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Biomedical subjects

J K Smolev

Publications and source records attributed to J K Smolev.

14 recordsLinked to original sources
PubMed1998

Successful reinnervation of the penis using an autogenous vein conduit.

Injury to the dorsal sensory nerve of the penis following penile prosthesis insertion is extremely rare. The authors report on a patient with insensitivity involving the right penile shaft and glans secondary to entrapment and fibrosis of the dorsal cutaneous nerve of the penis, following penile prosthesis insertion. Following resection of a 2-cm segment of fibrosed nerve, penile sensation was successfully restored using an autogenous vein graft conduit between the proximal and distal nerve segments.

Humans↗
PubMed1994

Comparison of duplex ultrasonography and nocturnal penile tumescence in evaluation of impotence.

Duplex ultrasound is used commonly to evaluate vascular function in impotent men. There is evidence, however, that some men with normal vascular function may have falsely abnormal duplex ultrasound results because of suppression of response to pharmacological stimulation due to anxiety. We performed a prospective blinded study of 40 impotent men comparing duplex ultrasound to a formal nocturnal penile tumescence evaluation. Duplex ultrasound was done with a standard 10 MHz. color Doppler unit after intracorporeal pharmacological stimulation. Nocturnal penile tumescence was performed at a sleep laboratory, and included measurements of penile circumference, axial rigidity, arterial pulsations, and direct patient and observer evaluation of erections. Of 40 men 20 had an abnormal duplex ultrasound result (maximum arterial velocity less than 30 cm. per second), including 9 who had normal nocturnal penile tumescence with at least 1 rigid erection (greater than 550 gm. axial rigidity) lasting at least 5 minutes. All 9 men had evidence of psychogenic dysfunction on history and personality inventory, and only 1 had evidence of vascular disease. Of the other 11 patients with abnormal duplex ultrasound and nocturnal penile tumescence findings, only 2 had evidence of psychogenic impotence and 9 had evidence of vascular disease. In these 11 men there were significant correlations between maximum arterial velocity on duplex ultrasound, and maximum rigidity and arterial pulsations on nocturnal penile tumescence. Of 40 patients 20 had a normal duplex ultrasound finding (maximum velocity greater than 30 cm. per second). Nine of these patients had a normal nocturnal penile tumescence test, of whom 5 had evidence of psychogenic impotence and only 1 had evidence of vascular disease. Eleven men with normal duplex ultrasound had an abnormal nocturnal penile tumescence test, including only 2 with any evidence of psychogenic impotence, while 9 had vascular disease and 1 had a history of neurological disease. Based on this study 9 of 14 men (64%) with a normal nocturnal penile tumescence test and other evidence of psychogenic impotence had abnormal duplex ultrasound. Therefore, an abnormal duplex ultrasound study should be interpreted cautiously if there is evidence of psychogenic impotence. In men with vasculogenic impotence there is an excellent correlation and cross-validation between maximum velocity on duplex ultrasound, and axial rigidity and arterial pulsations on nocturnal penile tumescence.

Adult↗
PubMed1993

Comparison of RigiScan and formal nocturnal penile tumescence testing in the evaluation of erectile rigidity.

Evaluation of male erectile function ideally should include measurement of axial rigidity expressed as grams force required to produce penile buckling. An axial rigidity more than 550 gm. is generally considered adequate for vaginal penetration. Unfortunately, this test cannot be done frequently and may disrupt sleep. An alternative method of determining rigidity is to use the RigiScan,* which makes repetitive measurements of radial rigidity at the base and tip of the penis expressed as per cent of normal maximum. Previous studies have demonstrated a positive correlation between axial and radial rigidity measurements but they have not been compared in patients with a wide range of erectile function. We performed a prospective study in a consecutive series of patients presenting with impotence comparing axial rigidity measured with a tonometer and radial rigidity measured by RigiScan. Erectile rigidity also was evaluated by a trained, blinded observer. Overall, RigiScan base and tip radial rigidity correlated well with axial rigidity (p < 0.002) and observer ratings (p < 0.003); axial rigidity similarly correlated well with observer ratings (p < 0.0001). However, when RigiScan base and tip radial rigidity exceeded 60% of maximum, there was a poor correlation with axial rigidity and observer ratings (p > 0.1). In this range, the RigiScan failed to discriminate axial rigidities between 450 and 900 gm. buckling force; however, axial rigidity in this same range again correlated well with observer ratings (p < 0.0001). Since an axial rigidity of more than 550 gm. is considered adequate for vaginal penetration, the RigiScan may not be able to detect mild abnormalities in erectile function. Further study is in progress to evaluate the significance of these findings but presently a RigiScan measurement of radial rigidity in excess of 60% of maximum should be interpreted cautiously and not necessarily regarded as normal. In this range further measurements of axial rigidity or observer ratings of rigidity may be necessary to establish the diagnosis.

