Ekkehard W. Hauck

Validation of the German version of the International Index of Erectile Function (IIEF) in patients with erectile dysfunction, Peyronie's disease and controls.

The objective of this study was to validate the German translation of the International Index of Erectile Function (IIEF). The IIEF was administered to 59 patients with erectile dysfunction (ED), to 38 patients with Peyronies disease and to 33 controls. All patients were investigated by standardized German versions of international questionnaires of anxiety, depression, social desirability, quality of partnership, physical complaints and life-satisfaction. The five subscales of the English version, however, could not be replicated. Internal consistency for the complete questionnaire of 15 items was high (Cronbachs alpha=0.95). Based on the total scale and two subscales, we were able to discriminate sexual function between the ED group and the comparison groups. There was no significant correlation between the IIEF scores and anxiety, depression, somatic complaints and life-satisfaction. The German version of the IIEF has found good comprehension, and acceptance by the majority of patients. Its use is somewhat limited by its focus on sexual activity in partnership. In contrast to the English version, it mainly addresses a single factor of sexual function.

Extracorporal Shock Wave Therapy in the Treatment of Peyronie’s Disease

Objective: To test whether extracorporal shock wave therapy (ESWT) has an effect in the treatment of Peyronie’s disease.Methods: 22 patients with Peyronie’s disease and previous unsuccessful oral drug therapy were treated with ESWT in a prospective design with a follow–up of at least 3 months; 23 age–matched patients without previous therapy received oral placebo drug for 6 months daily as control. The standard follow–up included palpation, ultrasound, autophotography and evaluation of symptomatology based on a symptom score. The shock waves were applied under ultrasound guidance using the ‘Storz Minilith SL1’ lithotripter.Results: The results show a significant decrease in penile curvature in the patients treated with ESWT. Concerning the decrease in pain, subjective improvement and improvement in the quality of sexual intercourse, there was no significant difference to the case–control group. The inhomogeneity of the 2 groups may influence these results due to the questionable varying natural history.Conclusions: A prospective, controlled multicenter study with standardized parameters (concerning technique and patients) is urgently required to test the effect of ESWT.

Diagnostic Value of Magnetic Resonance Imaging in Peyronie’s Disease—A Comparison Both with Palpation and Ultrasound in the Evaluation of Plaque Formation ☆

OBJECTIVE To compare the value of magnetic resonance imaging (MRI) with palpation and ultrasound in the evaluation of plaque formation in Peyronies disease. METHODS 57 patients underwent a standardized diagnostic procedure to evaluate plaque formation consisting of palpation and ultrasonography (7.5 MHz). MRI was performed during flaccidity and during erection induced by Prostaglandin E(1) including intravenous application of Gadolinium-diethylenetriaminepentaacetic acid (Gd-DPTA). RESULTS With all methods, 93 plaques have been detected in 57 patients. 85 plaques (91.4%) have been evaluated by palpation alone. Using ultrasound, 52 of these 93 plaques (55.9%) were detectable. This is equivalent to 61.1% of the palpable plaques. MRI confirmed 58 of the palpated plaques (68.2%) and exposed 8 primarily not palpable plaques at the penile basis. MRI revealed more palpable plaques than ultrasound, but this finding was not significant (p = 0.083). By means of sonography, calcification was evident in 14 plaques. MRI failed in revealing any calcification. After application of Gd-DPTA, 5 of 57 patients (9%) demonstrated contrast enhancement indicating local inflammation. None of these patients reported on penile pain. CONCLUSIONS Penile palpation in combination with ultrasound represents the method of choice to diagnose plaque formation in Peyronies disease. MRI provides better information on plaque formation at the penile basis. Calcification can only be proven by ultrasound, not by MRI. There may be additional information by MRI about local inflammation. A prospective study comparing the histological and MRI findings should be performed to answer the question, if pain is really associated with inflammation.

