Albert Leriche

Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism

To assess the long‐term outcome of forearm free‐flap phalloplasty in transsexuals, as obtaining a satisfying neophallus in female‐to‐male transsexuals is a surgical challenge.

Perceived Physiological and Orgasmic Sensations at Ejaculation in Spinal Cord Injured Men

INTRODUCTION With the advances in penile vibrator stimulation (PVS), most spinal cord injured (SCI) men can self-ejaculate. Oral midodrine may further increase ejaculation success, while maintaining autonomy. Since most SCI men attempt ejaculation for sexual rather than reproductive purposes, self-ejaculation should be emphasized and sensations explored. AIMS Explore (i) self-ejaculation success rate in SCI men; (ii) vascular parameters indicative of autonomic dysreflexia (AD) during sexual stimulation and ejaculation; and (iii) sensations associated with ejaculation. METHODS Ejaculation was assessed on 81 SCI men with complete ASIA A (49%) and incomplete B to D lesions (51%), subdivided into tetraplegics (C2-T2), paraplegics sensitive to AD (T3-T6), paraplegics not sensitive to AD (T7-T10), paraplegics with lesions to the emission pathway (T11-L2), and paraplegics with lesions interrupting the emission-ejaculation pathways (L3-below). Natural stimulation was attempted first followed, if negative, by PVS followed, if again negative, by PVS combined with oral midodrine (5-25 mg). MAIN OUTCOME MEASURES Ejaculation success, systolic and diastolic blood pressure, and perceived physiological and orgasmic sensations. RESULTS Overall 91% reached ejaculation, 30% with natural stimulation, 49% with PVS and 12% with midodrine plus PVS. Midodrine salvaged up to 27% depending upon the lesion. Physiological and orgasmic sensations were perceived significantly more at ejaculation than sexual stimulation. Tetraplegics did not differ from paraplegics sensitive to AD on perceived cardiovascular and muscular sensations, but perceived significantly more autonomic sensations, and generally more physiological sensations than lower lesions unsensitive to AD. CONCLUSION Most SCI men can self-ejaculate and perceive physiological and orgasmic sensations. The climactic experience of ejaculation seems related to AD, few sensations being reported when AD is not reached, pleasurable climactic sensations being reported when mild to moderate AD is reached, and unpleasant or painful sensations reported with severe AD. Sexual rehabilitation should emphasize self-ejaculation and self-exploration and consider cognitive reframing to maximize sexual perceptions.

What is the optimum dose of type A botulinum toxin for treating neurogenic bladder overactivity

To assess the effects of two doses of botulinum toxin A (Dysport®, Ipsen‐Biotech, France; 500 and 1000 Speywood units, SU) injected into the bladder for treating incontinence due to a neurogenic overactive bladder.

Outcome and Cost Analysis of Sacral Nerve Modulation for Treating Urinary and/or Fecal Incontinence

Background:Sacral nerve modulation (SNM) is an established treatment for urinary and fecal incontinence in patients for whom conservative management has failed. Objective:This study assessed the outcome and cost analysis of SNM compared to alternative medical and surgical treatments. Methods:Clinical outcome and cost-effectiveness analyses were performed in parallel with a prospective, multicenter cohort study that included 369 consecutive patients with urge urinary and/or fecal incontinence. The duration of follow-up was 24 months, and costs were estimated from the national health perspective. Cost-effectiveness outcomes were expressed as incremental costs per 50% of improved severity scores (incremental cost-effectiveness ratio). Results:The SNM significantly improved the continence status (P < 0.005) and quality of life (P < 0.05) of patients with urge urinary and/or fecal incontinence compared to alternative treatments. The average cost of SNM for urge urinary incontinence was &OV0556; 8525 (95% confidence interval, &OV0556; 6686–&OV0556; 10,364; P = 0.001) more for the first 2 years compared to alternative treatments. The corresponding increase in cost for subjects with fecal incontinence was &OV0556; 6581 (95% confidence interval, &OV0556; 2077–&OV0556; 11,084; P = 0.006). When an improvement of more than 50% in the continence severity score was used as the unit of effectiveness, the incremental cost-effectiveness ratio for SNM was &OV0556; 94,204 and &OV0556; 185,160 at 24 months of follow-up for urinary and fecal incontinence, respectively. Conclusions:The SNM is a cost-effective treatment for urge urinary and/or fecal incontinence.

Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

Associate Editor

Combination of Doxazosin and Sildenafil Exerts an Additive Relaxing Effect Compared with Each Compound Alone on Human Cavernosal and Prostatic Tissue

INTRODUCTION Phosphodiesterase 5 inhibitors (PDE5) such as sildenafil are first-line treatment for erectile dysfunction (ED). Alpha1 (alpha1)-adrenoceptor antagonists such as doxazosin are indicated for the treatment of patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). ED and LUTS/BPH are conditions that are often associated. Accordingly, alpha1-adrenoceptor antagonists and PDE5 inhibitors will be often prescribed in real life setting together. AIM To evaluate the effects of the combination of sildenafil and doxazosin on human cavernosal and prostatic tissue. METHODS Prostatic and erectile tissues were obtained from nine to 12 patients, respectively. Patients underwent cystoprostatectomy for infiltrating bladder cancer or penile surgery for penile implant, congenital curvature or Peyronies disease. MAIN OUTCOME MEASURES In organ baths, prostatic and cavernosal strips were submitted to either concentration-response curves (CRC) to phenylephrine (Phe) or norepinephrine (NE), respectively, in presence of vehicle, sildenafil (10(-6) M, 10(-5) M), doxazosin (10(-8) M, 3.10(-8) M, or 10(-7) M), or a combination of both. Continuous electrical field stimulation (EFS; 32 Hz, 5 ms, 5 seconds, 300 mA) was performed on prostatic strips which were incubated with sildenafil 10(-6) M or vehicle before the successive addition of doxazosin (10(-7) M, 10(-6) M) or vehicle. Cavernosal strips were pre-incubated with doxazosin (10(-9) M, 10(-8) M) or vehicle, then CRC to sildenafil were constructed on NE (3.10(-6) M) precontracted cavernosal strips. RESULTS Combination of sildenafil and doxazosin exerted a greater relaxing effect on CRC to Phe or NE compared with each compound alone in both tissues. Sildenafil significantly enhanced the relaxing effect of doxazosin on EFS-induced contractions in prostatic strips. Doxazosin significantly increased the ability of sildenafil to inhibit NE-induced contractions in cavernosal strips. CONCLUSIONS Sildenafil and doxazosin reduced adrenergic tone of prostatic and cavernosal smooth muscle and their combination provided a significant benefit when targeting relaxation of both tissues. These experiments provide support for further clinical evaluation of the sildenafil and doxazosin combination in ED patients with LUTS/BPH.

Posttraumatic erectile potential of spinal cord injured men: How physiologic recordings supplement subjective reports

OBJECTIVE To investigate by means of a neurophysiologic model the remaining erectile function in spinal cord injured men. DESIGN A nonrandomized control trial. SETTING A Referred Care Center. SUBJECTS Forty-seven spinal cord injured men and 7 noninjured controls. INTERVENTION The subject penile responses were recorded by a penile strain gauge during two sessions--one to obtain baseline responses, and one with reflexogenic stimulation (masturbation) and psychogenic stimulation (film). MEASURES Average tumescence, maximal tumescence, percentage rigidity, and duration of tumescence and rigidity. RESULTS Significant results were found for subjects with lower lesions using psychogenic stimulation as their optimal mode compared with reflexogenic stimulation as an alternate mode, and for subjects with higher lesions using reflexogenic stimulation as their optimal mode, compared with psychogenic stimulation as an alternate mode. The responses with optimal stimulation modes were comparable to those achieved by controls. CONCLUSION The findings validate the neurophysiologic model of posttraumatic erectile potential as a function of the lesion type and stimulation source. The results were comparable to those of noninjured subjects; the potential for normal function is present and may be amenable to sexual rehabilitation or use in conjunction with new oral drug treatments for impotence.

Treatment of neurogenic male urinary incontinence related to intrinsic sphincter insufficiency with an artificial urinary sphincter: a French retrospective multicentre study

Study Type – Therapy (retrospective cohort)
Level of Evidence 2b

PATTERNS OF MESSENGER RNA EXPRESSION FOR alpha1-ADRENOCEPTOR SUBTYPES IN HUMAN CORPUS CAVERNOSUM

PURPOSE The present study evaluated the expression of alpha1-adrenoceptor subtypes in human corpus cavernosum. MATERIALS AND METHODS The mRNA encoding alpha1a, alpha1b and alpha1d subtypes were assessed by RNA-directed complementary cDNA synthesis followed by Taq DNA amplification. The level of alpha1 mRNA was calculated in arbitrary optical density units and normalized with respect to the length of the respective cDNA fragments. RESULTS We found that alpha1a, alpha1b and alpha1d adrenoceptor subtypes are expressed in human corpus cavernosum, with a predominant expression of the alpha1a subtype. CONCLUSION These results suggest that alpha1a-adrenoceptor subtype is important and that understanding the biochemical and functional characteristics of this subtype may lead to the development of specific antagonists in the treatment of impotence.

Use of forearm free‐flap phalloplasty in bladder exstrophy adults

To assess the long‐term outcome and cosmetic results of forearm free‐flap phalloplasty for correcting micropenis associated with bladder exstrophy in men.