Erectile Dysfunction↗
PubMed1992

Objective double-blind evaluation of erectile function with intracorporeal papaverine in combination with phentolamine and/or prostaglandin E1.

We performed a double-blind, crossover study using objective measurements to compare maximum rigidity and duration of erections with papaverine hydrochloride in combination with phentolamine mesylate and/or prostaglandin E1. The rationale for the protocol was to combine a smooth muscle relaxant (papaverine) with either or both vasodilating agents (phentolamine and prostaglandin E1) commonly used for injection therapy. The 7 volunteer patients with organic impotence documented by abnormal nocturnal penile tumescence testing were injected with 0.5 to 1.0 ml. papaverine (30 mg./ml.) in combination with phentolamine (0.5 mg./ml.) and/or prostaglandin E1 (5 micrograms./ml.). Each patient received 2 injections on each of 2 testing dates; injection 2 was given after tumescence resulting from injection 1 had subsided completely. The medications were given in a randomized, counterbalanced order following double-blind procedures. Patients evaluated the erections subjectively. In addition, the RigiScan device was used to measure maximum rigidity and duration of erections. All patients observed increased duration of erections with both combinations containing prostaglandin E1. Analysis of RigiScan measurements showed no statistically significant differences for maximum rigidity (p greater than 0.1) but significantly greater duration of erections with papaverine plus prostaglandin E1, and papaverine plus phentolamine plus prostaglandin E1 compared to papaverine plus phentolamine (p less than 0.001). There was no statistical difference in rigidity or duration of erections between papaverine plus prostaglandin E1 and papaverine plus phentolamine plus prostaglandin E1. No patient reported significant penile pain with any of the injections. We conclude that the combination of papaverine and prostaglandin E1 produces erections of longer duration than papaverine plus phentolamine and that no additional benefit is gained by adding phentolamine to a combination of papaverine and prostaglandin E1. Further studies are in progress to define optimal dose response curves for papaverine and prostaglandin E1 as individual agents and in combination.

Alprostadil↗
PubMed1987

Mentor inflatable penile prosthesis.

Technical complications requiring frequent surgical revision of the most commonly used penile component prosthesis have led to the development of a new inflatable device that has been implanted in 202 patients. This hydraulic device provides excellent functional qualities; no connector separations, aneurysms, or ruptures have been encountered in these patients. Reoperations became necessary in 8 per cent of these patients. Cosmetic and functional results are good, and patient acceptance has been excellent.

Erectile Dysfunction↗
PubMed1986

Experience with the Mentor inflatable penile prosthesis.

We present our experience with the new Mentor inflatable penile prosthesis for the treatment of organic impotence. Technical complications requiring frequent revision of the most commonly used inflatable prosthesis have led to the development of a new device, which we have used in 116 patients. This hydraulic device provides excellent functional qualities. No connector separations, aneurysms or ruptures have been encountered. Reoperations became necessary in 10.5 per cent of the patients. Cosmetic and functional results were good, and patient acceptance has been excellent.

Erectile Dysfunction↗
PubMed1982

The urological evaluation and management of patients with congenital lower urinary tract anomalies prior to renal transplantation.

Previously, patients with chronic renal failure and major congenital anomalies of the lower urinary tract (often with urinary diversion) were thought to be poor candidates for renal transplantation. Pre-transplant evaluation and possible urinary reconstruction are essential in these patients to achieve successful renal transplantation. Ten patients, including 7 adults, presented with congenital anomalies of the lower urinary tract that were responsible for renal failure. Percutaneous suprapubic cystostomy aided in the assessment of bladder function. Undiagnosed posterior urethral valves were found in 2 adults. Patients with exstrophy, neurogenic bladder or a contracted bladder (with augmentation cystoplasty) had urinary drainage into the bladder at the time of renal transplantation. Sometimes an imperfect bladder can be used for urinary drainage with transplantation but, otherwise, intestinal conduits are still a viable alternative.

Adult↗
PubMed1980

Neonatal bilateral ureteropelvic junction obstruction.

The incidence of bilateral ureteropelvic junction obstruction appears to be higher in patients less than 1 year old. The aggressive surgical reconstruction of bilateral ureteropelvic junction obstruction in 3 neonates resulted in good renal function, even in an apparently dismal clinical setting.

Female↗
PubMed1977

Experimental models for the study of prostatic adenocarcinoma.

The Dunning R3327H transplantable rat tumor is a well differentiated prostatic adenocarcinoma. The biological properties of this tumor have been characterized, and it appears that this animal model is well suited for studying the nature of prostatic cancer. The established tumor responds to castration therapy and this is subsequently followed by relapse to a predominant state of hormone insensitivity. Cell kinetic studies indicate that 70 to 90 per cent of the total tumor cells are hormonally sensitive, and a subpopulation of 8 to 30 per cent are hormone insensitive. The therapeutic relapse to androgen deprivation represents the continued growth of the clone of cells, which were hormone insensitive. It appears that this animal mimics the relapse of phenomenon observed in the hormone control of human prostatic cancer.

