Priapism is a persistent penile erection that continues for hours beyond, or is unrelated to, sexual stimulation. Priapism requires a prompt evaluation and usually requires an emergency management. There are two types of priapism: 1) ischemic (veno-occlusive or low-flow), which is found in 95% of cases, and 2) nonischemic (arterial or high-flow). Stuttering (intermittent or recurrent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must decide whether the priapism is ischemic or nonischemic. In the management of an ischemic priapism, resolution should be achieved as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic agents is the next step. Surgical shunts should be performed in cases involving failure of nonsurgical treatment. The first management of a nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in cases that request treatment. The goal of management for stuttering priapism is prevention of future episodes. This article provides a review of recent clinical developments in the medical and surgical management of priapism and an investigation of scientific research activity in this rapidly developing field of study.
Emergencies ; Erectile Dysfunction ; Male ; Penile Erection ; Priapism* ; Stuttering ; Sympathomimetics

Purpose: The aim of this study was to evaluate the effect on sexual function after finasteride, tamsulosin, doxazosin single or combination therapy according the sexual function state before these therapies. Materials and Methods: This study included 192 men with benign prostatic hyperplasia (BPH) who had neither diabetes mellitus nor hypertension. All patients were classified into 2 groups according to their erectile dysfunction (ED) severity based on IIEF-5 before treatment; the above mild ED group (severe + moderate + mild to moderate) and mild or no ED group. The patients were assessed by IIEF inventory at the baseline and 1, 3 and 6 months after finasteride, tamsulosin, doxazosin single or combination therapies, respectively. Results: In the above mild erectile dysfunction group the mean IIEF score was significantly decreased at 3 and 6 months with finasteride single therapy, at 6 months with finasteride-tamsulosin combination therapy and at 3 and 6 months with finasteride-doxazosin combination therapy (p<0.05). In the mild or no erectile dysfunction group the mean IIEF score did not change significantly with any of the medications. Conclusions: Sexual function tended to decrease in the above mild ED group with finasteride single or combination therapy. Therefore, the patients in this group should be treated carefully at the beginning of these therapies.
Diabetes Mellitus ; Doxazosin* ; Erectile Dysfunction ; Finasteride* ; Humans ; Hypertension ; Male ; Prostatic Hyperplasia*

No abstract available.
Nephrotic Syndrome*

BACKGROUND: The purpose of this study was to compare prospectively two different anesthetic techniques with isoflurane or propofol for postoperative nausea, vomiting and recovery after tonsillectomy in children. METHODS: Sixty children, ASA physical status I, were assigned randomly to one of two groups. In group I, anesthesia was induced with thiopental 5 mg/kg and maintained with isoflurane 1~1.5 vol%. In group P, anesthesia was induced with fentanyl 1 mcg/kg, propofol 2 mg/kg and maintained with propofol infusion 5~10 mg/kg/hr. Both group received vecuronium 0.1 mg/kg for tracheal intubation and were ventilated with 33% O2 in N2O. The time to extubation, time to eye opening, PACU time, incidence and numbers of postoperative nausea and vomiting, and degree of sedation were recorded as well as perioperative complications. RESULTS: There were no significant difference in the duration of anesthesia and PACU time between two groups. The time to extubation and eye opening of group P were significantly shorter than group I (p<0.05). The degree of sedation and incidence of postoperative nausea and vomiting of group P were significantly lower than group I (p<0.05). But the frequency of intraoperative bradycardia was significantly higher in group P than group I (p<0.05). CONCLUSIONS: Propofol-fentanyl anesthesia results in less nausea and vomiting during postoperative period and more rapid recovery compared to isoflurane anesthesia and may be recommended in children undergoing tonsillectomy and adenoidectomy.
Adenoidectomy ; Anesthesia* ; Bradycardia ; Child* ; Fentanyl ; Humans ; Incidence ; Intubation ; Isoflurane* ; Nausea ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Propofol* ; Prospective Studies ; Thiopental ; Tonsillectomy* ; Vecuronium Bromide ; Vomiting*

