PubMed Health⌕ Search

Biomedical subjects

P G Katz

Publications and source records attributed to P G Katz.

At least 19 recordsLinked to original sources
PubMed1996

Long-term efficacy of a new formulation of prostaglandin E1 as treatment for erectile failure.

PURPOSE: We determined the long-term efficacy of intracavernous injection of a new formulation of prostaglandin E1 (Caverject) as treatment for erectile failure. MATERIALS AND METHODS: A prospective study was done at a university affiliated Veterans Affairs medical center. Subjects with erectile failure received injections of prostaglandin E1 at the office and self-administered injections at home for up to 18 months. RESULTS: Of 16 patients who performed home injections 15 completed 6 months and 10 completed 18 months of therapy. Patient and spousal satisfaction with intercourse was 90% for months 1 to 6, and patient satisfaction was 95% for months 7 to 18. CONCLUSIONS: Prostaglandin E1 was highly effective at producing penile rigidity and an erection with satisfactory vaginal intercourse.

Alprostadil↗
PubMed1996

Alkalization does not alleviate penile pain induced by intracavernous injection of prostaglandin E1.

PURPOSE: A prospective, randomized, double-blind study was done to determine whether alkalization of prostaglandin E1 decreases pain associated with intracavernous injection. MATERIALS AND METHODS: Ten subjects with a history of pain following at least 70% of injections of prostaglandin E1 received 2 injections of prostaglandin E1, 1 with and 1 without sodium bicarbonate. Patients reported the duration and intensity of pain following each injection. RESULTS: Comparing injections of prostaglandin E1 with and without bicarbonate, there were no significant differences in number of subjects reporting pain, or duration and intensity of pain. CONCLUSIONS: Addition of sodium bicarbonate does not alleviate penile pain associated with injection of prostaglandin E1.

Adolescent↗
PubMed1995

Long-term experience utilizing a new balloon expandable prostatic endoprosthesis: the Titan stent. North American Titan Stent Study Group.

OBJECTIVES: To determine the long-term safety and efficacy of the Titan endoprosthesis as a therapeutic alternative in the management of men with bladder outlet obstruction. METHODS: One hundred forty-four patients (mean age, 73.5 years +/- 4.2) had placement of the Titan stent. The stents were inserted under direct vision and expanded to 33 F using a balloon catheter. Of the 144 patients, 59 (41%) were in urinary retention and 85 (59%) presented with moderate to severe symptoms of prostatism. Patients were assessed at baseline and in follow-up at 1, 3, 6, 12, 18, and 24 months. Parameters of evaluation included the Madsen-Iversen symptom questionnaire, peak flow rate (Qmax), postvoid residual urine volume (PVR), and incidence of adverse events. RESULTS: At 24 months, for the retention cohort, symptoms, Qmax, and PVR were 5.21 +/- 0.81, 11.34 +/- 1.12 mL/s, and 31.00 +/- 12.8 mL, respectively (P < 0.002). For patients with symptoms of bladder outlet obstruction, the results were as follows at 24 months: (1) symptoms decreased from 15.89 +/- 0.47 to 9.33 +/- 0.86 (P < 0.001); (2) Qmax increased from 8.59 +/- 0.41 mL/s to 11.43 +/- 1.12 mL/s (P < 0.001); and (3) PVR decreased from 116.94 +/- 19.95 mL to 74.4 +/- 36.2 mL (P < 0.03). There were minimal complications; stents were removed from 28 patients (19%) because of migration, 10 of which were placed by one investigator. CONCLUSIONS: When properly placed, the Titan stent was an effective therapeutic alternative to prostatectomy or long-term catheterization in high-risk obstructed patients or those in urinary retention.

Aged↗
PubMed1995

The lowest effective dose of prostaglandin E1 as treatment for erectile dysfunction.

The recommended dose of prostaglandin E1 as treatment for erectile dysfunction has been reported to be 10 to 40 micrograms. However, adverse effects probably increase with increasing doses. We conducted a prospective, single-blind, dose-escalating study of prostaglandin E1 on 20 men with erectile dysfunction of various etiologies. The response to prostaglandin E1 was assessed by penile palpation and RigiScan rigidity monitoring. A total of 17 patients completed the study: 1 achieved rigidity with 1 microgram., 2 with 2 micrograms. and 4 with 3 micrograms. prostaglandin E1, while more than 70% achieved rigidity with 5 micrograms. or less and more than 80% had a full erection with 20 micrograms. Of 138 injections there were 2 episodes of pain after injection. We conclude that the often recommended starting dose of 20 micrograms. is too high. A more appropriate starting dose is 2.5 micrograms. with increments of 2.5 micrograms. until the lowest effective dose is achieved. This approach may lessen the major impediments to prostaglandin E1 use, that is burning and pain.

