Alternative minimally invasive methods treating benign prostate hyperplasia (BPH) have become more and more important. Transurethral needle ablation (TUNATM) has been demonstrated to be effective in both canine and the human prostate. The goal of our study was to prove the safety, feasibility and tolerance of this new procedure. In this prospective nonrandomized study, 33 patients underwent TUNATM-treatment. One, 3 and 6 months postoperatively, follow-up examinations were carried out assessing urodynamic parameters such as urinary flow rates, residual urine levels, and IPSS-scores. During the last visit additional cystomanometry and urethrocystoscopy were done. Six months postoperatively IPSS-score and residual urine volumes were decreased by 50% (range: 1–72%) and 75% (range: 12–97%). Improvement in maximum flow rate was 63% (range: 5–125%). No serious postoperative complications occurred. After a short ‘learning period’ most of the treatments where performed as an out-patient-procedure so the patients could leave the hospital without the need for indwelling catheters. The TUNATM appears to be a minimally invasive and safe out-patient procedure for the treatment of selected cases of BPH.
Variations of Hauri’s penile revascularization have been in clinical use since 1983. The hemodynamics of the so-called three-vessel anastomosis remain uncertain despite successful, clinically reproducible results. The goal of this study was to depict the increased perfusion of the erectile system of the penis following revascularization by means of the inferior epigastric artery. Ten mil-liliters of heparinized peripheral venous blood was drawn from 10 patients prior to surgery. The radioactively tagged erythrocytes (1 mCi 99mTc) were reinjected via an additional incision in the donor vessel proximal to the anastomosis following completion of the three-vessel anastomosis and intracaver-nous injection of 20 µg PGE1 Once again, blood was drawn during the tumescence phase from both a peripheral vein and the corpora cavernosa within the normal circulatory duration and compared to the original specimen. Eight of ten patients displayed evidence of primary reperfusion of the corpora cavernosa via the inferior epigastric artery as the donor vessel. Using strict indications, revascularization of the penis is an effective mode of therapy for arterial erectile dysfunction.
Summary. The purpose of this study was to analyse long‐term results of penile revascularization using Hauri's method in 124 patients with a mean follow‐up of 54 months. Of 176 patients undergoing this procedure, 124 were available for detailed analysis. The patients ranged in age from 22 to 71. A total of 25.8% of the patients (32/124) responded to intracavernous injection (ICI). Postoperatively, 74 patients (59.7%) exhibited spontaneous erections. Patients were classified as ‘satisfied’ or ‘dissatisfied’. In those who were satisfied, a high correlation was found (63/74=85%) between graft patency, as judged by ultrasound, and erectile function. The benefit for non‐responders to ICI (60/92) was higher than for responders (14/32). Only five of 12 diabetics profited from penile revascularization. A serious complication was glans hyperemia in 9/124 cases (7%).
Based on this experience, the following indicators are recommended for case selection: (i) non‐responder to ICI; (ii) age less than 55 years; (iii) nondiabetic; (iv) cavernous leakage excluded; (v) stenosis in the internal pudendal artery.
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