John P. Pryor

Nesbit Operation for Peyronie's Disease: 16-Year Experience

PURPOSE We analyze the long-term outcome of the Nesbit operation for the correction of the penile deformity due to Peyronies disease. MATERIALS AND METHODS Between 1977 and 1992, the penile deformity due to Peyronies disease was corrected in 359 patients using the Nesbit operation. RESULTS The overall success rate was 82%, which increased to 90% during the last 8 years with better patient selection due to improved preoperative investigation. Complications were minimal and only 6 patients had significant penile shortening that precluded sexual intercourse. CONCLUSIONS The Nesbit operation remains the procedure of choice to correct the penile curvature of Peyronies disease.

Outcome of penile prosthesis implantation for treating erectile dysfunction: experience with 504 procedures.

To evaluate the outcome of penile prosthesis surgery for different types of prosthesis.

Pedicled pubic phalloplasty in females with gender dysphoria

To describe a novel phalloplasty technique and to study the results and complications in female patients with gender dysphoria.

The Immunological Features of Peyronie's Disease

PURPOSE We investigated the immunological features and possible autoimmune basis of Peyronies disease. MATERIALS AND METHODS The sera of 100 patients with Peyronies disease were tested for circulating autoantibodies, including anti-penis antibodies, by indirect immunofluorescence. Antibody deposition and the immunological activity in Peyronies plaque tissue from patients with early and long-standing disease were also assessed. RESULTS Circulating anti-penis antibodies were not found in any patient although antinuclear antibodies were present in 24%. Patients with early Peyronies disease had IgM antibody deposition, marked T lymphocytic and macrocytic infiltration in the sub-tunical space, increased expression of adhesion molecules by endothelial cells and an increased human lymphocyte antigen class 2 expression by the cellular infiltrate, indicating cellular immune activation. CONCLUSIONS These results show that some of the features of autoimmunity, in particular the cell mediated response, are present in Peyronies disease.

The Nesbit operation for Peyronie's disease: an analysis of the failures

Objective To analyse critically the reasons for a poor outcome of the Nesbit operation for Peyronies disease in 51 patients over a 20‐year period.

The Genetic and Bacteriological Aspects of Peyronie's Disease

PURPOSE Peyronies disease has been associated with HLA tissue types, including HLA-A1, DR3, DQw2 and HLA-B7 cross-reactive group antigens which include HLA-B27. This association was tested as was the process of molecular mimicry where the host HLA surface antigen cross-reacts with a microorganism. MATERIALS AND METHODS HLA tissue typing was performed on 51 white patients with Peyronies disease, of whom 15 also had Dupuytrens contracture of the hand. Fecal, urine and urethral samples were taken from patients with Peyronies disease who had proved penile inflammation on biopsy. The samples were cultured for species of Campylobacter, Shigella, Salmonella, Yersinia, Chlamydia and gonococcus, all known to cross-react with the HLA-B27 surface antigen. Antibodies to Klebsiella species, Proteus species and Escherichia coli were also assessed in the sera of 65 patients with Peyronies disease. RESULTS A significant association between Peyronies disease and HLA-B27 was found (p = 0.02). The remaining antigens of the HLA-B7 group were not significantly associated with the disease individually (HLA-B7 p > 0.2, HLA-B22 p > 0.6, HLA-B40 p > 0.7) or as a group (p = 0.69). The previously found associations did not reach significance in this study (HLA-A1 p > 0.5, HLA-B8 p > 0.2, HLA-Cw7 p = 0.1, HLA-DR3 p > 0.4, HLA-DQ2 p > 0.4). Cultures for all enteric and urethral organisms were negative, and patients with Peyronies disease did not have elevated serum titers of anti Klebsiella, anti Proteus or anti E. coli antibodies. CONCLUSIONS Although there is an association between Peyronies disease and HLA-B27, molecular mimicry does not occur with the organisms tested, and an infectious agent has not been found in this study.

The Nesbit operation for congenital curvature of the penis

Objective: To assess the results of the correction of congenital penile curvature using the Nesbit operation.Patients and methods: The records of 106 patients who had a Nesbit operation to correct a congenital penile curvature between 1977 and 1992 were reviewed.Results: An excellent (78.3%) or satisfactory (17.9%) result was achieved representing an overall success rate of 96.2%. The reasons for a poor or satisfactory result were either an impaired erection—7 (6.6%) [all psychogenic] or a residual deformity of 10°–16 (15.1%). There were no major complications although five patients (5.3%) needed a further Nesbit operation.Conclusion: The Nesbit operation is a simple and effective technique for the correction of a congenital penile curvature.

Sildenafil: Efficacy and Safety in Daily Clinical Experience

Objectives: Sildenafil citrate (Viagra™) is a potent selective inhibitor of phosphodiesterase type 5 proposed for the oral treatment of erectile dysfunction (ED). The aim of this study was to evaluate its efficacy and safety when used in daily practice in patients with ED of various aetiology. Patients and Methods: From September 1998 to April 1999, 380 patients chose sildenafil as treatment for their ED. One hundred and forty–five (38%) of them suffered from psychogenic ED, 125 (33%) organic and 110 (29%) of mixed aetiology. The grade of erection achieved and the occurrence of satisfactory sexual intercourse assessed the efficacy. Safety and tolerance were evaluated recording any side effect or adverse event. Results: The overall efficacy of Viagra™ was 77%, with a response of 100% among the group of hormonal patients, 88% for psychogenic, 72% for mixed, 69% for diabetes, 65% for vascular and 60% for neurological symptoms. A few and mild to moderate side effects were recorded. Conclusion: These results indicate that the use of sildenafil citrate is an effective and well–tolerated therapy for men with ED of various aetiology with an overall success rate of 77%.

Safety of sildenafil.

Sildenafil has an excellent safety record in its clinical trials but there have been reports of deaths associated with its usage now that it is in widespread clinical use. Many of these deaths are clearly unrelated to the drug and some may be related to usage where there are clear contradictions to its use. Some deaths may occur because the patients are at risk from cardiac problems but there remains an occasional unexplained death. There is no evidence at present to suggest that sildenafil is a specific causative factor and the research so far has failed to support it as such.

Fertility considerations in the patient with testis cancer.

Fertility is an important aspect in the quality of life of patients surviving testis cancer. The question of future fertility should be considered before treatment commences, and the patients wishes may require modification of therapeutic regimens. The biggest improvement in the management of male infertility over the past 10 years has been the introduction of intracytoplasmic sperm injection (ICSI). This review gives a perspective of these issues, together with an outline of recent papers on the subject.