Adult↗
PubMed1995

Visually stimulated erection in castrated men.

Sexual interest and activity decrease following castration. We determined by objective criteria the erectile status of 16 men who were sexually active before castration for prostatic cancer. Castration was achieved by orchiectomy or hormonal manipulation. Patients answered a questionnaire regarding the medical status and erectile function before and after castration, and the blood level of testosterone was assessed. During viewing of an erotic videotape penile circumference and erection quality were monitored. Four patients (25%) achieved functional erection. Mean serum free testosterone levels in men who achieved erection were 1.125 +/- 0.362 pg./ml. (standard deviation) and 0.628 +/- 0.098 pg./ml. in those not achieving functional erection (p < 0.001). No statistically significant difference was noted in age, interval since castration, co-morbidity score or method of castration between the men who did and did not achieve erection.

Aged↗
PubMed1995

Combining intracavernous injection and external vacuum as treatment for erectile dysfunction.

We studied the effect of combining intracavernous injection and an external vacuum in 10 men with erectile dysfunction who previously failed attempts at treatment with either method as single therapy. We measured the length, circumference and buckling pressure of the penis at baseline, after applying negative pressure (250 mm. Hg for 2 minutes), 15 minutes after intracavernous injection of 60 mg. papaverine or 30 micrograms prostaglandin E1 and after combining both modalities. No patient achieved adequate rigidity (defined as a penile buckle pressure greater than 450 gm.) with single therapy. The mean buckle pressure using vacuum alone was 125.0 +/- 53.6 gm. After intracavernous injection the mean buckle pressure was 117.0 +/- 38.3 gm. In contrast, all 10 subjects responded to combination therapy with a mean buckle pressure of 565.0 +/- 56.8 gm. (p < 0.0001). After 10 months of followup 3 subjects were still using the combination and were satisfied with the erectile response, 1 found that he no longer needed the addition of external vacuum after using combination therapy for 3 months, 1 used the combination for 9 months and then stopped because of an intervening acute illness, 1 lost the partner due to death, 2 found combination therapy to be too cumbersome and 2 were lost to followup. We conclude that external vacuum devices can augment a partial response to intracavernous injection and the combination may be an alternative treatment before intrapenile prosthesis implantation.

Aged↗
PubMed1995

Incidence of penile pain after injection of a new formulation of prostaglandin E1.

PURPOSE: We determined the incidence of pain with injection of a new formulation of prostaglandin E1. MATERIALS AND METHODS: A total of 63 subjects with erectile dysfunction underwent treatment with the new formulation of prostaglandin E1. Evidence of pain associated with injection was obtained by questionnaire and through questioning. RESULTS: A total of 451 injections was given to 63 subjects in the office, with 16 episodes (3.5%) of pain in 10 (15.9%). Then, 680 injections were performed by 38 subjects at home, with 15 episodes (2.2%) of pain in 8 (21%). Pain was not dose related. CONCLUSIONS: The new formulation of prostaglandin E1 is less likely to be associated with pain compared with alcohol based formulations.

Adult↗
PubMed1994

Prostatic fluid analysis in spinal-cord-injured patients with recurrent urinary tract infections.

OBJECTIVE: Recurrent urinary tract infections are common in spinal-cord-injured patients. Our study was designed to evaluate the association of bacteria colony counts, white blood cell (WBC) count, and antibody-coated bacteria analyzed in urethral and prostatic samples in hospitalized spinal-cord-injured patients with recurrent urinary tract infections. METHODS: Thirty-three patients were studied and 4 noninfected patients served as controls; 17 patients were paraplegic and 20 were quadriplegic. Mean patient age was 34.8 years and mean follow-up period was ninety-three days. During the surveillance period, 19 of the 33 patients had relapsing infections (same organism), while 14 had reinfections (new organism). A modified Foley catheter was used to seal the bladder neck, so that urethral and prostatic samples could be obtained. RESULTS: Bacteria colony counts and WBC counts did not correlate with relapsing infection. However, significantly more patients with relapsing infection (8/19) had antibody-coated bacteria in their prostatic fluid than patients with reinfection (1/13) (P < 0.05). CONCLUSIONS: The presence of antibody-coated bacteria in prostatic fluid is associated with relapsing urinary tract infections and not with reinfection.

