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Paul S Sidhu - One of the best experts on this subject based on the ideXlab platform.
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phentolamine re dosing during penile dynamic colour doppler ultrasound a practical method to abolish a false diagnosis of Venous Leakage in patients with erectile dysfunction
British Journal of Radiology, 2004Co-Authors: Paolo Gontero, Seshadri Sriprasad, Gordon Muir, C.j. Wilkins, N Donaldson, Paul S SidhuAbstract:Increased sympathetic tone may cause an equivocal response to a prostaglandin E1 (PGE1) penile Doppler ultrasound (US) examination interpreted as a Venous Leak. We evaluated the US parameters and erectile response to the addition of phentolamine to a PGE1 penile Doppler US examination to ascertain whether addition of phentolamine would abolish a suboptimal response. 32 patients (median age 29 years, range 17–70 years) with either a previous Doppler US pattern of Venous Leakage or a clinical suspicion of venogenic impotence, underwent Doppler US after a total dose of 20 μg of PGE1. Peak systolic velocity (PSV), end diastolic velocity (EDV) and grade of erection were documented. If erectile response was suboptimal irrespective of the EDV measurement, 2 mg-intracavernosal phentolamine was administered and measurements repeated. Six patients had a normal erectile response, the remaining 26 received phentolamine. A significant increase in PSV between baseline and 20 μg PGE1 (p<0.001) was observed in all cases....
John P Mulhall - One of the best experts on this subject based on the ideXlab platform.
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mp43 18 assessing the impact of audio visual sexual stimulation avss on the need for repeat vasoactive agent injection during penile duplex doppler ultrasonography
The Journal of Urology, 2015Co-Authors: Lawrence C. Jenkins, Joseph Narus, Amparo Camacho, Christian J Nelson, John P MulhallAbstract:INTRODUCTION AND OBJECTIVES: The accuracy of penile duplex Doppler ultrasonography (DDUS) is optimized using a repeat vasoactive agent-redosing schedule. AVSS has been proposed as a means to achieve complete smooth muscle relaxation during DDUS thus minimizing the need for repeat intracavernosal injections (ICI). Clinical experience has taught us that while some patients are comfortable utilizing adult movies for AVSS, some are not. Our goal was to identify if AVSS decreased the number of ICI needed to achieve optimal penile rigidity. METHODS: Prior to DDUS patients were counseled regarding the potential utility of AVSS during the study. A variety of adult movies were available to the patients. No mandate was made to use AVSS, rather patients were encouraged to view the material only if they felt comfortable doing so. Penile rigidity was recorded on a 10-point scale (0 no tumescence, 10 maximal rigidity) by a single examiner. Patients received repeated ICI up to a total of 3 injections until they achieved rigidity equivalent to their best rigidity at home or until their end-diastolic velocities (EDV) were negative. The number of ICI required to achieve this was compared between those men who opted to use AVSS vs those who opted not to do so. RESULTS: Mean age of 168 men 1⁄4 54 14 years. 87 men used AVSS 81 men did not. Median number of vascular risk factors (VRF) 1⁄4 0 (IQR1⁄41), mean VRF 1⁄4 0.77 1.0, with no difference between the two groups. 27% had an abnormal DUS (8% arteriogenic ED, 18% Venous Leak, 2% mixed vasculogenic ED), evenly distributed across the two groups. Mean number of ICI used was not significantly different between groups (AVSSþ 1⁄41.9; AVSS1⁄4 1.8 1, p1⁄40.71). Median ICI number 1⁄4 2 for each group. There was a trend toward a higher percentage of men in the AVSS group needing phenylephrine reversal compared to the no AVSS group (43% vs. 30%, p1⁄40.08, RR 1⁄4 1.43, 95% CI: 0.95-2.17). CONCLUSIONS: One should expect an equivalent need for repeat ICI during DDUS in patients who opt to utilize AVSS compared to those who do not. It is possible that patients using AVSS may be more likely to need erection reversal after DDUS completion.
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the timing of penile rehabilitation after bilateral nerve sparing radical prostatectomy affects the recovery of erectile function
BJUI, 2010Co-Authors: John P Mulhall, Marilyn Parker, Bedford W Waters, Robert C FlaniganAbstract:Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To define if erectile function (EF) outcomes were better in men with early institution of penile rehabilitation after radical prostatectomy (RP), as one of the mechanisms by which patients fail to recover EF after RP is collagenization of corporal smooth muscle with subsequent Venous Leak development, and rehabilitation is aimed at preventing these structural alterations. PATIENTS AND METHODS The study population comprised patients who: (i) had clinically organ-confined prostate cancer; (ii) had fully functional erections, corroborated by the partner; (iii) had bilateral nerve-sparing RP; and (iv) committed to pharmacological penile rehabilitation. Patients completed the International Index of Erectile Function (IIEF) serially after RP. Patients were instructed to obtain three erections/week using initially sildenafil, and if unsuccessful, then intracavernous injections. Patients were subdivided into those starting rehabilitation at <6 months after RP (early) and those starting at ≥6 months after RP (delayed). RESULTS There were 48 patients in the early group and 36 in the delayed group; patients in both groups were matched for age, comorbidity status and baseline EF. The mean duration after RP at the time of starting penile rehabilitation was 2 and 7 months in the early and delayed groups, respectively (P < 0.01). At 2 years after surgery there was a highly statistically significant difference in IIEF EF domain score between the early and delayed groups (22 vs 16, P < 0.001). There were also statistically significant differences between the groups in the percentage of men at 2 years after RP who had unassisted functional erections and sildenafil-assisted functional erections (58% vs 30%, P < 0.01; 86% vs 45%, P < 0.01, respectively). CONCLUSIONS These data suggest that delaying the start of penile rehabilitation after RP is associated with poorer outcomes for EF.
