Ahmed A. Sattar

Cavernous oxygen tension and smooth muscle fibers : relation and function

PURPOSE We studied the effect of intracavernous oxygen tension on the alteration of cavernous smooth muscle fibers in potent and impotent men. MATERIALS AND METHODS Intracavernous oxygen tension (mm. Hg) was measured during flaccidity and 10 minutes after intracavernous prostaglandin E1 injection in psychogenic control patients, and those with venous leakage and arterial lesions. Cavernous biopsies were performed and the percent of smooth muscle fibers was analyzed objectively using immunohistochemical actin anti-actin staining. Simultaneously brachial oxygen tension (mm. Hg) was measured and the cavernous brachial oxygen tension index was then determined. RESULTS At flaccidity no significant difference was noted in oxygen tension values among the 3 groups of patients. After prostaglandin E1 injection cavernous oxygen tension and the cavernous brachial oxygen tension index in the control group were significantly different (p < 0.01) from those of the venogenic and arteriogenic groups (p < 0.01). The mean percent of cavernous smooth muscle fibers in the control group was significantly different from those of the venous leakage and arterial lesion groups (p < 0.01). There was a good correlation between the percent of cavernous muscle fibers and the value of oxygen tension before (p < 0.05) and after prostaglandin E1 injection (p < 0.01). A similar correlation was noted between cavernous muscle fibers and cavernous brachial oxygen tension index in the different groups of patients (p < 0.01). CONCLUSIONS Reduction of the intracavernous smooth muscle fibers in impotent patients could be explained by low intracavernous oxygen tension.

Corporeal veno-occlusive dysfunction: Predominantly intracavernous muscular pathology

PURPOSE We investigated whether a relationship exists between the flow to maintain an erection obtained at cavernosometry and the alteration of intracavernous structures in impotent patients with corporeal veno-occlusive dysfunction and normal arterial inflow. MATERIALS AND METHODS Computerized histomorphometric analysis of smooth muscle and elastic fibers, and endothelial cells was compared to the flow necessary to maintain erection after intracavernous vasoactive drug injection in 18 patients with corporeal veno-occlusive dysfunction. RESULTS A significant correlation between percentage of smooth muscle fibers and flow to maintain erection was observed, while no correlation was noted with elastic fibers and endothelial cells. CONCLUSIONS Corporeal veno-occlusive dysfunction seems to be due mainly to smooth muscular alterations. According to this observation treatment of impotent patients with this abnormality should not be restricted to the penile veins but should also include the intracavernous structures, predominantly the muscular component.

Computerized measurement of penile elastic fibres in potent and impotent men

Intracavernous elastic fibres may play a role in human erectile tissue compliance and elasticity. Using computerized image analysis we have measured objectively the percentage of elastic fibres in corpus cavernosum tissues in both potent and impotent men. Twenty-two penile biopsies were performed in 5 potent and 17 impotent patients due to vascular disease. The mean percentage of elastic fibres was 9% in normal patients. In 12 patients with venous leakage a significant decrease in the amount of elastic fibres of 5.1% was observed and in 5 patients with arterial disease it was 4.3%. No correlation between the reduction of the elastic fibre quantification and age was observed. Change in elastic fibre content may alter the relaxation properties of cavernosal tissue and play a role in the development of erectile dysfunction.

Objective Criteria in the Long-term Evaluation of Penile Venous Surgery

Caverno-venous leakage is a frequent cause of impotence and, since venous network resection gives poor results, a study was performed to evaluate the prognostic factors of this surgical procedure. A total of 23 patients underwent surgery for caverno-venous leakage. With a minimum followup of 1 year, 12 patients had normal erections for sexual intercourse. No significant difference was observed in patient age or maintenance flow rates between the responders and nonresponders. Objective quantification of the percentage of smooth muscle cells using computerized image analysis after immunohistochemical staining (desmin antidesmin) for smooth muscle cells on cavernous biopsies performed during the operation allowed us to differentiate significantly between the 2 groups. All responders had greater than 29% smooth muscle cells. Biopsy of the cavernous body with quantification of the different intracavernous structures seems to be a prognostic factor in selecting impotent patients for vascular reconstruction.

