Erectile dysfunction is common in patients with pelvic fractures associated with urethral injury. We believe that erectile function should be assessed and documented in such patients before attempting urethroplasty. In the majority of these patients erectile dysfunction is caused by disruption of the cavernous nerves with sparing of arterial inflow.

The authors reviewed the radiographic findings in 19 patients with phytobezoars of the small bowel. The most common predisposing causes were previous gastric outlet surgery and persimmon ingestion. Twelve patients underwent contrast material-enhanced studies of the upper gastrointestinal tract, and one patient underwent a barium enema study. These examinations revealed four gastric, two duodenal, and eight small bowel phytobezoars in 10 patients. The obstruction caused by small bowel phytobezoars frequently occurred in the jejunum or proximal ileum, more proximally than has been reported in previous series. Barium studies are useful in differentiating obstruction due to postoperative adhesions from obstruction caused by bezoars. In addition, barium studies enable the detection of residual gastric bezoars. This information has important implications in patient treatment because bezoar obstruction is unlikely to respond to conservative treatment, and concurrent gastric bezoars must be removed to prevent recurrent bowel obstruction.

Endovascular treatment with stent grafts in complicated access aneurysms is a simple, safe and rapid ambulatory procedure that enables treatment of both the aneurysm and its accompanying draining vein stenosis. It enables continued cannulation of the existing access and avoids the use of central catheters.

Heparin-bonded grafts demonstrated a trend to improved patency, but the difference was not statistically significant. Heparin-bonded grafts had a significantly lower early thrombosis rate that was sustained only for the first 5 months of follow-up.

From March 1995 to May 1997, 104 patients underwent 115 supracostal percutaneous nephrolithotomy (PCNL) procedures for the treatment of 102 complete staghorn calculi, 6 large semistaghorn calculi, 3 large upper-caliceal stones, and 4 significant volumes of residual stone fragments after SWL. Additional renal access was required mainly for complete staghorn stones (23 patients; 20%). Extracor poreal lithotripsy was performed in 30.4% of cases, and second-look PCNL was done in 15.6%. The stone-free rate was 87%, and the infection-free rate at 7 to 33 months was 88.5%. Among 115 supracostal PCNL procedures, complications were encountered in 10 (8.7%). These problems included four large pleural effusions that were drained by chest tube in three patients and by repeated thoracocentesis in one patient. Six patients developed significant atelectasis, which was treated by vigorous physiotherapy in five and flexible bronchoscopy in one. We conclude that the supracostal approach provides direct and optimal access to most staghorn calculi with an excellent stone-free rate. The advantages of this approach can be achieved with a slight and acceptable increase in morbidity.