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Ultrasonography can provide information about the integrity of organs; however, rarely is applied to the reproductive organ evaluation of bulls. The objective of the present study was to characterize and compare values for variables and ultrasonographic characteristics of the testes, epididymis and accessory sex glands, as well as spectral Doppler indices of the testicular and internal iliac arteries, between peri- and post-pubertal Nelore and Caracu bulls. Nelore (n = 203) and Caracu (n = 79) bulls were assigned by age class: peri-pubertal (12-15 months) and post-pubertal (> 22 months). Data were analyzed using SAS's PROC MIXED procedure (P < 0.05). The biometric variables of the testes and cauda epididymis differed between peri- and post-pubertal Nelore and Caracu bulls. There was a difference between breeds for the vesicular glands, ampulla of vas deferens, disseminate portion of the prostate, and craniocaudal dimension of the bulbourethral glands. Echogenicity of the testicular parenchyma differed between breeds and age classes. The pulsatility and resistive indices of the testicular arteries differed between Nelore and Caracu bulls. The biometric and ultrasonographic characteristics of the testes, epididymis and accessory sex glands, as well as of the arterial indices in bulls are affected by genetic group and age class, and when assessed there is useful information regarding the progression of sexual maturation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Male and female sexual dysfunction (SD) is considered a multifactorial condition. Numerous studies have shown the involvement of inflammatory processes in this pathological condition. Sexual intercourse requires healthy and functioning vessels to supply the pelvic region in both males and females, generating penile erection and clitoral and vaginal lubrication, respectively. Cardiovascular diseases and associated risk factors may contribute negatively to pelvic blood flow, possibly through immune system activation., Aim: The study aimed to address the correlation between vascular inflammation driven by immune system activation and SD in males and females., Methods: A literature review was performed to identify articles addressing male and female SD and vascular inflammation. Key words included "male and female sexual dysfunction," "vascular inflammation," "iliac and pudendal arteries dysfunction," "genitourinary tract," and "blood flow.", Main Outcome Measures: Management of systemic and local inflammation may be a useful alternative to improve SD and reduce the risk of cardiovascular diseases in the future., Results: Increased levels of cytokines and chemokines have been detected in humans and animals with hypertension, obesity, and diabetic conditions. Chronic activation of the innate immune system, especially by pathogen- or damage-associated molecular patterns, and metabolic-related disorders may act as triggers further contributing to an increased inflammatory condition. Due to the reduced size of vessels, SD and retinal vascular impairments have been shown to be predictive factors for cardiovascular diseases. Therefore, considering that blood flow to the genitalia is essential for sexual function, endothelial dysfunction and vascular remodeling, secondary to chronic immune system activation, may be implicated in male and female vasculogenic SD., Conclusions: Several conditions appear to play a role in SD. In the present review, we have identified a role for the immune system in generating vascular and tissue impairments contributing to erectile dysfunction and female SD. Calmasini FB, Klee N, Webb RC, et al. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019;7:604-613., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

This study investigated the frequency of an accessory pudendal artery in 15 adult cadavers fixed with formaldehyde solution. The prevalence of accessory pudendal artery varies between 7 and 75% according to the method of identification (imaging studies, microstereoscopic cadaveric dissection, and open and laparoscopic surgeries). Currently, under discussion is the role of this artery in postprostatectomy erectile dysfunction. Accordingly, it is important to know the true prevalence to appreciate its clinical significance. The internal pudendal system was examined through direct dissection, and findings were compared with the different methods of identification published., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: To investigate the feasibility and value of multi-slice spiral computed tomography angiography (CTA) in 3D imaging of internal pudendal arteries and their branches., Methods: Using 64-slice spiral computed tomography, we performed hypogastric CTA for 156 twenty to seventy years old males without vascular diseases. We assigned them to groups A (n = 83, 20 to 55 yr old) and B (n = 73, 56 to 70 yr old), and included 7 male patients with arterial erectile dysfunction (AED) aged 43 to 70 years in group C. We conducted maximum intensity projection (MIP), volume rendering (VR) and vascular analysis on the internal pudendal arteries and their branches, divided the MIP and VR images into 3 levels according to the resolution and continuity of the internal pudendal arteries and their branches for blind evaluation, and measured their diameters at various positions., Results: VR images of the internal pudendal arteries and their branches revealed significant differences between groups A and B (P<0.05), but not MIP images (P>0.05). There were no dramatic differences between MIP and VR in displaying internal pudendal arteries and their branches (P>0.05), nor any remarkable differences in the diameters of bilateral internal pudendal arteries and their branches at different levels in groups A and B (P>0.05). VR and MIP showed the 7 AED cases at grade III, and clearly revealed the degree and position of stenosis and occlusion in the internal pudendal arteries and their branches., Conclusion: CTA can display clear 3D images of internal pudendal arteries and their branches, and has a valuable role in the diagnosis and treatment of ED induced by internal pudendal artery diseases.

