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Taymour Mostafa - One of the best experts on this subject based on the ideXlab platform.
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Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open-Blinded End-Point (PROBE) Study
'Hindawi Limited', 2021Co-Authors: Adham Zaazaa, Michaela Bayerle-eder, Ramzy Elnabarawy, Mahmoud Elbitar, Taymour MostafaAbstract:Forceful corporal dilatation amidst Penile Prosthesis Implantation may injure cavernosal arteries compromising Penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable Penile Prosthesis Implantation with Coloplast Titan Touch® three-piece inflatable Penile implants. 16 patients had conventional Implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a Penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference (P=0.001). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5–344.2; P=0.0022). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860
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spontaneous Penile tumescence by sparing cavernous tissue in the course of malleable Penile Prosthesis Implantation
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:Abstract Introduction Spontaneous Penile tumescence after Penile Prosthesis Implantation has been sporadically reported in the literature. Aim To preserve residual erectile function of patients’ spontaneous Penile tumescence by sparing cavernous tissue in the course of malleable Penile Prosthesis Implantation. Methods Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable Penile Prosthesis Implantation, and patients undergoing the cavernous tissue–sparing technique. 1 month after surgery, these patients underwent Penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced Penile tumescence. Main Outcome Measures Postoperative changes were compared with the preoperative ones. Results The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue–sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P Clinical Implications This study provides a step-by-step approach to maintaining post-Implantation Penile tumescence and preserving Penile girth in a reproducible manner. Strengths & Limitations This is the first study to demonstrate the benefits of implanting a Penile Prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. Conclusion It could be concluded that the cavernous tissue–sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative Penile tumescence and preserved Penile girth. Zaazaa A, Mostafa T. Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation. J Sex Med 2019;16:474–478.
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spontaneous Penile tumescence by sparing cavernous tissue in the course of malleable Penile Prosthesis Implantation
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:INTRODUCTION: Spontaneous Penile tumescence after Penile Prosthesis Implantation has been sporadically reported in the literature. AIM: To preserve residual erectile function of patients' spontaneous Penile tumescence by sparing cavernous tissue in the course of malleable Penile Prosthesis Implantation. METHODS: Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable Penile Prosthesis Implantation, and patients undergoing the cavernous tissue-sparing technique. 1 month after surgery, these patients underwent Penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced Penile tumescence. MAIN OUTCOME MEASURES: Postoperative changes were compared with the preoperative ones. RESULTS: The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue-sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P < .01). In the cavernous tissue-sparing group, 41 of 46 patients (89.13%) reported having a significantly higher incidence of residual Penile tumescence vs 7 of 46 patients (15.2%) in the conventional surgery group (P < .001). The postoperative Penile girth was significantly higher in the cavernous tissue-sparing group than in the conventional surgery group (11.16 ± 1.1 cm vs 10.11 ± 1.15 cm, P < .001). CLINICAL IMPLICATIONS: This study provides a step-by-step approach to maintaining post-Implantation Penile tumescence and preserving Penile girth in a reproducible manner. STRENGTHS & LIMITATIONS: This is the first study to demonstrate the benefits of implanting a Penile Prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. CONCLUSION: It could be concluded that the cavernous tissue-sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative Penile tumescence and preserved Penile girth. Zaazaa A, Mostafa T. Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation. J Sex Med 2019;16:474-478.
Osama Shaeer - One of the best experts on this subject based on the ideXlab platform.
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Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique.
The journal of sexual medicine, 2018Co-Authors: Osama Shaeer, Kamal ShaeerAbstract:Abstract Background Penile Prosthesis Implantation into scarred corporeal bodies is one of the most challenging procedures in prosthetic urologic surgery, especially following infection and extrusion of a Penile implant. Several instruments and techniques have been used for making dilatation of scarred corporeal bodies easier and safer in expert hands. Nevertheless, in some cases, Implantation is not possible. Aim This work presents extracorporeal transseptal Implantation as a last resort in such cases. Methods In 39 patients with extensive corporeal fibrosis, Penile Prosthesis Implantation is attempted. After failure of alternative techniques, extracorporeal Implantation is resorted to in 10 patients. The corpus spongiosum is identified and protected. Diathermy knife is used to cut a longitudinal window into 1 corpus cavernosum, through the septum and into the contralateral corpus cavernosum. A single semirigid implant rod is inserted through the window at the base of the penis, halfway through. The 2 limbs of the rod are bent upward toward the glans, to assume a U shape. The limbs of the U are brought together at midshaft by a gathering suture passed through the corpora cavernosa and septum. The tips of the U are anchored under the glans. Outcomes Achievement of acceptable coital relationship. Results The procedure allowed acceptable coital relationship and concealment in 9/10 cases. In 1 case, infection occurred. ReImplantation with the same method was performed 6 months later, and the implant survived adequately. Perforation, migration, and urethral injury were not encountered. Clinical Implications This technique may help salvage abandoned cases with corporal fibrosis, particularly when the necessary expertise for alternative techniques is unavailable or when such techniques fail. Strengths & Limitations The technique presented is fairly straightforward and safe. However, the number of cases and duration of follow-up are limited. Conclusion Extracorporeal transseptal Penile Prosthesis Implantation can salvage cases with severe corporeal fibrosis when all alternatives fail. Shaeer O, Shaeer K. Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique. J Sex Med 2018;15:1350–1356.
