Archivio italiano di urologia, nefrologia, andrologia : organo ufficiale dell'Associazione per la ricerca in urologia = Urological, nephrological, and andrological sciences最新文献

From the beginning of the eighties papaverine was well established as the drug of choice for diagnosis and management of vasculogenic impotence. In the second half of the eighties decade many authors referred on experimental use of PGE1 in erection disease. PGE1 has been showed a safe and effectiveness drug. During the period September 1989-October 1990 at our Institution 98 pts. with erectile disorders were managed by I.C.I. with PGE1. Out of 98 cases 88 had success. Prolonged erection occurred in 4 pts. (4.2%). 10 pts. showed only tumescence. So there are been treated by I.C.I. with combined papaverine and PGE1 with better results. No side effects were formed in 10 pts. managed by self-injection of PGE1.

40 varicoceles were treated by occlusion of the internal spermatic vein using detachable balloons: the main indications were subfertility and abnormal spermatogenesis. The procedure was successful in 39 patients, with one complication; limited preocclusion venograms allowed precise balloon placement relative to collateral veins which could cause recurrence. This is a safe and effective nonsurgical method of obliterating varicoceles in outpatients.

Thrombosis in cavernous bodies during erection-induced blood stasis is a exceptional phenomenon. This observation, induced the Authors to study coagulative and fibrinolytic activities of blood in cavernous bodies during pharmacologically induced erection. The results of the tests performed show that the blood of cavernous bodies has a fibrinolytic activity 3 times higher than peripheral blood (FPLA = 277 +- 83 mm2) and did not decrease when plasma was incubated with anti t-PA. During middle length erections, this activity is not expressed and the absence of thrombi formation seems to be due to a slowing of blood coagulation processes. On the other hand, during long-lasting erections, fibrinolysis is induced resulting in a local consumption like coagulopathy. Fibrinolysis in this district is not related to high t-PA plasma levels.

Vasoactive drugs have been widely used for the treatment of impotence in the last years. Recently Prostaglandin E1 has been employed with success as a therapy in erection problems. The Authors have treated with Prostaglandin E1 209 patients complaining erection failure. Positive results were obtained in 155 patients (74,16%). No complications or side effects occurred. 129 patients of the 155 in which the test resulted positive were proposed a self-injection program and 115 accepted. Until now no side effects or complications occurred.

Priapism, that is a long lasting erection in absence of sexual desire and is sometimes painful, has represented a rare occurrence until few years ago; such occurrence has become much frequent since pharmaco-erection have been used. There are still many doubts about the etiopathogenesis of priapism, that anyway happens because of a long lasting pathological discrepancy between arterious flux to penis corpora cavernosa and venous down flowing. For to establish how and when we must treat priapism, it is very important to know the causes of it, so that we can use the more properly therapy for each case. It's possible to classify the therapies in the following ways: a) extracavernosa, b) located in the corpus cavernosum. These last ones are most used and include the punction and the drainage of the blood of the cavernous body and sometime the "shunt" spongio-cavernosum. The treatment must be effected without loss of time in those rare cases of spontaneous priapism. Indeed, according to our experience, it's not necessary to be extremely supporting for intervention for priapism post pharmaco-erection. In fact the wait of 8-10 hours reduces the number of invasive treatments, without danger for the integrity of cavernous tissue.

Human sexual behaviour is determined by different regulatory systems. Central and peripheral nervous system, endocrine and vascular systems, all play a pivotal role in the modulation of male sexual activity. Therefore, many steps of possible drug interference can be recognized. In this regard, drugs are usually classified on the basis of their side effects (impairment of libido, erection and/or ejaculation). In the present work we review the sexual-related side effects of drugs of widespread clinical use on the basis of their mechanism and site of action.

The Authors shows effects of various environmental agents on spermatogenesis and testicular androgen synthesis. In particular we analyse a large use of chemical substances as pesticides, biological as the hormones and psychological factors as the overwork. We underline the importance of a careful working anamnesis before a andrologic patient.

Varicocele normally presents itself in adolescence, with an incidence of 16 per cent. Less than one third of the boys, though, will suffer from male infertility in adulthood. Therefore, it seems excessive as well as imprudent to suggest surgery to all those patients. We worked out some parameters to identify "risky" cases of varicocele. From June to November 1990 we studied 45 patients from 10 to 16 years of age affected by varicocele, taking into consideration the following factors: puberal phase, symptomatology, degree of varicocele, testicular volume, Doppler ultrasound, hormonal profile. A Doppler ultrasound test evidenced a clinically undetected right reflux, in addition to a left varicocele, in 13 patients (34.4%). Sixty per cent of these 13 patients revealed a pathological response to LHRH test; this incidence is very close to that evidence in clinical bilateral varicocele. We believe that a right reflux showed by ultrasounds, represents a cause of further alteration in the patient's endocrinological balance in addition to increasing his risk of infertility. Purpose of this study was to draw a guideline for early diagnosis, correct treatment and follow-up of varicocele in peripubertal age.

The authors report on their experience about diagnosis and therapies concerning cases of impotentia erigendi on account of urological operations in the small pelvis in order to extirpate tumours (radical prostatectomy, total cystectomy). The oncological effectiveness of the nerve-sparing technique is pointed out. The therapeutic diagnostic level is shown for this type of iatrogenic impotence and the various therapeutic possibilities are pointed out in relation to the wishes of the patient and to his life expectancies.

Authors present a synthetic review on the etiopathogenetic classification of the posttraumatic urethral and cavernosal pathology. Furthermore they propose the current therapeutic assessment adopted at the Institute of Urology of Milan, both in case of urgent management and for elective treatment.