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Biomedical subjects

E Wespes

Publications and source records attributed to E Wespes.

At least 19 recordsLinked to original sources
PubMed1992

Penile extensibility: to what is it related?

Penile extensibility is the difference between the length of the flaccid penis and the penis submitted to a maximal constant traction. This measurement has been proposed for use as a new potential diagnostic method to assess intracavernous fibrosis. To determine the value of this method we measured penile extensibility before and after removing the skin and cavernous tissue in 17 cadavers and 4 patients undergoing penile implantation. In all cases a cavernous tissue biopsy was performed and the percentages of the different structures were objectively quantified by computer analysis. The extensibility decreased with patient age but it was not influenced by removal of the skin and/or cavernous tissue. No correlation was observed between decreased extensibility and the increase in fibrotic elements in the penile tissue. Penile extensibility seems to reflect the elasticity of the tunica albuginea, which is the limiting factor and cannot be an expression of fibrosis of the corpora cavernosa.

Adult↗
PubMed1992

Vascular impotence: focal or diffuse penile disease.

Using computerized image analysis the percentage of smooth muscle fibers was measured in several biopsies of the penis from 10 cadavers and 5 patients with vascular impotence. No significant difference was observed between the proximal and distal areas, and/or between the peripheral and central areas in 1 corpus cavernosum, and between the 2 corpora cavernosa for each patient or cadaver. The percentage of smooth muscle fibers was less in impotent patients in comparison with the cadavers, in which the erectile status was not known, and this reduction occurred throughout both cavernous bodies. Vascular impotence is a diffuse penile disease. Therefore, a cavernous body biopsy can be used to study the penile structure in the assessment of vascular impotence.

Adult↗
PubMed1992

Impotence due to corporeal veno-occlusive dysfunction: long-term follow-up of venous surgery.

Corporeal veno-occlusive dysfunction is an important cause of organic impotence and is characterized by increased flow rates to create and to maintain erection during artificial erection produced by intracavernous saline infusion. Sixty-seven patients with this erectile insufficiency underwent penile ligature-resection of deep dorsal vein between 1982 and 1986, and were evaluated by nocturnal plethysmography, pharmacocavernometry as well as a questionnaire about their sexual life for long-term follow-up. The surgical procedure was controlled in the operating room by reduction of the erectile flow rates. Thirty-one patients were potent postoperatively and were able to have satisfactory intercourse. Results after resection were slightly better than after simple ligation of the deep dorsal vein. Four patients had penile glans insensibility resulting from the surgical dissection. There were 7 relapses several months after the procedure due to leakage through other deeper veins. Eight failures were due to additional psychogenic disorders or to neurologic disease not accurately diagnosed before the treatment because they all developed normal papaverine-induced erection after venous surgery while before it they only developed a slight tumescence. Reduction of the erectile flow rates within normal values was impossible during surgery in 3 patients. Eleven failures were due to concomitant arterial disease. Resection of the deep dorsal vein can restore penile erection in patients with cavernovenous leakage in about 50% of well-selected patients.

Erectile Dysfunction↗
PubMed1991

Computerized analysis of smooth muscle fibers in potent and impotent patients.

Reduction or dysfunction of the intracavernous smooth muscle fibers can provoke impotence. Computerized digital image analysis of corpus cavernosum biopsies was performed in potent and impotent patients to quantify the percentage of smooth muscle fibers. In 5 normal patients the smooth muscle area represented 40 to 52% of the specimen, in 20 patients with cavernous dysfunction it was 10 to 36% and in 10 patients with arterial disease it was 13 to 25%. This method appears to be important to understand better certain mechanisms of impotence and to approach the potential treatment.

Adolescent↗
PubMed1991

[Cavernometry-cavernography].

The penile venous outflow is studied by cavernometry-cavernography associated with intrapenile injection of vasoactive drugs. This method allows the detection of patients with cavernovenous leak.

Erectile Dysfunction↗
PubMed1991

[Venous surgery for impotence].

The treatment of cavernovenous leak consists of the ligation resection of the deep dorsal vein and the cavernous veins when the arterial inflow is normal. When the penile arterial inflow is reduced, deep dorsal vein arterialization can improve the venous leakage.

