Jas Kalsi

The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie's disease.

Associate Editor

The management of low‐flow priapism with the immediate insertion of a penile prosthesis

Objective  To evaluate the outcome of patients undergoing the immediate insertion of a penile prosthesis as a treatment for acute low‐flow priapism.

Plaque incision and fascia lata grafting in the surgical management of Peyronie's disease.

To assess the outcome of using modified human fascia lata (TutoplastTM, Mentor Corp, Santa Barbara, CA, USA) in the surgical management of Peyronie’s disease (PD), as the penile deformity associated with PD can be corrected by plaque incision and saphenous vein grafting (Lue procedure).

A Rho-kinase inhibitor, soluble guanylate cyclase activator and nitric oxide-releasing PDE5 inhibitor: novel approaches to erectile dysfunction.

Approximately 50% of men aged over 40 suffer from male erectile dysfunction. Treatment options have widened since the launch of the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil citrate (Viagra™). However, a certain portion of the patient population, such as diabetics, do not gain significant benefit from PDE5 inhibitors, possibly due to a lack of endogenous nitric oxide. Therefore, new treatment modalities based on the absence of endogenous nitric oxide have been developed. Among them are Rho-kinase inhibitors, soluble guanylate cyclase activators and nitric oxide-releasing PDE5 inhibitors. The available data concerning these compounds will be summarised and their therapeutic potential for male erectile dysfunction will be discussed.

In the era of micro-dissection sperm retrieval (m-TESE) is an isolated testicular biopsy necessary in the management of men with non-obstructive azoospermia?

Study Type – Therapy (case series)

Novel PDE5 inhibitors for the treatment of male erectile dysfunction

Erectile dysfunction (ED) affects the lives of approximately 150 million men worldwide. ED may be a cause of male sub-fertility in a significant proportion of patients. There is now an expanding armamentarium for the management of ED, including oral agents such as phosphodiesterase type 5 (PDE5) inhibitors. PDE5 inhibitors may also be useful in situations of temporary ED in couples undergoing IVF. Two novel PDE5 inhibitors have been commercially launched in the European Union in the first quarter of 2003. This article reviews the pharmacology and clinical efficacy of these new agents and their potential role in treating patients with male sub-fertility.

Plaque incision and grafting as a salvage after a failed Nesbit procedure for Peyronie's disease

To analyse the outcome of plaque incision and grafting in patients who have a residual penile deformity after a Nesbit procedure for Peyronies disease, as a further Nesbit procedure may present difficulties in dissection at the previous operative site, and may result in further penile shortening.

Massive bilateral angiomyolipomas resulting in respiratory failure

A 35-year-old woman presented as an emergency complaining of right-sided abdominal pain, vomiting and abdominal distension. She also had a cough, increased difficulty in breathing and was febrile. Three years previously she had been diagnosed with tuberous sclerosis, bilateral renal angiomyolipomas (AMLs) and pulmonary lymphangio-leiomyomatosis (LAM). On admission her plasma creatinine level was 156 mmol/L and her haemoglobin level was 73 g/L. Initial management required intravenous resuscitation, broad-spectrum antibiotics and blood transfusion. At 72 h her respiratory and renal function deteriorated significantly and she was transferred to the intensive care unit for respiratory support and haemofiltration. Her respiratory function deteriorated further and the abdominal distension increased, requiring regular blood replacement and ultimately becoming transfusion dependent (although she was not haemodynamically compromised). CT of the abdomen revealed bleeding into the left kidney and retroperitoneal haemorrhage on the right side (Fig. 1). CT of the chest showed the abnormal features seen in LAM (Fig. 2). Renal angiography detected massively dilated renal arteries with the AMLs acting as arteriovenous shunts, but failed to identify active bleeding (Fig. 3); in view of her deteriorating clinical condition she underwent bilateral nephrectomy. At surgery two enormous kidneys were removed through a transverse anterior incision. The right kidney was 30 ¥ 21 ¥ 13 cm and weighed 3.828 kg, with the left kidney being even heavier (4.015 kg) and 30 ¥ 18 ¥ 1 cm. The patient made an impressive recovery, with normal respiratory function. Haemodialysis was commenced and the patient is currently awaiting a renal transplant.