- Email: [email protected]
INTRACORPORAL PRESSURE MEASUREMENT AS AN INDEX OF ERECTILE FUNCTION: IS THERE A BETTER WAY?
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
METHODS: Immunohistochemical techniques were applied to sections of human vaginal wall specimens in order to evaluate the presence of the cAK and cGKI (isoforms cGKI alpha and ß) in relation WR9,33*3 DQGH126UHVSHFWLYHO\9LVXDOL]DWLRQRIGRXEOHODEHOOHG VWDLQLQJVZDVFRPPHQFHGE\PHDQVRIODVHUÀXRUHVFHQFHPLFURVFRS\ In addition, Western-Blot analyses were conducted using cytosolic VXSHUQDWDQWV RI KRPRJHQL]HG VSHFLPHQV RI WKH YDJLQDO ZDOO DQG epithelium. 5(68/76 ,PPXQRVWDLQLQJVSHFL¿FIRUF*.,ZDVREVHUYHG in vascular and non-vascular smooth muscle of the vagina. In the HQGRWKHOLDO OD\HU F*., ZDV IRXQG FRORFDOL]HG ZLWK H126 ,Q contrast, no signals indicating cGKI alpha were registered. cAK-positive supepithelial vessels were found to be innervated by a dense meshwork RI 3*3FRQWDLQLQJ YDULFRVH QHUYH ¿EUHV RI ZKLFK VRPH SUHVHQWHG H[SUHVVLRQRI9,37KHH[SUHVVLRQRIF$.DQGF*.,ZDVFRQ¿UPHG by Western blotting. &21&/86,216 2XUUHVXOWVIRUWKH¿UVWWLPHGHPRQVWUDWH the expression of cAK and cGKIß in the human vagina. The coORFDOL]DWLRQZLWK9,3DQGH126XQGHUOLQHVWKHVLJQL¿FDQFHRIERWKWKH cAMP- and GMP-pathway in the control of human vaginal vascular and non-vascular smooth muscle. Source of Funding: None
809 DESIGN AND FABRICATION OF A DEVICE MEASURING PERINEAL PRESSURES REAL-TIME DURING BICYCLE RIDING TO DETERMINE ERECTILE DYSFUNCTION RISK Ershad Forghani, Ali Husain, Ashay Kparker, Hector Pimentel*, Craig S Niederberger. Chicago, IL. INTRODUCTION AND OBJECTIVE: Evidence from studies using stationary bikes with sensors on the saddle suggests that bicycling may cause erectile dysfunction (ED). We sought to manufacture a device to measure the pressures exerted on the perineum real-time during a typical bicycle ride, and to correlate pressures to penile artery occlusion pressure to determine ED risk. METHODS: To determine penile artery occlusion pressure, ultrasound with Doppler was used to measure peak systolic velocity (PSV). The PSV was measured at baseline and increasing pressure was DSSOLHGWRWKHSHULQHXPXQWLOFRPSOHWHDEVHQFHRIÀRZZDVDFKLHYHG (PSV=0). Sensors from FlexiForce® were selected and a drive circuit ZDVIDEULFDWHGWRDFFRPPRGDWHXSWRHLJKWVHQVRUV ¿JXUH ,QRUGHU to enhance portability, the recommended eight individual op-amps were replaced by two low power quad op-amps. This decreased the power requirements, dimensions, and the weight of the device. A RCM 4000 microcontroller was used to receive analog inputs from the sensors and convert them into digital signals to be stored in its memory. Data retrieval was facilitated by a File Transfer Protocol (FTP) server. Figure 1.0 gEDA Circuit Board Schematic
THE JOURNAL OF UROLOGY®
281
pressure transducer can be placed directly on the subject’s perineum allowing an accurate description of where the pressure is applied. The portability of this device allows placement in the rider’s pocket without interfering with the cycling experience. CONCLUSIONS: We’ve demonstrated that it is possible to fabricate a device that can reliably measure pressures at multiple locations, does not alter the bike riding experience, and is safe. Formal approval from the local institutional review board has been granted for the use of this device to measure how perineal pressures during cycling effect penile hemodynamics. Source of Funding: None