Adult↗
PubMed1994

Peyronie's-like plaque after penile injection of prostaglandin E1.

Intracavernous injection of vasoactive medication may cause fibrosis of the tunica albuginea or corpus cavernosum. These adverse effects have been clearly linked to papaverine and phentolamine but to our knowledge the development of fibrosis or a Peyronie's-like plaque after the injection of prostaglandin E1 has not been previously described. We report a case of intracavernous hematoma, penile curvature deformity and Peyronie's-like plaque that developed after initiating intracorporeal self-injection of prostaglandin E1 for erectile dysfunction.

Aged↗
PubMed1994

Treatment of erectile failure with prostaglandin E1: a double-blind, placebo-controlled, dose-response study.

We report a double-blind, randomized, placebo-controlled, dose-response study of prostaglandin E1 as treatment for erectile failure. A total of 15 men 55.8 +/- 9.2 years old with a mean duration of erectile dysfunction of 7.6 years participated. During phase 1 (double-blind) subjects received injections of prostaglandin E1 twice weekly at doses of 0 micrograms. (placebo), 2.5 micrograms., 5.0 micrograms., 7.5 micrograms. and 10 micrograms. During phase 2 (nonblind) the dose was increased until a full erection or intolerance developed. Response was measured using a RigiScan monitor. During phase 3 the subjects injected prostaglandin E1 at home. Of the subjects 66% achieved an erection adequate for intercourse, with an average rigidity of 59%. The dose-response curve reached a plateau at 5 to 10 micrograms. Among those responding to prostaglandin E1 intercourse was rated satisfactory by 81% of the subjects and by 90% of the partners. There were no prolonged erections requiring reversal and pain was reported with only 10% of the injections. In summary, intracavernous prostaglandin E1 is an efficacious and effective treatment for erectile failure.

Aged↗
PubMed1994

Prostaglandin E1 as treatment for erectile failure in elderly men.

OBJECTIVE: To determine the efficacy of intracavernosal injection of prostaglandin E1 (alprostadil) in elderly men with erectile failure. DESIGN: Prospective study. SETTING: Outpatients at a university-affiliated VA Medical Center. PARTICIPANTS: Ten subjects aged 65 years and older with duration of erectile failure of 6 months or longer. INTERVENTIONS: Subjects received intracavernosal injections of prostaglandin E1 in the office and self-administered intracavernosal prostaglandin E1 at home. MEASUREMENTS: Penile rigidity was measured by palpation and by the Rigiscan rigidity monitor. RESULTS: Intracavernosal injection of prostaglandin E1 produced erections adequate for intercourse in 9 of the 10 subjects. Attempts at intercourse were rated satisfactory by two-thirds of the subjects and their spouses. CONCLUSIONS: Intracavernosal injection of prostaglandin E1 is safe and effective for erectile failure in elderly men.

Age Factors↗
PubMed1992

Voiding by increased abdominal pressure in male spinal cord injury patients--long term follow up.

We reviewed the long term follow up of five spinal cord injury patients with detrusor areflexia who emptied their bladder using high abdominal pressure. Ages ranged from 29 to 58 years, and the mean time elapsed from injury was 18.9 years. The bladder pressure during voiding ranged from 95 to 160 cm of water. One patient developed vesicoureteral reflux and hydronephrosis. Long term monitoring is suggested in patients who use high abdominal pressure for bladder emptying.

Abdomen↗
PubMed1991

Arterial-ureteral fistula: case study with review of published reports.

