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Biomedical subjects

K Anafarta

Publications and source records attributed to K Anafarta.

At least 19 recordsLinked to original sources
PubMed2004

Effect of aging on quality of nocturnal erections: evaluation with NPTR testing.

Nocturnal penile tumescence and rigidity testing (NPTR) has traditionally been performed to distinguish psychogenic from organic impotence. However, considerable lack of uniformly accepted normative data for NPTR readings makes the reproducibility of the method questionable. In this study, we try to evaluate the impact of aging as independent criteria for quality of erectile episodes. A total of 455 patients (ages 20-71 y) whose initial complaints were erectile dysfunction underwent two nights NPTR measurement with Rigiscan device. After analyzing the data, 353 men out of 455 were regarded as having normal NPTR recordings. The number of normal erectile episodes (erectile episode of penile tip rigidity greater than 60% more than 10 min duration), RAU Tip, RAU Base, TAU Tip, TAU Base, Average event rigidity of Tip (%), Average event rigidity of Base (%) and Duration of erectile episodes > or =60% minute were re-evaluated with regard to five age groups (group I: <30 y; group II: 30-39 y; group III: 40-49 y; group IV: 50-59 y; group V: > or =60 y). The mean values of erectile episodes in the age groups were as follows: group I, 2.46; group II, 2.28; group III, 2.40; group IV, 1.58; group V, 1.27. When we analyzed the groups between themselves, we observed statistically significant difference after the age of 50 y. The mean erectile episodes in patients younger than 50 y were 2.37 (s.d.: 1.50), whereas 1.49 (s.d.: 1.15) in patients older than 50 y (P<0.001). We also observed statistically significant difference at all of the above-mentioned NPTR parameters with regard to age. The results of our study showed that aging negatively influence quality of nocturnal erections especially after 50 y and we suggest that age needs to be taken into account in the diagnostic interpretation of NPTR testing.

Adult↗
PubMed2003

Effect of sildenafil on nocturnal erections of potent men.

We try to evaluate the effect of sildenafil on nocturnal penile erections of potent men. We recruited 22 potent men (eight medical students and 14 urology residents) 23-29 years old into the study. A disorder-free medical and sexual history and normal erectile functions were the only inclusion criteria. All subjects completed three sessions of consecutive nights using the RigiScan Plus device. After a first night of adaptation, night 2 recordings were their baseline values whereas they received sildenafil 100 mg on night 3. We observed statistically significant improvement with regard to those NPT parameters at the nights with sildenafil: number of erectile episodes; duration of tip rigidity >60%, RAU tip, RAU base and TAU tip (P<0.005). Although the duration of erectile episodes (min) and TAU base were greater during the sildenafil night, these did not reach statistical significance. In conclusion, our study showed that sildenafil can improve nocturnal erectile quality not only in patients with erectile dysfunction as previously published but also in potent males.

Adult↗
PubMed2001

Effect of experimental hypercholesterolemia on cavernosal structures.

OBJECTIVES: To determine the effect of experimental hypercholesterolemia on the ultrastructure of cavernosal smooth muscle cells, endothelial cells, elastic fibers, and collagen content, which are the key structures fundamental for erection. METHODS: Forty-two New Zealand white rabbits were divided into a control group (group 1, n = 7, fed a standard diet), a hypercholesterolemia group (group 2, n = 20, fed a diet containing 1% cholesterol for 8 weeks), and a reversibility group (group 3, n = 15, fed a 1% cholesterol diet for 8 weeks, then switched to a standard diet for 4 weeks). Blood samples were obtained for lipid determination before and after the study. The cavernosal tissues were obtained at the end of 8 weeks for groups 1 and 2 and at the end of 12 weeks for group 3 and immunohistochemical examinations of these cells were performed. RESULTS: Immunohistochemical analysis revealed that hypercholesterolemia produces marked and reversible decreases in the cavernosal content of smooth muscle cells, endothelial cells, and elastic fibers and increases the content of collagen 3 and 4. CONCLUSIONS: Our findings suggest that hypercholesterolemia in this animal model affects the percentage of staining for smooth muscle actin, endothelial cells, elastin, and collagen 3 and 4. However, since this effect is temporary depending on the blood cholesterol levels, it might not alter the erectile function.

Animals↗
PubMed2001

Megacystis secondary to myenteric plexus pathology. Presentation of two cases.