Purpose: Vascular tumors and malformations of the male genitalia can affect urinary, sexual, reproductive, and emotional function., Methods: Male patients with a genital lesion evaluated or treated at our center from 1995 to 2010 were reviewed to analyze presentation, diagnosis, treatment modalities, and outcome., Results: Of the 3889 male patients, 117 had a vascular anomaly of the genitalia: 12 tumors and 105 malformations. The referring diagnosis was accurate in 72.7% of patients with a tumor, whereas 46.3% of malformations were misdiagnosed. Tumors included infantile hemangioma (n = 10) and kaposiform lymphatic anomaly (n = 2). Common vascular malformations were lymphatic (n = 46), venous (n = 33), and capillary-lymphatic-venous (n = 16). Presenting signs for tumors included ulceration (33.0%) and ambiguous genitalia (25.0%). Malformations manifested with swelling (40.0%), fluid leakage (16.2%), and pain (16.2%). Treatment was necessary for 69.9% (79/113) of patients. The remaining lesions (34/113) were observed. Tumor management included observation, pharmacotherapy, and excision. Malformations were largely treated with sclerotherapy and/or surgical procedures., Conclusions: Vascular anomalies of the male genitalia are uncommon and frequently misdiagnosed. Accurate diagnosis can be made and appropriate treatment can be instituted based on presentation, natural history, and radiographic imaging. Observation and pharmacotherapy are the mainstays of tumor management. Malformations require sclerotherapy and/or resection. Interdisciplinary care optimizes outcomes for males with these often-disfiguring vascular lesions., (Copyright © 2011 Elsevier Inc. All rights reserved.)

High-flow priapism is a very rare condition in children. The most common cause is perineal trauma, which is a major cause of arterio-cavernosal fistula. A few pediatric patients have high-flow priapism without an obvious cause. There are many therapeutic modalities for this condition, depending on the etiology. We report a case of idiopathic high-flow priapism in a 6-year-old boy who underwent repeated superselective embolization., (Copyright © 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

This article discusses the role of the central nervous system and testosterone hormone and its derivatives in the intrauterine development of male reproductive organs. The characteristics that define male personality first emerge in fetal stage of human development. Thereafter they continue to evolve during childhood. They become increasingly apparent after puberty and then remain prevalent throughout the individual's life time. The cited process affects both male phenotype and masculine behavior. Testosterone and its derivatives control the development of male reproductive organs. Their absence leads to predominance of female sexual characteristics even in the presence of a male chromosome pattern. The clinical entity of testicular feminization is a typical example for this phenomenon. The presented study pays special attention to those abnormalities of male reproductive organs that are identifiable by ultrasound during the fetal period. Most of these anomalies cannot be treated effectively before birth. Those conditions that are also incurable in extra uterine life, may serve as indication for pregnancy termination if they can be detected by ultrasound examination in early gestation.

The experience of treatment with favorable outcome of 3 patients, in whom gangrene of Fournier was diagnosed, was summarized.The necessity of application of "agressive" surgical tactics in early terms of the disease was stressed.

Objective: The recent increase in road traffic accidents and civil violence has resulted in a significant rise in injuries to male external genitalia, hence the need to document this new trend., Methods: All men and boys who presented to our institution with injuries to the external genitalia between 1996 and 2005 were evaluated for the cause, type and severity of injury. Treatment and factors determining outcome were also evaluated. Patients were followed up with regular clinical examination and investigations to detect late complications., Results: The mean age of the 131 patients was 28 (+/-3.2) years. Road traffic accidents and gunshot accounted for 68% and 16% of injuries, respectively. Avulsion injuries occurred in 25 cases, including complete avulsion of the penis, scrotum and testes in 2 cases; 7 cases involved penile amputation. Overall, there were 89 penile, 42 scrotal and 17 testicular injuries. About 22% of cases were managed non-operatively. Complications of treatment included wound infection and urethral stricture, seen in 42 (32%) and 12 (9.4%) cases, respectively. Associated injuries were seen in 41% of cases., Conclusion: Genital injuries resulted mainly from road traffic accidents and gunshot. Some injuries were associated with severe tissue loss. However, for the majority, function and cosmetic acceptability of the external genitalia were restored.