Is one single prostate biopsy helpful for choosing a medical treatment of benign prostatic hyperplasia? A quantitative computerized morphometric study

OBJECTIVES Individual differences in proportion of stroma, epithelium, and luminal space components prostatic hyperplasia (BPH) may explain the differences in clinical outcome of the patients treated with alpha-reductase inhibitors or alpha-blocking agents and other alternative treatments. Knowledge of the individual proportions of these elements may orient the clinician toward different therapeutic approaches. To determine whether a single prostate biopsy is representative of the whole adenoma, using quantitative morphometry, we have compared the percentage of smooth muscle cells and glandular cells in one prostate needle biopsy and in the corresponding prostate adenoma removed by open surgery. METHODS Quantification was made using a computerized image analysis system and immunohistochemical staining (actin antiactin for the smooth muscle cells and anti-prostate-specific antigen (PSA) for the epithelial cells) in 14 patients who underwent retropubic prostatectomy. RESULTS Mean percentage of smooth muscle fibers, glandular epithelium, and glandular lumina in the prostate biopsy were, respectively, 34% (range, 20% to 42%, SD 5.9), 29% (range, 13% to 42%, SD 7.2), and 20% (range, 13% to 30%, SD 4.8). In the corresponding prostate adenoma, they were, respectively, 38% (range, 28% to 45%, SD 4.7), 32% (range, 25% to 40%, SD 4.5), and 19% (range, 13% to 34%, SD 6.1). The mean percentages of epithelial or glandular cells in the prostate biopsy and the corresponding adenoma were not statistically different (P > 0.05), whereas those for the smooth muscle cell percentage were different (P = 0.02). However, a statistically significant correlation between the whole adenoma and the needle biopsy sample was found in the percentage of smooth muscle cells (P = 0.028). Analyzing the morphometric data in conjunction with the serum PSA level and the volume of the adenoma, we found a statistically significant positive correlation between the volume of the adenoma and the ratio (percentage of epithelial cells/serum PSA level) (P = 0.009, r = 0.67). CONCLUSIONS Major differences are found in the primary tissue composition of different hyperplastic prostates. Computerized histologic quantification of the different components of BPH in the entire adenoma and a needle biopsy demonstrate that a single prostate biopsy is representative of the entire prostate adenoma. Morphometric data from a single biopsy of the prostate adenoma in combination with the serum PSA level and the volume of the prostate adenoma could therefore help to orient medical treatment of BPH by patient selection based on the knowledge of the distribution of the various components of BPH.

Penile Electromyography and Its Smooth Muscle Content: Interpretation of 25 Impotent Patients

PURPOSE We studied the correlation of penile electromyography and the cavernous smooth muscle content in 25 impotent patients. MATERIALS AND METHODS After a complete hormonal and diagnostic evaluation, all patients underwent corpus cavernosum penile electromyography and a penile biopsy of the corpus cavernosum with the biopsy gun device. Cavernous tissue was analyzed using immunohistochemical stain actin anti-actin and computerized image analysis. RESULTS Of the patients 20 had normal and 5 had abnormal corpus cavernosum penile electromyography. Of the 20 patients with normal corpus cavernosum penile electromyography 12 (60%) showed a normal percentage of cavernous smooth muscle and 8 (40%) had abnormal muscle content. All patients with abnormal corpus cavernosum penile electromyography showed abnormally low cavernous smooth muscle fibers. CONCLUSIONS Our study showed an overall low sensitivity between corpus cavernosum penile electromyography potential amplitude and cavernous smooth muscle content. However, a high specificity (100%) of corpus cavernosum penile electromyography in the diagnosis of abnormal low cavernous muscle content was observed. Further studies with a larger number of patients are needed to evaluate corpus cavernosum penile electromyography as a predictor of cavernous smooth muscle function.

