Erectile dysfunction (ED) commonly occurs in approximately 15% of men over 70 years old. A number of causes of this condition are recognised with the major mechanism of ED being an impaired relaxation of the corpus cavernosum (CC) smooth muscle and resulting reduction in penile blood flow. There are reports that ED is associated with a reduction in local levels of endothelium-derived nitric oxide (NO) with most studies focussing on the potential role of endothelial nitric oxide synthase (eNOS) in the erectile process. Since there is a recognised neurogenic component of ED we have studied altered nerve density and neuronal nitric oxide synthase (nNOS) distribution by immunohistochemistry and nNOS protein expression by western blot analysis in penises from patients with neurogenic ED and diabetes compared with control tissue obtained from patients undergoing gender reassignment. There was a significant reduction in nerve density in tissue from ED compared with control patients (P < 0.05). Immunostaining for nNOS colocalised with nerves and was reduced in ED tissue, as were nNOS protein levels. We have shown that nerve degeneration observed in penile tissue from ED patients is accompanied by a decrease in nNOS suggesting that reduced neuronal- as well as endothelium-derived NO plays a role in this condition.
Objectives: To prospectively compare the performance of voided urine cytology (VUC) and the Matritech NMP22 BladderChek ® assay (NMP22) in their ability to detect urothelial transitional cell carcinoma (TCC). Methods: Successive patients presenting to our haematuria clinic were enrolled. All patients underwent ultrasound scan (US), intravenous urography (IVU), flexible cystoscopy and VUC. If bladder TCC was detected, urine was tested using the NMP22 BladderChek ® assay. The study group (group I) comprised 110 patients diagnosed with bladder tumour on flexible cystoscopy. The control group (group II) included 52 patients with a history of haematuria but no demonstrable bladder tumour. The TCC detecting ability of both the NMP22 BladderChek ® assay and VUC were compared. Results: In group I, the NMP22 result was positive in 62.7% (69/110) patients, while a positive VUC result was noted in 52.0% (52/100) patients. The overall sensitivity, specificity, positive predictive and negative predictive values for NMP22 vs. VUC were 62.7% vs. 52.0%; 86.5% vs. 95.5%; 90.8% vs. 96.3% and 52.3% vs. 48.0% respectively (not significant). The performance of both urine tests improved with increasing tumour grade (p ≤ 0.05). False positive rate in group II was 13.5% (7/52) for NMP22 and 4.5% (2/42) for VUC.
Paratesticular leiomyosarcoma is a rare tumour. It is seldom diagnosed pre-operatively and subsequent secondary resection is often required. Current treatment consensus comprises inguinal radical orchidectomy with high ligation of the spermatic cord. We present a case of a 74-year-old male with a 3-year history of a painless right-sided scrotal mass which following excision was found to be an epididymal leiomyosarcoma. A review of literature and treatment is presented in this article.
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