- Email: [email protected]
C98 UNILATERAL VERSUS BILATERAL VARICOCELECTOMY -THERE IS ANY DIFFERENCE?
inflammation and necrosis according to the time elapsed after Vaseline injection. Conclusions: Early detection of patients with Vaseline penile augmentation and urgent surgery are essential because the best aesthetic and functional results can be achieved in the acute period; this is when granuloma does not involve the subdermal but only the subcutaneous layer and local penile flaps with scrotal flaps can most commonly be used for reconstruction.
C95
Penile cancer: Our experience over the last 13 years
Perkovic J., Sudarevic B., Radoja I., Rakin I., Cosic I., Pavlovic O., Simunovic D., Galic J. University Hospital Osijek, Dept. of Urology, Osijek, Croatia Introduction & Objectives: Primary penile carcinoma is one of the rarest male genital tract tumors, with a reported incidence of 1 per 100000 males in Western European countries. More than 95% of penile cancers are squamous cell carcinomas (SCCs). It usually arises in the epithelium of the inner prepuce, coronal sulcus and glans. Social and cultural habits influence the incidence of the disease, which is related to the exposure to Human papilloma virus, poor hygiene, phimosis, chronic irritation and smoking. Penile carcinoma most commonly occurs in the fifth and sixth decade of life, with peak incidence in the eight decade. The aim of this retrospective study was to present our results of penile carcinoma surgical treatment, with emphasis on staging and complication rate. Material & Methods: From 1998-2010 we treated 25 penile carcinoma patients. Median age of the patients at the time of diagnosis was 62 years, range 45-92, with highest incidence in the sixth and seventh decade of life. Diagnostic procedures included detailed physical examination, patient history, and pelvic CT in patients with enlarged inguinal lymph nodes. Procedures performed included circumcision, partial/total penectomy, lymphadenectomy and adjuvant oncologic treatment. In most cases we performed intraoperative biopsy and cryosection procedure of the suspected lesion. Median follow up was 14 months, range 1-79 months. Results: Of the total number of penile cancer patients 48% had palpable inguinal lymph nodes at the time of the diagnosis. Final pathological evaluation revealed 96% of SCCs and 4% of Kaposi sarcoma. Most commonly performed procedures were partial/total penectomy in 72%, inguinal lymphadenectomy in 48% and circumcision in 36% of the patients. In one patient we performed immediate total penectomy due to severe life-threatening hemorrhage. 52% of the patients were treated with adjuvant oncological treatment, while one patient received neoadjuvant radiotherapy only. In 2 patients the disease has recurrence locally. We had no major complications, wound dehiscence was noted in two and prolonged lymphorrea in five patients treated with regional lymphadenectomy. Conclusions: Due to the relatively rare occurrence, age at the time of diagnosis and poorly educated population, majority of our patients have neglected early lesions for more than one year until they make first visit to their physician, which caused the delay of diagnosis and, subsequently, often inadequate treatment.
C96
Embolization of the deep dorsal vein using 96% ethanol for treatment of the venogenic erectile dysfunction
Chocholaty M. , Hanek P. , Jarolim L. , Padr. R. 1 Charles and University Hospital Motol, Dept. of Urology, Prague, Czech Republic, 2Charles and University Hospital Motol, Dept. of Radiological Techniques, Prague, Czech Republic 1
1
1
2
Introduction & Objectives: The effectiveness of the deep dorsal vein embolization using 96% ethanol for the treatment of erectile impotence due to veno-occlusive dysfunction was evaluated. Material & Methods: A total of 15 patients with the venogenic erectile dysfunction were included. The diagnosis was suspected based on findings of penile Doppler ultrasonography and venous leakage was confirmed by pharmacocavernosography. During the pharmacocavernosography the deep dorsal vein was isolated and cannulated under local anesthesia. We used 96% ethanol for embolization, with the total volume of 6.5 ml (2.5 – 10 ml). All patients were evaluated using the erectile function domain of the International Index of Erectile Function questionnaire (IIEF) before, and 1, 6 and 12 months after the embolization. Results: The average value of the IIEF – 5 score was 9.5, 17.5, 15.6 and 15.4, before, 1, 6 and 12 months after the embolization, respectively. While the postoperative IIEF – 5 scores at 1, 6 and 12 months were increased significantly (p<0.003), there was a significant decrease at 12 months when compared to that of 1 month (p<0.01). Twelve (80%) and eight (53.5%) patients were satisfied with the results at 1 and 12 months after the procedure, respectively. Conclusions: Deep dorsal vein embolization for venogenic erectile dysfunction is simple and safe method. More than 50% of patients were satisfied with erectile function one year after the embolization.
