Dynamic and morphologic evaluation of erectile dysfunction on penile doppler sonography and contrast cavernosography

BACKGROUND

Penile erection is a complex phenomenon that involves coordinated interaction of the psychologic, hormonal, nervous, arterial, venous, and sinusoidal systems. Erectile dysfunction (ED) is the persistent inability to attain or maintain penile erection sufficient for sexual intercourse. This study aims to determine the real-time morphologic vascular abnormalities in men with ED using penile Doppler sonography in Kano, Nigeria.

MATERIALS AND METHODS

Twenty-one patients who were referred from urology clinics on account of suspected vasculogenic ED were reviewed. The cavernorsal arteries were examined with 7.5 MHz linear transducer in gray scale and duplex Doppler modes before and after intracavernosal injection of 60 mg papevarine. Serial peak systolic velocity (PSV), end diastolic velocity (EDV), and diameter measurements were performed at 5-min intervals for 30 min.

RESULTS

The mean age of the patients was 43.14 ± 9.84 years. Out of the 21 patients examined, 5 showed normal findings while 10 had evidence of venous leakage. Five patients had arterial insufficiency; out of which 3 patients showed calcifications of the tunica albuginea, suggesting Peyronie's disease. Interestingly, 1 patient showed combining features of arterial insufficiency and of venous leakage. Those with arterial insufficiency were relatively older than other patients. They also had compounding medical conditions of diabetes and hypertension.

CONCLUSION

Vascular etiologies are important contributors of ED in our setting. Papavarine-induced Doppler sonography and cavernosography shows promise in accurate assessment and overall care of these patients.

Transurethral resection of the prostate in Northern Nigeria, problems and prospects

Background

Benign prostatic hyperplasia (BPH) is the commonest disease of the urinary tract afflicting the ageing male and is the commonest neoplastic disease in men aged 50 years and above.

Transurethral prostatectomy (TURP) is the ultimate treatment of choice for benign prostatic hyperplasia (BPH) due mainly to the preference of minimally invasive surgery, long term relief of symptoms and cost effectiveness. It is however not available to the majority of Nigerians in need of prostatic surgery in Public Health Institutions.

Methods

The records of patients who underwent prostatectomy in Aminu Kano Teaching Hospital, over the period June 2001 to July 2007 were examined. The bio data of patients and laboratory investigations performed were retrieved.

Results

Five Hundred and forty two patients were operated upon, out of which 40 were excluded due to open prostatectomy (22 patients), bladder neck stenosis (16 patients) or bladder tumour around the trigon (2 patients). The age range of the patients was 47–110 years with a mean of 67.2 years. 289 patients (80.1%) had urethral catheter in situ at presentation and 11 (3%) patients had suprapubic cystostomy of which only 3 (0.85%) had combined urethral stricture and BPH.

Only 131 (26%) had their PSA measured which ranged from 2–100 ng/ml out of which 39(29.8% n = 131) patients had more than 4 ng/ml and cancer of the prostate and 1(0.8%, n = 131) patient had a PSA level of 4 ng/ml and malignant prostate.

Hospital stay was 1–32 days (mean 7.9) and the mean follow up period was 5.6 months (range 0–60) and there were 17.5% complications comprising of urinary tract infection (UTI) 7.2%, Orchitis 2.2%, urinary incontinence 0.6%, atonic bladder 1%, erectile dysfunction 0.6%, cerebrovascular accident 0.4%, myocardial infarction 0.4%, deep vein thrombosis 0.4% and disseminated intravascular coagulopathy (DIC) 0.6% and 1.2% mortality. The cost of treatment inclusive of pre-admission investigations was US$ 615.00 (range US$ 300–1,300)

Conclusion

Despite advances in minimally invasive therapy for LUTH/BPH, TURP is the optimum treatment of choice for the ageing male of sub-Saharan Africa. It is however not available to the majority of patients in this region due to poor health allocation and inadequate facilities and training.

Gigantomastia complicating pregnancy: a case report

BACKGROUND

Mammary gigantism is a rare, cosmetically embarrassing complication of pregnancy that may ulcerate and have potentially fatal bleeding.

METHODS

A case report of a 20-year old primigravida with bilateral massive breast enlargement is presented to highlight the clinical presentation and management challenges of the condition.

RESULTS

She was treated with local debridement, bromocriptine, antibiotics and blood transfusion with good results. The pregnancy however terminated at 27 weeks of gestation.

CONCLUSION

Gigantomastia is a rare complication of pregnancy, which may pose a major management challenge. A favorable outcome may be achieved with prompt recognition of the condition and conservative management in selected cases.