Biomedical subjects

A Shafik

Publications and source records attributed to A Shafik.

At least 289 records · Page 16Linked to original sources

PubMedDate not supplied

Sex hormone status in male rats after exposure to 50 Hz, 5 mTesla magnetic field.

The question of whether extremely low frequency magnetic fields can affect biological system has attracted attention. The theoretical possibility of such an interaction is often questioned and the site of interaction is unknown. The influence of extremely low frequency magnetic field of 50 Hz, 5 mTesla on sex hormone status was studied. 60 male albino rats were divided into 6 groups and were continuously exposed to 50 Hz, 5 mTesla magnetic field generated by magnetic field chamber for periods of 1, 2 and 4 weeks. For each experimental point, sham treated group was used as a control. Assay of serum testosterone LH, FSH, and prolactin were performed. Serum testosterone showed no significant changes. FSH showed significant increase than sham exposed group after 1 week magnetic field exposure. LH showed significant increase than sham exposed group only after 4 weeks magnetic field exposure, while serum prolactin hormone level showed a significant increase in all magnetic field exposed groups than sham exposed animals. Exposure to 50 Hz, 5 mTesla magnetic field for periods of 1, 2 and 4 weeks has no effect on testosterone level, some changes on FSH and LH serum levels and increase in serum prolactin level.

Animals↗

PubMedDate not supplied

Molecular andrology as related to sperm DNA fragmentation/sperm chromatin biotechnology.

Genetic male infertility occurs throughout the life cycle from genetic traits carried by the sperm, to fertilization and post-fertilization genome alterations, and subsequent developmental changes in the blastocyst and fetus as well as errors in meiosis and abnormalities in spermatogenesis/spermatogenesis. Genes encoding proteins for normal development include SRY, SOX9, INSL3 and LGR8. Genetic abnormalities affect spermatogenesis whereas polymorphisms affect receptor affinity and hormone bioactivity. Transgenic animal models, the human genome project, and other techniques have identified numerous genes related to male fertility. Several techniques have been developed to measure the amount of sperm DNA damage in an effort to identify more objective parameters for evaluation of infertile men. The integrity of sperm DNA influences a couple's fertility and helps predict the chances of pregnancy and its successful outcome. The available tests of sperm DNA damage require additional large-scale clinical trials before their integration into routine clinical practice. The physiological/molecular integrity of sperm DNA is a novel parameter of semen quality and a potential fertility predictor. Although DNA integrity assessment appears to be a logical biomarker of sperm quality, it is not being assessed as a routine part of semen analysis by clinical andrologists. Extensive investigation has been conducted for the comparative evaluation of these techniques. However, some of these techniques require expensive instrumentation for optimal and unbiased analysis, are labor intensive, or require the use of enzymes whose activity and accessibility to DNA breaks may be irregular. Thus, these techniques are recommended for basic research rather than for routine andrology laboratories.

Biotechnology↗

PubMedDate not supplied

Urethral sphincters response to cavernosus muscles stimulation with identification of cavernoso-urethral reflex.

The functional activity of the urethral sphincters during cavernosus muscles' contraction at coitus has been poorly addressed in the literature. We investigated the hypothesis that cavernosus muscles' contraction affects reflex contraction of the urethral sphincters to guard against semen reflux into the urinary bladder or urine leakage from the bladder during orgasm and ejaculation. The electromyographic (EMG) response of the external (EUS) and internal (IUS) urethral sphincters to ischio- (ICM) and bulbo- (BCM) cavernosus muscle stimulation was studied in 15 healthy volunteers (9 men, 6 women, age 39.3 +/- 8.2 SD years). An electrode was applied to each of ICM and BCM (stimulating electrodes) and the 2 urethral sphincters (recording electrodes). The test was repeated after individual anesthetization of the urethral sphincters and the 2 cavernosus muscles, and after using saline instead of lidocaine. Upon stimulation of each of the 2 cavernosus muscles, the EUS and IUS recorded increased EMG activity. Repeated cavernosus muscles' stimulation evoked the urethral sphincteric response without fatigue. The urethral sphincters did not respond to stimulation of the anesthetized cavernosus muscles nor did the anesthetized urethral sphincters respond to cavernosus muscle stimulation. Saline infiltration instead of lidocaine did not affect the urethral sphincteric response to cavernosal muscle stimulation. Results were reproducible. Cavernosus muscles' contraction is suggested to effect EUS and IUS contraction. This action seems to be reflex and mediated through the 'cavernoso-urethral reflex.' Urethral sphincters contraction upon cavernosus muscles contraction during sexual intercourse presumably prevents urine leak from the urinary bladder to urethra, prevents retrograde ejaculation, and propels ejaculate from the posterior to the penile urethra. The cavernoso-urethral reflex can act a diagnostic tool in the investigations of patients with ejaculatory disorders.