C97
The use of sildenifil to study the role of phospholamban in erectile function
Dagrosa L.M.1, Joshi S.2, Werner M.2, Nelson M.T.3, Zvara P.1 1 University of Vermont, Dept. of Surgery, Burlington, Vt, United States of America, 2 The University of Manchester, Dept. of Cardiovascular Medicine, Manchester, United Kingdom, 3University of Vermont, Dept. of Pharmacology, Burlington, Vt, United States of America Introduction & Objectives: The understanding of the nitric oxide (NO)/cyclic GMP (cGMP)-dependent protein kinase G (PKGI) pathway in the smooth muscle of the corpora cavernosa (CC), which is integral to the penile erection, has led to the identification of phophodiesterase 5 inhibitors (PDE5-I), which have become a critical tool in the treatment of erectile dysfunction. They act by inhibiting the breakdown of cGMP, subsequently increasing the available PKGI leading to corpus smooth muscle relaxation and penile tumescence. Our understanding of the downstream control of this pathway however is incomplete, which presents a challenge when trying to understand the disease processes of PDE5-I non-responders. Previous studies attempting to quantify in vivo the effects of PDE5-I on CC smooth muscle relaxation have been unable to use adequate dosages due to a dangerous drop in blood pressure upon drug administration. The goals of our study were to first create an in vivo mouse model that could handle a PDE5-I dose comparable to that in a human and then to use this model to investigate the downstream control of the NO/ cGMP-dependent PKGI pathway using a phospholamban (PLB) knockout mouse. PLB is a protein that regulates the smooth muscle tone through inhibition of the sarcoplasmic reticulum Ca2+-ATPase. Material & Methods: The first phase of the study included testing the currently known anesthetic protocols which all used pentobarbital and/or 2-3% inhaled isoflurane and resulted in a drop in BP more than 40% after intracavernous sildenifil administration making erectile function testing impossible. These studies were forced to use sildenifil doses at only a fraction of the recommended clinical dosage. We therefore experimented with light sedation of 1-1.5% inhaled isoflurane. After establishing a working animal model we studied the effect of sildenifil on the intracavernous pressure of PLB knockout models compared to wild type C57BL6 mice. To do this we implanted a line in the carotid artery to measure intraoperitive mean arterieal pressure and another line into the CC to record intracavernous pressure. Sildenifil was administered into the contralateral CC. Results: We found that under light sedation of 1.25% isoflurane a sildenifil injection of 1mg/kg caused on average a 5.1% drop in systemic blood pressure. We then looked at the sildenifil induced changes in intracavernous pressure in the PLB knockout mouse versus the wild type. This response was significantly blunted with an average of 56 cmH2O increase in the wild type versus only 8.1 cm H2O in the PLB knockout. Conclusions: This study describes a new in vivo model in which the blood pressure in mice is preserved while using clinically applicable doses of sildenifil. Using this novel model we were able to show a significant role for phospholamban in allowing the NO/cGMP-dependant PKGI mechanism to exert its effect on corpus cavernosum smooth muscle relaxation.
C98
Unilateral versus bilateral varicocelectomy – there is any difference?
Sinescu I.1, Voinea S.1, Harza M.1, Manea I.1, Haineala B.1, Preda A.1, Gagiu C.1, Laci I.1, Matei M.2 1 Fundeni Clinical Institute of Uronephrology and Renal Transplantation, Dept. of Urology, Bucharest, Romania, 2CFR No.2 Clinical Hospital, Dept. of In Vitro Fertilization, Bucharest, Romania Introduction & Objectives: Varicocele represents the most common cause of male infertility. The majority of authors report that varicocelectomy for palpable varicocele has a beneficial effect on male fertility and pregnancy outcome. Little is known about the morbidity and outcome for unilateral versus bilateral repair. Material & Methods: From September 2008 and March 2010, 51 (group 1) and11 patients (group 2) with unilateral respectively bilateral varicocele were prospectively included using the next criteria: clinical palpable varicocele, normal reproductive hormones, at least 1 abnormal semen parameter and couple infertility. Unilateral (group1) and concomitant bilateral (group2) subinguinal varicocelectomy was performed by a single urologist using an operative microscope. Semen parameters, immediate postoperative pain, immediate (swelling, wound infection, bleeding) and late (hydrocele formation, tests atrophy, recurrence, numbness of scar area) complications were recorded. Results: The mean postoperative surveillance period was 8 month (3 to 18 month). The meen sperm concentration increased after surgery in group 1 from 7.5 to 18.1 million/ml and in group 2 from 7.1 to 26.7 million/ml. There was no difference in grade of pain, minor and major complications between groups, except the incidence of scrotal swelling at 2 weeks after surgery check up (9.8% in group 1 versus 45.5% in group 2). Conclusions: Bilateral varicocelectomy is associated with greater improvement in sperm concentration than unilateral varicocelectomy. In spite of little increase of morbidity we believe that bilateral concomitant varicocelectomy is a better choice than successive repair in men with bilateral palpable varicocele.
