Patients with a clinical diagnosis of prostatodynia were evaluated by bacteriological, urodynamic and psychological means. In a prospective study 27 patients were entered on a trial of phenoxybenzamine, baclofen and placebo. A 50% symptomatic response was reported with phenoxybenzamine.
The treatment of impotence in diabetic men with vacuum tumescence therapy was studied in a specialist clinic. Of 54 diabetic men referred with impotence, seven declined treatment, three chose self-injection with papaverine, and 44 chose vacuum therapy. Patients underwent autonomic function testing (heart rate response to respiration), measurement of penile blood flow (duplex Doppler scanning), and estimation of serum prolactin and testosterone levels. After 2 months, 33 men (75%) were able to have satisfactory intercourse using vacuum therapy. Three others could produce a satisfactory erection with vacuum therapy but their partners found it unacceptable. Eight men (18%) were unable to have satisfactory intercourse; six of these were later treated by self-injection. The median frequency of use of vacuum therapy was 5.5 (1-26) times a month. Outcome was independent of penile blood flow, autonomic function or endocrine status. Impotent diabetic men should be given counselling and offered a choice of the available treatments. Vacuum tumescence therapy is an effective and simple treatment which requires little investigation.
During transurethral prostatectomy 1-5% glycine in water is commonly used to irrigate the bladder. Absorption of small quantities of this solution is inconsequential. Occasionally, however, large amounts may be absorbed, leading to severe hyponatraemia. Such severe sodium depletion is associated with electrocardiogram (ECG) changes that include a widened and increased amplitude of QRS complex, T wave inversion," and bradycardia. We report on three patients in whom absorption of irrigation fluid during transurethral resection of the prostate led to the death of one and cardiovascular collapse in the other two. Case reportsThree patients aged 76, 62, and 75 admitted with acute retention of urine were treated initially by urethral catheterisation. They were otherwise fit patients, but in one (case 3) the ECG showed ST depression in V4-6 compatible with myocardial ischaemia. All underwent transurethral resection of benign prostate with the Travenol Intermittent Irrigation System using 1-5% glycine solution.Case 1-After roughly 30 minutes of resection under general anaesthesia, during which 18 g of prostatic tissue was removed, the patient's pulse rate fell to 35/min and systolic blood pressure to 60 mm Hg. Myocardial infarction was diagnosed and 1 mg intravenous atropine and 2 units of blood were given without effect, and asystole followed. Cardiac resuscitation failed. Necropsy examination did not show the cause of death. A venous blood sample taken during bradycardia had a sodium concentration of 86 mmol(mEq)/l (normal range 132-144 mmol/l(mEq)/l). Plasma glycine concentration was 80 mmol/l (600 mg/100 ml) (normal range 0-162-0-335 mmol/l; 1-22-2-52 mg/100 ml).Case 2-Under spinal anaesthesia 60 g of prostatic tissue was resected in one hour, and during this the patient became confused and disorientated. The pulse fell to 50/min, and systolic blood pressure fell to 80 mm Hg. A clinical diagnosis of hyponatraemia was made and a blood sample taken for immediate electrolyte analysis. A total of 300 ml of 8-4% sodium bicarbonate was given followed by 1 5 litres of Hartmann's solution. Frusemide 40 mg was given intravenously when the systolic blood pressure had risen to 100 mm Hg. The patient's mental state improved rapidly with this treatment. Blood taken at the time of the diagnosis of hyponatraemia and three hours later showed sodium concentration of 107 and 130 mmol(mEq)/l respectively.The plasma glycine concentration was 50 mmol/l (375 mg/ 100 ml) in the initial blood sample. The total bicarbonate concentration was 32 mmol(mEq)/l (normal range 23-32 mmol (mEq)/l) in the second sample.Case 3-Under general anaesthesia a total of 35 g of prostatic tissue was resected in one hour. The patient was then sent to the recovery room and roughly 10 minutes later had a respiratory arrest, with a bradycardia of 50/min. He was intubated and resuscitated with 200 ml of 8-4% sodium bicarbonate and 2 units of blood. An ECG tracing at this time showed ventricular ectopics, right bundle-branch block, and deep T wave inversion in V4-6...
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