All Men with Vasculogenic Erectile Dysfunction Require a Cardiovascular Workup

An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction.     

Long-term Impairment of Acquisition of a Spatial Memory Task following Isoflurane-Nitrous Oxide Anesthesia in Rats

Background: The authors demonstrated previously that isoflurane-nitrous oxide anesthesia attenuates performance improvement on an already-learned spatial memory task and that the effect persists for weeks. This experiment was designed to test the hypothesis that learning of new information is particularly susceptible to prolonged disruption after general anesthesia.

Methods: Six- (n = 5) and 20- (n = 5) month-old male Fischer 344 rats were anesthetized for 2 h with 1.2% isoflurane, 70% nitrous oxide, and 30% oxygen. Age-matched control rats received 30% oxygen and 70% nitrogen (n = 5 per group). Rats breathed spontaneously, and anesthetic and oxygen concentrations were measured. Spatial learning was assessed daily for 21 days on a 12-arm radial maze (RAM) beginning 48 h after anesthesia. In a post hoc experiment to examine locomotion, swim speed was assessed in a separate group of identically treated rats (n = 3 per group) for 4 days beginning 48 h after anesthesia.

Results: Aged rats were slower to complete the maze, made fewer correct choices before first error, and made more errors at baseline than young rats (P < 0.05). Anesthesia worsened maze performance in both age groups, as evidenced by increased time to complete the maze and a decreased number of correct choices before first error (P < 0.05), but there were no statistically significant differences in total number of errors. Interestingly, there were no age-by-anesthesia interactions. Aged rats swam slower than adult rats (P < 0.001), but there were no differences between the control and anesthesia groups.     

Ureteroscopic management of transitional cell carcinoma of the ureter using the neodymium:YAG laser

Ureteroscopy offers an extension of endoscopic diagnosis and treatment to upper urinary tract malignancy. Combination of ureteroscopy and the Nd:YAG laser permits accurate and effective treatment of ureteral neoplasms. Nine highly selected patients, six males and three females, were treated with low grade papillary transitional cell carcinomas of the ureter with at least 24 months follow-up. Follow-up cytology and IVP have indicated no evidence for disease recurrence between the follow-up periods and minimal morbidity to the ureteroscopy and laser treatment. © 1993 Wiley-Liss, Inc.     

Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants

PURPOSE: We compared infection rates in original inflatable penile prostheses implants between prostheses impregnated with InhibiZone (American Medical Systems, Minnetonka, Minnesota), an antibiotic surface treatment, and prostheses without antibiotic treatment. MATERIALS AND METHODS: We retrospectively reviewed patient information forms filed with the manufacturer following original implantation in the United States to implant AMS 700 series penile prostheses (American Medical Systems) between May 1, 2001 and April 30, 2003. We compared results in 4205 men, including 2261 with a mean age of 60.71 years who received prostheses with InhibiZone, a surface treatment combining rifampin and minocycline hydrochloride, and a control group of 1944 with a mean age of 61.04 years who received untreated prostheses. Followup in the treatment and control groups was 0 to 11.5 months (mean 5 and 8, respectively). In the treatment group only implants in which all components were treated were included. RESULTS: The reported incidence of infection after 60 days was 0.28% in the treated group and 1.59% in the control group (p = 0.0034). After 180 days the infection rate in the treated and control groups was 0.68% and 1.61%, respectively (p = 0.0047). The treated group had an infection rate that was 82.4% lower than in the control group after 60 days and 57.8% lower after 180 days. Erectile dysfunction etiologies occurred at statistically similar rates in the 2 groups and did not impact infection rate results. CONCLUSIONS: The use of InhibiZone to target postoperative infections results in a statistically significant decrease in penile prosthesis infection rates in original implants. Infection rates in the control group were consistent with those in the published literature.