810 THE DEVELOPMENT OF AN IN VIVO MODEL FOR THE ASSESSMENT OF CIGARETTE SMOKING-ASSOCIATED ERECTILE DYSFUNCTION Alexander Muller*, Mariana De Lorenzo, Keith Kobylarz, Andrew Dannenberg, John P Mulhall. New York, NY. INTRODUCTION AND OBJECTIVE: Smoking is a wellaccepted cardiovascular risk factor for atherosclerosis and endothelial damage. Current evidence supports the concept that erectile dysfunction (ED) may be a state of endothelial dysfunction. Epidemiological studies have documented an increased prevalence of ED in smokers compared to non-smokers. However, the mechanism by which smoke exposure leads to ED has not yet been elucidated. This study was undertaken WRLQYHVWLJDWHWKHLQÀXHQFHRIGLUHFWVPRNHH[SRVXUHRQWKHIXQFWLRQDO and structural changes in erectile tissue in the rat model. METHODS: Using a novel Jaeger-NYU smoke inhalation system, adult Sprague-Dawley rats were placed in custom fitted chambers directly breathing tobacco smoke (research cigarettes 2R4F) for 60 min/day, 6 days a week (S groups). The control animals (C groups) were exposed to room air in an equivalent manner. 24 hours after the last smoke exposure the maximal intracavernosal pressure (ICP) during cavernous nerve stimulation with the corresponding mean arterial blood pressure (MAP) were measured at either 14 or 28 days of treatment resulting in a total of 4 groups: C14, C28, S14, and S28, each ZLWKDQLPDOVJURXS3ULRUWRVDFUL¿FHSHQLOHWLVVXHZDVKDUYHVWHGDQG mid-shaft cross-sections were stained with Masson’s Trichrome (MT) to evaluate smooth muscle-collagen content (SMC ratio). Apoptotic indices (AI) were measured using TUNEL assay. RESULTS: Table 1 represents the results for weight gain, ICP/MAP ratio, SMC ratio, and AI for all 4 groups. Smoke exposed DQLPDOVKDGDVLJQL¿FDQWUHGXFWLRQLQZHLJKWJDLQFRPSDUHGWR&DQLPDOV (p<0.05). Both S groups had reduced erectile functional at both time points (p<0.001). After smoke exposure the SMC ratio was increased at 14 days (p=0.02), but at 28 days were similar to the C group (p=0.3). AI LQFUHDVHGVLJQL¿FDQWO\ZLWKLQERWK6JURXSV S FRPSDUHGWR& &21&/86,216 7R RXU NQRZOHGJH WKLV LV WKH ¿UVW LQYLYR model of smoking-induced ED. Smoking in this rat model caused a 26% and 32% reduction in erectile response at 14 days and 28 days respectively. The structural changes were time-dependent and appeared WREHPHGLDWHGE\FRUSRUDOVPRRWKPXVFOHFROODJHQL]DWLRQDVZHOODV smooth muscle and endothelial apoptosis. Table1 Average
C14
Weight gain (g) ICP/MAP ratio in % SMC ratio in % AI in %
S14
C28
S28
P value (C vs. S) 46 31 87 53 < 0.05 49 ±5 63 ±10 43 ±7 < 0.001 24.5 ±4.1 37.8 ±2.3 25.2 ±3.3 20.8 ±4 NS 7.2 ±1.5 9.6 ±2.5 8.7 ±2.3 14-9 ±4.1 < 0.01
Source of Funding: None
811
RESULTS: The mean arterial occlusion pressure for the test subject was 88 mmHg with a standard deviation of 5.5 mmHg. The ¿QDOGLPHQVLRQVRIWKHGHYLFHDUH [ [FPZLWKDZHLJKWRIJ This device can record pressures from 8 sensors for up to 4 hours. Our
INTRACORPORAL PRESSURE MEASUREMENT AS AN INDEX OF ERECTILE FUNCTION: IS THERE A BETTER WAY? Ling Xu De Young, Petra Erdeljan*, Jeffrey Carson, Gerald B Brock. London, ON, Canada. INTRODUCTION AND OBJECTIVE: Intracavernous pressure (ICP) induced through electro-stimulation of the cavernous nerve is
282
THE JOURNAL OF UROLOGY®
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