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dorsal phalloplasty to preserve penis length after Penile Prosthesis Implantation
Sultan Qaboos University Medical Journal, 2017Co-Authors: Osama Shaeer, Kamal Shaeer, Islam Abdel F S RahmanAbstract:Objectives: Following Penile Prosthesis Implantation (PPI), patients may complain of a decrease in visible penis length. A dorsal phalloplasty defines the penopubic junction by tacking pubic skin to the pubis , revealing the base of the penis. This study aimed to evaluate the efficacy of a dorsal phalloplasty in increasing the visible penis length following PPI. Methods: An inflatable Penile Prosthesis was implanted in 13 patients with severe erectile dysfunction (ED) at the Kamal Shaeer Hospital, Cairo, Egypt, from January 2013 to May 2014. During the surgery, nonabsorbable tacking sutures were used to pin the pubic skin to the pubis through the same penoscrotal incision. Intraoperative penis length was measured before and after the dorsal phalloplasty. Overall patient satisfaction was measured on a 5-point rating scale and patients were requested to subjectively compare their postoperative penis length with memories of their penis length before the onset of ED. Results: Intraoperatively, the dorsal phalloplasty increased the visible length of the erect penis by an average of 25.6%. The average length before and after tacking was 10.2 ± 2.9 cm and 13.7 ± 2.8 cm, respectively ( P <0.002). Postoperatively, seven patients (53.8%) reported a longer penis, five patients (38.5%) reported no change in length and one patient (7.7%) reported a slightly shorter penis. The mean overall patient satisfaction score was 4.9 ± 0.3. None of the patients developed postoperative complications. Conclusion: A dorsal phalloplasty during PPI is an effective method of increasing visible penis length, therefore minimising the impression of a shorter penis after Implantation. Keywords: Penile Implantation; Penile Prosthesis; Pubis; Erectile Dysfunction; Egypt.
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Dorsal Phalloplasty to Preserve Penis Length after Penile Prosthesis Implantation
Sultan Qaboos University, 2017Co-Authors: Osama Shaeer, Kamal Shaeer, Islam Abdel F S RahmanAbstract:Objectives: Following Penile Prosthesis Implantation (PPI), patients may complain of a decrease in visible penis length. A dorsal phalloplasty defines the penopubic junction by tacking pubic skin to the pubis, revealing the base of the penis. This study aimed to evaluate the efficacy of a dorsal phalloplasty in increasing the visible penis length following PPI. Methods: An inflatable Penile Prosthesis was implanted in 13 patients with severe erectile dysfunction (ED) at the Kamal Shaeer Hospital, Cairo, Egypt, from January 2013 to May 2014. During the surgery, nonabsorbable tacking sutures were used to pin the pubic skin to the pubis through the same penoscrotal incision. Intraoperative penis length was measured before and after the dorsal phalloplasty. Overall patient satisfaction was measured on a 5-point rating scale and patients were requested to subjectively compare their postoperative penis length with memories of their penis length before the onset of ED. Results: Intraoperatively, the dorsal phalloplasty increased the visible length of the erect penis by an average of 25.6%. The average length before and after tacking was 10.2 ± 2.9 cm and 13.7 ± 2.8 cm, respectively (P
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supersizing the penis following Penile Prosthesis Implantation
The Journal of Sexual Medicine, 2010Co-Authors: Osama ShaeerAbstract:Introduction. Following Implantation of a Penile Prosthesis, some couples are dissatisfied with Penile length, girth, shaft, or glans engorgement. This may be delusional because of the procedure per se or preexisting risk factors such as neglected priapism, Peyronie’s disease, radical prostatectomy, or overhanging suprapubic fat. Aim. In this work, we try to enhance Penile size in patients dissatisfied with its dimensions following Implantation of a Penile Prosthesis, using various augmentation techniques. Methods. Eighteen patients who have had Penile prostheses implanted were enrolled in this study based on dissatisfaction with Penile size. The complaint was relieved by counseling and administration of PDE5 inhibitors in seven patients. Two patients had elongation, girth augmentation, and glans injection; six had elongation and girth augmentation; and two had elongation and glans injection. Main Outcome Measures. Penile size, satisfaction, and sexual function. Results. Average preoperative length and girth were 7.87 cm and 11.62 cm, respectively. Mean postoperative length and girth were 11.62 cm and 14.07 cm. The gain in length (47.6%) and girth (21%) were statistically significant (P < 0.005). All patients and partners were satisfied with the results following surgery except one who suffered graft loss. Conclusion. Implantation of a Penile Prosthesis may improve Penile rigidity, yet may confound couple’s satisfaction with Penile size to variable degrees. Sex education may alleviate those concerns. In refractory cases, Penile augmentation may enhance phallic size and increase patient/partner satisfaction. Shaeer O. Supersizing the penis following Penile Prosthesis Implantation. J Sex Med 2010;7:2608–2616.
