Lorenzo Buttazzi

High-flow priapism: treatment and long-term follow-up

OBJECTIVES To determine the long-term follow-up of treatment of high-flow priapism, we reviewed the case records of 10 patients who were examined by the Urologic Clinic in Trieste from 1995 to 1998. High-flow or arterial priapism is a fairly rare dysfunction, generally resulting from penile or perineal trauma. In some cases, the etiology remains unknown. METHODS Trauma was reported in 6 of 10 cases. No etiologic causes were evident in the other patients. Nine patients underwent selective embolization during arteriography, and in 1 patient, corporotomy and ligature of the cavernous artery were performed. Color Doppler ultrasonography was repeated 1 day, 1 month, and 6 months after the operation. The determination of erectile function at a mean follow-up of 41 months (range 17 to 64) was performed using the International Index of Erectile Function. RESULTS Postoperatively, color Doppler ultrasonography revealed the absence of recurrence in 6 patients. Fistula recurrence was detected in 4 of 9 patients treated with selective embolization (44%). In three of these patients, a second embolization procedure was conclusive. In 1 case (11%), three consecutive embolizations were not conclusive and surgical ligature of the dorsal artery and collateral at the emergence of the penile root, out of the corpus cavernosum, was required. Sexual function was completely preserved in 80% of patients. CONCLUSIONS Pudendal angiography with superselective embolization is the treatment of choice. It is well tolerated and ensures a high preservation of premorbid erectile function.

Long-term results with Nesbit's procedure as treatment of Peyronie's disease

The objective was to assess sexual function at long-term follow-up after the Nesbit operation for Peyronies disease.One hundred and fifty seven out of 213 patients treated between 1986 and 1998 using the Nesbit procedure were reassessed by means of IIEF-5 questionnaire together with two questions about residual deformity and treatment satisfaction. The results from this questionnaire together with the patient case records constitute the basis of this paper.After an average 72-month follow-up subjective patient determination of satisfaction indicated that 87.9% were satisfied with the results of surgery, 136 patients (86.7%) had good erectile function (IIEF-5>21). Shortening of the penis (from 1.5 to 3 cm) occurred in 22 patients (14%), but only in 2 (1.3%) was intercourse difficult because of excessive shortening.In conclusion, the Nesbits operation results in the greatest amount of patient satisfaction about sexual function. When penile shortening occurs, it has not been a significant problem for patients who are properly counselled.

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with severe Peyronie's disease

Abstract. Our objective was to investigate the prevalence and Doppler characteristics of penile cavernosal–spongiosal communications (CSC) in patients with severe Peyronies disease. These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Twenty patients with severe Peyronies disease underwent penile color Doppler US after intracavernous injection of prostaglandin E1. Study inclusion criteria were penile curvature or shortening which made intercourse difficult or impossible. The quality of erectile response was subjectively scored. The spectral characteristics of CSC were evaluated in comparison with waveform changes in cavernosal artery. There were 4 patients with normal erectile response, 10 with discrepancy in rigidity of the penile base and tip, 4 with veno-occlusive dysfunction and 2 with arteriogenic dysfunction. The CSC just proximal to the plaques had peak systolic velocity (PSV) significantly higher and resistance index (RI) significantly lower than the other CSC. The PSV in CSC near the plaques of patients with base-tip discrepancy and with veno-occlusive dysfunction were significantly higher than in the other patients. In patients with severe Peyronies disease CSC near the plaques remain patent with low-resistance flow supporting the hypothesis that blood leakage can occur through these vessels.

Acute peritonitis due to introital stenosis and perforation of a bowel neovagina in a transsexual

Background Stenosis of the neovagina is a late postoperative complication of male-to-female sex reassignment surgery when patients do not have frequent sexual intercourse or do not perform vaginal dilation. Case A 39-year-old male-to-female transsexual who had sex reassignment surgery, in which a segment of sigmoid colon was used for neovagina construction, developed total introital stenosis and subsequent peritonitis caused by bowel perforation of the colon conduit. Conclusion To avoid stenosis of the neovagina, an inflatable silicon vaginal stent should be used all day for 30 days, then for 3 months overnight or until sexual function is regular.

Sclerotherapy of hemangioma of the glans penis.

Penile hemangiomas are very rare, small lesions. Possible therapies include surgical excision, electrofulguration, cryotherapy, and sclerotherapy. We describe an extremely rare case of a large hemangioma of the glans that was treated by means of repeated injections of 2% polidocanol under local anesthesia (5% lidocaine-prilocaine cream). No complications were observed after the operation, and a satisfactory aesthetic result was obtained. No relapse was noted 18 months after the treatment. A therapeutic reference standard for the treatment of penile hemangiomas is still lacking because of the rarity of the disease. Sclerotherapy proved to be an effective, low-cost, and easy-to-perform procedure. Moreover, it is repeatable in case of failure.

Bilateral Testicular Carcinoma In Patient With The Persistent MüLlerian Duct Syndrome

The persistent mullerian duct syndrome is a rare form of male intersex disorder in which a phenotypically normal male subject has fallopian tubes and a uterus along with testes and wolffian duct derivatives. This internal male pseudohermaphroditism is caused by a deficiency of mullerian duct inhibitory factor.1 A genetic mutation of chromosome 19 seems to be implicated in this condition.2 Like other undescended testes these gonads are at increased risk of malignant transformation, and a variety of germ cell tumors have been reported in association with this syndrome.3 These patients often present with cryptorchidism or an inguinal hernia with fallopian tubes and a uterus. We report a case of bilateral synchronous germ cell tumor in a patient with the persistent mullerian duct syndrome.