considered a reliable measure of penile erection. It is widely reported as the methodology of choice to understand the physiologic impact of disease states on erectile mechanisms. The aim of this study was to use an implantable telemetric penile pressure monitoring device in conscious free living rats and compare the results with standard nerve stimulated UHVSRQVHVDPRQJDQDHVWKHWL]HGDQLPDOVXVLQJDVWDQGDUGSUHSDUDWLRQ LQYROYLQJLQWUDFDYHUQRXVFDWKHWHUL]DWLRQ2XUK\SRWKHVLVLVWKDWIUHHOLYLQJ FRQVFLRXVDQLPDOVPD\EHDEHWWHUPRGHOWKDQDQDHVWKHWL]HGDQLPDOV for the study of vasoactive drugs and understanding the effect of disease on penile hemodynamics. METHODS: Sexually experienced male Sprague Dawley rats (450-500g) were implanted with telemetric devices (Data Science). Penile pressure was recorded during sexual activity with receptive female rats in the same cage under normal living conditions. These UDWVZHUHVXEVHTXHQWO\DQDHVWKHWL]HGDQGXQGHUZHQWDVWDQGDUG,&3 measurement using a bipolar electrode applied to the cavernous nerve ZLWKLQWUDFRUSRUDOFDWKHWHUL]DWLRQZLWKVLPXOWDQHRXVWHOHPHWULFSUHVVXUH recording. 5(68/76 $VVKRZQLQ¿JXUHEHORZSHQLOHSUHVVXUHSHDNV were greater but of shorter duration in conscious rats during sexual activity. Identical penile pressure patterns were recorded on the telemetric devices and intracorporal pressure transducers supporting the validity of the telemetric recordings. The altered pressure wave pattern measured with cavernous nerve stimulation is not physiologic and may obscure the effect of interventions in some protocols. CONCLUSIONS: Telemetric technology allows for reliable and repeated intracorporal pressure recordings among free living conscious animals and may provide a more accurate picture of erectile function than the current gold standard of cavernous nerve stimulation.
ureter is evaluated with a semirigid ureteroscope without inserting a guidewire. Subsequently, guidewire is inserted up to the middle ureter. Special caution is paid not to advance a guidewire beyond the middle XUHWHUWRDYRLGDQLQDGYHUWHQWLQMXU\WRWKHFROOHFWLQJV\VWHP$ÀH[LEOH ureteroscope is inserted into the ureter over a guidewire. After removing the guide wire, the ureteroscope is advanced into the upper ureter to UHQDO SHOYLV ZKLOH D ORZHVW ÀRZ SUHVVXUH RI LUULJDQW LV NHSW E\ XVLQJ UromatTM. RESULTS: Ninety-one (52 (57%) male, 39 (43%) female) SDWLHQWVZHUHLGHQWL¿HGZLWKDPHGLDQDJHRI UDQJH \HDUV The median suffered duration was 6 (range 1-144) months. Thirty-four (38%) patients had bleeding in the right, 56 (61%) in the left and 1 (1%) in both sides. The entire collecting system was completely inspected in all patients, including48 (53%) minute venous rupture (MVR) , 19 (21%) hemangioma, 4 (4%) papillary tumor, 3 (3%) varix, 1 (1%) calculus and 17 (18%) no lesions. The incidence of “no lesions” was less in the UHFHQW\HDUV WKDQWKH¿UVW\HDUV UHVSHFWLYHO\ ZKLOH the incidence of MVR increased from 45 to 42 and 77%. All patients with discrete lesions were successfully treated ureteroscopically by electrocoagulation. Recurrence was seen in 4 (4%) patients (postop 1 month, 2 years, 2 years, 12 years, respectively). CONCLUSIONS: Ureteropyeloscopy is highly useful for evaluation and treatment of chronic unilateral hematuria. The advent of PLQLDWXUL]HGXUHWHURVFRSHVZLWKWHFKQLFDOLPSURYHPHQWKDVFRQWULEXWHG to a more accurate etiology of chronic unilateral hematuria. (QGRVFRSLF¿QGLQJVLQSDWLHQWVZLWKFKURQLFXQLODWHUDOKHPDWXULD Minute venous Papillary N (%) Hemangioma rupture tumor 1987-1993 13 (45) 8 (28) 1 (3) (N=29) 1994-2000 (N=36) 2001-2006 (N=26) Total (N=91)
Varix Calculus 0
1 (3)
No lesion 6 (21)
15 (42)
7 (19)
3 (8)
2 (8) 0
8 (22)
20 (77)
4 (15)
0
0
2 (8)
48 (53)
19 (21)
4 (4)
3 (3) 1 (1)
0
16 (18)
Source of Funding: None
813
Source of Funding: Canadian Male Sexual Health Council.