Adenocarcinoma↗
PubMed1977

The surgical approach to urological complications in renal allotransplant recipients.

Urinary extravasation or ureteral obstruction occurred in 22 patients who received 30 transplants in a series of 290 renal transplants. This incidence represent 10.3 per cent of the entire transplant experience at The Johns Hopkins Hospital and Baltimore City Hospitals from 1968 to the present time. Ureteroneocystostomy was used as the primary form of urinary tract reconstruction in all but 1 patient who had urinary complications. These 22 patients received 30 renal transplants: 6 from living related donors and 24 from cadaver sources. There were 15 instances of urinary extravasation and 14 instances of obstruction. All but 2 fistulas were diagnosed within 30 days of the original transplant. Obstruction occurred later, with 4 cases of ureterovesical obstruction being diagnosed 3 to 5 years after the transplant procedure. The ureterovesical junction or bladder was the site of complication in 17 of the 29 instances. Surgical management in these cases was highly individualized, with successful outcomes more commonly attained in those cases characterized by obstruction. Ureteral stents were used in all but 1 secondary procedure involving the ureter and these stents were not associated with an increased incidence of urinary tract infection. Death directly related to the urological complications occurred in 2 cases, 5 patients underwent transplant nephrectomy and 2 patients died of rejection and infection more than 6 months after the urinary fistulas were successfully managed. From the original series, there are 15 of the 22 patients who have stable renal function after secondary or tertiary urological procedures on the transplanted kidney. Four patients underwent surgical correction of hydronephrosis associated with infection or diminishing renal function more than 3 years after the transplantation and 3 of these had good results.

Adolescent↗
PubMed1975

Prognostic value of host immunocompetence in urologic cancer patients.

To evaluate the prognostic significance of host immunocompetence in urologic cancer patients, the subsequent clinical course of 95 patients was determined a year after skin testing with dinitrochlorobenzene. A close correlation was demonstrated between dinitrochlorobenzene reactivity and prognosis among 38 transitional carcinoma patients. Of 19 patients with impaired reactivity 13 had tumor recurrences and 11 of these died of cancer within 1 year. Only 5 of 19 patients with normal dinitrochlorobenzene reactivity had recurrences and none died during the same interval. Although not statistically significant, similar results were observed among 10 renal cell carcinoma patients of whom 3 of 5 with impaired dinitrochlorobenzene reactivity had tumor recurrences, while 4 of 5 with normal reactivity remained free of tumor. One testis tumor patient with impaired dinitrochlorobenzene reactivity died of cancer, while 3 of 4 with normal reactivity remained free of tumor. Similarly, 1 patient with carcinoma of the penis with impaired dinitrochlorobenzene reactivity died of cancer, while 2 of 3 with normal reactivity remained free of tumor. In contrast, reactivity to dinitrochlorobenzene did not correlate with the clinical course of 38 prostatic carcinoma patients. Ten of 19 patients with normal dinitrochlorobenzene reactivity and 9 of 19 with impaired reactivity were dead or had symptomatic recurrences within 1 year, while 9 of 19 with normal reactivity and 10 of 19 with impaired reactivity were either free of tumor or asymptomatic. However, a trend toward a correlation between dinitrochlorobenzene reactivity and tumor progression was observed among patients not receiving endocrine therapy. The differences with respect to the prognostic significance of host immunocompetence between transitional carcinoma patients and those with prostatic carcinoma may be explained by fundamental differences in the biologic properties of these tumors, especially the endocrine sensitivity of prostatic carcinoma.

Adenocarcinoma↗
PubMedDate not supplied

Characterization of the Dunning R3327H prostatic adenocarcinoma: an appropriate animal model for prostatic cancer.

The Dunning R3327H rat prostatic adenocarcinoma appears to be an appropriate animal model for studying prostatic cancer. This report contains a detailed characterization of this tumor at the morphologic, biochemical, and therapeutic levels. Electron micrographic, histologic, and histochemical studies clearly establish the adenocarcinoma nature of this tumor. The histology of the R3327H tumor is similar to well-differentiated human prostatic cancer. The biochemical and enzymatic profile of the tumor indicates its origin from the rat dorsolateral prostate. The cell kinetics and growth rates of this tumor following a variety of hormonal manipulations (castration, estrogens, androgens, and antiandrogens) have established that 70%-90% of the cells in this tumor require androgens for their growth. However, 10%-30% of the cells are capable of growth in the absence of androgens. Both cell types are present in the initial tumor inoculum and these different cell types possess similar growth rates. The predominance of the androgen-sensitive cells accounts for the relatively greater size of the tumor achieved in the intact male animal at a given growth time. After the tumor is well established in an intact animal, subsequent estrogen therapy or castration resulted in a marked diminution in tumro volume. This was followed by a subsequent relapse. In addition, estramustine phosphate was also shown to cause shrinkage in the tumor volume.

Adenocarcinoma↗