Carlos Teodósio Da Ros

TAMOXIFEN VERSUS PLACEBO IN THE TREATMENT OF PEYRONIE'S DISEASE

PURPOSE We evaluated the effects of oral tamoxifen and placebo in patients with Peyronies disease. MATERIALS AND METHODS We selected 25 patients with Peyronies disease who did not have calcified plaque for treatment in the andrology outpatient clinic. A medical history was obtained, and physical examination, penile x-ray, penile ultrasound and pharmacologically induced erection with prostaglandin E1 were performed. Patients were randomly divided into group 1--those who received 20 mg. tamoxifen twice daily for 3 months and group 2--those who received placebo for the same period. The same evaluations were done 4 months later and results were compared. Qualitative (chi-square test) and quantitative (Students t test) results were analyzed using the Yates correction factor with p <0.05 considered significant. RESULTS Pain subsided in 66.6 and 75% of the patients treated with tamoxifen and placebo, respectively (p >0.05). In groups 1 and 2 a reduction in the penile deformity was noticed by 46.1 and 41.7% of the patients (p >0.05), and a decrease in plaque size was noticed by 30.7 and 25%, respectively. On the other hand, objective measurements did not reveal any difference in plaque area or curvature angle. CONCLUSIONS This study did not show significant improvement in pain, curvature or plaque size in patients with Peyronies disease who were treated with tamoxifen compared with those treated with placebo.

PENILE STRAIGHTENING WITH CRURAL GRAFT OF THE CORPUS CAVERNOSUM

PURPOSE We present a surgical alternative to penile straightening in Peyronies disease that avoids penile shortening by using tissue from the crural segment of the corpora cavernosa as a graft. MATERIALS AND METHODS We treated 7 patients with stable Peyronies disease and satisfactory penile rigidity but significant curvature that precluded intercourse with this technique. An incision is made in the fibrous area and after stretching the gap is covered with a graft removed from the crural segment of the corpora cavernosa. RESULTS In 6 of the 7 men straightening was satisfactory but in 1 it was not complete. No patient reported worse penile rigidity postoperatively. Donor site healing was uneventful. CONCLUSIONS Use of tissue from the corpus cavernosum to correct penile curvature is effective. However, our results are preliminary, and long-term effectiveness and safety must be confirmed in a larger number of cases.

Long-term follow-up of penile curvature correction utilizing autologous albugineal crural graft

PURPOSE Peyronie s disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Usually it results in impairment of the quality of life. Our objective is to review the long-term results of the albugineal grafting harvested from the penile crura for the treatment of severe penile curvature. MATERIALS AND METHODS Thirty-three patients with Peyronie s disease were submitted to a grafting with tunica albuginea from the penile crura for the correction of penile curvature. The results were evaluated after 6 months of the procedure. Variables studied were overall satisfaction with the procedure, correction of the penile curvature, erectile capacity, penile shortening and the presence of surgical complications. RESULTS Mean follow-up after surgery was 41 months. Complete correction of the curvature was achieved in 30 patients (90%). The mean preoperative curvature was 91.8 degrees and median plaque length was 2 cm (ranged from 1 to 5 cm). Three patients (9%) experienced recurrence of the penile curvature and required a new procedure. In 30 men (90%) the procedure fulfilled their expectations and in 31 patients (93.9%) their opinions were that sexual partners were satisfied with the penile correction. Penile shortening or augmentation was referred in 6 (18.1%) and 1 (3%) patient, respectively. CONCLUSION Our series demonstrated that grafting the albugineal defect after incision of the tunica albuginea with tunica from the crus for the correction of penile curvature is safe and results in satisfactory straight erections during along-term follow-up.

