Jonathan D. Schiff

An Analysis of the Natural History of Peyronie’s Disease

PURPOSE Little information exists on the natural history of PD. We defined the course of PD in a group of men with this condition who received no treatment. MATERIALS AND METHODS The study population comprised patients with PD who presented within 6 months of disease onset, had no medical treatment and were followed until at least 12 months after disease onset. At baseline and followup penile abnormality was determined following intracavernous injection and by measurement at maximum penile rigidity. RESULTS A total of 246 patients met inclusion criteria. At presentation mean age +/- SD was 52 +/- 22 years and the duration of PD was 3.5 +/- 1.5 months. At baseline in men with documented curvature 72% had dorsal, 17% had ventral and 11% had lateral curvature. Mean curvature at baseline was 42 +/- 22 degrees. Mean stretched flaccid penile length was 12.2 cm. The mean duration of PD at the followup assessment was 18 +/- 7 months. At followup stretched flaccid length had decreased to 11.4 cm (p = 0.035). Of the patients 32% complained of some degree of erectile dysfunction at baseline. All patients who reported penile pain had improvement and 89% reported complete resolution at followup. Of men with curvature 12% had improved, 40% remained stable and 48% had worsened at followup. In those in whom curvature improved the mean change was 15 degrees, while in those in whom curvature worsened the mean change was 22 degrees. CONCLUSIONS To our knowledge this is the largest study to explore the natural history of PD. A minority of men experienced improvement in penile abnormality, while penile length decreased during the 1-year followup. This information will permit clinicians to provide patients with realistic expectations at presentation for the evaluation of PD.

Laparoscopic vs open partial nephrectomy in consecutive patients: the Cornell experience

To compare a contemporary series of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) at one institution, to evaluate the size and types of tumour in each group and the early outcome after each procedure, as LPN is replacing open radical nephrectomy as the standard of care for uncomplicated renal tumours but partial nephrectomy remains significantly more difficult laparoscopically, especially if the goal is to duplicate the open surgical technique.

Correlation of ultrasonographic and orchidometer measurements of testis volume in adults

A study from New York was aimed at determining the correlation between testicular volume measurements made with an orchidometer and with high‐resolution scrotal ultrasonography; the authors found that measurements made with the former strongly correlate with those from the latter.

Managing Varicoceles in Children: Results With Microsurgical Varicocelectomy

UNLABELLED Authors from New York present their experience of elective varicocelectomy, using microsurgical techniques, in a large series of children. They found the procedure to be safe and effective, and gave a much lower complication rate than the published rate in open varicocelectomy. The results of urethroplasty in post-traumatic paediatric urethral strictures are presented by authors from Mansoura. They found the overall success of one-stage perineal anastomotic repair of such strictures to be excellent, with very little morbidity. OBJECTIVE To report our experience of microsurgical subinguinal varicocelectomy in boys aged < or = 18 years. PATIENTS AND METHODS Boys aged < or = 18 years treated with microsurgical varicocelectomy between 1996 and 2000 at one institution were retrospectively reviewed. Indications for surgery included ipsilateral testicular atrophy, large varicocele or pain. Microsurgery was assisted by an operating microscope (x10-25) allowing preservation of the lymphatics, and the testicular and cremasteric arteries. Patient age, varicocele grade, complications and follow-up interval were recorded. RESULTS In all there were 97 microsurgical subinguinal varicocelectomies (23 bilateral) in 74 boys (mean age 14.7 years). Left-sided varicoceles were significantly larger (mean grade 2.9) than right-sided (mean grade 1.4) varicoceles. The mean follow-up was 9.6 months. There were four complications: two hydroceles, of which one resolved spontaneously after 4 months; one patient had persistent orchialgia that resolved after 8 months; and one developed hypertrophic scarring at the inguinal incision site. There were no infections, haematomas or intraoperative injuries to the vas deferens or testicular arteries. All boys were discharged home on the day of surgery. CONCLUSIONS Microsurgical subinguinal varicocelectomy in boys is a safe, minimally invasive and effective means of treating varicoceles. Compared with published results of the retroperitoneal mass ligation technique, which has a 15% overall complication rate and a 7-9% hydrocele occurrence rate, the microsurgical subinguinal approach appears to offer less morbidity, with a 1% hydrocele rate. We consider that microsurgical subinguinal varicocelectomy offers the best results with lower morbidity than other techniques.

Epidemiology of Erectile Dysfunction

Erectile dysfunction (ED) is a pervasive problem among men worldwide. The National Institutes of Health Consensus Conference defined ED as the “consistent inability to attain or maintain a penile erection, or both, sufficient for adequate sexual relations” (1).