PURPOSE: The AVSS with 3-D HMD is considered to provide a more realistic image and more comfortable circumstances in which the subjects are absorbed in the stimulation. We investigated the efficacy of using 3-D combined with oral medication and a stimulation (COS) test for the evaluation of vasculogenic erectile dysfunction (ED). MATERIALS AND METHODS: 66 patients with complaints of ED, 28 patients diagnosed with vasculogenic ED and 38 patients diagnosed with psychogenic ED were included in this study. The patients were randomly divided into the 2-D group and the 3-D group. The 2-D group patients were examined with using 2-D combined an injection and a stimulation (CIS) test. The 3-D group patients were examined with 3-D CIS test. Then a week later, the patients underwent the AVSS with 3-D HMD 1 hour after oral PDE 5 inhibitor medication. The degree of erection was monitored using the Nocturnal Electrobioimpedance Volumetric Assessment (NEVA) system. RESULTS: On the 2-D CIS tests, 12 of 27 patients showed normal erection, and this resulted in a sensitivity and specificity of 72.7% and 56.3%, respectively. On the 3-D CIS tests, 20 of 39 patients showed normal erection and on the 3-D COS tests, 17 patients showed normal erection and this resulted in a sensitivity and specificity of 88.2% and 81.8%, and 94.1% and 72.7%, respectively. No significant difference were present in the results of the diagnosis between the 3-D CIS and 3-D COS tests. CONCLUSIONS: Both the 3-D CIS and 3-D COS tests offer the advantage of higher sensitivity and specificity than the conventional CIS test. The 3-D COS test may be used as a substitute for the conventional CIS test due to its simplicity and less invasive nature.
Diagnosis* ; Erectile Dysfunction* ; Genetic Complementation Test ; Humans ; Male ; Photic Stimulation ; Sensitivity and Specificity ; Vardenafil Dihydrochloride

PURPOSE: Unilateral testicular torsion is usually associated with damage to both the affected and the contralateral testis and thus with diminished fertility. This study was preformed to evaluate whether the capsaicin prevents contralateral testicular damage and how long the protection lasts. MATERIALS AND METHODS: Eight groups of 8 male Sprague-Dawley rats(5 weeks old; 150~180 g) were studied. Groups 1 and 5 were sham-operated controls, groups 2 and 6 were testicular torsion controls, groups 3 and 7 underwent sham operation 24 hours after intraperitoneal administration of 0.5 cm3 of capsaicin, and groups 4 and 8 had testicular torsion performed 24 hours after the intraperitoneal administration of 0.5 cm3 capsaicin. The contralateral testis of each animal was harvested at 24 hours after the operation(groups 1~4) or at 4 weeks(groups 5~8). The weight, histologic findings, and extent of apoptosis were evaluated. RESULTS: At 4 weeks, the weight of the contralateral testis and the diameter of the seminiferous tubules were decreased in the testicular torsion groups. The histologic grade and spermatogenesis was significantly lower in groups 6 and 8. The apoptosis index was significantly higher in groups 2, 6, and 8. CONCLUSIONS: Capsaicin prevents early contralateral testicular damage from unilateral torsion(within 24 hours). However, these effects are not sustained at 4 weeks.
Animals ; Apoptosis ; Capsaicin* ; Fertility ; Humans ; Male ; Rats* ; Rats, Sprague-Dawley ; Seminiferous Tubules ; Spermatic Cord Torsion* ; Spermatogenesis ; Testis*

