Jyoti Shah

Erectile dysfunction through the ages

The term impotence has traditionally been used to describe the inability of the male to attain and maintain an erection adequate for sexual intercourse. Although the term has been used for centuries, as will be described in this article, it generates much confusion and has been replaced by ‘erectile dysfunction’ since 1992 [1]. This then differentiates the problem from the many other processes that are involved in male sexual function. This review will use the term impotence because historically it is the term that is found in the literature. Many people believe that impotence is a modern curse to man. In 1940, Stekel [2] said that ‘Impotence is a disorder associated with modern civilization’. However, man’s preoccupation with potency, or the lack thereof, has been present through the ages. The word impotence is derived from the Latin word impotencia , which literally translated means lack of power. The term was first used by Thomas Hoccleve (1370– 1454) in 1420, in his 5500-verse poem, ‘De Regimine Principum’ (the Government of Princes): ‘ Hir impotence, Strecchith naght so fer as his influence ’ [3]. At the time he used it to mean want of strength. It was in 1655 that the use of impotence to mean loss of sexual power was first encountered. Thomas Fuller (1608– 1661) wrote in ‘The Church History of Britain’: ‘ Whilest Papists crie up this, his incredible incontinency: others uneasily unwonder the same by imputing it partly to impotence afflicted, by an infirmitie ’ [4]. This article describes the aetiology of and beliefs about the condition, and the developments of treatments for impotence over time

Male genital tract injuries after contemporary inguinal hernia repair

Inguinal hernia repair is a common disorder affecting 5% of the male population [1]. Moses Maimonides (1135–1204), a Jewish philosopher, practised medicine in several parts of the Arab empire. He wrote widely on the subject and mentions the treatment for a hernia: ‘one takes two measures of juniper nuts, one measure of its leaves, two zuzim of fresh canary grass, and one measure of acacia. One kneads this out while it is still warm on a cloth and places this on the hernia at the time the patient comes out from a steam bath on an empty stomach, and he lies down on his back. On the cloth, one places padding and wrappings. He should sleep on his back until the compress dries. One renews this for 40 days’ [2]. Edward Bassini originally described the basis of the current open method of inguinal herniorraphy more than 100 years ago [3]. Many modifications have been made to this procedure in the interim, with varying degrees of efficacy [4]. The advent of minimally invasive techniques and synthetic mesh repairs heralded a major change in strategies for herniorrhaphy in recent years. Laparoscopic inguinal hernia repairs are associated with less postoperative pain than open repairs and an earlier return to normal levels of activity [5]. However, acceptance of this technique has been limited, principally because of the increased expense, duration and technical complexity of the procedure. Indeed, initial complication rates were high and reflected the experience and training needed by the surgeon [6–8]. Added to this is a general acceptance of traditional open repair by the public and therefore its adoption by the surgical community has not mirrored the rapid adoption of laparoscopic approaches to cholecystectomy [9]. Despite these problems, many reported benefits, e.g. reduced operating time, have increased the use of minimally invasive techniques in synchronous bilateral inguinal herniorrhaphy [10]. This has implications in considering genital tract injury; unilateral injuries may go unnoticed and therefore under-reported, whereas bilateral injuries may manifest as deficiencies in fertility in later life. In addition, the long-term effect of mesh, whether placed by laparoscopic or open methods, is unknown. The lower recurrence rate associated with synthetic mesh repairs is facilitated by the fibrosis by which the mesh is anchored. Because it is placed close to the spermatic cord, it is possible that this may cause vas deferens dysfunction after surgery. The body of published evidence about the incidence of genital tract injuries is derived primarily from fertility and microsurgical reconstruction studies. Putative mechanisms of iatrogenic genital tract injury in adults after hernia repair are predominately derived from small series and anecdotal reports. Indeed, much of the data available relates to open herniorraphy and therefore laparoscopic issues must be extrapolated. At present, the incidence, mechanisms and implications of these occurrences are unclear. The objective of this review is to elucidate the incidence and putative mechanisms of genital tract injuries in laparoscopic herniorrhaphy and place them into the context of current and future treatment strategies.

Can shoe size predict penile length

Objective  To establish if the ‘myth’ about whether the size of a mans penis can be estimated from his shoe size has any basis, infact.