Twenty-five milligrams of clomiphene citrate presents positive effect on treatment of male testosterone deficiency - a prospective study

INTRODUCTION Male testosterone deficiency is associated with bad sexual function and quality of life (QoL). The aim of this study was to determine whether a daily dose of 25 mg clomiphene citrate (CC) is effective in stimulating the endogenous testosterone production pathway and to address the applicability of this medication as a therapeutic option for symptomatic hypogonadism. MATERIALS AND METHODS This was a prospective study. Men with low sexual desire and testosterone levels (T) below 400 ng/dL were selected to receive CC. Blood samples were obtained to determine baseline measurements of serum T, estradiol, LH, lipid profile and fasting plasma glucose. Each patient was treated with a daily dose of 25 mg CC for at least 3 months. Patients were asked if they experienced any side effects related to the use of CC and if they experienced any improvement in their sexual profile. Paired samples T-test was utilized to analyze responses to therapy. RESULTS Our cohort consisted of 125 men with hypogonadism and low libido. Mean age was 62 years (± 11.1 years). Serum T levels ranged from 309 ng/dL (baseline, mean value) to 642 ng/dL (3 months after CC initiation, mean value) (p < 0.001). Serum cholesterol levels ranged from 197 to 186 mg/dL (p = 0.003). There were no statistically significant differences when comparing pre and post-treatment HDL-Cholesterol, triglycerides, fasting plasma glucose and prolactin. All men reported improvements in the post-treatment QoL scores. No serious adverse events were recorded. CONCLUSIONS The CC was effective in stimulating the endogenous production of testosterone. A lower level of total cholesterol was verified after three months of treatment. This medication should be considered as a therapeutic option for some patients with symptomatic male testosterone deficiency.

Prosthetic Penile Infection: “Rescue Procedure” with Rifamycin

Penile prosthetic implantation is a successful procedure for the management of male erectile impotence. However, infection remains the most serious complication requiring removal of the device. Later reinsertion can be difficult due to fibrosis and a shortened penis. We present 3 cases of penile infection with Staphylococcus epidermidis in which a new penile prosthesis was placed after 72 hours of continuous irrigation of the corpora cavernosa with rifamycin. The procedure requires judicious selection of patients and a stable clinical status.

DOES INTRATESTICULAR TESTOSTERONE ADMINISTRATION MODIFY THE EVOLUTION OF TRANSITORY TESTICULAR ISCHEMIA IN PREPUBERTAL RATS

PURPOSE Testicular torsion followed by ischemia results in variable degrees of infertility and until now there appears to be no effective way to recover it. Testosterone participation in the maintenance of male sexual organs and spermatogenesis led us to hypothesize that intratesticular administration could recover ischemic injury. MATERIALS AND METHODS We divided 40 Wistar rats in 2 groups, of 20 each. One group was control and the other underwent a 120-minute testicular ischemia by means of a vascular clamp on the left spermatic cord. Each group was further subdivided in 2 subgroups. The first one was observed and the second received intratesticular testosterone 25 mg. starting on the third day after injury and during the next 7 consecutive days. Half the animals were sacrificed 30 days after injury and the remaining ones after 60 days. Weight, volume, number of seminiferous tubules, histology and spermatogenesis of the same side and contralateral testes were examined. For statistical analysis ANOVA and Fishers tests were applied. RESULTS It was found that testosterone was capable of acting upon volume and weight of the left testis (p=0.0001). The animals receiving intratesticular testosterone showed lower testicular weight and volume after 30 and 60 days, respectively. This subgroup also showed a higher number of seminiferous tubules, modified histology and absent spermatogenesis suggesting testicular atrophy. CONCLUSIONS We concluded that intratesticular injection of testosterone 25 mg. once a day during 7 consecutive days after transitory testicular ischemia causes ipsilateral testis atrophy. The animals in control group showed testicular histological recovery 60 days after injury. There were no significant histological differences in the contralateral testes.

Magnetic Spheres as Foreign Body into the Bladder

INTRODUCTION A great variety of foreign bodies in the lower urinary tract have been described; many of them are self-inflicted by the patient with masturbatory purposes. Depending on the nature of the foreign body the diagnostic and management might be challenging. AIMS We report a case of an unusual magnetic self-inserted foreign body into the bladder for autoerotism and briefly discuss the diagnostic and therapeutic implications in this challenging situation. METHODS We describe all the steps we have used to adequately diagnose the problem, describe the foreign body and treatments for the patient. Related articles were found by utilizing the PubMed database and are summarized in this study. RESULTS   The management approach must be planned according to the nature of the foreign body and should minimize bladder and urethral trauma. However, most of cases can be managed endoscopically. CONCLUSION Removal of magnetic foreign body may be quite challenging, requiring high-level surgical skills and minimally invasive techniques resulting in fast recovery and low complication rate.