PURPOSE: Despite of dysmorphic change of penis and critical genital infection, self-injection of unsafe filler such as paraffin is still performed for penile augmentation. We evaluated surgical outcome and patients' satisfaction of penile paraffinoma removal. MATERIALS & METHODS: From January 1999 to December 2004, a total of 37 patients underwent penoplasty after removal of penile paraffinoma for complications. Penoplasty was performed using primary repair in localized penile paraffinoma (primary repair group, n=17) and bilateral scrotal flap in extensive cases (bilateral scrotal flap group, n=20). The surgical outcome, change of penile length and patients' satisfaction was assessed, retrospectively. RESULTS: The early postoperative complications were wound infection (1 in primary repair group, 3 in bilateral scrotal flap group), wound dehiscence (1 in primary repair group) and skin necrosis (2 in bilateral scrotal flap group). Stretched penile length after paraffinoma removal was not statistically different in both groups. Patients' satisfaction about penile shortening, decreased penile circumference and decrease of sexual satisfaction were not statistically different in both groups. In long term follow-up, inflammatory skin discharge (3 in primary repair group) and erectile dysfunction (1 in bilateral scrotal flap group) were identified. CONCLUSIONS: In localized paraffinoma, complete removal of paraffinoma is crucial to prevent long term complications. In extensive penile paraffinoma, bilateral scrotal flap is a proper procedure with lower complications and not to interfere with patients' satisfaction in long term overview.
Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Necrosis ; Paraffin ; Penis ; Postoperative Complications ; Skin ; Surgical Flaps ; Wound Infection

PURPOSE: To evaluate the effects of oral Tamoxifen only versus L-Carnitine plus Tamoxifen in patients with Peyronie's disease. MATERIALS AND METHODS: All 45 patients with Peyronie's disease, diagnosed using accepted definitions, were randomized into two groups and treated for 3 months with Tamoxifen only(40 mg/day)(n=17) or a combination ofL-Carnitine(2 g/day) and Tamoxifen(40 mg/day)(n=28). A medical history was obtained, and a physical examination was performed. Plaque size, pain, erectile function(IIEF score), and penile curvature were assessed. Both before and after therapy, the differences between the 2 groups were compared using independent-sample t-test with p<0.05 considered significant. RESULTS: The mean age of the 45 patients was 52.1 years, and no severe adverse events occurred in either group. In the Tamoxifen only group, the mean decrease of plaque-length was 0.46+/-0.88 mm, and mean reduction in the pain rating scale was 0.44+/-0.53. In the L-Carnitine and Tamoxifen group, mean decrease of plaque-length was 1.57+/-0.92 mm, and mean reduction in the pain rating scale was 1.27+/-0.96. Based on IIEF scores, the improvement of erectile function was 0.88+/-0.64 in the Tamoxifen only group and 1.56+/-0.75 in the L-Carnitine and Tamoxifen group. The degree of penile curvature was also measured, and the reduction of curvature angle was 9.17+/-4.92 degrees in the Tamoxifen only group and 9.55+/-6.50 degrees in the L-Carnitine and Tamoxifen group. CONCLUSIONS: This study showed significantly greater improvements in plaque size, pain, erectile function, and curvature in patients with Peyronie's disease who were treated with L-Carnitine and Tamoxifen compared with those treated with Tamoxifen only.
Carnitine* ; Humans ; Male ; Penile Induration* ; Physical Examination ; Tamoxifen*

No abstract available.
Animals ; Calcium ; Rats* ; Urinary Bladder*

Disseminated intravascular coagulation (DIC) is a pathological syndrome in which activation of coagulation cascade leads to fibrin clot formation, consumption of platelets and coagulation factors, and secondary fibrinolysis. We report a case of severe postoperative hemorrhagic diathesis due to DIC. A 59-year-old man was scheduled for reduction of tibia fracture and anatrophic nephrolithotomy of staghorn calculi. On the fifth postoperative day, second operation was performed for nephrectomy due to perirenal hematoma. Two days later, third operation was performed for hemostasis because of the continuous bleeding. Coagulation tests showed positive DIC profiles of thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products, and prolonged prothrombin time and thrombin time. The patient recovered uneventfully and discharged on the 59th postoperative day.
Blood Coagulation Factors ; Calculi ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Fibrin ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Hemorrhagic Disorders ; Hemostasis ; Humans ; Middle Aged ; Nephrectomy ; Postoperative Complications ; Prothrombin Time ; Thrombin Time ; Thrombocytopenia ; Tibia