Herein, 2 cases of megacystis secondary to myenteric plexus pathology are reported. Unlike the entity of visceral myopathy, there was ganglion cell loss both in the bladder and in the colon of these 2 cases. Moreover, they did not present any gastrointestinal symptoms. Megacystis was the common pathology in these patients, whereas 1 of them suffered from unilateral vesicoureteral reflux. We could not find any similar report dealing with this phenomenon up to this time in the literature.

Adolescent↗
PubMed2000

Effect of microsurgical subinguinal varicocele ligation to treat pain.

OBJECTIVES: The traditional treatment for a painful varicocele consists of conservative measures followed by varicocelectomy. We report our results with microsurgical subinguinal varicocele ligation to treat pain. METHODS: From 1996 to 1999, a total of 119 men underwent subinguinal microsurgical varicocele ligation for painful varicocele. The diagnosis of varicocele was based on the findings of both physical examination and color Doppler ultrasound. Patients described pain with testicular discomfort as scrotal heaviness or a dull ache. While waiting for the operation (range 3 to 5 weeks), all the patients underwent a preoperative trial of conservative management for pain. RESULTS: Of 119 men, 82 (69 %) were available for follow-up 3 months postoperatively. Of those 82 patients, 72 (88%) reported complete resolution of pain, 4 patients (5%) partial resolution, 5 patients (6%) no change, and 1 patient (1%) epididymal discomfort that resolved with conservative measures. Of the 9 patients with partial or no change, 2 patients had reflux recurrence as seen on color Doppler ultrasound. CONCLUSIONS: Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicocele when performed in selected patients.

Adolescent↗
PubMed1999

Penile epithelioid sarcoma.

Epithelioid sarcoma is a rare mesenchymal neoplasm. We had the opportunity to report a case of epithelioid sarcoma of the penis.

Adult↗
PubMed1998

Failure of ureteral replacement with Gore-Tex tube grafts.

OBJECTIVES: To evaluate the role of polytetrafluoroethylene (Gore-Tex) as a ureteral substitute in dogs after resection of a 5 to 8-cm-long middle segment. METHODS: Five mongrel dogs underwent resection of the middle segment of the left ureter and segmental replacement of the resected part with segments of Gore-Tex over a double-J catheter. The double-J stents were removed at 21 days and the dogs were evaluated by excretory urography and abdominal ultrasonography 12 weeks after surgery. They were then killed and the ureters and the kidneys examined both grossly and microscopically. RESULTS: There was radiologic evidence of advanced hydronephrosis on the left side in all 5 dogs. Grossly, the left kidneys showed marked pelvic and proximal ureteral dilatation and atrophy of parenchyma. Severe stricture at the anastomotic sites and marked fibrous tissue around the prostheses were found. No cellular lining was found in the Gore-Tex lumen. CONCLUSIONS: There is no potential for ureteral replacement by Gore-Tex tube graft.

Animals↗
PubMed1998

Clinical experience with Dynaflex penile prostheses in 120 patients.

OBJECTIVES: To present our experience with the Dynaflex (American Medical Systems) self-contained inflatable penile prosthesis and define specific complication and patient dissatisfaction rates. METHODS: From May 1990 through January 1998, 120 men underwent implantation of a Dynaflex prosthesis. The follow-up period ranged from 2 to 80 months (mean 42). RESULTS: Specific complication rates observed after penile prosthesis implantation were as follows: prosthetic infection, 4.16%; mechanical device failure, 7.5%; and patient dissatisfaction because of inability to work the pump, 16.66%. After intensive teaching, the patient dissatisfaction rate dropped to 0.83%. The overall complication rate was 14.15%. CONCLUSIONS: With several types of penile prostheses available, Dynaflex can be regarded as an appropriate alternative with a relatively low mechanical failure rate. However, careful preoperative assessment and patient education in the use of the pump mechanism are essential to obtain a successful result.

Erectile Dysfunction↗
PubMed1997

Is deep dorsal vein arterialization an alternative surgical approach to treat venogenic impotence?

OBJECTIVE: Several surgical techniques have been applied for the treatment of cavernosal venous leakage, sufficient enough to create erectile dysfunction. In light of the variable success rates, we report our experience with deep dorsal penile vein arterialization for the management of severe cavernosal venous leakage. PATIENTS AND METHODS: Twenty-four impotent patients with venous leakage were treated by the Virag-II type of end-to-end anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally. Diagnostic evaluation included color flow Doppler sonography before and after intracavernous 60 mg papaverine injection and dynamic cavernosometry/ cavernosography, which indicated veno-occlusive dysfunction in 28 patients. Revascularization was technically possible in 24 of the patients, although in 4 anastomosis could not be achieved due to the poor quality of the inferior epigastric artery. RESULTS: Five patients had early occlusion in the immediate postoperative period and 4 had late occlusion within 8 months. Potency was improved initially in 9 (38%) of the 24 patients in whom successful anastomosis had been achieved, with longer term improvement in 6 (25%) of 24 who realized restoration of erectile potency as defined by clinical investigations. The mean follow-up was 24 months (range 3-36 months). CONCLUSION: We believe that anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally in cases of venous leakage results in a low success rate due probably to a pancavernosal alteration in corporal tissue compliance.

