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Introduction: Given the high prevalence of erectile dysfunction in male population between 40-70 years old and the effect of radical prostatectomy on this domain, it is important to perform a baseline study., Material and Methods: Prior radical prostatectomy, erectile function has been assessed prospectively in 112 prostate cancer patients using the erectile function (EF) domain of the International Index of Erectile Function (EF-IIEF), Erectile Hardness Score (EHS) and a penile doppler ultrasound (PDUS). Comorbidities and Charlson index were collected. The EORTC QLQ C-30 and PR-25 tests were administered., Results: According to EF-IIEF questionnaire, 50.9% of patients showed normal EF and EHS grade 3-4 erection was achieved in the 75.9%. PDUS was normal only in 28.6% of patients and 51.8% showed arterial insufficiency. We found a significant association (P<.0001) between categorized EF-IIEF (normal, mild/moderate/severe) and the EHS value. Between PDUS (normal vs. pathologic) and EHS (3-4 vs. 1-2) statistically significant association (P=.005) was found. Just 35.3% of patients with EHS 3-4 showed normal PDUS. Correlation between the PDUS and the EF-IIEF (≥26 vs.<26) was statistically significant (P=.043). Moreover, only 38.6% of patients with EF-IIEF≥26 had a normal PDUS., Conclusions: In order to predict EF recovery after surgery, global assessment is required. Solely self-administered tests are not enough. In this baseline study, PDUS can play an important role., (Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To determine the current status of the patients operated on for hypospadias in our region, in order to adapt the surgical technique to their real needs., Material and Methods: A descriptive and observational study. Interviews were conducted with hypospadias surgery patients in our hospital between 1976 and 1996, focusing on their urinary and sexual function and psychological impact. We performed a descriptive statistical analysis and comparisons between types of hypospadias (SPSSv19)., Results: 566 patients were operated on for hypospadias during the study period, interviewing 100 aged between 18 and 40 years. The 73% were distal and 27% proximal. Of all patients, 30% do not have an orthotopic meatus, 10% have fistula, 18% have some degree of stenosis and 52% have penile curvature. The 13% feel to have had disadvantages in their life. They consider they have a different penis in: size (19%), glans shape (17%), curvature (14%), scars (10%) and lowest hole (7%). Sexual satisfaction was valued at 8.9 on a scale of 1 to 10, with no differences between the types of hypospadias. Proximal hypospadias patients have more ejaculation problems: 42% versus 11% in distal hypospadias. The 68% of the proximal ones would like to improve compared to 20% of the distal in: appearance (17%), size (11%) and way to urinate (11%)., Conclusions: Anatomic abnormalities are maintained but the aspects that values the adult patient differ from those persecuted by practiced surgeries. A significant percentage of patients would try to get another surgery. Keeping the size of the penis and natural appearance of the glans should be a priority in hypospadias surgery.

In these article we review the main mechanisms involved in human erection. We review and update in detail the biochemical (nitric oxide and Rho-kinase pathways), cellular (smooth muscle relaxation mechanisms), neural (autonomic and somatic pathways) and microscopic penile principles.

The penis physiological states of flaccidity or erection, result from the contraction or relaxation, respectively, of smooth muscle cells in the corpora cavernosa (CSMCs). They result from the interaction of various inter and intracellular molecular signaling pathways. During the more usual state of flaccidity seems to predominate a tonic sympathetic activity, releasing noradrenaline (NA) and other agonists that generate contractile signals in the CSMCs, with the likely cooperation of endothelium-derived messengers. Through activation of membrane receptors in the CSMCs they raise the intracellular messengers inositol triphosphate (IP3) and diacylglycerol (DAG). This results in a transient increase in cytosolic calcium concentration [Ca2+]i that starts the contractile response which is further sustained by the parallel agonist-induced activation of a "calcium sensitizing" mechanism involving the RhoA/Rho-kinase pathway. Overexpression of the latter might contribute to several vascular disorders as hypertension, vasospasm or erectile dysfunction. On sexual stimulation the cavernous nerves release nitric oxide (NO) that starts the erectile response. They also release acetylcholine that stimulates the endothelium to generate a more sustained release of NO. NO diffuses into CSMCs and increases their intracellular levels of cyclic guanosin monophosphate (cGMP) which decreases [Ca2+]i and deactivates the calcium sensitizing mechanism, thus relaxing CSMCs. This main physiological pathway for CSMCs relaxation is helped by the cyclic adenosin monophosphate (cAMP) pathway activated by various intercellular messengers from neural or paracrine sources, including prostaglandins E (PGE). Different phosphodiesterase enzymes (PDEs) inactivate the cyclic nucleotides thereby limiting their erectogenic action. Indeed the pharmacological inhibition of PDEs, especially the cGMP-specific PDE5, greatly enhances the erectile responses. There are crosstalk mechanisms between the cGMP and cAMP signaling pathways that offer additional possibilities for the pharmacotherapy of erectile dysfunction.

Objective: To evaluate the penile echo Doppler study and review the anatomy, perfusion, innervation and physiology of erection., Methods: The technique, spectral morphological changes of the cavernous arteries after drug-induced erection, modifications and normal values are described., Results/conclusion: Impotence or erectile dysfunction, which is defined as the inability of the male to achieve or sustain an erection sufficient for successful sexual intercourse, is a benign condition with an important impact on the wellbeing of the patient. Statistical studies have shown a high age-dependent prevalence in healthy subjects and an association with different conditions in patients. To establish whether impotence is organic or not and to identify its underlying cause require submitting the patient to not a few diagnostic tests. Since most of the cases of organic impotence are of vascular origin, it is necessary to utilize a diagnostic method that can identify patients with an underlying vascular disorder (the most common cause) and distinguish those with arteriogenic impotence from those with insufficiency of the complex corporeal veno-occlusive system.

Objective: The present study reviews the mechanism involved in the initiation and maintenance of penile erection., Method: The study reviews the literature on the basic concepts supporting either "magically" or scientifically the erectile mechanism. An anatomo-physiological update is also included (i.e., the main neurological, muscular, and vasculoendothelial phenomena)., Results: Present studies based on the vasoactive action of different drugs have increased the knowledge on the neurological, muscular, and vasculoendothelial phenomena. The cavernous muscular relaxation may start and finish due to the equilibrium between the contractile adrenergic and the relaxing non adrenergic-non cholinergic stimulus through intracellular nitric oxide synthesis. This is an essential phenomenon involved in the entry and "trapping" of blood within the sinus spaces., Conclusions: Our knowledge on the erectile mechanisms through neuromediators is increasing. The role of the endothelium in intracellular nitric oxide synthesis and its relaxing effect, will improve our understanding of both physiological and therapeutic phenomena.

The evaluation of erectile dysfunction by popliteal and pudendal evoked potentials is not widely utilized in our country, although the foregoing has proved to be a useful technique in the evaluation of a possible neurological etiology. This study describes this simple, fast and low cost method of evaluation and reports the normal ranges. The study comprised 40 subjects; 15 were healthy volunteers and the remaining had consulted for impotence and referred antecedents suggesting a neurological etiology. The results show that a latency of 40.9 +/- 2.1 msec in P1 for the pudendal evoked potentials is normal. Concerning the popliteal evoked potentials, the normal latency for P1 is 38.07 +/- 2.8 msec.