The clinical benefit of PGE1in erectile dysfunction in men is well proven, while other species including non-human primates show almost no response. The reason for that difference is still unclear. We examined PGE1binding in human surgical material (n=27) and from transsexual surgery (n=7) as well as rhesus (n=10) and cynomolgus monkeys (n=8) corpus cavernosum tissue. Erection was judged after intracavernous injection of PGE1in men (10 μg) and in monkeys (5 μg). Human corpus cavernosum shows high- (binding capacity 24.7±3.3 pmol/mg protein) and low-affinity (binding capacity 77.4±7.3 pmol/mg protein) PGE1binding sites. Oestrogen (3 mg/day) for more than one month before transsexual surgery decreases receptor density significantly. In rhesus and cynomolgus monkeys no high-affinity binding could be detected, while they respond on PGE1with slight tumescence only. These findings indicate a significant correlation between corpus cavernosum PGE1receptor density and the erectile response.

Objective To evaluate the long-term safety and efficacy of intracavernosal alprostadil (prostaglandin E-1, PGE(1)) in patients with erectile dysfunction [ED) and assess the feasibility of self-injection treatment,Patients and methods The study included 848 men (aged 18-75 years) with ED of greater than or equal to 4 months' duration. The initial home-use dose of alprostadil, defined as a dose producing an erection satisfactory for intercourse and lasting for greater than or equal to 20 min, was determined for each patient in the investigator's clinic and in the patient's home. This dose-finding phase was followed by a 6-month, self-injection, home-maintenance phase. The efficacy and adverse effects were documented.Results An initial home-use dose was determined for 93% of the patients and in most (86%) it was less than or equal to 20 mu g. During the 6-month study period, 88% of injections assessed by the patients resulted in satisfactory sexual activity (intercourse or masturbation) and 90% of injections assessed, by partners resulted in satisfactory intercourse. Penile pain occurred in 44% of patients, but this incidence decreased with time. In 52% of patients with pain it was mild and only 3% of patients discontinued the study because of pain. Prolonged erection and priapism occurred in 8% and 0.9% of patients, respectively, Penile fibrosis occurred in 4% of patients. Drug-related systemic medical events occurred in 5%, of patients and none of these were serious. Haemodynamic events occurred in <I% of patients and were not considered to be clinically relevant.Conclusion Intracavernosal alprostadil is an effective and safe therapy for EU, provided that the individual dose is established by titration, patients are trained in the self-injection technique and supervised periodically.

In this study, the role of platelets in the human erectile response was assessed. Twenty patients with erectile dysfunction were studied by means of (111)In-oxine-platelets and blood pool imaging using 99mTc. Seventeen patients received intracavernously prostaglandin E1, and three patients received papaverine together with phentolamine. In patients who responded with erection, an increase by between 16 to 137% platelets/ml and a rapid platelet accumulation in the penis during the initial phase of erection were observed. In patients without erection, no change in local platelet concentration occurred. It is likely that platelets play a major role in human erection, probably by temporary activation, thereby regulating venous outflow.

Recent advances in the functional anatomy, neurophysiology and pharmacology of penile erection have fostered a dramatic improvement in the understanding of the physiology of erection and the approaches to correct impotence. However, the complex mechanism of human erection still remains incompletely explained. In vivo animal studies in the Chacma baboon (Dormehl et al., 1984) suggested that an enhanced platelet activity exits in the penis during erection. In this study we evaluate whether a similar accumulation of platelets during erection also occurs in humans.

Objective To determine the benefit of renal autotransplantation in selected patients with either renovascular lesions, renal or urothelial carcinomas or other disorders of the urinary collecting system.Patients and methods Between 1977 and 1994, 12 patients underwent renal autotransplantation, six involving renovascular hypertension, two involving tumours of the renal parenchyma, two with urothelial tumours and two with long ureteric stenoses. Pre‐operative renal function was normal in six patients and impaired in five. One patient was on haemodialysis. Five patients had a solitary kidney and four patients had functionally solitary kidneys. The follow‐up period ranged from 1 to 93 months (mean 34.9).Results Post‐operatively, six patients had normal kidney function (serum creatinine ≤12 mg/L), five patients had impaired renal function (creatinine content ≤26 mg/L) and one patient was on haemodialysis due to arterial graft thrombosis. Serum creatinine levels improved in four patients and were stable in another four. Renal function deteriorated in three patients and one patient required a graft‐nephrectomy. Immediate post‐operative complications included arterial thrombosis in one patient, perirenal haematoma in two, pulmonary oedema in one and severe intra‐operative bradycardia requiring a transient cardiac pacemaker in one.Conclusion Renal autotransplantation represents an effective alternative treatment with good long‐term results for selected patients with long ureteric lesions and renovascular disorders. It is also an effective method for patients with urological malignancies, especially those with solitary kidneys where the maintenance of renal function is of major concern.