Objective: The incidence of laparoscopically diagnosed accessory pudendal arteries (APAs) varies depending on how proactive the surgeon is to find them. Their preservation depends on their calibre and location. Our objective was to provide a detailed description of how to identify, dissect, and preserve APAs during laparoscopic radical prostatectomy (LRP)., Methods: Between January 2003 and January 2005, we treated 377 men with LRP; 325 met inclusion criteria for this study. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex and extending caudally towards the anterior perineum, other than cavernous arteries, corona mortis, and satellite arteries to the superficial and deep vascular complex. Two distinct varieties of APAs were identified: (1) lateral APAs course along the lateral aspect of the prostate and branch off any of the terminal branches of the hypogastric artery; and (2) apical APAs emerge through the levator ani fibres near the apical region of the prostate and most likely branch off the pudendal artery or corresponds to an aberrant course of the pudendal artery itself. We present a video depicting the laparoscopic anatomy of APAs and the technique to preserve them., Results: Ninety-six of 325 men (30%) were found to have 125 separate APAs. Using the depicted surgical technique, we were able to preserve 83% of all APAs. Forty-nine of 55 lateral APAs (89%) and 55 of 70 apical APAs (79%) were preserved. Thirty-five of 38 large-calibre APAs (92%) and 70 of 87 small-calibre APAs (80%) were spared. The side-specific incidence of PSMs were 3% and 6% when APAs were preserved and not preserved, respectively (p=0.5)., Conclusions: APAs are frequently identified during laparoscopic prostatectomy. Their preservation is feasible in LRP without increasing the risk of causing a PSM. It is reasonable to integrate APA preservation as part of the modern radical prostatectomy, although their role in functional outcomes still needs to be prospectively established.

Fistulas complicating an abdominal aortic aneurysm (AAA) are rare, and fistulas involving the left renal vein are particularly uncommon. We highlight here a fistula between an infrarenal aortic aneurysm and a retroaortic left renal vein, revealed by left flank pain associated with hematuria and acute renal failure. The multislice CT angiography performed in this 68-year-old patient revealed communication and equal enhancement between the aorta and the left gonadic vein, suggesting the presence of a fistula. The three-dimensional VRT reconstructions presented in this case were of great value in the preoperative planning, enabling immediate visualization of this unusual feature. Alternative diagnoses to consider when encountering this clinical presentation are reviewed.

Sixty patients with chronic prostatitis and sexual dysfunction were divided into two groups. All the patients received one-month standard course of physiotherapy. In addition, group I (n = 30) was given levitra (vardenafil; 5 mg per os each other day), the control group was not given this drug. Follow-up covered 6 months to 1.5 years. General urological examination, questionnaire survey, ultrasound investigation of male genital organs were made before, 1 and 6 months after treatment. The results were processed statistically. Levitra improves circulation in male sexual organs promoting increased arterial inflow to the prostate and penis. Aftertreatment effect persisted for half a year. Regular levitra intake (2-3 times a week) is recommended to correct circulation in the sexual system, including prostatic gland, but not only for correction of erectile dysfunction as a result of psychogenic and vascular disorders in the penis accompanying chronic prostatitis.

Purpose: To determine the feasibility of time-of-flight magnetic resonance (MR) angiography to visualize the internal pudendal arteries (IPAs) in potent men undergoing permanent-seed prostate brachytherapy and to calculate the radiation dose received by these arteries., Methods and Materials: Prostate brachytherapy is performed at the University Health Network/Princess Margaret Hospital by use of transrectal ultrasound (TRUS) preplanning and preloaded needles. All patients received (125)I, with a mean seed activity of 0.32 mCi/seed (0.41 U). Postplan evaluation is performed at 1 month by magnetic resonance-computed tomography fusion. Twenty consecutive potent men had time-of-flight MR angiography as part of their postplan evaluation., Results: The mean V100 was 96.5%, and the mean D90 was171.5 Gy. The IPAs were easily visualized for 18 of the 20 men. The mean peak dose received by the IPA was 17 Gy. The highest peak dose received by any patient was 38.2 Gy, with only 1 other patient receiving a peak dose greater than 30 Gy. Eleven of 18 had a measurable portion of at least 1 IPA that received 10% of the prescribed dose (V10 = 14.5 Gy). Only 2 patients had nonzero values for V25. The distal third of the IPA received the highest dose for 16 of the 18 patients., Conclusions: The IPAs can be well visualized in the majority of potent men by use of time-of-flight MR angiography 1 month after brachytherapy. The IPAs receive a low but calculable dose from permanent-seed (125)I brachytherapy. Further research is needed to determine if this outcome has any correlation with subsequent potency.

A prolonged period of daily ejaculations via masturbation may result in an episode of hematospermia, possibly due to stress applied to the vasculature of the reproductive system.