Adult↗

PubMedDate not supplied

Identification of c-kit-positive cells in the human prostate: the interstitial cells of Cajal.

The prostate exhibits electric activity in the form of slow waves (SWs) and action potentials (APs). As the interstitial cells of Cajal (ICCs) are considered the pacemaker cells which generate the electric waves, we investigated the hypothesis that the prostate contains ICC. Prostatic biopsies were obtained from 15 healthy volunteers (mean age 36 +/- 3.8 SD years). They were subjected to c-kit immunohistochemistry. Controls for the specificity of the antisera consisted of tissue incubated with normal rabbit serum substituted for the primary antiserum. C-kit-positive cells were identified as fusiform with dendritic processes. The cytoplasm was granular and the nucleus large and oval. Mast cells, also c-kit-positive, were round and lacked the dendritic processes. Immunoreactivity was absent in the negative controls. There were cells in the prostate with morphological and immunological phenotypes similar to ICCs of the gut. We predict an abnormal distribution of these cells in prostatic diseases. The study of the integrity of these cells may prove to be a useful investigative tool in the diagnosis of prostatic diseases and in the planning of an appropriate treatment.

Adult↗

PubMedDate not supplied

Penile erection in dogs by magnetic stimulation of the cavernous nerve.

The study investigated the effect of magnetic stimulation (MS) of the cavernous nerve on penile erection of the dog. A total of 14 male dogs (mean weight 14.8 +/- 3.2 kg) were studied. The cavernous nerve was activated by means of a magnetic coil with a magnetic stimulator, using a stimulation of 70% intensity, 20 Hz frequency and 50 s on and 50 s off for 10-min duration. With the dog lying supine and anesthetized, the magnetic coil was moved over the dorsum of the penis to get the optimal position for obtaining maximal intracorporeal pressure and penile rigidity. This position was found to lie on the penile dorsum in the vicinity of the symphysis pubis. MS with the aforementioned parameters effected an increase of the penile length and diameter as well as of the intracorporeal pressure (p < .0001). The mean latency was 7.8 +/- 2.8 s, and full erection and maximal intracorporeal pressure were achieved after a mean period of 21.4 +/- 5.3 s. Upon off-stimulation, erection and intracorporeal pressure returned to the baseline after a mean of 14.2 +/- 3.2 s. After an off-time of 50 s the response returned and was reproducible indefinitely, provided the off-time period was observed. MS of the cavernous nerve led to full penile erection in the dog. This method is noninvasive, simple, easy, and safe. It can be applied in humans with erectile dysfunction.

Animals↗

PubMedDate not supplied

Physioanatomic entirety of external anal sphincter with bulbocavernosus muscle.

Stimulation of the glans penis evokes contraction of both the bulbocavernosus muscles (BCM) and the external anal sphincter (EAS). This synchronous contraction of the two muscles led us to study their physioanatomic relationship and possible role in erection and ejaculation. Fifteen male cadavers were studied (8 neonatal deaths and 7 adults; mean age 48 years) by dissection. The bulbocavernosus reflex action was performed in 12 healthy male volunteers (mean age 37 years) before and after anesthetizing the EAS. The response of the EAS and BCM to inferior rectal nerve stimulation was assessed in 6 men (mean age 41 years). The superficial fibers of the base loop of the EAS extended forward to the penile bulb where they were arranged into 3 groups: 1 median and 2 lateral. The median fibers, or the "retractor penis muscle," were found inserted into the corpora cavernosa and the lateral fibers, or the "compressor bulbae muscle," into the perineal membrane. Upon glans penis stimulation, both the EAS and BCM contracted synchronously with similar latency and action potentials. During EAS anesthesia, the two muscles did not respond to glans penis stimulation. They contracted simultaneously with similar latency and action potentials upon inferior rectal nerve stimulation. The BCM is an integral part of the EAS, and the muscle in its entirety is appropriately named "anogenital muscle." The muscle plays a dual and synchronous role in fecal control and sexual response.

Adult↗

PubMedDate not supplied

Effect of magnetic stimulation on the electromechanical activity of the rectum: an experimental study.