OBJECTIVE:To determine the benefit of renal autotransplantation in selected patients with either renovascular lesions, renal or urothelial carcinomas or other disorders of the urinary collecting system.PATIENTS AND METHODS:Between 1977 and 1994, 12 patients underwent renal autotransplantation, six involving renovascular hypertension, two involving tumours of the renal parenchyma, two with urothelial tumours and two with long ureteric stenoses. Pre-operative renal function was normal in six patients and impaired in five. One patient was on haemodialysis. Five patients had a solitary kidney and four patients had functionally solitary kidneys. The follow-up period ranged from 1 to 93 months (mean 34.9).RESULTS:Post-operatively, six patients had normal kidney function (serum creatinine < or = 12 mg/L), five patients had impaired renal function (creatinine content < or = 26 mg/L) and one patient was on haemodialysis due to arterial graft thrombosis. Serum creatinine levels improved in four patients and were stable in another four. Renal function deteriorated in three patients and one patient required a graft-nephrectomy. Immediate post-operative complications included arterial thrombosis in one patient, perirenal haematoma in two, pulmonary oedema in one and severe intra-operative bradycardia requiring a transient cardiac pacemaker in one.CONCLUSION:Renal autotransplantation represents an effective alternative treatment with good long-term results for selected patients with long ureteric lesions and renovascular disorders. It is also an effective method for patients with urological malignancies, especially those with solitary kidneys where the maintenance of renal function is of major concern.

Casodex (Bicalutamide, ICI 176,334) is a potent, non-steroidal, selective anti-androgen with a long half-life allowing once-daily oral administration. In this randomised, open, multicentre study, Casodex 50 mg monotherapy was compared with castration (medical, using goserelin acetate, [Zoladex], or surgical) in 245 patients with advanced prostate cancer. Primary end-points were time to treatment failure, time to objective progression and survival. Subjective responses, quality of life and tolerability were also evaluated. There was no significant difference between the groups in terms of objective progression or subjective responses. Treatment failed in 59 of 119 patients (50%) randomised to Casodex and in 61 of 126 patients (48%) randomised to castration (no statistically significant difference). An updated analysis showed that survival was similar in the two groups. Casodex was well tolerated with a low incidence of diarrhoea and sexual dysfunction. On the basis of this study, Casodex monotherapy is an effective alternative to castration in the treatment of metastatic prostate cancer.

Rodrigues, M.; Stackl, W.; Graenneger, S.; Pirich, C.; Sinzinger, H. Author Information

Since 1982, many substances have been used for intracavernous injection to produce erections. Because the first-generation drugs (phenoxybenzamine, papaverine) were associated with severe side effects, including priapism and fibrosis of the penis, it was important that a safe and effective substance for intracavernous injection be found. In our series of 550 men with erectile dysfunction who received a test dose of 20 μg prostaglandin E1, 385 (70%) developed an erection lasting more than 30 min. Side effects were minimal: only one patient required treatment for priapism, and no fibrosis was found. A total of 275 patients entered an autoinjection protocol. All of these men were capable of engaging in intercourse and experienced no major side effects. In conclusion, prostaglandin E1 is effective, safe and preferable to all other drugs currently used for intracavernous injection.

Die intrakavernöse Injektion gefäßaktiver Substanzen hat die Diagnostik und die Therapie der Erektionsstörungen revolutioniert. Medikamente, die bisher für die intrakavernöse Injektion beim impotenten Mann verwendet werden, verursachen Fibrosen, Priapismus und systemische Reaktionen [4]. Nach Papavarininjektion wurde sogar kürzlich ein Todesfall berichtet [3]. In der Hoffnung, eine Substanz zu finden, welche wirksam und sicher ist, begannen wir im Juli 1986 Prostaglandin E1 in der Diagnostik und Therapie der Impotenz einzusetzen [5].

