Aims of this study: To determine the associations, if any, of cavernosal oxygen tension with vasculogenic impotence. Materials and Methods: We evaluated penile cavernosal blood gas levels in men with suspected vasculogenic impotence during penile duplex ultrasonography andaor dynamic infusion cavernosometry and cavernosography (DICC). Patients with suspected impotence were evaluated from 1992 ± 1996. Patient ages ranged from 24 ± 75 y (mean 48 y). Eighteen men had arteriogenic impotence diagnosed by abnormal penile duplex ultrasound after injection of a vasoactive agent, and 23 men had venous leakage diagnosed by DICC. Results: Eighteen men with arteriogenic impotence had the following mean blood gas values: pH 7.38 AE 0.01, PCO2 45.50 AE 0.94, PO2 65.17 AE 2.16. Twenty-three men with venogenic (venous leak) impotence had the following mean cavernosal blood gas values: pH 7.41 AE 0.01, PCO2 42.26 AE 0.83, PO2 74.17 AE 2.51. The differences in PO2 were signi®cant (P`0.05). A subgroup of men with severe venous leakage had PO2 values that were similar to the low arterial PO2 values. Conclusion: The low PO2 in patients with arteriogenic impotence, and the subset of men with severe venous leak impotence, support a global concept of low cavernosal PO2 as a mechanism for both arteriogenic and venogenic impotence.
Since the work of Huggins and Hodges, hormonal therapy, i.e., orchiectomy or estrogens, has been the gold standard of treatment for patients with advanced adenocarcinoma of the prostate. Recently, many new drugs have been introduced in the hope of achieving a beneficial response as compared with hormonal therapy, while avoiding some of the adverse effects. Various newer agents are reviewed. It appears that while these agents may be attractive secondary to specific effects, they do not appear to offer any survival advantage over diethylstilbestrol or orchiectomy .Finally, the theory of total androgen blockade is reviewed. Institution of total blockade does not appear to offer a survival advantage over standard androgen blockade.
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