Adult↗
PubMed1996

Ultrastructual changes of corpora cavernosa in vascular erectile dysfunction.

Corpora cavernosa of 4 impotent patients with arterial pathology and 6 with venous insufficiency were studied by electron microscopy. The findings in all of the smooth muscle samples were the following: pronounced thickening of the basal lamina; marked reduction of contractile myofilaments and electron dense bodies; finger-like cytoplasmic projections; increase in mitochondria with swelling and aggregation; huge protrusions of nuclear membrane into the cytoplasm; increased proportion of interstitial matrix to smooth muscle cells. These were more marked in the dark than in the light cells, which was considered as the beginning of degeneration. Another finding was degenerative changes in the endothelial cell lining of the sinusoids, especially denudation, fragmentation and marked thickening of the basal lamina. Severity of the symptoms did not change in any of the patients with different pathologies. So, we can assume that the pathological alterations may be due to chronic penile vascular insufficiency or vice versa.

Adult↗
PubMed1996

Evaluation and surgical treatment of patients with penile curvature.

In patients with adult penile curvatures the aim of treatment is to have a penis straight enough and firm enough to allow satisfactory sexual function. Several operative approaches have been used to correct this condition. Herein, we describe our experience with the evaluation and surgical treatment of 37 patients with penile curvature. When we have decided on surgery, we either preferred to elongate the ventral corpora cavernosa by interposition of a piece of dura mater (2 patients) or in most cases (the remaining 35 patients) only excised wedges of tunica albuginea at the arcs of the maximum curvature located with artificial erection (Nesbit's operation). In conclusion, our results showed that Nesbit's operation is a versatile procedure that proved to be useful for correction of penile curvatures in patients with Peyronie's disease. However, further studies and clinical trials are needed to determine if the dura mater is an alternative in the treatment of penile curvatures due to congenital aetiology.

Adolescent↗
PubMed1996

Clinical experience with inflatable and malleable penile implants in 104 patients.

Penile prosthesis was implanted for erectile impotence of mainly organic origin in 104 patients. The AMS Dynaflex penile prosthesis was inserted in 39 cases, the AMS Malleable 600 prosthesis in 61 and the AMS Ultrex Plus prosthesis in 4. In 1 patient receiving a malleable prosthesis both rods had to be removed owing to erosion into the urethra and reimplantation was performed at the same operation. Only 1 patient who underwent implantation of the Dynaflex device had mechanical failure that necessitated surgical revision. After implantation of the new prosthesis both patients had satisfactory intercourse. One Dynaflex penile prosthesis, implanted into a juvenile-onset diabetic, became infected and required removal. Another complication was secondary to spontaneous erosion (noninfected) in 1 patient with malleable prosthesis who suffered loss of only one rod and who is still satisfied with the result. The overall complication rate in our series has been approximately 4%. The rest of the patients report satisfaction with the ability to move the penis voluntarily permitting normal sexual activities as well as normal appearance in the flaccid position. According to our experience, careful preoperative assessment from the views of both patient and device selection along with patient education, and strictly obeying the rules of sterility during implantation and applying systemic and local antimicrobial prophylaxis are essential in obtaining a successful result in prosthesis implantation for the individual patient.

Adult↗
PubMed1995

Treating erectile dysfunction with a vacuum tumescence device: a retrospective analysis of acceptance and satisfaction.