Erectile Dysfunction↗
PubMed1990

Study of human penile venous system and hypothesis on its behavior during erection.

To determine the role of the venous outflow restriction during human erection, we compared intracavernous pressure with deep dorsal vein pressure in 6 normal subjects during papaverine-induced erection and penile saline infusion. In addition, flows necessary to produce and maintain erection were measured in 10 cadavers before and after resection of the deep dorsal vein alone or together with ligation of the cavernous veins. Elongation of tunica albuginea was measured at the crural and mid portions of the penis. At rigidity there was complete blockage of the venous return through the emissary veins. The venous outflow through the cavernous veins was reduced but still persisted. The distention of the tunica albuginea was less important at the crural portion than at the distal portion and could explain why the cavernous veins were not blocked completely.

Blood Pressure↗
PubMed1990

Urinary retention due to sacral myeloradiculitis: a clinical and neurophysiological study.

We report 5 cases of sacral myeloradiculitis presenting with transient urinary retention. Neurophysiological testing, including bulbocavernosus reflex, pudendal evoked response and external anal sphincter electromyography, was performed. Parasympathetic pelvic nerves, pudendal nerves as well as the spinal cord seem to be involved to various degrees in this infrequent disorder.

Acute Disease↗
PubMed1990

Neurophysiological investigations of two hundred men with erectile dysfunction. Interest of bulbocavernosus reflex and pudendal evoked responses.

Two-Hundred consecutive patients complaining of impotence have had complete urological and neurophysiological investigations to determine a possible organic cause of their sexual dysfunction. All patients had urological and neurological history and examination: nocturnal penile plethysmography, papaverine intracavernosus injection, penile arterial doppler and/or arteriography, cavernography-cavernometry, serum hormonal levels, and bulbocavernosus reflex (BCR). Peripheral conduction velocities and pudendal-evoked responses (PER) were also performed if neurological history or examination and/or BCR were abnormal. Only 30 patients (15%) had an abnormal BCR. In 17 patients, a neurological associated disorder was found. Four patients had normal erections during plethysmography, despite their complaints. Nine patients with an isolated prolonged BCR also presented a vascular abnormality that could explain impotence. Abnormal PER was observed only in 6 patients, 4 of them with a prolonged BCR as well. These results suggest that PER is not an interesting neurophysiological routine test for the diagnosis of neurogenic impotence and that the relationship between an abnormal BCR and neurogenic impotence is doubtful.

Erectile Dysfunction↗
PubMed1990

Role of the bulbocavernosus muscles on the mechanism of human erection.

The role of the human bulbocavernosus muscles on the intracavernous pressure and on the venous return were investigated during artificial erection. Contractions of these muscles were voluntary or produced by dorsal nerve stimulation. During such contractions, elevations in intracavernous pressure and a decrease in the erectile flow rates to produce and to maintain the erection were observed. These results demonstrate involvement of the bulbocavernosus muscles in the process of penile rigidity and suggest that they could participate in the mechanism of rigidity during intercourse.

Adult↗
PubMed1990

Use of Biopty gun for corpus cavernosum biopsies.

Needle biopsy of the corpus cavernosum with the Biopty gun system has been performed in impotent patients. This technique is cost-effective, rapid, safe, relatively harmless and effective in obtaining erectile tissue to identify the presence of intracavernous structures (smooth muscle cells, collagen, arteries and nerves). It can certainly replace the open method, but we have to determine its place in the assessment of impotent patients.

Biopsy, Needle↗
PubMed1990

[Peptide innervation of the penis].

Immunoreactive (IR) vasoactive intestinal polypeptide (VIP) and neuropeptide Y (NPY) nerve fibers processes have been observed in venous and arterial tunicae and in intracavernous smooth muscles of the human penis taken at autopsy or during surgery using light and electron microscopic immunohistochemical techniques. Numerous IR-VIP and IR-NPY nerve fibers were mostly concentrated in the inner part of the adventitia close to the media of the arterial and venous vessels. In the corpora cavernosa and in the corpus spongiosum, IR-VIP and IR-NPY nerve processes were intermingled between the smooth muscle fibers around the sinusoid spaces. The density of the staining was much more important for NPY than for VIP. Positive soma were not observed in the penis. At ultrastructural level, post embedding immunogold technique, IR-VIP and IR-NPY were localized exclusively in large dense granules of nerve terminals. This peculiar distribution of IR-VIP and IR-NPY nerve fibers suggested that it could participate in regulating arterial and venous blood flow and intracavernous smooth muscle tone in the mechanism of flaccidity and erection of the penis.