Technology & Instruments: Laparoscopy, Ureteroscopy (II) Moderated Poster Session 29 Monday, May 19, 2008
10:30 am - 12:30 pm
812 URETEROSCOPIC EVALUATION AND TREATMENT OF CHRONIC UNILATERAL HEMATURIA: A 20-YEAR EXPERIENCE Motoo Araki*, Kouichi Monden, Shinya Uehara, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon. Okayama, Japan. INTRODUCTION AND OBJECTIVE: Chronic unilateral KHPDWXULDLVFKDUDFWHUL]HGE\LQWHUPLWWHQWRUFRQWLQXRXVJURVVKHPDWXULD that cannot be diagnosed by conventional radiology and hematologic WHVWV,WLVDGLI¿FXOWSUREOHPRIGLDJQRVLVDQGWUHDWPHQW:HUHSRUWRXU 20-year experience. METHODS: We retrospectively reviewed our patients with chronic unilateral hematuria from 1987 to 2006. Distal to middle
SAFETY AND EFFICACY OF FLEXIBLE URETERENOSCOPY AND HOLMIUM:YAG LITHOTRIPSY FOR INTRARENAL STONES IN ANTICOAGULATED PATIENTS Burak Turna*, Robert J Stein, Marc C Smaldone, Bruno R Santos, John C Kefer, Stephen V Jackman, Timothy D Averch, Mihir M Desai. Cleveland, OH, and Pittsburgh, PA. INTRODUCTION AND OBJECTIVE: We compare perioperative outcomes in patients undergoing ureterorenoscopy (URS) and holmium:YAG (Ho:YAG) lithotripsy for renal calculi with or without anticoagulation (AC). METHODS: We reviewed the records of all patients undergoing ÀH[LEOH856DQG+R <$*OLWKRWULSV\IRUUHQDOFDOFXOLLQLQVWLWXWLRQVIURP WR:HLGHQWL¿HGSDWLHQWVRQ$& FRXPDGLQFORSLGRJUHORU aspirin) in whom AC therapy was not discontinued prior to surgery. Data from the AC group were retrospectively compared to a contemporary matched cohort of 37 controls without AC who underwent a similar operative procedure. Both groups were compared with regards to stoneIUHHUDWHLQWUDRSHUDWLYHDQGSRVWRSHUDWLYHFRPSOLFDWLRQVZLWKVSHFL¿F reference to bleeding and thromboembolism. 5(68/76 %RWKJURXSVZHUHPDWFKHGIRUVWRQHVL]HVWRQH location, number of stones, bilateral procedures, and presence of concomitant ureteral stones. The AC group patients were older (58.2 vs. 50.4 years, p=0.0209) and had a greater ASA score (2.8 vs. 1.9, p<0.0001) compared to the control group. No procedure had to be terminated in the AC group due to poor visibility from bleeding. The median postoperative hemoglobin drop was greater in the AC group compared to the control group (0.6 vs. 0.2 g/dl, p<0.0001). Stone-free rate (81.1% vs. 78.4%, p=0.7725), intraoperative (0% vs. 3%, p= 0.3140) and postoperative complications (11% vs. 5%, p=0.3943) as well as hemorrhagic or thromboembolic adverse events were comparable in the two groups.
