Our technique of neurovascular bundle preservation during bulboprostatic anastomotic urethroplasty may solve the problem of postoperative impotence.

The tunica albuginea (TA) is the outer covering of the corpora cavernosa (CCs) and corpus spongiosum (CS) of the penile shaft. The different histoanatomical patterns of the TA, as well as the mode of attachment of the ischio-/bulbo-cavernosus muscles (ICM, BCM) to the TA, were studied, aiming at elucidating their role in the mechanism of erection. Twenty-eight cadaveric specimens (18 adults, 10 neonatal deaths) were studied morphologically and histologically after staining with hematoxylin and eosin and Verhoeff-van Gieson stains. The TA consisted in 20 specimens of 2 layers: inner circular and outer longitudinal, in 6 specimens of 3 layers: inner circular, longitudinal and outer circular, and in 2 of only one longitudinal layer. The CS TA was formed of one layer of longitudinal fibers. The mode of cavernosus muscles insertion into the TA revealed 3 patterns. The conjoint BCM and ICM formed a fibrous belt over the CCs in 18 specimens, a muscular belt in 6 and no belt in 4. The functional role of the variations in the TA morphological structure is not exactly known. We hypothesize that the 3-layered TA gives more penile rigidity than the double and single layers. Considering the type of cavernosus muscles insertion into the TA, it appears that the fibrous belt exerts more CC compression than the other 2 types of insertion.

Background Right ventricle infarction (RVI) is predominantly a complication of inferior wall myocardial infarction; it occurs in approximately one third of these patients. Right ventricle dysfunction in patients with inferior STEMI and RV infarction was under assessed. Nevertheless, studies which targeted RV assessment by echocardiography, did not evaluate RV diastolic dysfunction. Purpose In this study, we aimed to evaluate RV diastolic dysfunction and its prognostic value in patients with inferior STEMI and RVI. Methods Sixty patients with inferior STEMI and RV infarction, who underwent primary PCI were enrolled in the study. Presence of a pre-existing clinical conditions that might affect RV function, were excluded. Echocardiography was performed within twenty-four hours following the PCI, to assess the RV systolic and diastolic functions with special focus on tricuspid inflow velocities (E velocity, A velocity and E/A ratio) by pulsed wave (PW) doppler and tricuspid annular velocities by tissue doppler index (TDI) (e', a' and E/e' ratio). Clinical features and MACE, including cardiogenic shock, arrhythmia, stroke, reinfarction and death were analyzed in all our patients within 3 months follow up period. Results The average age of the study population was 51.58±10.11 years, 10% were females. Five patients developed MACE (death, cardiogenic shock and pulmonary oedema, anterior STEMI and cardiogenic shock, recurrent inferior STEMI, and arrhythmia and stroke), of whom four occurred in hospital within the first 48 hours. Patients who developed MACE had high filling pressures, as all of them had E/e' >6. E' velocity ≤6 cm/s was associated with increased MACE as 25% of patients with e' velocity ≤6 cm/s had MACE compared with 2.3% of patients with e' velocity >6 cm/s with a P value of 0.015. Conclusions Because tricuspid inflow velocities by PW doppler varies with respiration, volume status and other conditions, tricuspid annular velocities by TDI are essential when evaluating RV diastolic dysfunction. E/e' and e' has a prognostic value in patients with Inferior STEMI and RV infarction. Funding Acknowledgement Type of funding sources: None.

Background Right ventricle infarction (RVI) is predominantly a complication of inferior wall myocardial infarction; it occurs in approximately one third of these patients. Right ventricular dysfunction in patients with inferior STEMI and RV infarction was under assessed. Nevertheless, studies which targeted RV assessment by echocardiography, did not routinely evaluate RV diastolic dysfunction. In this study, we aimed to evaluate RV diastolic dysfunction and its prognostic value in patients with inferior STEMI and RVI. Results Sixty patients with inferior STEMI and RV infarction, who underwent primary PCI were enrolled in the study. Patients with pre-existing clinical conditions that might affect RV function, were excluded. Echocardiography was performed within twenty-four hours following the PCI, to assess the RV systolic and diastolic functions with special focus on tricuspid inflow velocities (E velocity, A velocity and E/A ratio) by pulsed wave (PW) doppler and tricuspid annular velocities by tissue doppler index (TDI) (E′, A′ and E/E′ ratio). Clinical features and MACE, including cardiogenic shock, arrhythmia, stroke, reinfarction and death were analyzed in all our patients within 3 months follow up period. The average age of the study population was 51.58 ± 10.11 years, 10% were females. Five patients developed MACE (death, cardiogenic shock and pulmonary edema, anterior STEMI and cardiogenic shock, recurrent inferior STEMI, and arrhythmia and stroke), of whom four occurred in hospital within the first 48 h. Patients who developed MACE had high filling pressures, as all of them had E/E′ > 6. E′ velocity ≤ 6 cm/sec was associated with increased MACE as 25% of patients with E′ velocity ≤ 6 had MACE compared with 2.3% of patients with E′ velocity > 6 with a p value of 0.015. Conclusions Tricuspid annular velocities by TDI are essential when evaluating RV diastolic dysfunction. E/E′ and E′ velocity have a prognostic value in patients with inferior STEMI and RV infarction; E/E′ > 6 and E′ velocity ≤ 6 cm/sec were associated more MACE in patients with inferior STEMI and RVI.

High risk groups of inferior STEMI patients are those with heart block, right ventricle infarction (RVI), cardiogenic shock and cardiac arrest.RVI occurs in approximately one third of patients with inferior STEMI, in about one half of those patients, it is of hemodynamic significance. RVI results in a decrease in the right ventricle (RV) compliance and an increase in filling pressures, consequently the RV stroke volume decreases. RV diastolic dysfunction serves as an early quantifiable marker of subclinical RV dysfunction and usually present before apparent systolic dysfunction, RV dilatation or RV hypertrophy. By reviewing the literature there is scant data on Evaluation of RV diastolic function.

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