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 23 hydronephrotic kidneys in 10 male and 12 female patients (mean age 32 years) with diuresis renography and simultaneous, continuous renal pelvic pressure measurement to compare isotope washout with pelvic pressure changes. No correlation was found between these 2 parameters. Of the kidneys 14 were investigated further by a standard Whitaker pressure flow study. There was only a poor correlation between diuresis renography and the pressure flow study, and between the pelvic pressures during perfusion and forced diuresis. Impaired renal uptake fraction signifying the degree of obstructive nephropathy did not correlate with the dynamic tests. An Anderson-Hynes pyeloplasty was done in 19 patients. There was no correlation between the presence of organic stenosis or external compression and the outcome of the diagnostic tests. We concluded that the currently used diagnostic procedures for hydronephrosis generally are insufficient to discriminate between significant and nonsignificant obstruction.
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.
Seven procedures had to be converted to open procedures for the following reasons: poor visualization of the renal hilum (n = 5); bleeding from a splenic laceration (n = 1); and difficulty finding the kidney via a retroperitoneal approach (n = 1). The median operating time was 190 min, which decreased with experience. The median blood loss was 150 ml. There were two major complications (one small bowel perforation and one port-site herniation, both necessitating re-exploration) and seven minor complications (five infections, one case of temporary hip pain and one of surgical emphysema). Conclusions. Laparoscopic nephrectomy is a technically demanding procedure with the risk of serious complications, especially in the initial learning phase. However, after gaining experience the procedure can be performed with an acceptable operating time, minimal morbidity and a short hospital stay. Laparoscopic nephrectomy should be the standard procedure in most cases, both malignant and benign, with the possible exception of tumours > 10 cm. In order to expand the use of the technique, it is important to focus specifically on laparoscopic training in the education of trainee urologists.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.