Klaus P. Jünemann

Unilateral vs bilateral sacral neuromodulation in pigs with formalin-induced detrusor hyperactivity

To investigate the efficacy of unilateral vs bilateral sacral neuromodulation (SNM) under standard experimental conditions by stimulating the dorsal sacral roots in pigs with formalin‐induced detrusor hyperactivity.

Functional Impact of the Rhabdosphincter Branch of the Pelvic Nerve on the Membranous Urethra in Comparison to That of the Pudendal Nerve in Male Rabbits

Introduction: The innervation of the membranous urethra (MU) is still under debate. We analysed the functional effects of electrostimulation of the rhabdosphincter branch of the pelvic nerve (RBP) on the MU in a standardized male rabbit model, paying attention both to the efferent and the possible afferent effects of stimulation. Material and Methods: Six male rabbits (chinchilla bastards) were included in this study. Pudendal nerve branches as well as pelvic nerve branches were exposed bilaterally in all animals. Randomized electrostimulation trials of both the pudendal nerve fibres and the RBP were carried out using a biphasic signal (0.3 mA, 200 μs). The stimulation frequency ranged from 10 to 40 Hz in a randomized pattern. Changes in MU pressure were measured urodynamically. The pressure changes occurring as a result of stimulation were compared in both nerve structures. At the end of the stimulation trial, the RBP and the pudendal nerve were dissected at different positions before repeating the stimulation and the MU pressure recording. Results: The mean MU baseline pressure without stimulation was 24 cm H2O (range 21–27) in all animals. During unilateral pudendal stimulation, the mean pressure response rose by highly significant values (p < 0.005) compared to baseline. The pressure response was frequency dependent. Stimulation of the RBP resulted in a small but significant change of the MU pressure in the lower frequency range (10 and 20 Hz) (p > 0.05). On performing stimulation at higher frequencies, there was no significant difference from baseline. The pressure response of the MU during stimulation of the intact RBP did not differ significantly from the response after dissection of the RBP. However, after dissecting the pudendal nerve, the MU pressure response to RBP stimulation was diminished. Conclusion: Our results confirm the primacy of the pudendal nerve in the innervation of the MU. Stimulation of the RBP, however, may produce an afferent signal which is transmitted to the pudendal nerve, thus resulting in a pressure increase of the MU and contributing towards continence. We showed the importance of the RBP to maintain full urinary continence in rabbits. Our results suggest that substantially higher continence rates can be achieved through a nerve-sparing procedure in radical prostatectomy. Nerve-sparing radical prostatectomy incidentally also protects the RBP from injury.

semi-rigid penile prosthesis as a salvage management of idiopathic ischemic stuttering priapism

Introduction Priapism is the persistent erection resulting from dysfunction of the mechanisms that regulate penile swelling, stiffness, and sagging. It is a full or partial erection that persists for a period more than 4 hours beyond sexual stimulation and/or orgasm or is unrelated to sexual stimulation. Ischemic priapism should be managed in a step-by-step fashion. Objective To demonstrate step-by-step management of stuttering refractory ischemic priapism. We report a case of stuttering refractory ischemic priapism. Moreover, we reviewed different approaches to priapism management in the literature. Case presentation A 53-year-old male presented with a painful erection of 29 hours’ duration, probably caused by consumption of alcohol. The penile blood gas showed a pH of 7.08, PCO2 of 75 mmHg and PO2 of 39 mmHg. Aspiration was followed by irrigation of an α-adrenergic, Winter and T-shunt operations were preformed, and finally a semi-rigid penile prosthesis was implanted to overcome the refractory stuttering ischemic priapism. Conclusion In case of stuttering refractory ischemic priapism, immediate implantation of a penile prosthesis is a simple and effective procedure that manages both the acute episode and the inevitable erectile dysfunction that would otherwise occur, while preserving penile length.

The effect of Pueraria mirifica on cytologic and urodynamic findings in ovariectomized rats.

