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Vasoactive Intracavernous Pharmacotherapy for Impotency: Methodology and Patient Education
462 VASOACTIVE INTRACAVERNOUS PHAR.MACOTHERAPY FOR IMPOTENCY: METHODOLOGY AND PATIENT EDUCATION. *Abraham A. Sidi,
CORPOROGLANS SHUNT IN PRIAPISM, OPERATIVE TECHNIQUE BASED ON 47 PATIENTS.
*Linda M. Duffy, *Brenda F. Roche, and Paul. H. Lange. Minneapolis, lvIN.
Aizid I. Hashmat, Richard J. Macchia, Brooklyn, N.Y. (Presentation to be made by Dr. Hashmat).
Vasoactive intracavernous pharrnacotherapy (VIP) using papaverine and phentolamine is attracting wide interest and gaining increasing acceptance. However, details on the methodology of this therapy, such as drug preparations and dosagesi injection techniques, patient education, complications, and follow-up, are still not well known.
This movie presents in detail the VIP methodology developed at the University of Minnesota through experience witl1 over 300 men, Topics covered include patient selection, the use of pharmacologic agents and doses based on the etiology of impotence, the testing protocol including injection technique and response evaluation, teaching the self-injection technique, treatment of sustained erections, and follow-up,
A video-tape presentation of the technique of the shunt. The experience consists of 47 consecutive cases with corporoglans shunts at our institution. 20 patients retained potency 12 months following the shunt procedure. In 45 patients corporoglans shunt was the primary procedure, in 2 patients it was a secondary procedure. There were 2 major complications. #1, in one patient the glans sloughed, //2, in a second patient the right side of the shaft of penis sloughed. Two patients developed segmental impotence, erection occured only at the base of the penis. In conclusion, corpora-glans shunt in priapism has less than 50% chance of success.
464 T"i:lE OPrIMIZED SPER,t,J PENETRATION ASSAY. ·•Aron Johnson, L. I. Lipshul tz and Roy G. Smith, Houston, TX (Presentation to be made cy Aron Johnson). Our laboratory has established a highly sensitive and controlled method for assessing the fertilizing potential of human sperm using tJ1e zona-free hamster ova sperm penetration assay (SPA). By optimizing both sperm and ova processing, we achieve a 40-100 fold increase in sperm penetration rates when oompared to the more standard techniques. 'fuis high penetration rate dramatically increases assay sensitivity. We score this assay cy reporting the merage number of penetrations per ovum (P/0) now termed the Sperm Car:acitation Index (SCT). Semen is stored at 4C for 2 days followed cy thermal shock to 37C Only motile sperm are then selected for testing. We have also developed the use of cryopreserved semen standards to monitor irrterassay variation (10%). 'mis uniqL,e aspect of our test allows us to directly compare with a high degree of ccnf iclence SR\ results obtained on different dates, In a prospoctive study SCI results were correlated to the i:ercent of human ova fertilized in 136 consecutive in vitro fertil.ization (IVF) cycles., Of tho02 patients that had a favorable NF cycle (fertilizing at least 1/3 of tl1e human ova) 106 of 115 (92%) had a SCI >5 P/0. However, of the 21 patients that had a poor IVF cycle, only 3 (14%) achieved a SCI score >5 P/0, Increasing the assay's sensitivity and paying careful attention to quality control has allowed us to greatly reduce the incidence of false negatives without introducing false rositives. '!he optimized SPA has become a powerful diagnostic aid in characterizing male infertility as well as an important research tool in understanding sperm function.
MALE IMPOTENCE:CORPOREAL BENDING. Nelson Rodrigues Netto Jr, J~A.Reinato*,Paulo Palma,Carlos Arturo L.D'Ancona,Osamu Ikari*. Sao Paulo-Brazil. (Presentation to be made by Dr.Palma). The dinamic cavernosography test developed since 1981 permits to diagnose venous incompetence as a source of vasculogenic impotence. Artificial ereetion not produced at flow rates up to 180 ml/min and simultaneous pressure readings show no rise of pressure above 60mm,nof mercury. The test is repeated with the addition -of papaverine. The contrast phase in these patients shows excessive venous runoff into the superficial and deep penile'JVein systems.Digital compression of the crura diminished the venous runoff and erection is obtained at flow rates below 180ml/min. Surgery consists of corporeal bending at 3 cm of the distal end of the crura and represents part of the vein ligation which should be done in these cases.Good results were obtained in 80% of the patients with venous incompetence.