Urogenital infection and sperm motility

Summary.  Male accessory sex gland infections are considered as potential hazards to male fertility. Various pathophysiological concepts have evolved from experimental and clinical studies that begin to explain the effects of bacteria and immunological events on the function of spermatozoa and sperm motility in particular. Besides direct influences of pathogenic bacteria on spermatozoa whose impact on the motility of human spermatozoa is reviewed herein, recent studies have identified and evaluated infectious mediators that appear to be responsible for specific molecular processes in infections that particularly affect the motility of spermatozoa. This review will focus in detail on direct bacterial effects of sperm motility, the role of seminal leucocytes and the impact of pro‐inflammatory cytokines on the motility of spermatozoa.

François de la Peyronie and the disease named after him

THE LANCET • Vol 357 • June 23, 2001 2049 Peyronie’s disease is a connective-tissue disorder with plaque formation in the tunica albuginea of the corpora cavernosa. It predominantly affects men aged 40–60 years with an incidence of about 0·3% to 3%. The plaque is usually unifocally located in the penile dorsum causing a typical dorsal deviation and hour glass like-deformity in some cases. The disease may also be combined with erectile dysfunction or distal flaccidity. In the initial, acute phase, patients suffer from penile pain in flaccidity and/or during erection, which is thought to be the result of the active, inflammatory process. In most cases, pain ceases with time. Spontaneous resolution of the disease is typical in the early stages in about half of patients. Morphologically, an inflammatory reaction with thickening of the tunica with increased fibrin deposition, excessive production of collagen, and loss of elastic fibres is typical; and later on, a fibrotic, often calcified plaque develops. Although the disease was described by Francois de la Peyronie as early as 1743, its causes remain unclear even today. Recurrent penile trauma during sexual

Evaluation of penile perfusion by color-coded duplex sonography in the management of erectile dysfunction

The etiology of erectile dysfunction is wide ranging. Penile vascular disorders may result in impaired erection or complete impotence. Almost 30% of erectile dysfunction is due to the presence of systemic disease which affects the blood supply to the penis. The intracavernosal injection test with prostaglandin E1 alone offers limited information on the vascular status. In accordance with the increasing demand for less invasive procedures, penile color-coded duplex sonography (CCDS) combined with the pharmaco-erection test represents a first-line noninvasive approach to investigate arterial and veno-occlusive function. Peak systolic velocity and a change in cavernous artery diameter are indicators of arterial inflow, while the pathological end diastolic velocity and resistance index point out veno-occlusive dysfunction. The combined investigation of power and standard color Doppler ultrasound may yield more details of penile vascular anatomy.

Prospective Analysis of Single Nucleotide Polymorphisms of the Transforming Growth Factor β-1 Gene in Peyronie’s Disease

PURPOSE The detection of increased expression of transforming growth factor beta-1 (TGF-beta1) in Peyronies disease plaques and the possibility of initiating a Peyronies disease-like condition by intratunical injection of a synthetic heptopeptide with TGF-beta-like activity in an animal model has provided evidence for the central role of this cytokine in the pathogenesis of this entity. Recently 2 defined single nucleotide polymorphisms in the coding region of the TGF-beta1 gene have been described that are associated with different levels of TGF-beta1 production. Based on these data we prospectively investigated the genetic association of distinct TGF-beta1 genotypes with Peyronies disease. MATERIALS AND METHODS DNA samples from 111 consecutive patients with idiopathic Peyronies disease and 100 controls were genotyped for the 2 defined dimorphic single nucleotide polymorphisms T869C and G915C in the coding region of the TGF-beta1 gene using allele specific polymerase chain reaction. RESULTS We found an increased frequency of the homozygous genotype of the single nucleotide polymorphism G915C in patients with Peyronies disease compared with healthy controls (89.2% versus 79%, p = 0.04). However, there were no significant differences in allele frequencies of the single nucleotide polymorphism T869C. CONCLUSIONS Experimental data from other investigators have shown that TGF-beta1 has an important role in the etiopathology of Peyronies disease. Our results indicate that the homozygous wild type of the G915C single nucleotide polymorphism in the coding region of the TGF-beta1 gene, which was recently associated with elevated TGF-beta1 production and pulmonary fibrosis, may influence the predisposition to Peyronies disease. However, it does not represent a major genetic risk factor.

