Message from the Editor-in-chief

Dear Colleagues,I am pleased to inform you that the initial Impact Factor of the Asian Journal of Andrology (AJA) is 0.827, which was recently published at the Journal of Citation Report (JCR), Institute for Scientific Information, USA. As indicated by JCR, the impact factor of AJA ranks third among the international andrological journals.     

What does the anesthetist expect from the obstetrician?

The anaesthetist would ideally like the following to be observed in a timely order in the antenatal phase: 1. early provision of information to the patient regarding epidural catheter for pain relief in labour, 2. informing the anaesthetist about relevant points in the patient history and examination findings, 3. knowledge of the contraindications to lumbar regional anaesthesia, 4. clear information as to the urgency of a caesarian section, 5. provision of aspiration prophylaxis. In the intrapartum phase it is necessary through clear communication to agree early on: 1. monitoring instructions for epidurals in the delivery room, 2. instructions for epidural top ups, 3. whether the presence of relatives in theatre in the case of a caesarian section is appropriate. In the postnatal phase anaesthetists expect to be actively involved in the resuscitation of newborns to fulfill educational requirements, to have clear decisions about responsibilities for monitoring of patients post caesarian sections and detailed information about early symptoms of possible complications of lumbar regional anaesthesia.     

Electric waves recorded from the testicle: are they capsular or from the testicular tissue?

We demonstrated in a previous study that electric waves could be recorded from the testicle by applying the electrodes either directly to the tunica albuginea (TA) or transcutaneously. As the TA contains smooth muscle fibres which presumably transmit the electric waves, we investigated the hypothesis that the electric waves recorded from the testicle originated from the TA. During the repair of inguino-scrotal hernia in 24 men [age 36.6 +/- 8.6 years (mean +/- SD)], the tunica vaginalis was everted because of the presence of hydrocele. The electric activity of the TA was recorded by three surface electrodes and that of the testicle by three needle electrodes. The recorded potentials were amplified and displayed on an electromyographic apparatus. Triphasic slow waves (SWs) were recorded from the TA. They showed similar frequency, amplitude and conduction velocity from the three electrodes of the individual subject and were reproducible. They were followed or superimposed by bursts of action potentials (APs) which occurred randomly. No waves were recorded from the three needle electrodes inserted into the testicular tissue. The current study could demonstrate that the electric waves recorded from the electrodes applied to the testicle were derived from the TA and not from the testicular tissue. This finding apparently denotes that the TA has a resting tone and probably motile activity, the role of which in testicular function needs to be studied.     

Does the Adamkiewicz artery originate from the larger segmental arteries?

OBJECTIVE: The Adamkiewicz artery supplies most of the blood to the anterior spinal artery, which perfuses the anterior two thirds of the spinal cord. During operations for thoracoabdominal aortic aneurysm, detailed anatomic knowledge of the Adamkiewicz artery and its correlation with the intercostal and/or lumbar arteries is important to prevent postoperative paraplegia. METHODS: Minute dissection was performed on 102 formol-fixed adult cadavers without any history of circulatory disorders. The Adamkiewicz artery was found in the epidural space after laminectomy of the vertebrae. The entire course between the Adamkiewicz artery and the intercostal and/or lumbar artery was dissected carefully. The vertebral level, laterality, and mean diameter of all Adamkiewicz arteries were investigated. The correlation between the diameter of the Adamkiewicz artery and that of the intercostal and/or lumbar arteries was also determined. RESULTS: The mean number of Adamkiewicz arteries per cadaver was 1.3 +/- 0.65, and the mean diameter was 0.77 +/- 0.24 mm (range, 0.50 to 1.49 mm). Approximately 70% of the Adamkiewicz arteries originated from the intercostal and/or lumbar arteries on the left side, frequently at the T8-L1 vertebral level. There was no statistically significant correlation between the diameter of the Adamkiewicz artery and that of intercostal and/or lumbar arteries. CONCLUSION: This study provides evidence that, during operations on the thoracoabdominal aorta, the intercostal and/or lumbar arteries should be preserved, regardless of their diameter, to prevent postoperative paraplegia.     

OAB Evidence from the Urologist’s Perspective

Overactive bladder (OAB) is the term introduced by the International Continence Society in 2002 to describe the symptoms of urgency, with or without urge incontinence, usually in the presence of frequency and nocturia. Community-based prevalence studies have shown an estimated 16% of the adult population in the US and Europe suffers the symptoms of OAB, and in many cases the symptoms can have a profound effect on quality of life. OAB can also co-exist with other disorders (e.g. depression, sleep deprivation, urinary tract and skin infections) which further increases the burden to the patient. Contemporary therapeutic algorithms, based on clinical experiences and evaluations of the published literature, suggest that the majority of patients with OAB can be treated conservatively with behavioral intervention and pharmacotherapy. Only in complicated or refractory cases should there be the need to resort to urodynamic evaluation studies and invasive treatment approaches such as electrical neuromodulation and surgery.     

Satisfaction with the malleable penile prosthesis among couples from the Middle East--is it different from that reported elsewhere?

No studies from the Middle East have investigated the psychosexual aspects of penile prosthesis. Therefore, several questions were used herein to address satisfaction with the use of malleable penile prosthesis among couples from this geographic area, as an option to treat erectile dysfunction (ED). A total of 50 patients who underwent the insertion of AMS 650 and Acu-form penile prostheses and their partners were evaluated with a retrospective clinical record review, as well as patient and partner questionnaires. In all, 70% of the patients and 57% of the partners were satisfied with the prosthesis. There was an increase in frequency of intercourse, sexual desire, and ability to achieve orgasm. Dislike for the device was the most common cause for nonsatisfaction of patients with the device, while sense of unnaturalness was that for partners. Results from this evaluation highlight the obvious need for proper preoperative counseling for both the patient and his partner to minimize unrealistic expectations. They also emphasize the importance of careful screening of both psychosocial and psychosexual aspects of the couple based on cultural ethnic background, since these are important predictors of the therapeutic outcome of prosthesis insertion. Efforts to extend information about ED to the public may be useful to reduce patients' exaggerated embarrassment about this problem and make their partners actively involved in the treatment.     

Hydrogen peroxide--a party trick from the past?

Hydrogen peroxide solutions are found in almost every operating theatre and are used by many surgical specialties, often with little knowledge of their inherent risk. We reviewed the literature and evidence related to the use of hydrogen peroxide in surgery. We found little evidence supporting the use of hydrogen peroxide solutions intraoperatively, a large number of reports of sometimes-fatal oxygen embolism and other evidence of tissue toxicity. We conclude that the use of hydrogen peroxide as an antiseptic has no direct benefit, but is associated with significant risk, and therefore should be reconsidered.     

An unusual mass arising from the vas deferens

An 18-year-old man presented with a history of fightsided abdominal pain and weight loss. Clinical examination revealed the presence of a right-sided abdominal mass arising from the pelvis. Baseline haematological and biochemical investigations were normal. A computerized tomography scan revealed a 78×56 mm cystic mass indenting the right posterolateral aspect of the bladder. The right kidney was absent with a congenital anomaly and duplication of the inferior vena cava below the left renal vein. A dimercaptosuccinic acid (DMSA) scan revealed