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We compared the erectile response to intracavernous injection of a combination of papaverine and prostaglandin E1 with that of a combination of papaverine and phentolamine (49 patients), and prostaglandin E1 alone (38). The degree of erection achieved was significantly better with papaverine plus prostaglandin E1 than with papaverine plus phentolamine and the duration of erection was less, although the incidence of prolonged erections (greater than 5 hours) was similar with both combinations. Papaverine with prostaglandin E1 likewise resulted in a significantly better degree of erection than prostaglandin E1 alone (prolonged erections occurred only after the drug combination). All erections subsided spontaneously and none required medical intervention throughout the study. Pain was noted only after injection of prostaglandin E1. The incidence was clearly lower (7 of 38 versus 13 of 38) after the injection of only 5 micrograms. prostaglandin E1 in combination with papaverine (although the difference is not statistically significant). Subjectively, the side effects caused by the drug combination were described as much less dramatic by the patients than after prostaglandin E1 alone. The combination of papaverine and prostaglandin E1 shows a clearly synergistic effect and might suitably replace papaverine plus phentolamine or prostaglandin E1 alone in patients who do not respond well or suffer side effects after high single doses.

A detailed questionnaire was sent to urologists in Austria, Switzerland and West Germany on the frequency of contraceptive vasectomies, vasectomy reversal, technique and success rates. The response rate was 859 of 2,137 (40.2%). The rate of annual contraceptive vasectomies averaged 28,519 or 378 vasectomies per million inhabitants. The rate of vasovasostomies and vasoepididy-mostomies was 8.3 and 3.8 procedures per million inhabitants, respectively. A macroscopic technique was used by 9.5% of the responding urologists, loupes were used by 58.5% and an operating microscope by 32%. The majority (74.1%) preferred a 1-layer technique and an unstented anastomosis (84.4%). The average patency and pregnancy rates were 73 and 47%, respectively, for vasovasostomy and 45 and 18%, respectively, for vasoepididymostomy. A total of 78 alloplastic spermatoceles was reported, with detection of motile spermatozoa in 19 and pregnancy in 1.

We report a case of adrenal cortical carcinoma with tumor thrombus extending to the right atrium. Tumor extension was demonstrated preoperatively with sonography and computerized tomography. We recommend that both modalities be used when evaluating masses in the suprarenal space. The preoperative diagnosis of tumor extension via the adrenal vein into the inferior vena cava was confirmed at operation.