Endoscopic removal of gallbladder stones via a percutaneous transperitoneal approach appears to be an attractive alternative to surgical cholecystectomy, provided that the gallbladder is normal. Compared with ESWL and adjunctive chemolysis, this procedure offers the advantage of immediate removal of all stone material, regardless of its composition. In 20 patients subjected to this method in a 10-month period, it was successful in 14 patients, with minimal morbidity and an average hospitalisation of 4 days. The procedure failed and cholecystectomy had to be carried out because the tract could not be established in two patients, because of problems with disintegrating large stones in three and because of late biliary leakage in one patient. The experience suggests that the results should be improved considerably by limiting the method to stones <3cm in diameter and by excluding very mobile gallbladders or designing a technique to hold them in place during percutaneous manipulation.

In spite of long-term adjunctive oral dissolution therapy, residual gallstones have been reported in up to 50% of gallstone patients 3 months after extracorporeal shock-wave lithotripsy. Six women and five men, aged 31-75 years, underwent percutaneous endoscopic cholecystolithotripsy between April 1988 and October 1988. The gallbladder was punctured by means of an anterior transperitoneal approach. The tract was dilated, and gallstones were removed with a modified 21-F cholecystoscope under direct visual inspection. Calculi too large for extraction were disintegrated with ultrasound or electrohydraulic lithotripsy. Eight patients were stone-free and two had small residual stones 3 months later; nine were stone-free 6 months after the procedure. Although more invasive than shock-wave lithotripsy, percutaneous endoscopic cholecystolithotripsy has the advantage of immediate removal of more calculi, causes less pain, necessitates less postoperative immobilization, and allows patients to leave the hospital sooner.

To compare the local and systemic effects of chronic intracavernous injection of papaverine, prostaglandin E1, and saline on erectile tissue, eight pigtail monkeys underwent 75 injections over a nine-month period. Monkeys were divided into three groups; each group received papaverine (10 mg.), prostaglandin E1 (20 μg.), or saline (one ml.). The erectile response was closely observed for two hours after each injection to monitor the onset, degree, and duration of erection. Liver function tests were performed every three months to detect early systemic metabolic changes. After sacrifice, the simian penises were perfused in situ and examined histologically with both light and electron microscopy.

Percutaneous cholecystolithotripsy can be performed with a transhepatic or transperitoneal approach. Because the anatomy of the gallbladder varies from person to person, the authors began a study to evaluate the position of the gallbladder with computed tomographic scans of 100 patients known to have stones in their gallbladders. Four variations in the relationship of the gallbladder to the liver and anterior abdominal wall were noted: completely intrahepatic gallbladders (39%) (type I), gallbladders bulging anterior to the anterior rim at least in part (35%) (type II), gallbladders completely anterior to the liver (17%) (type III), and gallbladders in a lateral position (9%) (type IV). In 51%, the colon was in direct contact with the gallbladder, and in 13% it was positioned between the abdominal wall and gallbladder. A safe percutaneous puncture was not possible in 34% of the patients (nine type IV gallbladders, 23 type I organs, and two type III gallbladders with anterior interposition of the colon).

To investigate the erectile response and side effects of intracavernous injection of vasoactive agents, 7 groups of 5 rabbits each underwent injection of either isotonic saline or 1 of 6 drugs. Phentolamine most consistently produced full erection with few inflammatory reactions, while phenoxybenzamine produced erection but also severe inflammation and sclerosis of the corpus cavernosum. With prostaglandin E1, neither erection nor inflammation was observed.

Intracavernous injection of prostaglandin E1 was used in 210 men as a screening test for the differential diagnosis of vasculogenic impotence. Of these 210 patients 112 entered an autoinjection protocol for treatment of erectile dysfunction. Prostaglandin E1 appears to be effective in the diagnosis and treatment of nonvasculogenic impotence because it is a physiological agent that is metabolized locally within the cavernous tissue. Additionally, in our series neither systemic reactions nor priapism occurred, nor was fibrosis of cavernous tissue or scar formation observed after up to 90 injections.