Richard L. Fein

Intracavernous medication for treatmentof premature ejaculation

Abstract Sixteen men complained of premature ejaculation during a five-month period between May 1987, and October 1987. Eight patients entered this study using intracavernous vasoactive drugs as treatment for their problem. The patients, ages twenty-four through fifty-eight (average 42 years), were all physically healthy and taking no medications. Five patients had normal findings on nocturnal tumescence monitor, while 3 patients did not use the monitor. A mixture of phentolamine mesylate, 1.0 mg/mL, and papaverine hydrochloride, 30 mg/mL, was used. The required was from 0.10 mL to 0.40 mL. All 8 patients responded successfully to this treatment Three patient stated they were cured and stopped the treatment. The other 5 patients continued using the medication cation after fourteen months. The drug-induced erection lasted between two and four fours despite e ejaculation There have been no side effects through April 1988. All patients report satisfaction with the results of this treatment. The study showed that intracavernous medication therapy can be successful in the treatment of premature ejaculation.

Classification of Sexual Dysfunction for Management of Intracavernous Medication-Induced Erections

A total of 75 patients was placed into 1 of 3 classes of sexual dysfunction based on nocturnal penile tumescence tracings rather than on etiology of the sexual dysfunction. The patients then were given an intracavernous injection with incremental dosages of 0.2 to 1.0 ml. of a combination of papaverine hydrochloride and phentolamine mesylate vasoactive intracavernous therapy. The results of the study were categorized as class 1--mild sexual dysfunction (100% successful with low dosages of medication), class 2--moderate sexual dysfunction (95% successful but larger dosages of medication were required) and class 3--severe sexual dysfunction (a 50:50 chance of a successful treatment and even higher dosages of medication were required). A portable home nocturnal tumescence monitor classification of severity of sexual dysfunction provided a guideline for the intracavernous pharmacological injection initial dosage and the probability of success or failure in patients who desire this form of therapy for male sexual dysfunction.

Early Problems Encountered with the Mentor Inflatable Penile Prosthesis

We present 9 consecutive patients who underwent insertion of the Mentor inflatable penile prosthesis. Of these patients 3 had successful results after repeated problems with the Scott inflatable penile prosthesis. Complications included spontaneous inflation of the prosthesis, a tubing kink, aneurysmal cylinder ballooning and cylinder disruption. Slow deflation seems to be an inherent problem with the Mentor system. Although penile squeezing may be used to help deflation, traumatic urethritis may occur. However, concealment may not be possible without such squeezing. Interim use of a noninflatable prosthesis to treat a damaged corpus cavernosum is recommended. Although ingenious technology has enabled successful implant surgery, no penile prosthesis yet devised has proven to be ideal. Further refinements are being made. Ultimate evaluation will require years of followup in the spirit of the pre-700 series of Scott inflatable penile prostheses.

GFS Mark II inflatable penile prosthesis: Four-year clinical study

OBJECTIVE The objective of the study was to evaluate the mechanical performance and the patient/partner satisfaction of the GFS Mark II inflatable penile prosthesis (IPP). METHOD A total of 138 patients had GFS Mark II IPP implants between October 1988 and December 1991 with a follow-up of twelve to fifty months (mean 31.7 months) were studied. Each patient was evaluated for prosthesis performance and each patient/partner satisfaction was evaluated by a questionnaire and personal interview. RESULTS There was only one prosthetic mechanical problem which involved the tubing. There were seven problems requiring explanation; two of which were postoperative infections. Thirteen patients required an addition of normal saline through the resipump as an office procedure. Ninety-three percent of the patients and 98 percent of the partners reported satisfaction with the use of the prosthesis. Men who had a previously inserted penile prosthesis replaced with the GFS Mark II IPP preferred the GFS over the malleable and the self-contained prosthesis, but there was no conclusive preference between the different IPPs. CONCLUSIONS This study concludes that the GFS Mark II connectorless IPP has shown few mechanical problems over a four-year period and has a good patient/partner satisfaction. This prosthesis has the additional feature of the resipump to adjust the fluid volume as an office procedure when required.

The G. F. S. Mark II Inflatable Penile Prosthesis

The G.F.S. Mark II inflatable penile prosthesis was implanted in 80 men who were followed for up to 27 months. In this study there have been no mechanical problems. Of the patients 6 required repositioning of the reservoir pump and 4 required postoperative addition of fluid to the reservoir pump. This study indicates that the revised connectorless G.F.S. Mark II inflatable penile prosthesis has eliminated the previous problems with connectors and tubings. The G.F.S. Mark II inflatable penile prosthesis reservoir pump provides a means of postoperative fluid adjustment within the system performed as an office procedure.

Clinical evaluation of inflatable penile prosthesis with combined pump-reservoir

Sixteen impotent men were implanted with the Mentor inflatable penile cylinders which were attached to a combination pump-reservoir. The prosthesis is working satisfactorily in 14 patients six months post-implant. A pre-assembly technique accommodated insertion of the prosthesis as a unit. The combination of pump-reservoir appears to adequately replace a separate reservoir and pumping device when attached to inflatable penile cylinders.

Bladder Calculi Enveloped by Extensive Cystitis Glandularis: Case Report

We report a case of 2 large calculi encased within a 15 gm. tumor of cystitis cystica and cystitis glandularis. The patient presented with acute right epididymitis. An excretory urogram showed 2 bladder calculi. Cystoscopy revealed a mass around the stones resembling adenocarcinoma of the bladder base. Transurethral resection of the tumor and cystolitholapaxy were performed. The final diagnosis was bladder calculi within a mass of cystitis cystica and cystitis glandularis. A review of the literature failed to reveal a similar case.

Cylinder problems with ams 700 inflatable penile prosthesis

Six cases of cylinder problems encountered in 1986 with the AMS 700 Silastic inflatable penile prosthesis (IPP) were studied in detail. The problems included 1 case of significant penile bending, the development of a cylinder tear, and several cylinder aneurysms. Possible causes of the problems are explored, along with possibilities for prevention of future problems.