METHODS: Immunohistochemical techniques were applied to sections of human vaginal wall specimens in order to evaluate the presence of the cAK and cGKI (isoforms cGKI alpha and ß) in relation WR9,33*3 DQGH126UHVSHFWLYHO\9LVXDOL]DWLRQRIGRXEOHODEHOOHG VWDLQLQJVZDVFRPPHQFHGE\PHDQVRIODVHUÀXRUHVFHQFHPLFURVFRS\ In addition, Western-Blot analyses were conducted using cytosolic VXSHUQDWDQWV RI KRPRJHQL]HG VSHFLPHQV RI WKH YDJLQDO ZDOO DQG epithelium. 5(68/76 ,PPXQRVWDLQLQJVSHFL¿FIRUF*.,ZDVREVHUYHG in vascular and non-vascular smooth muscle of the vagina. In the HQGRWKHOLDO OD\HU F*., ZDV IRXQG FRORFDOL]HG ZLWK H126 ,Q contrast, no signals indicating cGKI alpha were registered. cAK-positive supepithelial vessels were found to be innervated by a dense meshwork RI 3*3FRQWDLQLQJ YDULFRVH QHUYH ¿EUHV RI ZKLFK VRPH SUHVHQWHG H[SUHVVLRQRI9,37KHH[SUHVVLRQRIF$.DQGF*.,ZDVFRQ¿UPHG by Western blotting. &21&/86,216 2XUUHVXOWVIRUWKH¿UVWWLPHGHPRQVWUDWH the expression of cAK and cGKIß in the human vagina. The coORFDOL]DWLRQZLWK9,3DQGH126XQGHUOLQHVWKHVLJQL¿FDQFHRIERWKWKH cAMP- and GMP-pathway in the control of human vaginal vascular and non-vascular smooth muscle. Source of Funding: None
809 DESIGN AND FABRICATION OF A DEVICE MEASURING PERINEAL PRESSURES REAL-TIME DURING BICYCLE RIDING TO DETERMINE ERECTILE DYSFUNCTION RISK Ershad Forghani, Ali Husain, Ashay Kparker, Hector Pimentel*, Craig S Niederberger. Chicago, IL. INTRODUCTION AND OBJECTIVE: Evidence from studies using stationary bikes with sensors on the saddle suggests that bicycling may cause erectile dysfunction (ED). We sought to manufacture a device to measure the pressures exerted on the perineum real-time during a typical bicycle ride, and to correlate pressures to penile artery occlusion pressure to determine ED risk. METHODS: To determine penile artery occlusion pressure, ultrasound with Doppler was used to measure peak systolic velocity (PSV). The PSV was measured at baseline and increasing pressure was DSSOLHGWRWKHSHULQHXPXQWLOFRPSOHWHDEVHQFHRIÀRZZDVDFKLHYHG (PSV=0). Sensors from FlexiForce® were selected and a drive circuit ZDVIDEULFDWHGWRDFFRPPRGDWHXSWRHLJKWVHQVRUV ¿JXUH ,QRUGHU to enhance portability, the recommended eight individual op-amps were replaced by two low power quad op-amps. This decreased the power requirements, dimensions, and the weight of the device. A RCM 4000 microcontroller was used to receive analog inputs from the sensors and convert them into digital signals to be stored in its memory. Data retrieval was facilitated by a File Transfer Protocol (FTP) server. Figure 1.0 gEDA Circuit Board Schematic
THE JOURNAL OF UROLOGY®
281
pressure transducer can be placed directly on the subject’s perineum allowing an accurate description of where the pressure is applied. The portability of this device allows placement in the rider’s pocket without interfering with the cycling experience. CONCLUSIONS: We’ve demonstrated that it is possible to fabricate a device that can reliably measure pressures at multiple locations, does not alter the bike riding experience, and is safe. Formal approval from the local institutional review board has been granted for the use of this device to measure how perineal pressures during cycling effect penile hemodynamics. Source of Funding: None