Blunt Renal Trauma: Biomechanics and Origination of Renal Lesions

OBJECTIVES Computer-assisted simulation of trauma is supposed to improve protective systems in traffic and risky leisure activities. In case of blunt renal injury biomechanical data being concerned with kidneys as a whole are extremely sparse. To enable three-dimensional simulations this study should supply important data of the renal biomechanics and elucidate the relationship between force distribution and origination of renal lesions. MATERIALS & METHODS The present study investigated 66 isolated uninjured porcine kidneys using a drop impactor. Changes in deformation, brake force of power, deceleration and intrapelvic pressure are depicted while varying energy application between 1.4 and 14.2J. Lesions were detected by cross-dissecting the organs into slices. RESULTS The measured values reflect a high correlation between load energy or brake force of power and deformation. Except the intrapelvic pressure all biomechanical parameters rise under increasing energy load. Comparing the different parameters over time a simultaneous concurrence of maximum brake force of power, deceleration and intrarenal pressure can be shown, the peak of deformation was reached belatedly. CONCLUSIONS The paths of biomechanical curves prove a viscoelastic behaviour of the kidney. In contrast to the literature the region principally bearing the load seems to be the collision zone between renal pelvis and cortex where first lesions appear. This is mainly caused by the fluid filled pelvis, an incompressible support, that is supposed to change its shape after exceeding energy application of about 4J.

Long-term results of Essed–Schroeder plication by the use of non-absorbable Goretex™ sutures for correcting congenital penile curvature

This study evaluated the long-term outcome of the Essed–Schroeder procedure for correcting congenital penile curvature using non-absorbable Goretex™ sutures. The Essed–Schroeder procedure was performed in 35 patients with congenital ventral penile curvature (minimum 30°). Follow-up included a standardized interview with measurement of angulation. Twenty-three of 35 patients were available for complete long-term follow-up (average 34.3 months). The mean preoperative ventral curvature was 54°. In 17/23 patients, the penis remained straightened. Recurrent curvature (average 23°) was observed in six of 23 patients. Fifteen of 23 patients complained of penile shortening (average 1.8 cm). Two of 23 patients reported disturbing side effects that were caused by plication nodes. In most cases, the results of penile straightening by the Essed–Schroeder procedure are excellent with a high grade of subjective satisfaction. Regarding the main problem, that is recurrent curvature, there is no decisive advantage of applying Goretex™ sutures. Discomfort caused by plication nodes can be reduced to a minimum by using a combination of soft Goretex™ sutures with the ‘inverting stitch-technique’.

Computer-assisted evaluation of the smooth-muscle electromyogram of the Corpora cavernosa by fast Fourier transformation

OBJECTIVE The aim of our study was to investigate analogous and digital recording of corpus cavernosum EMGs (CC-EMGs) in normal men according to criteria that were recently agreed upon in an international consensus workshop. METHODS CC-EMGs were analogously and digitally registered from 37 normal subjects. Power spectra in the frequency domain were determined via fast Fourier transformation (FFT). RESULTS Thirty-one of men showed identical or at least very similar electrical activity patterns in the analogous and digital registration. Needle penetration artifacts (investigated in 18 subjects) were found in 17/18 CC-EMGs during the first 20 min. Power spectra show a maximum of power at a frequency of 0.3 Hz with more than 90% of the power located between 0 and 5 Hz. CONCLUSIONS Registration of CC-EMGs in normal men resulted in interindividually reproducible recordings. Age hardly affected CC-EMGs. Computer-assisted evaluation by FFT after elimination of artifacts was feasible. Thus, interpretation of the CC-EMG signals by a computer-aided expert system seems to be promising for clinical routine, in particular with respect to an increase in objectivity and a decrease in time needed for interpretation.