OBJECTIVES: To evaluate the quality of erections, ability to perform sexual intercourse, incidence of complications and satisfaction of patients using an external vacuum erection device in the treatment of erectile failure. PATIENTS AND METHODS: Of the 61 impotent men who participated in this clinical trial, 49 used the device and were surveyed. The mean follow-up period was 12.8 months. A subjective rating scale from 1 to 10 was used to assess the patients' satisfaction with the device, where 1 indicated 'dissatisfied' and 10 indicated 'very satisfied'. RESULTS: The ease of using the device, satisfaction with the quality of erections and ability to perform intercourse were given scores > 5 by 88, 84 and 82% of the patients, respectively. Sixteen (33%) of the men withdrew from the trial, primarily because they were unable to achieve and maintain a full erection, or suffered conflicts in their relationship, or for reasons not related to the device. Overall, the effectiveness rate was 67%. Of 32 patients with arteriogenic impotence, 28 (88%) had satisfactory results and had an improvement in their capacity for spontaneous erections with the device. The most frequent adverse effects were blocked ejaculation, bruising or the development of ecchymosis, discomfort during pumping and discomfort from using the constriction bands. CONCLUSION: These results suggest that the vacuum device is an effective and safe treatment for impotence of various aetiologies, especially for those patients with arteriogenic impotence.

Adult↗
PubMed1994

The significance of histopathological changes of the normal tunica albuginea in Peyronie's disease.

Five patients with Peyronie's disease were operated and the tissue specimens from the plaque involving the tunica albuginea and from the tunica of the unaffected contralateral side were obtained. The specimens were then subjected to histopathological examination and the findings were correlated with those of men proved not to have Peyronie's disease but operated for other reasons. In the specimen of plaque, the changes varied from collagen destruction to cartilaginous and osseous metaplasia. However, in the tunica of the contralateral side the changes such as disregularity of collagen bundles extending even to widespread focal areas, and appearance of pale, rough, eosinophilic collagen degeneration, instead of its characteristic bright birefringence, and focal mucinous degeneration were noted. Interestingly, these alterations were not observed in the specimens of normal tunica albuginea in the control group. But the existence of minimal alterations, the regularity in the apparently normal contralateral tunica albuginea specimens in Peyronie's disease implied that there was an active turnover in collagen production, and the possible factor causing collagen degeneration and so plaque formation was probably the microtraumatization of the tunica albuginea.

Adult↗
PubMed1994

Color flow Doppler sonography in the diagnosis of vesicoureteric reflux.

We describe an alternative technique using color flow Doppler sonography (CFDS) for detection of vesicoureteric reflux (VUR). Twenty-one children, ages 2-16 years, were investigated for VUR using voiding cystourethrography (VCU) and CFDS. Forty-two ureterovesical junctions were studied and a total of 27 were found to be refluxing at VCU. Five of these 21 patients were operated for VUR and they were also reevaluated 3 and 6 months after the operation. With good diuresis ureteric jets could easily be detected with CFDS and if there was a reflux of urine into the ureter this could also be displayed. Afterwards, the patient was asked to urinate and if reflux into the ureter was detected, particular attention was paid to the detection of ureteral and pelvicalyceal dilatation by conventional gray-scale sonography. Taking VCU as the gold standard, CFDS revealed reflux in all cases except 1. There were 3 patients who had only one-sided reflux at VCU and bilateral reflux at CFDS examination (false-positive: 20%). Correlation of CFDS and VCU was 90, 100 and 75% in low grade, grade III and grade IV reflux, respectively. The results of CFDS correlated well with the results of VCU during the follow-up of 5 patients who had antireflux operations. As a conclusion, CFDS could be used as an adjunct to standard ultrasonography for detection of VUR.

Algorithms↗
PubMed1994

Adenosine: a new agent in the diagnosis of impotence.

The haemodynamic effects of different dosages of adenosine were studied using colour flow Doppler sonography (CFDS) in 33 men, whose penile vascular bed responded well to papaverine. In six cases, we injected 25, 50, 100, 250 micrograms dosages of adenosine intracavernously at 15 min intervals and no erection occurred. However, 500 and 1000 micrograms doses of adenosine increased the arterial blood velocities for a few seconds in five cases. Later on, in eight cases, we infused 80 and 120 micrograms/kg/min adenosine for 3 min and only with 120 micrograms/kg/min dosage, did we observe clinical response and significant changes in CFDS parameters. Finally, 120 micrograms/kg/min adenosine dosage was infused for 10 min in 14 men and eight showed full erection while six had only tumescence. As adenosine was rapidly metabolized by adenosine deaminase, the erection lasted for only 5 to 13 min. No prolonged erection and no other side-effect was observed. In addition no fibrosis and curvature was detected 6 months after the injections. We found that, in men, 10 min infusion of 120 micrograms/kg/min adenosine increased the arterial flow and to some extent venous resistance, resulting in full erection or tumescence. Therefore, adenosine may be used as an agent for the diagnosis of vasculogenic impotence, but further studies for determining the standard dosage of adenosine are needed.

Adenosine↗