810 THE DEVELOPMENT OF AN IN VIVO MODEL FOR THE ASSESSMENT OF CIGARETTE SMOKING-ASSOCIATED ERECTILE DYSFUNCTION Alexander Muller*, Mariana De Lorenzo, Keith Kobylarz, Andrew Dannenberg, John P Mulhall. New York, NY. INTRODUCTION AND OBJECTIVE: Smoking is a wellaccepted cardiovascular risk factor for atherosclerosis and endothelial damage. Current evidence supports the concept that erectile dysfunction (ED) may be a state of endothelial dysfunction. Epidemiological studies have documented an increased prevalence of ED in smokers compared to non-smokers. However, the mechanism by which smoke exposure leads to ED has not yet been elucidated. This study was undertaken WRLQYHVWLJDWHWKHLQÀXHQFHRIGLUHFWVPRNHH[SRVXUHRQWKHIXQFWLRQDO and structural changes in erectile tissue in the rat model. METHODS: Using a novel Jaeger-NYU smoke inhalation system, adult Sprague-Dawley rats were placed in custom fitted chambers directly breathing tobacco smoke (research cigarettes 2R4F) for 60 min/day, 6 days a week (S groups). The control animals (C groups) were exposed to room air in an equivalent manner. 24 hours after the last smoke exposure the maximal intracavernosal pressure (ICP) during cavernous nerve stimulation with the corresponding mean arterial blood pressure (MAP) were measured at either 14 or 28 days of treatment resulting in a total of 4 groups: C14, C28, S14, and S28, each ZLWKDQLPDOVJURXS3ULRUWRVDFUL¿FHSHQLOHWLVVXHZDVKDUYHVWHGDQG mid-shaft cross-sections were stained with Masson’s Trichrome (MT) to evaluate smooth muscle-collagen content (SMC ratio). Apoptotic indices (AI) were measured using TUNEL assay. RESULTS: Table 1 represents the results for weight gain, ICP/MAP ratio, SMC ratio, and AI for all 4 groups. Smoke exposed DQLPDOVKDGDVLJQL¿FDQWUHGXFWLRQLQZHLJKWJDLQFRPSDUHGWR&DQLPDOV (p<0.05). Both S groups had reduced erectile functional at both time points (p<0.001). After smoke exposure the SMC ratio was increased at 14 days (p=0.02), but at 28 days were similar to the C group (p=0.3). AI LQFUHDVHGVLJQL¿FDQWO\ZLWKLQERWK6JURXSV S FRPSDUHGWR& &21&/86,216 7R RXU NQRZOHGJH WKLV LV WKH ¿UVW LQYLYR model of smoking-induced ED. Smoking in this rat model caused a 26% and 32% reduction in erectile response at 14 days and 28 days respectively. The structural changes were time-dependent and appeared WREHPHGLDWHGE\FRUSRUDOVPRRWKPXVFOHFROODJHQL]DWLRQDVZHOODV smooth muscle and endothelial apoptosis. Table1 Average
C14
Weight gain (g) ICP/MAP ratio in % SMC ratio in % AI in %
S14
C28
S28
P value (C vs. S) 46 31 87 53 < 0.05 49 ±5 63 ±10 43 ±7 < 0.001 24.5 ±4.1 37.8 ±2.3 25.2 ±3.3 20.8 ±4 NS 7.2 ±1.5 9.6 ±2.5 8.7 ±2.3 14-9 ±4.1 < 0.01
Source of Funding: None
811
RESULTS: The mean arterial occlusion pressure for the test subject was 88 mmHg with a standard deviation of 5.5 mmHg. The ¿QDOGLPHQVLRQVRIWKHGHYLFHDUH [ [FPZLWKDZHLJKWRIJ This device can record pressures from 8 sensors for up to 4 hours. Our
INTRACORPORAL PRESSURE MEASUREMENT AS AN INDEX OF ERECTILE FUNCTION: IS THERE A BETTER WAY? Ling Xu De Young, Petra Erdeljan*, Jeffrey Carson, Gerald B Brock. London, ON, Canada. INTRODUCTION AND OBJECTIVE: Intracavernous pressure (ICP) induced through electro-stimulation of the cavernous nerve is
282
THE JOURNAL OF UROLOGY®
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