Eur Urol Suppl 2010;9(6):643
C95
Penile cancer: Our experience over the last 13 years
Perkovic J., Sudarevic B., Radoja I., Rakin I., Cosic I., Pavlovic O., Simunovic D., Galic J. University Hospital Osijek, Dept. of Urology, Osijek, Croatia Introduction & Objectives: Primary penile carcinoma is one of the rarest male genital tract tumors, with a reported incidence of 1 per 100000 males in Western European countries. More than 95% of penile cancers are squamous cell carcinomas (SCCs). It usually arises in the epithelium of the inner prepuce, coronal sulcus and glans. Social and cultural habits influence the incidence of the disease, which is related to the exposure to Human papilloma virus, poor hygiene, phimosis, chronic irritation and smoking. Penile carcinoma most commonly occurs in the fifth and sixth decade of life, with peak incidence in the eight decade. The aim of this retrospective study was to present our results of penile carcinoma surgical treatment, with emphasis on staging and complication rate. Material & Methods: From 1998-2010 we treated 25 penile carcinoma patients. Median age of the patients at the time of diagnosis was 62 years, range 45-92, with highest incidence in the sixth and seventh decade of life. Diagnostic procedures included detailed physical examination, patient history, and pelvic CT in patients with enlarged inguinal lymph nodes. Procedures performed included circumcision, partial/total penectomy, lymphadenectomy and adjuvant oncologic treatment. In most cases we performed intraoperative biopsy and cryosection procedure of the suspected lesion. Median follow up was 14 months, range 1-79 months. Results: Of the total number of penile cancer patients 48% had palpable inguinal lymph nodes at the time of the diagnosis. Final pathological evaluation revealed 96% of SCCs and 4% of Kaposi sarcoma. Most commonly performed procedures were partial/total penectomy in 72%, inguinal lymphadenectomy in 48% and circumcision in 36% of the patients. In one patient we performed immediate total penectomy due to severe life-threatening hemorrhage. 52% of the patients were treated with adjuvant oncological treatment, while one patient received neoadjuvant radiotherapy only. In 2 patients the disease has recurrence locally. We had no major complications, wound dehiscence was noted in two and prolonged lymphorrea in five patients treated with regional lymphadenectomy. Conclusions: Due to the relatively rare occurrence, age at the time of diagnosis and poorly educated population, majority of our patients have neglected early lesions for more than one year until they make first visit to their physician, which caused the delay of diagnosis and, subsequently, often inadequate treatment.
C96
Embolization of the deep dorsal vein using 96% ethanol for treatment of the venogenic erectile dysfunction
Chocholaty M. , Hanek P. , Jarolim L. , Padr. R. 1 Charles and University Hospital Motol, Dept. of Urology, Prague, Czech Republic, 2Charles and University Hospital Motol, Dept. of Radiological Techniques, Prague, Czech Republic 1
1
1
2
Introduction & Objectives: The effectiveness of the deep dorsal vein embolization using 96% ethanol for the treatment of erectile impotence due to veno-occlusive dysfunction was evaluated. Material & Methods: A total of 15 patients with the venogenic erectile dysfunction were included. The diagnosis was suspected based on findings of penile Doppler ultrasonography and venous leakage was confirmed by pharmacocavernosography. During the pharmacocavernosography the deep dorsal vein was isolated and cannulated under local anesthesia. We used 96% ethanol for embolization, with the total volume of 6.5 ml (2.5 – 10 ml). All patients were evaluated using the erectile function domain of the International Index of Erectile Function questionnaire (IIEF) before, and 1, 6 and 12 months after the embolization. Results: The average value of the IIEF – 5 score was 9.5, 17.5, 15.6 and 15.4, before, 1, 6 and 12 months after the embolization, respectively. While the postoperative IIEF – 5 scores at 1, 6 and 12 months were increased significantly (p<0.003), there was a significant decrease at 12 months when compared to that of 1 month (p<0.01). Twelve (80%) and eight (53.5%) patients were satisfied with the results at 1 and 12 months after the procedure, respectively. Conclusions: Deep dorsal vein embolization for venogenic erectile dysfunction is simple and safe method. More than 50% of patients were satisfied with erectile function one year after the embolization.