Endothelial cells in the intact adult are, apart from those in the female reproductive organs, believed to be quiescent. Systematic examination of endothelial cell proliferation in male reproductive organs has not been performed and was therefore the aim of the present study. Intact adult rats were either pulse labeled or long-term labeled with bromodeoxyuridine to label proliferating cells. The roles of Leydig cells and testosterone were examined after castration or treatment with the Leydig cell toxin ethane dimethane sulfonate (EDS) and testosterone substitution. After perfusion fixation, all blood vessels remained open and were easily identified. In all male reproductive organs studied, particularly in the testis and epididymis, endothelial cell proliferation was considerably higher than in other tissues such as the liver, brain, and muscle. Proliferating endothelial cells were observed in all types of blood vessels in male reproductive organs, but other characteristics of new blood vessel formation were not seen. High endothelial cell proliferation may reflect a continuous high turnover of endothelial cells rather than classical angiogenesis. In the epididymis, the ventral and dorsolateral prostate lobes, and the seminal vesicles, endothelial cell proliferation decreased after testosterone withdrawal and increased following testosterone treatment. In the testis, endothelial cell proliferation was decreased after Leydig cell depletion but remained low after testosterone substitution. High, hormonally regulated endothelial cell proliferation is not unique to the female but is also seen in the male reproductive organs.

Scintigraphic techniques have contributed to many aspects of our understanding of genital and reproductive physiology and pathophysiology. Few of these methods have become mainstream diagnostic techniques; nonetheless, their flexible, physiologic, and intrinsically quantitative nature have contributed information and insights not readily available by other means. The techniques discussed in this review measure various dynamic processes within the body, including blood flow, variation of blood volume, and lymphatic and fallopian tube transport. Dynamic measurement of these processes exploits nuclear medicine's ability to radiolabel and monitor substances while preserving normal physiologic behavior. Consideration of these methods will potentially stimulate future development and application of radionuclide techniques to emerging questions in the fields of reproductive and genital physiology.

To determine the possibility of providing alternative surgical techniques for male genital reconstruction and for male-to-female sex reassignment surgery, the authors undertook an anatomic investigation of the perineogenital region in male cadavers. Anatomic dissection was performed on 14 male adult human cadavers (fresh and formalin-preserved) studying the main afferent vessels to the anterior perineal region and their mean internal diameters: deep external pudendal artery (0.60 mm), superficial perineal artery (0.50 mm), and funicular artery (0.37 mm). We established their exact topography, together with vascular anatomic variations, main vascular anastomosis circuits (base of the penis, scrotal septum, and perineal fat and lateral spermatic-scrotal fascia), angiosomes, anatomy of the rectovesical septum cavity, and their "critical" key points of dissection. The authors discuss the clinical possibility of elevation of a "tree" of previously described paragenital-genital flaps including mainly those based on the terminal branches of the internal pudendal vascular system, the erectile tissue pedicled flaps, and finally, flaps of the external pudendal system. The authors indicate the concrete vascularization system for each flap.

Objective and Design: The role of mast cells in spontaneous leukocyte rolling in venules of the mouse cremaster muscle and rat mesentery was investigated., Materials: The experiments were carried out using mast cell-deficient rats (Ws/Ws), WBB6F1 mice (W/Wv), and their congenic littermates (wild type)., Treatment: Administration of compound 48/80 intraperitoneally (50 microg) in rats and intrascrotally (5 microg) in mice, 4 h prior to the experiments., Methods: Intravital microscopy of the terminal vascular beds in mouse cremaster muscle and rat mesentery., Results: The level of spontaneous leukocyte rolling and the rolling velocity in venules of mast cell-deficient animals exactly matched that seen in wild-type animals. Challenge with compound 48/80 markedly increased leukocyte adhesion and emigration in venules of wild-type animals. In contrast, the number of adherent and extravascular leukocytes was very low in compound 48/80-challenged animals lacking mast cells and did not differ from that seen in control animals treated with phosphate-buffered saline., Conclusions: The presence or activation of mast cells has no bearing on spontaneous leukocyte rolling, at least not in rat and mouse microvessels.

A case of post-traumatic high flow priapism in a 32-year-old man is reported. The diagnosis was based on cavernous blood gas analysis and left internal pudendal arteriography. He was treated by unilateral super-selective embolization of the fistula with coils and gelatin sponge. At 1 month after embolization, erectile function had recovered, as demonstrated by measurement of nocturnal penile tumescence.

