who presented with massive hemorrhage after transrectal prostatic biopsy and transurethral resection of the prostate. Diagnosis was established by means of magnetic resonance imaging and confirmed by arteriography. Our attempt at management by embolization and subsequent surgical ligation is described. A literature review and discussion of arteriovenous anomalies are presented.
Although papaverine-phentolamine preparations are being employed for pharmacologic erection programs across the nation, their chemical properties have not been described in the literature. We found that the pH of papaverine-phentolamine solution in all concentrations tested remained less than 4.0. Attempts to buffer the solution resulted in a precipitate at a pH greater than or equal to 5.0. The pH of prostaglandin E1 was less than 5.0 but could be easily buffered to pH 7.4 or even 10.75 and remained stable. The effect of an acidic solution on corporal connective tissue and smooth muscle meshwork is unknown. We believe that buffering by blood will lead to the precipitation of papaverine-phentolamine and may cause primary intracorporal scarring. Extravasation or improper injection into the subcutaneous tissue exposes the mixture to blood and may secondarily result in additional scarring for the same reason. Therefore, prostaglandin E1 may be a more appropriate agent for penile injection.
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