Testicular microlithiasis occurs in more than 5% of healthy young men. In contrast, testicular cancer develops in 3/100,000 to 5/100,000 men or 1,000-fold less often. The relative prevalence of testicular microlithiasis with respect to testicular cancer, increased prevalence in minorities, bilateral distribution, and inverse geographic distribution of men with testicular microlithiasis and testicular cancer represent evidence against an association of the 2 conditions. This study indicates that testicular microlithiasis is a common finding in asymptomatic men that may not be related to testicular cancer.

Chronic pain syndromes are well known to the medical community. The incidence of chronic pain syndromes and cost of evaluating these patients are rapidly increasing. Chronic testicular pain is a fairly common manifestation of a chronic pain syndrome. Retrospectively, we reviewed the records of 48 patients with chronic testicular or scrotal pain (greater than 6 months) evaluated at our institution during the last 7 years. These patients had multiple diagnostic and interventional procedures with few positive findings. There was little improvement in these patients after multiple surgical procedures. Based on the paucity of objective clinical findings a carefully directed diagnostic evaluation for orchialgia is outlined. The treatment of these patients is best managed by a multidisciplinary approach involving the urologist and a pain clinic environment. We believe that extensive diagnostic testing is not indicated in the absence of clinical findings and may serve to worsen the condition or lead to iatrogenic injury. Surgical intervention should be limited to cases when a clear indication is present.

Erectile dysfunction develops in greater than 80% of patients treated for prostate cancer. External beam radiation has the same risk for erectile dysfunction as radical prostatectomy.

Testicular microlithiasis occurs in more than 5% of healthy young men. In contrast, testicular cancer develops in 3/100,000 to 5/100,000 men or 1,000-fold less often. The relative prevalence of testicular microlithiasis with respect to testicular cancer, increased prevalence in minorities, bilateral distribution, and inverse geographic distribution of men with testicular microlithiasis and testicular cancer represent evidence against an association of the 2 conditions. This study indicates that testicular microlithiasis is a common finding in asymptomatic men that may not be related to testicular cancer.

Testicular cancer will not develop in the majority of men with testicular microlithiasis (98.4%) during a 5-year followup interval. We believe that an intensive screening program for men with testicular microlithiasis is not cost-effective and would do little to improve outcomes associated with testicular cancer. We continue to recommend testicular self-examination in men at risk.

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KEY WORDS: diabetes mellitus, penile erection Diabetes mellitus affects more than 6.2% of the population in the United States. Therefore, more than 8 million American men have the potential of being affected by diabetes mellitus induced erectile dysfunction (DMED). 1 An association between diabetes mellitus and the development of erectile dysfunction has been documented in the literature since 1798. 2 In fact, DMED represents one of the largest groups of erectile dysfunction. Between 25% and 75% of men with type 2 diabetes will complain of erectile dysfunction. 3 In numerous epidemiological studies the odds ratio of having erectile dysfunction if a man is diabetic is 1.9 to 4 times greater than a population without diabetes, making diabetes one of the greatest risk factors for erectile dysfunction. 4, 5 The incidence of DMED has been shown to be age associated. By the age of 30 years approximately 15% of diabetic men have erectile dysfunction, whereas by the age of 60 years 55% will have it. 6 -8 Not only does erectile dysfunction occur at a higher frequency in younger patients with diabetes, but also DMED occurs at a greater frequency across all age groups.As the treatment of diabetes improves and patient life spans increase, the importance of quality of life issues in the treatment of diabetes becomes more prominent. Diabetic patients with erectile dysfunction have a significantly poorer quality of life demonstrated by self-reported quality of life indexes. The focus of diabetic therapy in the year 2002 is now directed toward decreasing the sequela of diabetes mellitus, including erectile dysfunction. A review of the mechanisms responsible for causing DMED and a focus on the clinical manifestations of diabetic erectile dysfunction will lead us to improved prevention and treatment of DMED. The purpose of this article is to review research, and preclinical and clinical information related to DMED, and discuss possible treatment, prevention strategies and future goals needed to improve our understanding of the unique pathophysiological attributes of diabetes and erectile dysfunction. MECHANISM OF DMEDA significant amount of basic science research has greatly elucidated numerous possible mechanisms for DMED at the cellular and molecular level. This extensive body of literature using animal models of diabetes mellitus and human cavernosal tissue from diabetic men has suggested the multifactorial mechanism of DMED. No single mechanism is responsible for DMED. An overview demonstrates that multiple mechanisms act synergistically to initiate DMED at an early age, leading ultimately to irreversible cavernosal damage. The goal of diabetic erectile dysfunction research is to translate present animal research into clinical paradigms that will be useful in improving and optimizing treatment for DMED. Controversy exists regarding key mechanisms for DMED at the basic science level. This body of literature, however, gives us interesting insight into the multifactorial nature of DMED. Animal models using either genetically diab...