Giant prostatic hyperplasia (GPH) is an uncommon pathologic entity with only 10 reported cases of prostate glands exceeding 500 g. We report the uncomplicated removal of a 526-g prostatic adenoma by simple retropubic prostatectomy.

Patient satisfaction with the Mentor inflatable penile prosthesis was assessed by sending a thirty-six-item questionnaire to 251 patients who had undergone implantation of the device by the senior author (D.C.M.). A total of 152 (61%) of the patients responded. Recovery time, satisfaction, reasons for dissatisfaction, perceptions of erection quality, and psychosexual parameters were evaluated. Eight-eight percent of the patients were engaging in regular sexual activity. Depending on the definition of satisfaction, 81-89 percent of the respondents reported that they were satisfied with the prosthesis. Sixty-eight percent of the survey group were satisfied with the length, width, and firmness of their prosthetic-induced erection. The majority of patients reported improvement in psychosexual functioning after implantation. Reasons for dissatisfaction included inadequate penile length, insufficient firmness, and difficulty with inflation and deflation of the penile cylinders.

Present-day whole bladder photodynamic therapy (WBPDT) is cumbersome and time consuming because cystoscopic and ultrasonic manipulations are necessary to position the light emitter within the bladder. More important, WBPDT is inherently unsafe and often ineffective since neither uniform photoirradiation nor accurate light dosimetry can be achieved with the techniques employed to photoirradiate the bladder wall. The intravesical laser catheter (IVLC) eliminates the need for cystoscopy and ultrasonography because passage of the treatment fiber into the catheter's central lumen automatically positions its light-diffusing tip within the center of the bladder. Use of the IVLC delivery system also assures accurate photoirradiation of the bladder wall since inflation of the catheter's balloon transforms the asymmetric bladder into a sphere of known diameter. The light sensor incorporated in the balloon wall provides a method to monitor light fluence and measure total light dose. When provided the parameters of bladder volume, laser energy output, and desired light dose, the computerized control system calculates treatment time and automatically adjusts the period of photoirradiation to compensate for variations in laser light production, energy losses during transmission, and for variations in light intensity resulting from the integrating sphere effect of the bladder wall. This delivery system also increases the safety of WBPDT since the monitor automatically discontinues treatment if any unsafe situation, with respect to light fluence, develops during photoirradiation.

The standard Mentor inflatable is an extremely reliable prosthesis that will provide complete satisfaction in 87 to 99 per cent of the patients in whom it is implanted. The proved long-term reliability and superior functional characteristics of the three-component Mentor prosthesis make it a standard investigators may use to compare the recently introduced mechanical and modified inflatable prostheses. The short-term results of the new Mentor GFS prosthesis also are encouraging. The new prosthesis provides an attractive alternative to the standard inflatable prosthesis in patients with normal-sized genitalia, especially for surgeons who prefer to implant the device through a penoscrotal incision.

No AccessJournal of Urology1 Jul 1989Re: Implantation of Model Ams 700 Penile Prosthesis: Long-Term Results, by W. L. Furlow, B. Goldwasser and J. C. Gundian, J. Urol., 139: 741-742, 1988 Daniel C. Merrill Daniel C. MerrillDaniel C. Merrill More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)38696-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Implantation of Model Ams 700 Penile Prosthesis: Long-Term Results, by W. L. Furlow, B. Goldwasser and J. C. Gundian, J. Urol., 139: 741-742, 1988." The Journal of Urology, 142(1), p. 141 © 1989 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 142Issue 1July 1989Page: 141 Advertisement Copyright & Permissions© 1989 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel C. Merrill More articles by this author Expand All Advertisement PDF downloadLoading ...