Purpose: Cremasteric or extrafunicular reflux is considered by many a major cause of primary and recurrent varicocele. Therefore, surgical techniques that allow ligation of the intrafunicular and extrafunicular veins are often performed. We evaluated the incidence of cremasteric reflux in patients with primary or recurrent varicocele with a new and simple venographic technique., Materials and Methods: A series of 73 patients with primary (54) or recurrent (19) varicocele underwent venography of the left iliac vein while standing and performing Valsalva's maneuver to reveal the possible presence of reflux in cremasteric or other extrafunicular veins. In patients with recurrent varicocele antegrade transcrotal spermatic venography was also performed immediately before surgery., Results: None of the patients presented with reflux of contrast material from the left iliac vein to the left pampiniform plexus via the extrafunicular veins. Cremasteric veins, in particular, were always continent at the confluence with the epigastric vein even when grossly dilated at spermatic antegrade venography in recurrent cases., Conclusions: Cremasteric reflux seems to have a limited role if any in the pathogenesis of primary and even recurrent varicocele. Dilatation of the extrafunicular veins is not necessarily a sign of reflux but may represent only a consequence of venous overflow due to insufficiency of the internal spermatic vein and possibly partial obstruction of the left iliac vein. The rationale of surgical treatments aimed at ligation of the extrafunicular veins should be questioned.

Case report of a 54-year old patient, calling on the emergency unit with testicular pain and necrotic-looking lesions in the skin and the scrotum. After ruling out a Fournier's gangrene, the diagnosis was reached by scrotal biopsy, the pathoanatomic report confirming the presence of an infrequent vascular disease, segmentary hyalinizing vasculitis, on which we make a review of the literature.

We have investigated possible (negative) feedback and (positive) feed-forward activity within the human male gonadotropic axis by measuring serum concentrations of LH, FSH, and testosterone in blood sampled frequently and for a prolonged interval (every 20 min for 19 h) simultaneously from the peripheral circulation and the left spermatic vein. Cross-correlation analysis with time lag was used to evaluate relationships among serial serum LH, FSH, and/or testosterone concentrations over time (i.e. consistency or dissociation of trends in concentrations). Separately, Cluster analysis was applied to identify discrete LH, FSH, and testosterone pulses, which were cataloged for possible peak coincidence. The hypergeometric probability distribution was then used to test the null hypothesis that LH, FSH, and testosterone pulses are randomly associated. Cross-correlation analysis revealed: 1) peripheral blood LH and testosterone concentrations correlate positively at lags of 40-120 min with LH increases preceding testosterone increases, viz., feed-forward (P < 0.001); 2) LH and FSH concentrations in peripheral blood are positively correlated in simultaneous blood samples, as well as when FSH lags LH by 20 min (P < 0.01); 3) unexpectedly, LH and FSH concentrations in peripheral blood are inversely related at a lag of 80-100 min (P = 0.002) and 0.004, respectively) where LH lags FSH; 4) LH and testosterone concentrations in the spermatic vein show strongly positive correlations at lags of 80, 100, and 120 min (P = 0.002, 0.004, and 0.021, respectively); 5) spermatic vein testosterone concentrations correlate negatively with peripheral blood LH concentrations 20 or 40 min later (P = 0.012 and 0.05, respectively), which indicates autonegative feedback; and 6) in contrast, testosterone levels in the spermatic vein correlate negatively with FSH values in the periphery 100 and 120 min later (P < 0.01), indicating more delayed negative feedback of testosterone on serum FSH concentrations. Discrete pulse coincidence analysis disclosed: 1) a total of 30 testosterone pulses in the spermatic vein and 25 testosterone pulses in peripheral blood, with 28 LH and 29 FSH pulses in the periphery; 2) individual LH and FSH peak concordance was significantly nonrandom for FSH pulse maxima lagging LH pulse maxima by 20 min (P < 0.05 vs. randomness), with 6 observed coincidences vs. 2.9 +/- 1.5 (SD) expected; 3) peripheral LH pulses and spermatic vein testosterone pulses were strongly nonrandomly coupled at an 80-min lag, with 8 events observed vs. 3.0 +/- 1.5 events expected (P = 0.004); and 4) LH peaks in peripheral blood followed testosterone peaks in the spermatic vein by 40 min in a nonrandom manner, specifically, n = 11 observed vs. 3.0 +/- 1.5 expected (P < 0.001), indicating possible LH escape from testosterone's negative feedback. In summary, physiological regulation of the human male LH, FSH, and testosterone axis comprises multidirectional interactions, consisting of both (positive) feed-forward and (negative) feedback coupling. Based on a concept of network integration, we propose that age and other pathophysiological factors might modulate and/or disrupt these dynamic within-axis multihormonal linkages.