Correlation of nocturnal penile tumescence monitoring, duplex ultrasonography and infusion cavernosometry for the diagnosis of erectile dysfunction

PURPOSE Nocturnal penile tumescence monitoring was compared to penile duplex ultrasonography and pharmaco-infusion cavernosometry in 50 cases of erectile dysfunction. MATERIALS AND METHODS Nocturnal penile tumescence was evaluated in all patients as normal or abnormal according to standard general criteria. The results were compared to penile duplex ultrasonography parameters (peak systolic velocity, normal greater than 35 cm. per second, and diastolic velocity, normal less than 5 cm. per second), and to the flow rate needed to maintain erection (normal less than 15 ml. per minute) with pharmaco-infusion cavernosometry. RESULTS Of the 50 patients 26 had normal nocturnal penile tumescence, including 25 (96%) with normal penile velocity, 18 (69%) with normal penile diastolic velocity and 22 (85%) with normal flow to maintain erection. On the other hand, 24 men had abnormal nocturnal penile tumescence of whom 7 (29%) had abnormal penile blood flow velocity, 17 (71%) had abnormal diastolic flow velocity and 18 (75%) had high flow rate to maintain erection. CONCLUSIONS Normal nocturnal penile tumescence appears to correlate well with normal systolic blood velocity and cavernosometry but poorly with diastolic blood velocity. On the other hand, a low correlation exists between abnormal nocturnal penile tumescence and abnormal diastolic blood flow or abnormal cavernosometry. Furthermore, no correlation exists between abnormal nocturnal penile tumescence and abnormal systolic blood flow. According to this observation we presume that nocturnal penile tumescence, penile duplex and infusion cavernosometry should be performed to achieve a reasonably accurate diagnosis.

Prostate capsule: Computerized morphometric analysis of its components

OBJECTIVES There is little objective information on what is designated as being the prostate capsule. We have quantified objectively with computerized image analysis the percentage of smooth muscle fibers (SMFs) surrounding the surgical specimens of radical prostatectomies. METHODS Ten radical prostatectomy specimens were used. Six different parts from prostate lobe were analyzed. Thirty different fields were examined from each tissue section. For tissue sections, different stains were used: hematoxylin and eosin, Massons trichrome, and immunohistochemical staining with antiactin for SMFs. RESULTS The mean thickness of the prostate capsule was 0.5 to 2 mm. The mean percentages of SMFs in the different regions of the prostate capsule was 30.6%. No difference was noted between the percentage of SMFs in the prostatic capsule compared with that in the prostate parenchyma itself (30.7%). CONCLUSIONS This study provides objective evidence to demonstrate that the prostate does not have a true capsule. This capsule represents a fibromuscular band that probably should be considered as the extension of the internal parenchyma.

Objective Quantification of Cavernous Endothelium in Potent and Impotent Men

Penile corporeal lacunar endothelium is active in the local neural control of corporeal smooth muscle relaxation by producing nitric oxide, a potent vasodilator neurotransmitter. Via computerized image analysis we quantified objectively the percentage of endothelial cells in corpus cavernosum tissues of potent and impotent men. Immunohistochemical staining factor VIII was used to identify the endothelial cells. Five normal potent men had a mean of 2.8% cavernous endothelial cells, compared to 2.4% in 12 patients with venous leakage and 2.8% in 10 with arterial disease. Objective quantification showed no difference in the numbers of cavernous endothelial cells between potent and impotent men.

Sensory conduction velocity of dorsal nerve of the penis during pharmacoerection: a more physiological technique?

OBJECTIVE Sensory conduction velocity (SCV) of the dorsal nerve of the penis is technically difficult to perform at rest and very slow SCV has been observed in the literature. This study evaluates the effect of pharmacoerection on the SCV measurement. METHODS Twenty-four men, 16 with a normal neurologic examination, 8 with a diabetic neuropathy, were studied at rest and after a 20-micrograms injection of prostaglandin E1. RESULTS Only 5 subjects had a recordable potential at rest. The mean SCV increased from 32.3 +/- 6.7 to 47.4 +/- 8.2 m/s after injection. Nine had only a recordable potential after injection. Ten had no potential at all, but 6 of them had a diabetic neuropathy. CONCLUSION Pharmacoerection was helpful in 37.5% of the subjects to obtain a sensory potential. Moreover, pharmacoerection may be the best way of calculating dorsal nerve SCV, as 47.4 m/s is what should be expected for a large myelinated nerve. This may be due to a correct interelectrode distance measurement as full tumescence may straighten the nerve at an individual and physiological length.