Arnold Melman

Evaluation of the Dermal Graft Inlay Technique for the Surgical Treatment of Peyronie’sdisease

The results of treatment with the dermal graft inlay technique for 7 patients with Peyronies disease and the inability to achieve intercourse are discussed. All 7 patients were unable to attain tumescence postoperatively. We believe that patients who require surgical therapy for Peyronies disease and who have functional impotence should be treated with silicone penile implants.

The possible role of the catecholamines of the corpora in penile erection.

The etiology of impotence, which effects 50 per cent of the men with diabetes, is unknown. The neurotransmitter (norepinephrine) released from adrenergic neurons is thought to be the most direct regulator of vascular smooth muscle. We have measured the norepinephrine content of the erectile tissue of diabetic men. Our results indicate the presence of a dual neural regulator mechanism of the corpora that controls penile erection.

Experience with Implantation of the Small-Carrion Penile Implant for Organic Impotence

The 13 patients described herein have had successful placement of a Small-Carrion penile prosthesis through a penile incision. Because of surgical control and possible decreased chance of infection this approach is advocated over the perineal incision except in cases of post-priapism impotence or simultaneous placement of a Kaufman anti-incontinence device.

Ureteral Obstruction Owing to Endometriosis: Reversal with Synthetic Progestin

A case of unilateral ureteral obstruction owing to extensive pelvic endometriosis is presented. There was complete resolution of ureteral obstruction following treatment with synthetic progestin. Sequential assessment of renal function was provided by renal imaging and renograms. It would appear that selected patients with obstructive uropathy may respond favorably to medical management, which would allow for preservation of reproductive capabilities and restoration of renal excretory function.

Increased Incidence of Renal Cell Carcinoma with Hypertension

Of 276 patients who underwent evaluation to determine the cause of hypertension 2 were found to have unsuspected renal cell carcinoma. This prevalence of 0.73 per cent is 16 times higher than expected for an age-matched population. Both patients exhibited abnormalities of plasma renin activity before radical nephrectomy but they remained hypertensive postoperatively. The data suggest an unexplained association between hypertension and renal cell carcinoma. Furthermore, abnormalities on excretory urograms in hypertensive people should be defined by selective renal arteriography.

Improved Diagnostic Accuracy of Renal Venous Renin Ratios with Stimulation of Renin Release

Fifty patients who underwent renal angiography and bilateral renal venous determinations had reconstructive or ablative surgery. The importance of stimulating renin release was underlined in 11 patients who attained a renal venous ratio greater than 1.5 to 1 only after being in an upright posture and in 5 who were studied with and without salt depletion. A protocol designed to suppress or stimulate peripheral plasma renin activity was followed in 19 patients. Stimulated peripheral plasma renin activity was not useful in identifying hypertension of renovascular origin but 10 of 12 patients whose plasma renin activity was not suppressed normally were improved by an operation. Satisfactory surgical responses were obtained in 81 per cent of the patients with unilateral and 91 per cent with bilateral atherosclerosis, and 88 per cent with unilateral and 60 per cent with bilateral fibromuscular hyperplasia. Our observations indicate that renal artery stenosis can be identified consistently only by angiography. A stimulated renal venous renin rate of 1.5 to 1 appears to have the best predictive value in surgical control of renovascular hypertension.

Development of contemporary surgical management for erectile impotence

The act of genital intercourse is dependent upon the ability to achieve a rigid, straight phallus. Many men, however, are unable to achieve erection because of disease or injury. This report is a review of the development and survey of the surgical techniques that are available to treat the problem of erectile impotence.

Placement of the Small-Carrion penile prosthesis to enable maintenance of an exdwelling condom catheter

Four patients in our Medical Center underwent placement of a Small-Carrion penie prosthesis for the primary purpose of maintaining an exdwelling condom catheter. The major benefits of being able to carry on daily activities, while maintaining satisfactory perineal hygiene, without the need for an indwelling Foley catheter is a most significant factor in the consideration of prosthetic surgery.

Nonassociation of hyperamylasemia and prostatic disease

The possible correlation of hyperamylasemia and prostatic disease was investigated in patients with benign prostatic hyperplasia, adenocarcinoma of the prostate, and in patients without clinical evidence of prostatic lesion. Our results indicate that prostatic lesions whether benign or malignant are not associated with either elevation of serum amylase or abnormal isozyme zymograms.

The diagnosis and therapy of impotence associated with diabetes

Diagnosis and surgical treatment of impotence resulting from diabetes is examined along with the advantages and disadvantages of two surgical procedures. A case report is presented and analyzed for illustration purpose.