considered a reliable measure of penile erection. It is widely reported as the methodology of choice to understand the physiologic impact of disease states on erectile mechanisms. The aim of this study was to use an implantable telemetric penile pressure monitoring device in conscious free living rats and compare the results with standard nerve stimulated UHVSRQVHVDPRQJDQDHVWKHWL]HGDQLPDOVXVLQJDVWDQGDUGSUHSDUDWLRQ LQYROYLQJLQWUDFDYHUQRXVFDWKHWHUL]DWLRQ2XUK\SRWKHVLVLVWKDWIUHHOLYLQJ FRQVFLRXVDQLPDOVPD\EHDEHWWHUPRGHOWKDQDQDHVWKHWL]HGDQLPDOV for the study of vasoactive drugs and understanding the effect of disease on penile hemodynamics. METHODS: Sexually experienced male Sprague Dawley rats (450-500g) were implanted with telemetric devices (Data Science). Penile pressure was recorded during sexual activity with receptive female rats in the same cage under normal living conditions. These UDWVZHUHVXEVHTXHQWO\DQDHVWKHWL]HGDQGXQGHUZHQWDVWDQGDUG,&3 measurement using a bipolar electrode applied to the cavernous nerve ZLWKLQWUDFRUSRUDOFDWKHWHUL]DWLRQZLWKVLPXOWDQHRXVWHOHPHWULFSUHVVXUH recording. 5(68/76 $VVKRZQLQ¿JXUHEHORZSHQLOHSUHVVXUHSHDNV were greater but of shorter duration in conscious rats during sexual activity. Identical penile pressure patterns were recorded on the telemetric devices and intracorporal pressure transducers supporting the validity of the telemetric recordings. The altered pressure wave pattern measured with cavernous nerve stimulation is not physiologic and may obscure the effect of interventions in some protocols. CONCLUSIONS: Telemetric technology allows for reliable and repeated intracorporal pressure recordings among free living conscious animals and may provide a more accurate picture of erectile function than the current gold standard of cavernous nerve stimulation.
ureter is evaluated with a semirigid ureteroscope without inserting a guidewire. Subsequently, guidewire is inserted up to the middle ureter. Special caution is paid not to advance a guidewire beyond the middle XUHWHUWRDYRLGDQLQDGYHUWHQWLQMXU\WRWKHFROOHFWLQJV\VWHP$ÀH[LEOH ureteroscope is inserted into the ureter over a guidewire. After removing the guide wire, the ureteroscope is advanced into the upper ureter to UHQDO SHOYLV ZKLOH D ORZHVW ÀRZ SUHVVXUH RI LUULJDQW LV NHSW E\ XVLQJ UromatTM. RESULTS: Ninety-one (52 (57%) male, 39 (43%) female) SDWLHQWVZHUHLGHQWL¿HGZLWKDPHGLDQDJHRI UDQJH \HDUV The median suffered duration was 6 (range 1-144) months. Thirty-four (38%) patients had bleeding in the right, 56 (61%) in the left and 1 (1%) in both sides. The entire collecting system was completely inspected in all patients, including48 (53%) minute venous rupture (MVR) , 19 (21%) hemangioma, 4 (4%) papillary tumor, 3 (3%) varix, 1 (1%) calculus and 17 (18%) no lesions. The incidence of “no lesions” was less in the UHFHQW\HDUV WKDQWKH¿UVW\HDUV UHVSHFWLYHO\ ZKLOH the incidence of MVR increased from 45 to 42 and 77%. All patients with discrete lesions were successfully treated ureteroscopically by electrocoagulation. Recurrence was seen in 4 (4%) patients (postop 1 month, 2 years, 2 years, 12 years, respectively). CONCLUSIONS: Ureteropyeloscopy is highly useful for evaluation and treatment of chronic unilateral hematuria. The advent of PLQLDWXUL]HGXUHWHURVFRSHVZLWKWHFKQLFDOLPSURYHPHQWKDVFRQWULEXWHG to a more accurate etiology of chronic unilateral hematuria. (QGRVFRSLF¿QGLQJVLQSDWLHQWVZLWKFKURQLFXQLODWHUDOKHPDWXULD Minute venous Papillary N (%) Hemangioma rupture tumor 1987-1993 13 (45) 8 (28) 1 (3) (N=29) 1994-2000 (N=36) 2001-2006 (N=26) Total (N=91)
Varix Calculus 0
1 (3)
No lesion 6 (21)
15 (42)
7 (19)
3 (8)
2 (8) 0
8 (22)
20 (77)
4 (15)
0
0
2 (8)
48 (53)
19 (21)
4 (4)
3 (3) 1 (1)
0
16 (18)
Source of Funding: None
813
Source of Funding: Canadian Male Sexual Health Council.
