Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients： medial or lateral？

The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle （NVB） to correct ventral congenital penile curvatures （CPCs）. The bundle was mobilized using the medial and lateral dissection technique in 21 （Group 1） and 13 （Group 2） patients, respectively. In the medial technique, Buck＇s fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea （TA） is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck＇s fascia above the urethra at the 5 and 7 o＇clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients＇ photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 （P= 0.01）. In Group 1, nine patients （42.8%） required one diamond excision, 10 （47.6%） required two diamond excisions and two （9.5%） required more than two excisions; in Group 2, six patients （46.2%） required two diamond excisions and seven patients （53.8%） required more than two diamond excisions （P = 0.019）. The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.

Effects of extra-corporeal shock waves on penile hemodynamics and histopathology in rats

Aim: To study the effect of extra-corporeal shock wave (ESW) on the penile hemodynamics and histopathology in rats. Methods: Adult male Sprague-Dawley rats were divided at random into 3 groups. ESW application was performed with a Siemens Lithostar with the rats under anesthesia lying prone on the balloon probe. Rats in Group Ⅰ received a total of 1000 shocks at 18 kV and immediately underwent hemodynamic evaluation performed by direct electrostimulation of the cavernous nerve and measurement of intracavernous pressure (ICP). Rats in Group Ⅱ received 3 times 1000 shocks at 18 kV at weekly intervals and hemodynamic evaluation was performed 1 month after the last ESW application. Group Ⅲ served as the control. Histopathological examinations of penile tissues were done on Masson's trichrome and hematoxylin and eosin stained sections. Results: Penile hemodynamic evaluation showed a trend toward a diminished mean maximal ICP, duration of erection, ICP during the plateau phase and maximal ICP/blood pressure ratio in Group Ⅰ, although there was no significant significance. The mean latency period in Groups Ⅰ and Ⅱ was prolonged. Petechial bleeding within tunical layers and small loci of hemorrhage within the corpora cavernosa were observed in Group Ⅰ. However, histopathological examination failed to reveal any significant differences between the groups in terms of smooth muscle content, tunical thickness, organization of collagen bundles and elastic fiber-lattice framework. Conclusion: ESW has certain damaging effects on the penis. (Asian J Androl 2002 Dec; 4: 249-253)

Evaluation of gonadotropireplacement therapy in male patients with hypogonadotropic hypogonadism

Hypogonadotropic hypogonadism(HH)is a rare disease in which medical treatment has a high success rate to achieve fertility.This study aimed to an a lyze the efficacy of horm one replacement therapy and determi ne predictive factors for successful spermatogenesis and spontaneous pregnancy in patients with idiopathic HH.A total of 112 patients with low testosterone(T),luteinizing hormone(LH)and follicle-stimulating hormone(FSH),and normal prolactin levels were diagnosed with HH and administered LH and FSH analogs as hormone replacement therapy.During treatment,96(85.7%)patients had sperm present in ejaculate samples.Among these patients,72 were married and wanted a child.Of these 72 patients,48(66.7%)of couples had pregnancies from natural conception.After initiation of treatment,the mean time for the appearance of sperm in semen was 9.48 months.There were no significant differences between baseline FSH,T,and LH levels;however,older age,larger testicular size,and low rate of undescended testes were favorable factors for successful spermatogenesis.Larger testicular size and older age were also the main predictive factors for natural conception.We found that patients with undescended testes had a younger age,smaller testes,and lower T levels compared with patients exhibit!ng descended testes.The rate of sperm found in the ejaculate was not significantly decreased in patients with undescended compared with descended testis(73.7%vs 87.6%,P=0.261).The medical approach for males with HH and azoospermia provides a successful treatment modality in regard to successful spermatogenesis and achievement of pregnancy.