Phlebographic sclerotherapy and embolization are better methods, from the biological and cost-effectiveness viewpoints, to treat male varicocele than conventional surgery. On the other hand, positive technical results are not always obtained and the rates of relapses and recurrences are high. A retrospective study was carried out on 70 (of 81) sclerotherapies performed in the Radiology Department of S. Anna Hospital, Turin, from 1993 to September, 1995. The results confirmed the feasibility of this treatment in a nonangiographic department, with technical success rates increasing with growing operators' experience (70% success rate in 1993, vs. more than 95% in 1994-95). Recurrence rate was 4.9% and the rate of limited persistence was 7.3% at clinical and Doppler follow-up ranging 6-24 months (mean: 10.2 months). Both rates appeared to be related to varicocele initial size, increasing progressively from grade I to grade III. Therefore, such new and expensive techniques as balloon or spiral embolization are justified only in the most severe cases. The follow-up showed improved or normalized sperm exams in 70.4% of treated and followed-up patients, with 5 full-term pregnancies. To conclude, sclerotherapy and embolization of the spermatic vein are very good tools to treat male varicocele with subfertility.

Vasoactive intestinal polypeptide, a neuropeptide with wide distribution in the central and peripheral nervous system, has a broad spectrum of biologic actions. The demonstration of vasoactive intestinal polypeptide containing nerve fibers within the female and male genital tract 17 years ago indicated a putative role for this peptide in the local nervous control of reproductive functions. The genes encoding the preprovasoactive intestinal polypeptide precursor molecule and the vasoactive intestinal polypeptide receptor have been identified. The gene expression has been studied by the use of specific antibodies against the functional domains of the vasoactive intestinal polypeptide precursor and the biologic action elucidated by both in vivo and in vitro methods. Evidence has been provided to support vasoactive intestinal polypeptide as a neurotransmitter in several physiologic events in the genital tracts (i.e., blood flow and nonvascular smooth muscle relaxation). In the ovary vasoactive intestinal polypeptide seems to play an important role as regulator and/or modulator of folliculogenesis and steroidogenesis. In the male genital tract vasoactive intestinal polypeptide seems to participate in the control of erection. Vasoactive intestinal polypeptide has been suggested as a causative factor in some diseases of the genital organs (e.g., it may play a pathophysiologic role in male impotence and the peptide is currently used in the treatment of this condition). Vasoactive intestinal polypeptide may be important for control of the low resistance in the fetomaternal vascular bed and is therefore a putative factor involved in the development of preeclampsia. The therapeutic potential of vasoactive intestinal polypeptide and future agonists and antagonists will be revealed by ongoing and forthcoming studies.

A case of posttraumatic fistula of the internal pudendal artery-urethra is reported. The patient was referred with prolonged pulsatile gross hematuria requiring multiple blood transfusions after a motor vehicle accident. Associated injuries included a comminuted pubic ramus fracture. Initial uroradiographic evaluations did not identify the site of origin of hematuria but eventually selective angiography allowed diagnosis. Selective arterial embolization of the internal pudendal artery provided definitive treatment.

Quantitative alterations of the sexual hormones are present in cirrhotic patients whose testicular volumes are decreased with tubular atrophy in more than 50% of cases. The authors performed an experimental study utilizing end-to-side portacaval anastomosis in the rat in order to evaluate the consequences of the complete interruption of the portal blood to the liver in the male genital system, i.e. testicular alterations, due to the missing hepatic inactivation. Forty male Sprague-Dawley rats were used for this study. Twenty rats were subjected to end-to-side porta-caval anastomosis according to Lee, 10 rats underwent sham-operation while the remaining 10 rats were utilized as negative controls. The rats were weighed and necropsied three and six months after surgery and the liver and genital organs were weighed. In rats subjected to porta-caval anastomosis loss of weight was shown, about 20 g three months after surgery and 30 g six months after surgery, while other rats (sham-operated and negative controls) showed an increase of its weight, about 60 g after three months and 80 g after six months. In rats subjected to porta-caval anastomosis the liver was hypotrophic and its weight was decreased in comparison with the control group. In the same rats testicular volumes were decreased and hypotrophic in comparison with the control groups with average length 0.5 to 1 cm, while control groups showed values of 1.7 to 2.5 cm. Testosterone levels were 0.50 ng/ml in rats subjected to porta-caval anastomosis while in control groups the levels were 2.20 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