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original research surgery Penile Prosthesis Implantation in cases of fibrosis ultrasound guided cavernotomy and sheathed trochar excavation
The Journal of Sexual Medicine, 2007Co-Authors: Osama ShaeerAbstract:ABSTRACT Introduction Implantation of a Penile Prosthesis into fibrosed corpora cavernosa is a difficult and risky procedure. Specialized instruments that assist safer and more efficient excavation include Otis Urethrotome and various cavernotomes, all of which operate underneath the tunica albuginea, out of sight. The blind use of such instruments can result in perforation of the tunica albuginea or injury to the urethra. Aim This work describes the utility of ultrasonography for adding visual monitoring to any of the above-mentioned instruments, maintaining them in the mid-corpus cavernosum position to avoid perforation, and describes the application of alternative sheathed, sharp instruments that allow fast, efficient, and visually monitored drilling into fibrous tissue. Main Outcome Measures Clinical outcome data were examined. Methods Surgery was performed on five cases with extensive fibrosis of the penis. Initial blunt dilatation by Hegar dilators faced considerable resistance. An ultrasound probe was applied to the ventral aspect of the penis. A laparoscopy sheath was advanced under ultrasound guidance up to the fibrous tissue. A sharp laparoscopy trochar was inserted through the sheath. Its tip was oriented in the mid-corpus cavernosum by longitudinal and transverse sonography sections, as it drilled into the fibrous tissue. Laparoscopy scissors were used in the same fashion to cut fibrous tissue lumps. After full excavation, Penile Prosthesis was implanted. Results All implants survived adequately. No complications occurred following Implantation. Operative time ranged from 50 to 60 minutes. No difficulty was encountered at excavation. Conclusion Ultrasound guidance can be a handy adjunct to any of the available techniques developed for excavating the fibrosed corpora cavernosa, with a possible decrease in difficulty and complication rate of the procedure. Utility of sheathed, sharp instruments guided by sonography is an alternative to the cavernotomes, allowing fast and efficient drilling into fibrous tissue. Shaeer O. Penile Prosthesis Implantation in cases of fibrosis: Ultrasound-guided cavernotomy and sheathed trochar excavation.
Adham Zaazaa - One of the best experts on this subject based on the ideXlab platform.
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Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open-Blinded End-Point (PROBE) Study
'Hindawi Limited', 2021Co-Authors: Adham Zaazaa, Michaela Bayerle-eder, Ramzy Elnabarawy, Mahmoud Elbitar, Taymour MostafaAbstract:Forceful corporal dilatation amidst Penile Prosthesis Implantation may injure cavernosal arteries compromising Penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable Penile Prosthesis Implantation with Coloplast Titan Touch® three-piece inflatable Penile implants. 16 patients had conventional Implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a Penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference (P=0.001). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5–344.2; P=0.0022). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860
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spontaneous Penile tumescence by sparing cavernous tissue in the course of malleable Penile Prosthesis Implantation
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:Abstract Introduction Spontaneous Penile tumescence after Penile Prosthesis Implantation has been sporadically reported in the literature. Aim To preserve residual erectile function of patients’ spontaneous Penile tumescence by sparing cavernous tissue in the course of malleable Penile Prosthesis Implantation. Methods Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable Penile Prosthesis Implantation, and patients undergoing the cavernous tissue–sparing technique. 1 month after surgery, these patients underwent Penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced Penile tumescence. Main Outcome Measures Postoperative changes were compared with the preoperative ones. Results The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue–sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P Clinical Implications This study provides a step-by-step approach to maintaining post-Implantation Penile tumescence and preserving Penile girth in a reproducible manner. Strengths & Limitations This is the first study to demonstrate the benefits of implanting a Penile Prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. Conclusion It could be concluded that the cavernous tissue–sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative Penile tumescence and preserved Penile girth. Zaazaa A, Mostafa T. Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation. J Sex Med 2019;16:474–478.