Humans↗
PubMed1990

[Neurophysiological studies in 200 impotent men: the value of the bulbocavernous reflex and of penile evoked potentials].

After having investigated 200 males with impotence, the authors conclude that the study of the bulbocavernous reflex and the penile evoked potentials are of a certain importance when a neurological origin is suspected as the cause of the impotence. The usual urological investigations during the work-up of impotence should always be carried out in order to improve the insight into the relationships between the different examinations.

Erectile Dysfunction↗
PubMed1989

Effect of phentolamine on venous return in human erection.

A group of 25 patients underwent Doppler penile blood examination and cavernometry before and after 5 mg of phentolamine injected intracavernously. The organic or psychogenic nature of impotence was determined by psychological testing, the intracavernous injection of papaverine, hormonal evaluation, neurological examination, Doppler penile blood flow measurement and cavernometry for vascular investigations. The intracavernous injection of phentolamine had no effect on the venous return and it provoked penile arterial dilatation. The erectile angle, which was also measured, was less evident than after the injection of papaverine. The results confirmed the fact that an increase in arterial inflow alone is not sufficient to induce a rigid erection in man.

Humans↗
PubMed1989

Deep dorsal vein arterialisation in vascular impotence.

A series of 12 patients with vasculogenic impotence (4 arterial lesions; 8 arterial and venous lesions) underwent deep dorsal vein arterialisation after pre-operative assessment by a multidisciplinary approach. Cumulative graft patency was 58% (7 of 12 patients) up to 21 months but only 4 patients developed almost normal erections. Digital angiography, with and without the intracavernous injection of papaverine, was performed during follow-up to determine the vascular physiological status. At flaccidity, the corpora cavernosa were never opacified in the absence of a venocorporeal shunt. The penile glans was always visualised. Opacification of the deep dorsal vein and the circumflex system decreased with penile rigidity, resulting from their compression between Buck's fascia and the tunica albuginea. Intracavernous pressure recorded before and after the surgical procedure showed a marked increase when a caverno-venous shunt was performed. Hypervascularisation of the glans occurred in 2 cases. The relevance of this new surgical technique and its functional mechanism are discussed.

Adult↗
PubMed1989

Extracorporeal shock wave lithotripsy for urinary stone disease: clinical experience with the electromagnetic lithotriptor 'Lithostar'.

400 urinary stone patients were treated with the electromagnetic lithotriptor Siemens 'Lithostar': 66.3% had renal stones and 33.7% had ureteral stones. Ninety percent of the treatments were performed under intravenous sedation only: 14.5% of the patients had more than one session. After 3 months more than 80% of the patients with a single stone smaller than 1.5 cm and 46% of the patients with stones larger than 2.5 cm were 'stone-free'.

Adult↗
PubMed1989

[Reliability of endorectal echography of the prostate in the screening and staging of prostatic cancer].

1433 transrectal ultrasonographies were performed for prostatic disease. In 453 cases, histopathologic correlation was obtained and compared to digital rectal examination and transrectal ultrasonography done after the clinical examination. The sensitivity of digital rectal examination was 91% and the specificity was 85%. The sensitivity and the specificity of ultrasonography were respectively 95 and 81%. 4 prostatic cancers, not suspected by digital rectal examination, were diagnosed by ultrasound (0,9%). The total number of subclinical cancer was 9 (2%). Interest of ultrasound compared to digital rectal examination concerns less than 1% of the total number of controlled patients. The staging of local extension of prostatic cancer is better by ultrasound than by the digital rectal examination. On 9 cases of clinical unsuspected extracapsular invasion, 6 were diagnosed by ultrasound.

Humans↗