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congruence between veno occlusive parameters during dynamic infusion cavernosometry assessing the need for cavernosography
International Journal of Impotence Research, 2004Co-Authors: John P Mulhall, Matthew Anderson, Marilyn ParkerAbstract:While dynamic infusion cavernosometry (DIC) is being performed with increasing rarity, some centers continue to use this investigation modality. Cavernosography may be utilized to identify the location of patent Venous channels in men with Venous Leak. In an era when Venous ligation surgery is being performed with less frequency, the role of cavernosography has been questioned. This study was conducted to define the congruence between the three parameters (flow-to-maintain (FTM), pressure decay (PD) and cavernosography) used in the diagnosis of Venous Leak during DIC. Established values for the three parameters were utilized and the diagnosis of Venous Leak was based upon the FTM measurement. All studies were performed using a vasoactive agent-redosing schedule. Cavernosography was conducted using a nonionic contrast agent at an intracorporal pressure of 90 mmHg. In patients with an elevated FTM value, 24% had a normal PD recorded, all of whom had FTM values <10 ml/min. The Pearson correlation coefficient for the relationship between FTM and PD was 0.58 (P=0.025). In all, 36 patients (54%) had an abnormal cavernosogram (CG). All patients who had positive findings on CG had elevated FTM values. On the other hand, 46% of patients with abnormal FTM values had a normal CG. This analysis indicates that almost one-half of men with Venous Leak diagnosed at the time of DIC based on FTM measurement will fail to have any veins visualized on cavernosography. These data further undermine the value of cavernosography, particularly in men with low-grade Venous Leak.
Daniele Regge - One of the best experts on this subject based on the ideXlab platform.
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percutaneous vertebroplasty and bone cement Leakage clinical experience with a new high viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures
CardioVascular and Interventional Radiology, 2008Co-Authors: Giovanni Carlo Anselmetti, Gregg H Zoarski, Antonio Manca, Salvatore Masala, Haris Eminefendic, Filippo Russo, Daniele ReggeAbstract:The aim of this study was to assess the feasibility of and Venous Leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 +/- 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA Leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p < 0.05) in Leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p < 0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic Leak in the Venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal Leak occurred in 6 of 98 (6.1%). In Group B, a Venous Leak was seen in 38 of 92 (41.3%) and a discoidal Leak in 12 of 92 (13.0%). Reduction of Venous Leak obtained by high-viscosity PMMA was highly significant (p < 0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, Leakage-related complications.
Paolo Gontero - One of the best experts on this subject based on the ideXlab platform.
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phentolamine re dosing during penile dynamic colour doppler ultrasound a practical method to abolish a false diagnosis of Venous Leakage in patients with erectile dysfunction
British Journal of Radiology, 2004Co-Authors: Paolo Gontero, Seshadri Sriprasad, Gordon Muir, C.j. Wilkins, N Donaldson, Paul S SidhuAbstract:Increased sympathetic tone may cause an equivocal response to a prostaglandin E1 (PGE1) penile Doppler ultrasound (US) examination interpreted as a Venous Leak. We evaluated the US parameters and erectile response to the addition of phentolamine to a PGE1 penile Doppler US examination to ascertain whether addition of phentolamine would abolish a suboptimal response. 32 patients (median age 29 years, range 17–70 years) with either a previous Doppler US pattern of Venous Leakage or a clinical suspicion of venogenic impotence, underwent Doppler US after a total dose of 20 μg of PGE1. Peak systolic velocity (PSV), end diastolic velocity (EDV) and grade of erection were documented. If erectile response was suboptimal irrespective of the EDV measurement, 2 mg-intracavernosal phentolamine was administered and measurements repeated. Six patients had a normal erectile response, the remaining 26 received phentolamine. A significant increase in PSV between baseline and 20 μg PGE1 (p<0.001) was observed in all cases....
Giovanni Carlo Anselmetti - One of the best experts on this subject based on the ideXlab platform.
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percutaneous vertebroplasty and bone cement Leakage clinical experience with a new high viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures
CardioVascular and Interventional Radiology, 2008Co-Authors: Giovanni Carlo Anselmetti, Gregg H Zoarski, Antonio Manca, Salvatore Masala, Haris Eminefendic, Filippo Russo, Daniele ReggeAbstract:The aim of this study was to assess the feasibility of and Venous Leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 +/- 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA Leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p < 0.05) in Leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p < 0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic Leak in the Venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal Leak occurred in 6 of 98 (6.1%). In Group B, a Venous Leak was seen in 38 of 92 (41.3%) and a discoidal Leak in 12 of 92 (13.0%). Reduction of Venous Leak obtained by high-viscosity PMMA was highly significant (p < 0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, Leakage-related complications.