A total of 83 male Japanese quails of the following age groups were used for this study: 11, 18, 25, 32, 35, 37, 39, 41, 43 days, and 7, 9, 17 weeks after hatching. Neoprene-Latex, Tensol-Cement, and the china ink were injected via the aortic arch. In most of male Japanese quails, the testes are supplied by the A. testicularis originated from the Aorta descendens through a common trunk with the A. renalis cranialis. But in only 3 quails had this artery originated directly from the Aorta descendens on either side. In 9 quails had the A. testicularis accessoria originating independently from the Aorta descendens and running cranially or caudally in short distance to the normal A. testicularis. The arteries for the Ductus deferens were divided into 3 categories. The Rami ureterodeferentiales craniales were spread out from A. testicularis or Rami epididymales. The Rami ureterodeferentiales medii came from the A. renalis media and the A. renalis caudalis. The Rami ureterodeferentiales caudales originated from the A. caudae lateralis and A. pudenda. The Receptaculum ductus deferentis, the Corpus vasculare paracloacalis and the Phallus nonprotrudens in the Cloaca were supplied from the thick Ramus cloacalis of the A. pudenda. The Ramus bursalis of this artery supplied the Glandula proctodaealis and the Bursa cloacalis, and was also thick. The arteries to the genital organs were observed in the 11 day old male quail. The A. pudenda began developing at about 30 days after hatching when the quail's body matured. While the A. testicularis began developing at about 40 days after hatching when the male Japanese quail was full of the spermatogenic activity.

Variations in anatomy were found quite frequently during bilateral gonadal vein dissection and resection for pelvic varices in the past 5 years (120 cases). In about one fourth of the cases, routine gonadal phlebography was not technically feasible or did not correlate exactly with the operative findings. Some cases of male varicocele showed recurrence after surgery. These facts, in addition to the scarce information provided by anatomy textbooks, induced us to study thoroughly the gonadal veins. One hundred cadaver dissections (200 veins) were done for length, diameter, number, and location of valves and collaterals, number of trunks in each side, and mode of termination in the renal vein and vena cava. Topographic division of the veins by thirds facilitated the information. Variations from the classic anatomic description were encountered frequently. As to the number of trunks, at the middle third, where the vein is usually divided, only 60% have one trunk on the left and only 75% have one on the right side. The rest are multiple; as many as four and six trunks in the lower third were found. The knowledge of these anatomic variations, not clearly described before, is of great importance to both surgeons and invasive radiologists and conducive to successful results.

A case is presented to illustrate the evaluation of varicocele in a boy by a combined technique of spermatic venography and excretory urography. The pertinent technical, anatomical and clinical considerations are discussed. Varicocele is a clinical diagnosis. If the diagnosis is suspected or the clinical presentation is unusual, then a combined technique of spermatic venography and excretory urography may be of value.

Translumbar aortographies performed in 91 patients for limiting leg ischemia were reviewed, and stenosis was graded by points from one (normal vessel) to five (complete occlusion) for each vessel. Of 62 nondiabetic patients, 18 (29 per cent) were impotent, while of 29 diabetics, 17 (58.6 per cent) were impotent (p less than 0.01). Significantly greater stenosis (p less than 0.005) was found in the internal pudendal arteries of impotent patients when compared statistically with potent patients. This was true for the group as a whole, for diabetics and nondiabetics, and for patients over 50 years old both with and without diabetes. There was no significant difference in the extent of stenosis of the iliac arteries (common and internal) between potent and impotent patients. There was also no significant difference in the pattern of stenosis between diabetic and nondiabetic patients in the group as a whole and also in the potent and impotent subgroups analyzed separately. Neither diminished femoral pulses nor aortographic evidence of external iliac and common femoral arterial stenosis correlated significantly with impotence. These observations indicate that vascular lesions are as important in diabetics as in nondiabetics in the genesis of impotence. Clinical implications regarding diagnostic investigations and treatment are discussed.

Among the iatrogenic complications of the surgery of varicose veins, the author has encountered several cases of impotence following stripping of the internal saphenous. Without rejecting the possibility of a psychogenic impotence due to the operation itself, he raises the question of the possible mechanism of this complication. Alter considering the vascularization of the erectile body and the haemodynamic process of erection, he reviews the arterial and venous causes of impotence and sets out the hypothesis which he feels to be the most plausible. Under the arch of the internal saphenous passes the external pudendal artery; injury to this does not usually produce any significant damage, since the erectile body of the penis is vascularized by the internal pudendal artery. But if as a result of a congenital anomaly of the internal pudendal, the supply derives from the external pudendal, ablation of the latter, sometimes carried out by surgeons in the course of ligature of the arch of the internal saphenous vein, could explain this complication. If this hypothesis proves correct, it would be necessary to require surgeons to touch the external pudendal artery in order to avoid this complication, which though exceedingly rare, is psychologically traumatic.

This review considers diagnosis and treatment of vasculogenic impotence. It describes current information related to normal mechanisms of penile erection and pathophysiology of organic impotence, methods of preoperative diagnosis, quantitative evaluation of penile blood flow and operative techniques to be employed in aneurysmal or occlusive aorto-iliac disease. The importance of preserving internal iliac flow and neural fibres enervating the genitalia is stressed. Large vessel reconstructions have proved practical in maintaining or restoring normal erectile function, but at present reconstructions of isolated pudendal or penile artery occlusions are experimental. Medical therapy can be effective in certain marginal cases of small vessel occlusion.