C97
The use of sildenifil to study the role of phospholamban in erectile function
Dagrosa L.M.1, Joshi S.2, Werner M.2, Nelson M.T.3, Zvara P.1 1 University of Vermont, Dept. of Surgery, Burlington, Vt, United States of America, 2 The University of Manchester, Dept. of Cardiovascular Medicine, Manchester, United Kingdom, 3University of Vermont, Dept. of Pharmacology, Burlington, Vt, United States of America Introduction & Objectives: The understanding of the nitric oxide (NO)/cyclic GMP (cGMP)-dependent protein kinase G (PKGI) pathway in the smooth muscle of the corpora cavernosa (CC), which is integral to the penile erection, has led to the identification of phophodiesterase 5 inhibitors (PDE5-I), which have become a critical tool in the treatment of erectile dysfunction. They act by inhibiting the breakdown of cGMP, subsequently increasing the available PKGI leading to corpus smooth muscle relaxation and penile tumescence. Our understanding of the downstream control of this pathway however is incomplete, which presents a challenge when trying to understand the disease processes of PDE5-I non-responders. Previous studies attempting to quantify in vivo the effects of PDE5-I on CC smooth muscle relaxation have been unable to use adequate dosages due to a dangerous drop in blood pressure upon drug administration. The goals of our study were to first create an in vivo mouse model that could handle a PDE5-I dose comparable to that in a human and then to use this model to investigate the downstream control of the NO/ cGMP-dependent PKGI pathway using a phospholamban (PLB) knockout mouse. PLB is a protein that regulates the smooth muscle tone through inhibition of the sarcoplasmic reticulum Ca2+-ATPase. Material & Methods: The first phase of the study included testing the currently known anesthetic protocols which all used pentobarbital and/or 2-3% inhaled isoflurane and resulted in a drop in BP more than 40% after intracavernous sildenifil administration making erectile function testing impossible. These studies were forced to use sildenifil doses at only a fraction of the recommended clinical dosage. We therefore experimented with light sedation of 1-1.5% inhaled isoflurane. After establishing a working animal model we studied the effect of sildenifil on the intracavernous pressure of PLB knockout models compared to wild type C57BL6 mice. To do this we implanted a line in the carotid artery to measure intraoperitive mean arterieal pressure and another line into the CC to record intracavernous pressure. Sildenifil was administered into the contralateral CC. Results: We found that under light sedation of 1.25% isoflurane a sildenifil injection of 1mg/kg caused on average a 5.1% drop in systemic blood pressure. We then looked at the sildenifil induced changes in intracavernous pressure in the PLB knockout mouse versus the wild type. This response was significantly blunted with an average of 56 cmH2O increase in the wild type versus only 8.1 cm H2O in the PLB knockout. Conclusions: This study describes a new in vivo model in which the blood pressure in mice is preserved while using clinically applicable doses of sildenifil. Using this novel model we were able to show a significant role for phospholamban in allowing the NO/cGMP-dependant PKGI mechanism to exert its effect on corpus cavernosum smooth muscle relaxation.
C98
Unilateral versus bilateral varicocelectomy – there is any difference?
Sinescu I.1, Voinea S.1, Harza M.1, Manea I.1, Haineala B.1, Preda A.1, Gagiu C.1, Laci I.1, Matei M.2 1 Fundeni Clinical Institute of Uronephrology and Renal Transplantation, Dept. of Urology, Bucharest, Romania, 2CFR No.2 Clinical Hospital, Dept. of In Vitro Fertilization, Bucharest, Romania Introduction & Objectives: Varicocele represents the most common cause of male infertility. The majority of authors report that varicocelectomy for palpable varicocele has a beneficial effect on male fertility and pregnancy outcome. Little is known about the morbidity and outcome for unilateral versus bilateral repair. Material & Methods: From September 2008 and March 2010, 51 (group 1) and11 patients (group 2) with unilateral respectively bilateral varicocele were prospectively included using the next criteria: clinical palpable varicocele, normal reproductive hormones, at least 1 abnormal semen parameter and couple infertility. Unilateral (group1) and concomitant bilateral (group2) subinguinal varicocelectomy was performed by a single urologist using an operative microscope. Semen parameters, immediate postoperative pain, immediate (swelling, wound infection, bleeding) and late (hydrocele formation, tests atrophy, recurrence, numbness of scar area) complications were recorded. Results: The mean postoperative surveillance period was 8 month (3 to 18 month). The meen sperm concentration increased after surgery in group 1 from 7.5 to 18.1 million/ml and in group 2 from 7.1 to 26.7 million/ml. There was no difference in grade of pain, minor and major complications between groups, except the incidence of scrotal swelling at 2 weeks after surgery check up (9.8% in group 1 versus 45.5% in group 2). Conclusions: Bilateral varicocelectomy is associated with greater improvement in sperm concentration than unilateral varicocelectomy. In spite of little increase of morbidity we believe that bilateral concomitant varicocelectomy is a better choice than successive repair in men with bilateral palpable varicocele.
Eur Urol Suppl 2010;9(6):643