219A
CORPOROGLANS SHUNT IN PRIAPISM, OPERATIVE TECHNIQUE BASED ON 47 PATIENTS.
*Linda M. Duffy, *Brenda F. Roche, and Paul. H. Lange. Minneapolis, lvIN.
Aizid I. Hashmat, Richard J. Macchia, Brooklyn, N.Y. (Presentation to be made by Dr. Hashmat).
Vasoactive intracavernous pharrnacotherapy (VIP) using papaverine and phentolamine is attracting wide interest and gaining increasing acceptance. However, details on the methodology of this therapy, such as drug preparations and dosagesi injection techniques, patient education, complications, and follow-up, are still not well known.
This movie presents in detail the VIP methodology developed at the University of Minnesota through experience witl1 over 300 men, Topics covered include patient selection, the use of pharmacologic agents and doses based on the etiology of impotence, the testing protocol including injection technique and response evaluation, teaching the self-injection technique, treatment of sustained erections, and follow-up,
A video-tape presentation of the technique of the shunt. The experience consists of 47 consecutive cases with corporoglans shunts at our institution. 20 patients retained potency 12 months following the shunt procedure. In 45 patients corporoglans shunt was the primary procedure, in 2 patients it was a secondary procedure. There were 2 major complications. #1, in one patient the glans sloughed, //2, in a second patient the right side of the shaft of penis sloughed. Two patients developed segmental impotence, erection occured only at the base of the penis. In conclusion, corpora-glans shunt in priapism has less than 50% chance of success.
464 T"i:lE OPrIMIZED SPER,t,J PENETRATION ASSAY. ·•Aron Johnson, L. I. Lipshul tz and Roy G. Smith, Houston, TX (Presentation to be made cy Aron Johnson). Our laboratory has established a highly sensitive and controlled method for assessing the fertilizing potential of human sperm using tJ1e zona-free hamster ova sperm penetration assay (SPA). By optimizing both sperm and ova processing, we achieve a 40-100 fold increase in sperm penetration rates when oompared to the more standard techniques. 'fuis high penetration rate dramatically increases assay sensitivity. We score this assay cy reporting the merage number of penetrations per ovum (P/0) now termed the Sperm Car:acitation Index (SCT). Semen is stored at 4C for 2 days followed cy thermal shock to 37C Only motile sperm are then selected for testing. We have also developed the use of cryopreserved semen standards to monitor irrterassay variation (10%). 'mis uniqL,e aspect of our test allows us to directly compare with a high degree of ccnf iclence SR\ results obtained on different dates, In a prospoctive study SCI results were correlated to the i:ercent of human ova fertilized in 136 consecutive in vitro fertil.ization (IVF) cycles., Of tho02 patients that had a favorable NF cycle (fertilizing at least 1/3 of tl1e human ova) 106 of 115 (92%) had a SCI >5 P/0. However, of the 21 patients that had a poor IVF cycle, only 3 (14%) achieved a SCI score >5 P/0, Increasing the assay's sensitivity and paying careful attention to quality control has allowed us to greatly reduce the incidence of false negatives without introducing false rositives. '!he optimized SPA has become a powerful diagnostic aid in characterizing male infertility as well as an important research tool in understanding sperm function.
MALE IMPOTENCE:CORPOREAL BENDING. Nelson Rodrigues Netto Jr, J~A.Reinato*,Paulo Palma,Carlos Arturo L.D'Ancona,Osamu Ikari*. Sao Paulo-Brazil. (Presentation to be made by Dr.Palma). The dinamic cavernosography test developed since 1981 permits to diagnose venous incompetence as a source of vasculogenic impotence. Artificial ereetion not produced at flow rates up to 180 ml/min and simultaneous pressure readings show no rise of pressure above 60mm,nof mercury. The test is repeated with the addition -of papaverine. The contrast phase in these patients shows excessive venous runoff into the superficial and deep penile'JVein systems.Digital compression of the crura diminished the venous runoff and erection is obtained at flow rates below 180ml/min. Surgery consists of corporeal bending at 3 cm of the distal end of the crura and represents part of the vein ligation which should be done in these cases.Good results were obtained in 80% of the patients with venous incompetence.
219A