We recently studied the effect of sacral magnetic stimulation (MS) on the rectal mechanical activity. The current communication investigates its effect on the rectal electric activity. Twelve mongrel dogs (weight 15.2 +/- 3.2 kg, 7 male, 5 female) were anesthetized, the abdomen was opened, and three electrodes were sutured to the rectal serosa. The rectal pressure was recorded by a manometric catheter. The effect of sacral MS on the rectal electric activity and pressure was recorded before and after anesthetization of the sacral skin. Stimulation parameters were set at 70% intensity, 20 Hz frequency, and 1 to 5 s burst activity. Sacral MS of the empty and full rectum effected a significant increase of the rectal electric activity and pressure as well as a decrease of the rectal neck (anal canal) pressure. MS of the anesthetized sacral skin produced no significant changes in the rectal electromechanical activity or the anal canal pressure. MS of the saline-injected sacral skin produced rectal and anal changes similar to those without saline injection. In conclusion, MS presumably produces its effect on the rectum by increasing the rectal electric activity. It might provide a more convenient method for rectal evacuation than electrostimulation through implanted electrodes. The procedure is simple, easy, and noninvasive.

Action Potentials↗

PubMedDate not supplied

Study of the effect of colonic mass movements on the rectosigmoid junction with evidence of colo-rectosigmoid junction reflex.

Mass movements of the left-sided colon bring the colonic material contained in it to the sigmoid colon. The cause why the colonic contents do not pass directly to the rectum but stop short of the rectosigmoid junction (RSJ) was studied. The study comprised 10 healthy volunteers (mean age 39.2 +/- 10.2 years; 8 men, 2 women). A condomended tube was introduced into the descending colon (DC) per anum. The pressure response of the DC, sigmoid colon (SC), and RSJ to condom inflation with carbon dioxide (CO2) in increments of 10 ml was recorded by means of a three-channel microtip catheter. The responses were registered upon inflation of the upper, middle, and lower third of the DC. The test was repeated after individual anesthetization of the descending colon and the RSJ on separate days. Colonic distension with 10 and 20 ml CO2 produced no significant pressure changes in the DC, SC, and RSJ (p > .05); 30 ml distension effected a pressure rise in both the DC (p < .01) and RSJ (p < .05), but no change in the SC pressure (p > .05); and 40, 50, and 60 ml distension produced pressure changes similar to those obtained with 30 ml distension. The RSJ pressure responded to distension of the saline-injected but not of the anesthetized DC. Thus, the RSJ response to colonic distension affirms the hypothesis of the possible involvement of a reflex, which we term colo-RSJ reflex. This reflex seems to regulate the passage of stools from the colon to the rectum. Further studies are required to investigate its role in the diagnosis of defecation disorders.

Adult↗

PubMedDate not supplied

Role of the enteric nervous plexus in rectal motile activity: an experimental study.

The gut innervation is formed by an intrinsic and an extrinsic component. The former is responsible for the intestinal contractions that occur in the total absence of extrinsic innervation. We hypothesize that the intrinsic plexuses do not produce local contraction, but mediate reflex actions of the gut musculature. This hypothesis was investigated in the rectum of the experimental animal. In 16 anesthetized mongrel dogs, the rectum was exposed, and 3 monopolar silver-silver chloride electrodes were sutured serially to the rectal wall and connected to a rectilinear pen recorder. The rectal electric activity was recorded at rest and on rectal inflation while the anal pressure was synchronously registered. The tests were repeated after separate drug administration using phentolamine, propranolol (adrenoceptor blocking agents), atropine (cholinergic blocking agent), drotaverine (direct smooth muscle relaxant), and nitroglycerine. (NO donor, inhibitory noncholinergic, nonadrenergic mediator). Slow waves or pacesetter potentials (PPs) and action potentials (APs) were recorded from the three electrodes. Rectal balloon distension caused an increase of frequency, amplitude, and conduction velocity of these waves, as well as a decrease of anal pressure. Repetition of the test after administration of phentolamine, propranotol, and atropine effected no change in rectal electromyelographic (EMG) activity or anal pressure, while drotaverine and nitroglycerine administration aborted both the electric activity and the anal pressure response. We conclude that the rectal electric activity, presumably responsible for rectal motility, was not aborted by enteric nervous plexus block but by direct muscle relaxant. This suggests that the enteric plexus has no direct action on the rectal motile activity but mediates the rectal reflex actions. This concept might explain some of the hitherto unknown mechanisms of rectal dyssynergia syndromes.

Action Potentials↗

PubMedDate not supplied

Effect of rectal distension on rectal electromechanical activity.

