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Have you read ? Best of the Best: Clinical
The NIH-CPSI is considered the gold-standard
for assessing PLS severity. Although previous
studies investigated the impact of prostatitis,
vesiculitis or epididymitis on semen parameters,
correlations between their related symptoms and
seminal or scrotal/transrectal colour-Doppler
ultrasound (CDU) characteristics have not been
carefully determined. And no previous study
evaluated the CDU features of PLS in infertile
men. This study was aimed at investigating
possible associations among NIH-CPSI (total
and subdomain) scores and PLS, with seminal,
clinical and scrotal/transrectal CDU parameters
in a cohort of males of infertile couples. PLS of
400 men (35.8 ± 7.2 years) with a suspected
male factor were assessed by the NIH-CPSI. All
patients underwent, during the same day, semen
analysis, seminal plasma interleukin 8 (sIL-8,
a marker of male genital tract inflammation),
biochemical evaluation, urine/seminal cultures,
scrotal/transrectal CDU. PLS was detected in 39
(9.8%) subjects. After adjusting for age, waist
and total testosterone (TT), no association among
NIH-CPSI (total or subdomain) scores or PLS and
sperm parameters was observed. However, we
found a positive association with current posi-
tive urine and/or seminal cultures, sIL-8 levels
and CDU features suggestive of inflammation of
the epididymis, seminal vesicles, prostate, but
not of the testis. The aforementioned significant
associations of PLS were further confirmed by
comparing PLS patients with age-, waist- and
TT-matched PLS-free patients (1 :3 ratio). In
conclusion, NIH-CPSI scores and PLS evaluated
in males of infertile couples, are not related to
sperm parameters, but mainly to clinical and
CDU signs of infection/inflammation.
Peyronie’s Disease
Carson CC et Levine LA:
Outcomes of Surgical
Treatment of Peyronie’s Disease.
BJU Int. 2013 Nov 13.
To assess the literature on published outcomes
and complications associated with surgical treat-
ments for Peyronie’s disease (PD). To assist cli-
nicians in the effective management of PD by
increasing understanding and awareness of the
outcomes associated with current surgical treat-
ment options. A PubMed literature search was
conducted to identify relevant, peer-reviewed
clinical and review articles published between
January 1980 and October 2013 related to
outcomes of surgical correction of PD. Search
terms for this nonsystematic review included
“Peyronie’s disease,” “outcomes,” “complica-
tions,” “erectile dysfunction or ED,” “patient ex-
pectation,” “patient satisfaction”; search terms
were searched separately and in combination.
Case studies and editorials were excluded, pri-
mary manuscripts and reviews were included,
and bibliographies of articles of interest were
reviewed and key references were obtained.
Assessment of the study design, methodology,
clinical relevance, and impact on the surgical
outcomes of PD was performed on the sixty-one
articles that were selected and analyzed. Cur-
rently, there are several investigational minimally
invasive and non-surgical treatment options for
PD; however, surgical treatment remains the
standard of care for patients with stable disease
and disabling deformity or drug-resistant erectile
dysfunction (ED). Each of the different surgical
procedures that are used for treatment of PD,
including tunical shortening, tunical lengthening
(plaque incisions or partial excision and grafting),
and use of inflatable penile prostheses, carries
its own advantages and disadvantages in terms
of potential complications and postoperative sat-
isfaction. Because of the variety of ways that
PD may present in affected patients, no single,
standard, surgical treatment for this disorder has
prevailed and multiple variations of each type of
procedure may exist. Surgical outcomes of the
most commonly used procedures are not sub-
stantially different; therefore, the appropriateness
of each treatment option may often depend on
disease and patient characteristics (eg, deformity
and erectile function). Surgical algorithms have
been published to guide surgeons and patients
through the selection of surgical procedures in
the absence of conclusive, long-term outcomes
data. Accumulating data on outcomes associated
with established procedures, modifications to
these procedures, and new surgical techniques
and materials may serve to further guide practice
and refine evidence-based selection of the surgi-
cal approach.The current literature was reviewed
to assess the published short- and long-term
outcomes of surgical treatments for PD. Each
surgical treatment option among the standard
surgical procedures for PD (tunical shortening,
tunical lengthening [plaque incisions or partial
excision and grafting], or inflatable penile pros-
thesis) carries its own advantages and disadvan-
tages. Surgical outcomes of the most commonly
used procedures are not substantially different;
therefore, patients’ preference, surgeons’ ex-
pertise, and risk of complications should play
a major role in treatment selection. Surgeons
should thoroughly educate patients about surgi-
cal options, realistic outcome expectations, and
potential complications to manage postopera-
tive satisfaction. Larger clinical studies of the
effectiveness of currently employed and newly
emerging surgical approaches are needed.
Priapism
Salonia A et alt:
European Association of Urol-
ogy Guidelines on Priapism.
Eur Urol. 2013 Nov 16.
Priapism is defined as a penile erection that
persists beyond or is unrelated to sexual interest
or stimulation. It can be classified into ischae-
mic (low flow), arterial (high flow), or stuttering
(recurrent or intermittent). To provide guidelines
on the diagnosis and treatment of priapism. Sys-
tematic literature search on the epidemiology,
diagnosis, and treatment of priapism. Articles
with highest evidence available were selected
to form the basis of these recommendations.
Ischaemic priapism is usually idiopathic and the
most common form. Arterial priapism usually
occurs after blunt perineal trauma. History is
the mainstay of diagnosis and helps determine
the pathogenesis. Laboratory testing is used to
support clinical findings. Ischaemic priapism is
an emergency condition. Intervention should
start within 4 – 6 h, including decompression
of the corpora cavernosa by aspiration and
intracavernous injection of sympathomimetic