Technology & Instruments: Laparoscopy, Ureteroscopy (II) Moderated Poster Session 29 Monday, May 19, 2008
10:30 am - 12:30 pm
812 URETEROSCOPIC EVALUATION AND TREATMENT OF CHRONIC UNILATERAL HEMATURIA: A 20-YEAR EXPERIENCE Motoo Araki*, Kouichi Monden, Shinya Uehara, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon. Okayama, Japan. INTRODUCTION AND OBJECTIVE: Chronic unilateral KHPDWXULDLVFKDUDFWHUL]HGE\LQWHUPLWWHQWRUFRQWLQXRXVJURVVKHPDWXULD that cannot be diagnosed by conventional radiology and hematologic WHVWV,WLVDGLI¿FXOWSUREOHPRIGLDJQRVLVDQGWUHDWPHQW:HUHSRUWRXU 20-year experience. METHODS: We retrospectively reviewed our patients with chronic unilateral hematuria from 1987 to 2006. Distal to middle
SAFETY AND EFFICACY OF FLEXIBLE URETERENOSCOPY AND HOLMIUM:YAG LITHOTRIPSY FOR INTRARENAL STONES IN ANTICOAGULATED PATIENTS Burak Turna*, Robert J Stein, Marc C Smaldone, Bruno R Santos, John C Kefer, Stephen V Jackman, Timothy D Averch, Mihir M Desai. Cleveland, OH, and Pittsburgh, PA. INTRODUCTION AND OBJECTIVE: We compare perioperative outcomes in patients undergoing ureterorenoscopy (URS) and holmium:YAG (Ho:YAG) lithotripsy for renal calculi with or without anticoagulation (AC). METHODS: We reviewed the records of all patients undergoing ÀH[LEOH856DQG+R <$*OLWKRWULSV\IRUUHQDOFDOFXOLLQLQVWLWXWLRQVIURP WR:HLGHQWL¿HGSDWLHQWVRQ$& FRXPDGLQFORSLGRJUHORU aspirin) in whom AC therapy was not discontinued prior to surgery. Data from the AC group were retrospectively compared to a contemporary matched cohort of 37 controls without AC who underwent a similar operative procedure. Both groups were compared with regards to stoneIUHHUDWHLQWUDRSHUDWLYHDQGSRVWRSHUDWLYHFRPSOLFDWLRQVZLWKVSHFL¿F reference to bleeding and thromboembolism. 5(68/76 %RWKJURXSVZHUHPDWFKHGIRUVWRQHVL]HVWRQH location, number of stones, bilateral procedures, and presence of concomitant ureteral stones. The AC group patients were older (58.2 vs. 50.4 years, p=0.0209) and had a greater ASA score (2.8 vs. 1.9, p<0.0001) compared to the control group. No procedure had to be terminated in the AC group due to poor visibility from bleeding. The median postoperative hemoglobin drop was greater in the AC group compared to the control group (0.6 vs. 0.2 g/dl, p<0.0001). Stone-free rate (81.1% vs. 78.4%, p=0.7725), intraoperative (0% vs. 3%, p= 0.3140) and postoperative complications (11% vs. 5%, p=0.3943) as well as hemorrhagic or thromboembolic adverse events were comparable in the two groups.