A total of 400 male renal transplant recipients (RTR) were investigated. Data on medical, sexual history, clinical examination and laboratory variables were collected. The severity of erectile dysfunction (ED) was assessed using the International Index of Erectile Function questionnaire. Univariate and multivariate logistic regression analyses were used to determine prognostic variables, which have independent impact on erectile function. ED was detected in 35.8% of the whole group. Current erectile function as compared to pretransplant status was improved, deteriorated or remained static in 44, 12.5 and 43.5% of the evaluated transplant recipients, respectively. After logistic regression analysis, age, hemoglobin level and presence of DM and/or peripheral neuropathy had significant and independent negative impact on erectile function. We concluded that renal transplantation has varying effects on erectile function. ED is highly prevalent among RTR and its pathogenesis is multifactorial.

Our 14-year experience with the use of isolated ileal segments for replacement of the bilharzial ureter is analyzed retrospectively. Of 52 patients subjected to this procedure followup data were available for 38, in whom 52 ureters were repaired. The results generally were unsatisfactory: the morbidity and mortality rates were high and the percentage of functional improvement was low. The risk was higher for patients with low creatinine clearance. Therefore, we recommend that this operation be avoided when possible. If the operation is unavoidable, tapering of the ileal segment with antireflux ileovesical anastomosis may improve the outcome. Further clinical study must be done.

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OBJECTIVETo compare the safety, efficacy and durability of neodymium (Nd):YAG laser prostatectomy with transurethral electrovaporization of the prostate (TUVP) for treating benign prostatic hyperplasia (BPH). March 1995 to March 1997 patients with bladder outlet obstruction secondary to BPH were randomized equally either to Nd:YAG laser therapy or TUVP. Laser therapy combined two different techniques, side-fire coagulation of the lateral lobes and contact vaporization of the median lobe. Before treatment the two groups had a comparable International Prostate Symptom Score (IPSS), quality-of-life score (QoL), maximum urinary flow rate (Q max ), postvoid residual urine volume (PVR), and prostate and adenoma volume. In all, 62 and 78 patients completed the 1, 2, 3 and 4-year follow-up from the laser and TUVP groups, respectively. PATIENTS AND METHODS From RESULTSAt each follow-up, the IPSS, QoL, Q max and PVR were significantly better and more durable in the TUVP than in the laser group. In the TUVP and laser groups respectively, at the 4-year follow-up the mean value of the IPSS was 3.7 vs 11.9, the QoL 1.3 vs 3.1, the Q max 21.4 vs 13.6 mL/s and the PVR 25.1 vs 64.6 mL (all P < 0.001). The mean prostate and adenoma volume were significantly lower after TUVP than after laser therapy ( P < 0.001) at the 1-and 4-year follow-up, with final values of 27.9 vs 35.9 and 11.7 vs 20 mL (both P < 0.001) for the TUVP and laser groups, respectively. Retrograde ejaculation was significantly more common after TUVP (63%) than after laser therapy (18%; P < 0.001). Impotence was reported in 8% of men after TUVP and in none after laser therapy ( P = 0.040). The re-operation rate was 12% after TUVP and 38% after laser treatment ( P < 0.001). CONCLUSIONThese 4-year follow-up results confirm that TUVP is significantly more effective and durable than the Nd:YAG laser for treating BPH. Residual obstructing adenoma was the main cause of failure in the laser group, which reflects the inadequacy of laser therapy for removing the adenoma.The Department of Urology and Nephrology in Mansoura, Egypt has turned their attention to many facets of urological practice in a thorough and interesting way. They have been involved in several technological treatments for LUTS in recent years, and here they describe a 4-year follow-up study where patients were randomized to Nd:YAG laser treatment or TUVP. They confirmed the view that TUVP is associated with effective and durable results, whereas the laser treatment was not.Authors from Sheffield describe a pilot study wherein they evaluate the acute effect of magnetic stimulation of the pelvic floor on involuntary detrusor activity during natural filling. They found a decrease in the amplitude of involuntary detrusor contractions and an increase in bladder capacity assessed by cystometry. They found a variable effect on overactive bladder symptoms, and felt that magnetic stimulation may not produce a lasting effect on these symptoms.

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