Arterial-ureteral fistula, a rare cause of gross hematuria, may be associated with life-threatening hemorrhage if not rapidly diagnosed and treated. Recently, a patient at the Hunter H. McGuire Veterans Administration Medical Center developed an arterial-ureteral fistula at the site of the confluence of the external iliac artery and a superior mesenteric artery bypass graft. Review of the world's literature revealed 31 additional reported cases of arterial-ureteral fistulas. This current case is only the second one reported in which the diagnosis was made with arteriography. Several common features of arterial-ureteral fistulas were present in this case: a history of ureteral obstruction and urinary tract infections, upper urinary tract disease, and previous vascular surgery. The condition is usually associated with either prior upper urinary tract instrumentation or vascular surgery, and an antecedent period of intermittent hematuria, followed by life-threatening hematuria, is common. A high index of suspicion and early surgical intervention are required for successful management. The major surgical challenges are to establish unobstructed urinary drainage and restore vascular continuity. Exclusion of prosthetic material from potentially infected areas is mandatory.

Fistula↗
PubMed1991

Effect of implanted epidural stimulator on lower urinary tract function in spinal-cord-injured patients.

A spinal cord stimulator was implanted in the epidural space in 33 spinal-cord-injured patients for the treatment of severe extremity spasticity. We prospectively evaluated the effect of the stimulator on the lower urinary tract in these patients. Urodynamic evaluation was performed preoperatively, and in 23 patients 3 months to 1 year after implantation. Postoperative changes in the lower urinary tract function were noted in 6 patients. One patient converted from detrusor areflexia to detrusor hyperreflexia, and 1 patient converted from detrusor hyperreflexia to detrusor areflexia. Four patients demonstrated changes in the duration of detrusor contraction and external sphincter dyssynergia. In 2 of these 4 patients, the changes in the duration of detrusor contraction and external sphincter dyssynergia were related to the activation and deactivation of the stimulator. Urodynamic parameters did not change significantly following implantation in the remaining 17 patients. We conclude that epidural stimulator implanted for the treatment of spasticity may alter the lower urinary tract function. Patients with postoperative changes in the lower tract function should be evaluated with the stimulator activated and deactivated.

Adult↗
PubMed1991

Urologic considerations in geriatric erectile failure.

In summary, an understanding of the anatomy and physiology of erection demonstrates how vulnerable this mechanism is to age-associated urologic disease and surgery. Malignant disease or surgical resection of the pelvic organs can disrupt neural pathways, and vascular disease or its reconstruction can disrupt vascular channels. Fortunately, advances in our understanding of the pathophysiology and treatment of erectile failure now permit the clinician and patient to choose from a variety of options. Nerve-sparing techniques can be used in pelvic surgery, and orthoses or self-injection can be used for the patient who prefers a nonsurgical approach. Finally, when nonsurgical options are unsatisfactory, a penile prosthesis can be implanted with success in the vast majority of patients. Through a compassionate and conscientious approach to geriatric erectile failure, the clinician can help patients regain a portion of life that often remains important despite aging and disease.

Aged↗
PubMed1990

Transurethral incision of the bladder neck and prostate.

Between March 1983 and December 1988, 66 men 50 years old and older with symptomatic bladder outlet obstruction underwent transurethral incision of the bladder neck and prostate. Patients selected for incision had a small, clinically benign, prostate and peak urinary flow rate of less than 15 ml. per second. Preoperative and postoperative evaluation included symptom questionnaires and uroflowmetry. A single midline incision was made extending from the bladder neck to the verumontanum. Results were available in 64 of the 66 men who underwent the procedure with a mean followup of 2.24 years. Mean symptom scores decreased from 9.66 preoperatively to 4.59 postoperatively (p less than 0.001) and peak urinary flow rates increased from 7.4 to 14.7 ml. per second (p less than 0.0001). Antegrade ejaculation was preserved in 83.3% of the men who preoperatively had antegrade ejaculation. Subsequent transurethral resection of the prostate was required in 5 patients (7.6%). With a mean followup of greater than 2 years transurethral incision of the bladder neck and prostate was effective in treatment of bladder outlet obstruction caused by a small prostate while maintaining antegrade ejaculation in the majority of patients.

Follow-Up Studies↗
PubMed1990

The effect of vacuum devices on penile hemodynamics.

External vacuum devices are being used increasingly for the management of erectile dysfunction. There is limited information regarding the effect of vacuum devices on penile blood flow and potential for ischemic penile injury. The penile xenon washout rate was measured before and after application of 2 vacuum systems in 15 subjects. Compared to flaccid state measurements the xenon washout rate did not change significantly with the Synergist Erection System but it was significantly reduced with the Osbon ErecAid System. However, the degree and duration of decrease in penile blood flow that may result in ischemic changes are unknown.

Adult↗