Masaharu Takanami

Content and distribution of vasoactive intestinal polypeptide (VIP) in cavernous tissue of human penis

Penile erection is controlled by a valvular structure in the helicine artery in humans. The opening and closing of this valve are believed to be regulated by the autonomic nervous system, especially through the release of vasoactive intestinal polypeptide (VIP). We determined the content of VIP in cavernous tissue in 18 impotent patients and in 5 normal controls by radioimmunoassay, and we examined the distribution of VIP-ergic nerve fibers in cavernous tissue by an immunohistochemical method. As a result, it was found that the lower penile VIP content was more frequent among patients with organic impotence than among the controls. Furthermore, VIP-ergic nerve fibers were seen to be diffusely and loosely distributed in a large number of organic impotence patients. These findings suggest that organic impotence in some patients may be due to decreases in the VIP content and in VIP-ergic nerve fibers.

Testicular tumor in Down syndrome.

Abstract  A 33‐year‐old male patient with Down syndrome, who stayed in a welfare institution, visited our hospital due to left testicular enlargement. He was diagnosed as having a left testicular tumor and underwent radical inguinal orchiectomy.

Primary lipogranuloma of male genitalia

Lipogranulomas developing secondarily in the genitourinary system have been reported rather frequently, but primary lipogranulomas without any past history of etiologically related conditions are rare. We report on 2 cases recently encountered in which tumors were diagnosed as sclerosing lipogranuloma on histopathologic examination.

Hematospermia associated with congenital arteriovenous malformation of internal iliac vessels

Abstract:  The presence of blood in the ejaculate is called hematospermia or hemospermia. While often perceived as a symptom of little significance, hematospermia can cause great concern to men who experience it. We report an unusual case of hematospermia associated with pelvic arteriovenous malformation (AVM). A 60‐year‐old man who visited our hospital complaining of hematospermia and pollakisuria was found to have AVM and aneurysmal changes in the left side of the pelvis using computed tomography (CT). The patient was treated with steel coil embolization of the left inferior gluteal artery, and after the procedure the hematospermia and pollakisuria remained absent without flare‐ups.

Is Diabetic Neuropathy Responsible for Diabetic Impotence

It is well known that diabetes mellitus is accompanied by complications of sexual dysfunction and it is believed that diabetic neuropathy may cause impotence. In our study, we found that not all the patients who visited our center with the chief complaint of diabetic impotence were suffering from organic impotence, and diabetes mellitus per se served as a means of psychological stress in a substantial number of cases. Probably because no method has been available to provide precise information on the state of the penile-controlling nerves, we found that a larger number of patients than expected were suffering from a vascular disorder.

Clinical Experience and Successful Impregnation Using an Artificial Spermatocele

We have to date installed artificial spermatoceles made of silicone in a total of 33 patients. Artificial insemination of husband (AIH) was performed in 1-9 times using semen collected from 11 of the 33 patients in whom spermatocele was installed, and pregnancy was achieved in 2 cases. Reported cases of pregnancy achieved using semen collected from artificial spermatoceles are few in number; indeed, our successful cases were the fifth and sixth reported so far. The key point for success in achieving pregnancy by means of the artificial spermatocele is considered to be attempting AIH as soon as possible after collecting the sperm, because collection of sperm soon becomes impossible, due to early obstruction of the incised region at the epididymis by degeneration of fibrous tissue. 3% HSA-TMPA medium was found to be useful for sperm collection.

Large-scale questionnaire survey of erectile dysfunction drugs in Japanese men

AimThe aim of the present study was to investigate the assessment of currently prescribed drugs and approaches to overall erectile dysfunction (ED) therapy.MethodsA large-scale questionnaire survey was conducted in patients with ED who had taken an ED drug in the past 2 months.ResultsOf the 308 patients surveyed, 23% became aware of having ED more than 3 years ago. In the early stages, the patients frequently experienced ‘anxiety and a sense of loss’ and ‘irritation and powerlessness’. The ED drugs taken were sildenafil and vardenafil in 65 and 31% of the patients, respectively. Although their efficacy was generally high, approximately 80% of the patients (younger patients in particular) experienced some problems with these medications. As negative assessments, the difficulty in finding a good time to take the drug and the strange sensation of the drug forcing the patient to have an erection were pointed out.ConclusionUse of an ED drug such as tadalafil, which produces long-lasting effects and allows more spontaneity in sexual activity, will improve ED symptoms in a favorable manner, and will not only improve the self-image of the ED patients, leading to activation and fulfillment of their lives as a whole, but will also enhance the satisfaction and security of their partners.

THE MECHANISM OF BLOOD OUTFLOW FROM THE CAVERNOUS TISSUE OF HUMAN PENIS BY COMPUTER GRAPHICS

There are two theories concerning the mechanisms of human penile erection and its maintenance. One theory goes that the artery responsible for blood inflow into the cavernous space relaxes, while the vein responsible for blood outflow actively contracts. The other theory asserts that no active closing mechanism in present in the penile venous system, but rather the erection is totally controlled by the amount of blood inflow. In order to corroborate the vascular construction of the penis, we prepared serial sections of the penis specimens obtained at autopsy and observed these sections by light microscopy, and we investigated the construction of veins which let blood flow out from the corpus cavernosum penis by computer graphics. As a result, we were unable to find any valves in the blood outflow system. Moreover, efferent vessels were seen to let blood flow from the cavernous spaces, after running immediately below the tunica albuginea for a small distance, to the tunica albuginea, running obliquely through inner veins toward the outside of the tunica albuginea in the direction of the long axis of the penis; then these veins are continuous to the veins on the tunica albuginea. From the above-mentioned structures we can infer the following mechanism of penile erection.(ABSTRACT TRUNCATED AT 250 WORDS)