Objective: To evaluate the effect of Pueraria mirifica on vaginal and urethral cytology, bladder pressure and capacity, residual urine, and leak point pressure in ovariectomized rats. Methods: Seventy-two adult, ovariectomized, female Sprague-Dawley rats were placed into one of four groups: control, estradiol, or 100 or 1,000 mg/kg of Pueraria mirifica (PM-100 and PM-1000, respectively). The vaginal and urethral smears were checked after 30 days of ovariectomy at pretreatment and at day 28 of treatment. A single cystometry, defined as the micturition interval, filling pressure, threshold pressure, micturition pressure, and voided volume, was performed. Peak bladder pressure was calculated for each leak point pressure measured at half bladder capacity by slowly and manually increasing abdominal pressure until a leak occurred, at which point external pressure was rapidly released. Leak point pressure was tested three times per rat. Results: After 28 days of treatment, the estradiol, PM-100, and PM-1000 groups had significantly higher numbers of vaginal and urethral superficial cells compared with the control group (P < 0.05). Regarding the urodynamic parameters, the threshold pressure, micturition pressure, and leak point pressure were higher in the estradiol, PM-100, and PM-1000 groups compared with the control group (P < 0.05). The control, PM-100, and PM-1000 groups had the same values for micturition interval, bladder capacity, voided volume, and residual volume (P > 0.05) but lower values compared with the estradiol group (P < 0.05). Conclusions: Pueraria mirifica 100 and 1,000 mg/kg/day showed an estrogen-like effect on the vaginal and urethral epithelium of ovariectomized rats. They did not change bladder capacity and residual urine volume but increased leak point pressure according to urodynamic study.

Surgical site infections after radical prostatectomy: A comparative study between robot-assisted laparoscopic radical prostatectomy and retropubic radical prostatectomy

OBJECTIVE Surgical site infection (SSI) is defined as infection at or near surgical incisions within 30 days of an operative procedure and classified either incisional superficial and deep or organ/space. The aim of the study is to report and compare the incidence and management of SSIs after robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP). MATERIAL AND METHODS Within the last 4 years, we identified 285 patients that underwent RRP, n=187 (66%) or RALP, n=98 (34%). We reviewed the frequency, types and way of management of SSI complications. RESULTS A significant difference was found between RALP and RRP (2/98, 2% vs. 27/187, 14.4%; p<0.0001) as for SSIs. The time interval between the time of surgery and diagnosis of SSIs was longer in RALP relative to RRP (median 13.5 vs. 12.9 days, p=0.761). CONCLUSION All types of SSIs could be developed after RP, however RALP patients only experienced organ or space SSIs and have a lower rate of SSIs and shorter treatment time.

Benchmarks for Partial Segmental Thrombosis of the Corpus Cavernosum: ACase Report and Review of the Literature

Introduction: Partial segmental thrombosis of the corpus cavernosum (PSTCC) is an uncommon clinical condition; it is known in the literature as partial priapism which chiefly affects young men; the underlying reasons and its pathogenesis are inadequately understood. Case report: A 26-year-old male presented with a perineal swelling and pain of 11 hours duration, which had started after 10-hour flight, and a dull aching pain with insidious onset. The patient denied a history of excessive sexual activities, drug abuse, or trauma with unremarkable past medical history. Aims and methods: With deficiency of curd data for PSTCC, only case reports without precisely case numbers; therefore all existing case reports, whether abstracts or full text, under the title of partial segmental thrombosis of the corpus cavernosum or partial priapism have been screened and statistically analyzed. Results and outcome: The total number of cases was 41 and chiefly affects young men: 63.4% of the patients are in the age group 20-40, with a mean age of 32.3 yrs. 10 cases 24.4% were treated surgically, 21 cases 51.2% were managed conservatively, while 3 cases 7.3% were treated by surgical aspiration ± injection or irrigation and 2 cases 4.9% were only follow up without treatment. Conclusion: PSTCC is a rare non-emergency urological condition that usually has a good outcome. Conservative treatment with systemic anticoagulants has shown an excellent outcome and surgical treatment should be reserved for cases, if conservative management fails.