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spontaneous Penile tumescence by sparing cavernous tissue in the course of malleable Penile Prosthesis Implantation
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:INTRODUCTION: Spontaneous Penile tumescence after Penile Prosthesis Implantation has been sporadically reported in the literature. AIM: To preserve residual erectile function of patients' spontaneous Penile tumescence by sparing cavernous tissue in the course of malleable Penile Prosthesis Implantation. METHODS: Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable Penile Prosthesis Implantation, and patients undergoing the cavernous tissue-sparing technique. 1 month after surgery, these patients underwent Penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced Penile tumescence. MAIN OUTCOME MEASURES: Postoperative changes were compared with the preoperative ones. RESULTS: The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue-sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P < .01). In the cavernous tissue-sparing group, 41 of 46 patients (89.13%) reported having a significantly higher incidence of residual Penile tumescence vs 7 of 46 patients (15.2%) in the conventional surgery group (P < .001). The postoperative Penile girth was significantly higher in the cavernous tissue-sparing group than in the conventional surgery group (11.16 ± 1.1 cm vs 10.11 ± 1.15 cm, P < .001). CLINICAL IMPLICATIONS: This study provides a step-by-step approach to maintaining post-Implantation Penile tumescence and preserving Penile girth in a reproducible manner. STRENGTHS & LIMITATIONS: This is the first study to demonstrate the benefits of implanting a Penile Prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. CONCLUSION: It could be concluded that the cavernous tissue-sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative Penile tumescence and preserved Penile girth. Zaazaa A, Mostafa T. Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation. J Sex Med 2019;16:474-478.
Robert J. Krane - One of the best experts on this subject based on the ideXlab platform.
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reconstitution of human corpus cavernosum smooth muscle in vitro and in vivo
Tissue Engineering, 2002Co-Authors: R T Kershen, Richard B Moreland, Robert J. KraneAbstract:A large number of congenital and acquired abnormalities of the genitalia would benefit from the availability of transplantable, autologous corpus cavernosum tissue for use in reconstructive procedures. We describe the results of preliminary experiments designed to determine the feasibility of using cultured human corporal smooth muscle cells seeded onto biodegradable polymer scaffolds for the formation of corpus cavernosum smooth muscle in vitro and in vivo. Primary cultures of human corpus cavernosum smooth muscle cells were derived from operative biopsies obtained during Penile Prosthesis Implantation. Cells were characterized in vitro and seeded as a contiguous multilayered sheet onto polymers of non-woven polyglycolic acid. The seeded polymer constructs were then implanted subcutaneously in athymic mice. Animals were killed 7, 14, and 24 days after surgery and implants were examined via histology, immunocytochemistry, and Western blot analyses. Cultured cell multilayers were identified as smooth muscl...
R T Kershen - One of the best experts on this subject based on the ideXlab platform.
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reconstitution of human corpus cavernosum smooth muscle in vitro and in vivo
Tissue Engineering, 2002Co-Authors: R T Kershen, Richard B Moreland, Robert J. KraneAbstract:A large number of congenital and acquired abnormalities of the genitalia would benefit from the availability of transplantable, autologous corpus cavernosum tissue for use in reconstructive procedures. We describe the results of preliminary experiments designed to determine the feasibility of using cultured human corporal smooth muscle cells seeded onto biodegradable polymer scaffolds for the formation of corpus cavernosum smooth muscle in vitro and in vivo. Primary cultures of human corpus cavernosum smooth muscle cells were derived from operative biopsies obtained during Penile Prosthesis Implantation. Cells were characterized in vitro and seeded as a contiguous multilayered sheet onto polymers of non-woven polyglycolic acid. The seeded polymer constructs were then implanted subcutaneously in athymic mice. Animals were killed 7, 14, and 24 days after surgery and implants were examined via histology, immunocytochemistry, and Western blot analyses. Cultured cell multilayers were identified as smooth muscl...