Orchiectomy is the preferred method for treating patients with metastatic adenocarcinoma of the prostate (MAP) because it is safer and more reliable than estrogen therapy. Nonetheless, a survey of Northern California urologists showed that 57 percent of their patients with MAP were treated with diethylstilbestrol (DES) rather than orchiectomy. Factors which determined treatment selection include the physician's belief that estrogen therapy was either equally (35%) or more (22%) effective than orchiectomy and the patients' rejection of orchiectomy even if it were recommended to them (20-30%). The survey also showed that previous attempts to increase the acceptability of orchiectomy by performing a subcapsular procedure have failed because urologists do not believe the procedure is effective (45%), or that subcapsular orchiectomy provides a satisfactory cosmetic result (20%). Recent laboratory and clinical investigations have shown that complete and subcapsular orchiectomy were equally effective in reducing serum testosterone. Patient acceptance of subcapsular orchiectomy may be increased by utilizing the term testicular curettage, which does not imply castration, to describe the procedure and by implantation of intracapsular testicular prostheses to restore normal testicular anatomy after the testicles' hormone-producing tissue has been removed.

Transcutaneous electrical nerve stimulation (TENS) was employed to reduce postoperative pain in 40 patients who had either radical nephrectomy, radical prostatectomy, or implantation of an inflatable penile prosthesis. These patients used 68 per cent less pain medication and made 84 per cent fewer requests for meperidine hydrochloride (Demerol) injections than did 40 control patients who had similar surgical procedures. The TENS units were easy to use, and there were no complications to electroanalgesia. The TENS program also was costeffective. TENS provided a simple, safe method of reducing postoperative pain in the three surgical procedures tested. Electroanalgesia may have application in other types of urologic surgery, and TENS should be particularly useful in patients who have outpatient surgery.

Previous studies have shown that electroanalgesia is an effective method of reducing postoperative pain in patients who have urologic surgery. All prior studies of postperative transcutaneous electrical nerve stimulation (TENS) have employed TENS stimulators which were designed for the control of chronic pain. Disadvantages to the use of standard TENS stimulators in postoperative patients include the high cost of the devices and their operative complexity which make it difficult for staff and patients to use them. FasTENS is a lightweight, relatively inexpensive disposable TENS stimulator which has been designed specifically for use in postoperative patients. We evaluated the effectiveness of FasTENS in patients who had implantation of an inflatable penile prosthesis, radical retropubic prostatectomy, or radical nephrectomy. Patients treated with FasTENS used 60 percent less pain medication (P less than 0.001) and made 61 percent fewer requests for Demerol injections (P less than 0.001) than did control patients who were not treated with postoperative electroanalgesia. FasTENS was most effective in patients who had radical prostatectomy or penile prosthetic surgery. FasTENS was not cost-effective or practical in patients who had radical nephrectomy.

The Mentor inflatable penile prosthesis (IPP) has been implanted in 206 patients with organic (95.2 %) or psychologic (4.8 %) impotency. The patients have been followed up for an average of 18.1 (4–42) months. A satisfactory result has been achieved in 98 per cent of these patients. A life analysis of the series shows that 88 per cent of all devices implanted will survive forty-two months without mechanical failure. One hundred sixty-four of these patients had not had previous penile surgery while 42 had had one or more penile prostheses implanted previously. The projected forty-two-month survival for the Mentor prosthesis in these subgroups is 94 per cent and 74 per cent, respectively. The improved life expectancy of the Mentor IPP, compared with the Scott IPP, is due to the superior durability of Mentor's polyurethane cylinders and to the increased reliability of the Mentor snap-on connector system. In this respect, there have been only one cylinder failure and 3 connector failures in the Mentor series. The connector failures occurred early in the series before the development of connector pliers; there have been no connector failures in the last 202 consecutive implantations. Wear-induced tubing leaks, the most common cause of device failure, occurred in 2.9 per cent of all implantations. Tubing failures were more common in patients who have had previous surgery, occurring in 9 per cent of salvage procedures and 1.3 per cent of primary implantations. The reason for the difference in tubing survival in virgin and salvage procedures is unknown; possibly the subcutaneous scar tissue present in secondary surgical procedures increases the chance of tubing segments touching and abrading each other. Laboratory studies suggest that the nylon-reinforced tubing used in the manufacture of devices implanted since 1985 is more durable than is the standard silicone tubing used in the construction of devices implanted previously.