Radio-opaque contrast medium was injected into the deferential vein of the dog in vivo and was seen to pass, in two of five animals, into the intrinsic veins of the prostate and the cavernous tissue of the prostatic urethra. In other cases an increase in abdominal venous pressure was required to bring about the retrograde flow. The observations support the previously cited evidence that the prostate receives hormonal stimuli via the deferential vein.

A common opinion among physicians is that some symptoms from the prostate gland are stress-dependent. However, no experimental support for this view has been presented. In the present study blood perfusion of the major genital organs of male rats were measured after they had been subjected to experimental "short- and long-term" stress stimuli. The blood-flow measurements were made by means of a radioactive microsphere technique. The used experimental "short-term" stress reduced the prostatic blood flow by approximately 50 percent. A decreased blood flow and a concomitant atrophy, indicating that the reduction in blood flow has been in force over a prolonged period of time, were noticed in all examined genital organs of the rats subjected to prolonged stress stimuli. The decreases in blood flow and weight were most pronounced in the prostate gland.

A new technique of indirect revascularization of the corpora cavernosa in patients with sexual impotence of distal arterial origin is described. It consists of a termino-lateral anastomosis between the epigastric artery and the deep dorsal vein of the penis, followed by a latero-lateral anastomosis between that vein and one of the corpora cavernosa. This double epigastro-venous and veno-cavernous fistula has proved effective and has given satisfactory functional results in 5 patients followed up for a mean period of 12 months.

The copulatory apparatus of the male turkey consists of two parts: the Phallus nonprotrudens, composed of the paired Corpora phallica lateralia and Plicae lymphaticae, and the paired Corpora vascularia paracloacalia. The Corpus vasculare paracloacale receives its vascular supply and drainage from the Arteria (A.) and Vena (V.) pudenda interna, respectively, and its innervation from the Nervus pudendus internus. During sexual stimulation lymph produced in the Corpora vascularia paracloacalia rapidly flows through the lymph sinuses into larger lymph channels located in the Phallus nonprotrudens producing tumescence. With detumescence, the lymph flows cranially from Phallus nonprotrudens into the Vasa lymphatica pudenda interna, which parallels the A. and V. pudenda interna.

The anatomical structure of the ejaculatory groove region (EGR) of the drake was investigated macro- and microscopically in connection with its function. The EGR covers a part of the urodeum and the second fold of the cloaca. The EGR is unique to the males and is characterized by red colored appearance and less smooth surface of the mucosa. The mucosa of EGR forms folds giving less smooth surface to it and is lined with psuedostratified columnar epithelium. A vascular layer which contains many capillaries and lymphocytes and gives red color to the mucosa lies just beneath the epithelium. The EGR develops at puberty together with the developments of the testis and the penis. Blood supply and the arrangement of the lymphatic sinuses of EGR were described and their functions were discussed.

A retrospective analysis of 177 retrograde venographies of the left renal and gonadal veins was made. Renal venography seems a useful investigation in cases of male infertility without clinically palpable variococele. Selective venography of the internal spermatic vein seems of little value, as it may give false positive ("iatrogenic") spermatic venous reflux. This can be explained by passing the catheter over a competent valve. After operation for subclinical varicocele, the spermiogram does not change, but a pregnancy rate of 30% is obtained. These results are analogous to those obtained in an operated group of clinical varicoceles.

The localization of vasoactive intestinal polypeptide (VIP) in the male genitourinary tract was investigated in the rabbit and man by means of radioimmunoassay and immunohistochemistry. In addition, the in vitro effect of VIP upon penile smooth muscle from man, the Vervet monkey, and the rabbit was investigated. Significant concentrations of VIP immunoreactivity were found in the human penis and all the organs of the rabbit genital tract apart from the testis. VIP immunoreactive nerve fibres were observed in the erectile tissue of the human and rabbit penis and in the other organs of the rabbit genital tract apart from the testis. Fibres were most abundant in association with blood vessels, in smooth muscle tissue, and subepithelially in glandular tissue. Strips of smooth muscle taken from the corpus cavernosum of Vervet monkey and man showed a dose-dependent relaxation in response to VIP at concentrations of 6 X 10(-8) mol X L-1 and 6 X 10(-7) mol X L-1. The data indicate that VIP may be an inhibitory neurotransmitter involved in the nervous control of penile erection.

Venography has been proposed as an aid in preventing persistent varicoceles after internal spermatic vein ligation. Since 1984, 10 patients between 4 and 18 years old underwent successful outpatient varicocelectomy with high ligation and intraoperative internal spermatic venography to assure that all appropriate veins and collaterals had been isolated before ligation.