OBJECTIVE To present evidence that rats fed a high‐fat diet could serve as a useful animal model to study both lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), as recent epidemiological studies have shown a strong association between LUTS and ED but the physiological basis behind this relationship is unknown. MATERIALS AND METHODS In all, 24 male Sprague‐Dawley rats were divided into two groups: nine controls were fed a ‘normal’ diet and 15 were fed a high‐fat diet (hyperlipidaemic rats). After 6 months all the rats had bladder and erectile functions evaluated using awake cystometry and cavernosal nerve electrostimulation, respectively. After the functional studies were completed, the penis, prostate and bladder were collected for immunohistochemical analysis. RESULTS The hyperlipidaemic rats had significantly higher serum cholesterol and low‐density lipoprotein than the controls (P < 0.05). The hyperlipidaemic rats also had significantly worse erectile function (P = 0.004) and developed more bladder overactivity (P = 0.004) than the controls. In the hyperlipidaemic rats there was significant muscle hypertrophy in the peri‐urethral lobe of the prostate (P < 0.001) and in the bladder (P < 0.05). There was also greater P2X1 (purinoceptor) staining as well as other molecular changes in the bladder of the hyperlipidaemic rats. CONCLUSIONS In this hyperlipidaemic rat model three abnormalities were consistently detected: prostatic enlargement, bladder overactivity, and ED. This rat model could be a useful research tool for understanding the common causes of LUTS and ED, as well as facilitating the development of preventive measures and better therapies to treat both conditions.

Conservative débridement of penetrating injuries to the external genitalia should be stressed to maximize tissue preservation. Testicular salvage rates are significantly higher in gunshot wound injuries (75%) compared to stab wounds/lacerations injuries (23%) (p <0.001). A select group of patients with penile and scrotal injuries (ie those with injuries superficial to Buck's or dartos fascia) may undergo nonsurgical treatment of the penetrating external genital injury with minimal morbidity.

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images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 354;13 www.nejm.org march 30, 2006 1402A 61-year-old woman whose medical history was notable for hypertension and type 2 diabetes . Computed tomography of the abdomen demonstrated bilateral renal-vein thrombosis (larger on the right than on the left) (thin arrows), with extension to the inferior vena cava (thick arrow). A renal biopsy revealed membranous glomerulonephritis. Low-molecular-weight heparin was begun, and the patient was given warfarin at discharge. The risk of renal-vein thrombosis is increased in patients with the nephrotic syndrome, owing to the loss of clotting inhibitors in the urine.