In these studies, strong inferential evidence is provided which suggests that thoracic impedance provides reliable estimates of thoracic blood volume changes in man. There were 24 volunteers studied in 4 different experiments. The results of these studies are as follows: Impedance derived blood volume changes in the calf of man correlate closely with standard estimates of calf blood volume changes made with strain gauge plethysmography. There is a close linear relationship between the increase of thoracic impedance and the increase of calf blood volume during head-up tilt. Volunteers who develop syncope during head-up tilt (presumably due to excessive decreases of central blood volume) demonstrate exaggerated increases of thoracic impedance. Decreases in central venous pressure produced by lower body negative pressure are significantly correlated to thoracic impedance increases.

Scrotal skin was employed to cover skin defects resulting from palliative groin and suprapubic dissections designed to remove large masses of tumor which had eroded the skin. This technique provides a simple and effective alternative to more complex procedures using rotational skin and myocutaneous flaps to achieve primary skin closure in similar circumstances.

The Mentor inflatable penile prosthesis was designed to decrease the incidence of mechanical failures associated with the Scott inflatable penile prosthesis. The penile cylinders of the Mentor prosthesis are manufactured from Bioflex polyurethane, a new polymer which is more durable and less elastic than silicone. The Mentor prosthesis also has a connector system which employs plastic clamps rather than suture ties to fix tubings to connectors. The new prosthesis has been implanted in 30 patients with organic impotency. These patients have been followed for an average of 7.7 (5-12) months. All patients achieved a satisfactory cosmetic and functional result from the procedure.

The Scott inflatable penile prosthesis was implanted in 150 patients with organic (89%) and psychologic (11%) impotency from 1979 to 1982. The patients were followed up for an average of twenty-five (6-46) months. A satisfactory result was achieved in 133 (89%) patients. Forty-nine major complications occurred in 38 patients. Forty-four surgical procedures were performed in 33 patients to correct mechanical or technical complications (32), replace the device (9), or remove the device (3). Two patients refused corrective surgery, and the complications could not be corrected in 2 patients. Cylinder leaks (15), leaks at tubing/connector junctions (14), and cylinder aneurysms (7) were responsible for most of the mechanical failures. Additional refinements in surgical technique will not eliminate these problems. Device modifications should be made to increase cylinder durability, to eliminate the need for suture ligation of tubing/connector junctions, and to assure symmetrical cylinder expansion.

The new Mentor prosthesis is similar in appearance to the Scott inflatable penile prosthesis, consisting of a pump, a reservoir, and two penile cylinders. The penile cylinders of the Mentor prosthesis are constructed of Bioflex polyurethane, a new polymer which is more durable and less elastic than silicone. The use of Bioflex cylinders should increase device longevity and eliminate cylinder aneurysms. It also may be possible to correct penile deformities produced by silicone cylinders which have formed aneurysms by replacing the dilated cylinders with Bioflex cylinders. The new Mentor prosthesis utilizes snap-on connectors which rely on plastic clamps rather than suture ties to fix tubings to connectors. This method of attaching tubing to connectors will reduce operating time and should reduce the incidence of connector leaks.

A comparison of urethral pressure profiles performed with the air infusion, water infusion, membrane catheter, and transducer tip catheter techniques was made in a canine model. The gas and water infusion methods gave statistically identical results if the gas studies were performed at flow rates of 100 ml. /min. and pull rates of 5 cm. /min. The transducer tip catheter and the gas and water infusion techniques gave accurate recordings of peak urethral pressure but were incapable of detecting multiple areas of urethral compression. The transducer tip catheter measurements often were difficult to interpret because of rotation and flexion artifact. The membrane catheter was capable of recording multiple areas of urethral compression but gave spuriously high recordings of peak urethral pressure. We conclude that none of the methods tested will give accurate recordings of urethral pressure in all clinical situations.

The effect of baclofen (Lioresal) and dantrolene (Dantrium) on bladder stimulation-induced detrusor-sphincter dyssynergia was studied in normal and chronic T-10 paraplegic dogs. Dantrolene, which depresses skeletal muscle contractility, had little effect on electrically evoked contractions of the urethral sphincter in dogs. Baclofen, which acts centrally by potentiating presynaptic inhibition, depressed the pudendal to pudendal nerve reflex and decreased urethral resistance during bladder stimulation.