The rectum possesses electric activity in the form of pacesetter potentials (PPs) and action potentials (APs). The latter are associated with rectal pressure elevation and share in the rectal motile activity. A recent study has shown that electric waves are transmitted by the longitudinal but not the circular rectal muscle fibers. Rectal motile activity under normal physiologic conditions was suggested to be induced by the electric waves, that effect longitudinal muscle contraction, as well as by circular muscle stretch resulting from rectal distension. The current study investigated the effect of rectal overdistension on the rectal electromechanical activity aiming at assessing the effect of stool accumulation in the rectum on rectal motile activity. Under general anesthesia, the abdomen of 16 mongrel dogs was opened, the rectum exposed, and 3 electrodes were sutured to the rectal serosa. The rectal pressure was measured by a 10-F catheter connected to a pressure transducer. Rectal distension was achieved by a balloon inflated with carbon dioxide (CO2). Simultaneous recording of the electric activity and rectal pressure was performed during rectal inflation in increments of 10 mL CO2. There was significant increase of rectal pressure as well as of frequency, amplitude, and conduction velocity of PPs and APs on rectal distension. The more the rectal balloon was distended, the more was the increase in rectal pressure and waves variables; the increase was maximal just before balloon expulsion at 40 mL distension. Upon rectal overdistension (50 and 60 mL), no PPs or APs were recorded and the rectal pressure was 0; no balloon expulsion occurred. Rectal overdistension (pathologic distension) appears to abort the electromechanical activity of the rectum and lead to failure of the rectum to expel the balloon. This effect is suggested to be due to overstretch of rectal musculature with a resulting loss of the rectal electric waves and noncontraction of the muscle fibers. These findings appear to explain the cause of rectal atony, which occurs in rectal inertia and leads to constipation.

Action Potentials↗

PubMedDate not supplied

Testicular suspension: effect on testicular function.

The present communication studies the testicular function during suspension of the testicle to the scrotal neck. The material consisted of 28 dogs: 20 test dogs and 8 controls. In the 20 test dogs, the 2 testicles were suspended to the skin at the scrotal neck by 2-3 silk stitches. After one year, the testiculo-scrotal suspension was released. During testicular suspension, there was significant drop in the scrotal-rectal temperature difference. Semen quality showed gradual deterioration so that by the 12th month, 80% of the test dogs were azoospermic. There was a significant drop of serum testosterone and elevation of serum prolactin. 8 of the 20 test dogs which produced pregnancy when mated before testicular suspension, failed after suspension. After release of testicular suspension by 3 months, scrotal-rectal temperature difference, sperm count and morphology and hormonal assay showed normal levels. Mating of the same 8 dogs produced pregnancy. In conclusion, testicular suspension leads to spermatogenic depression and infertility which are reversible.

Animals↗

PubMedDate not supplied

Effect of different types of textile fabric on spermatogenesis. I. Electrostatic potentials generated on surface of human scrotum by wearing different types of fabric.

This paper comprises a study of the electrostatic potentials generated on the surface of the scrotal area when different types of textile fabric were worn. 21 healthy volunteers were divided into 3 equal groups. The first group was dressed in underpants made of 100% polyester, the second of 100% cotton, and the third of a 50:50% polyester:cotton mixture. With an electrostatic kilovoltmeter, the electrostatic potentials were measured 1 h after wearing the pants once at daytime and a second time at night. The test was repeated 4 times, each on a separate day. No electrostatic potentials were detected on the cotton underpants. The polyester pants showed the highest potentials (mean 338.9 +/- 25 SD Volt cm-2) while the mixed polyester:cotton pants produced less than half that level (mean 148.3 +/- 16 SD Volt cm-2). The readings at daytime were higher than at night, probably due to the higher temperature during the day. The accumulated electrostatic charges on the pants are due to the friction of the pants with the skin. As a result of friction, equal and opposite charges are accumulated on the skin surface and on the inner surface of the pants facing the skin. Eventually, an 'electrostatic field' is produced traversing the scrotal contents and may disturb the testicles and/or epididymis leading to disordered spermatogenesis.

Adult↗

PubMedDate not supplied

Extrapelvic cavernous nerve stimulation in erectile dysfunction. Human study.

An extrapelvic subpubic approach was used in dogs to stimulate the cavernous nerve (CN) with a resulting increase in the intracavernous pressure and full erection. This approach was used for the treatment of erectile dysfunction (ED) in 15 men with a mean age of 42.6 years (range from 32 to 55 years). Routine erectile function tests showed normal readings for endocrine assay, Doppler examination of the penile arteries, penobrachial pressure index and cavernosometry. Nocturnal penile tumescence was absent. The CN was exposed through a parapenile incision. The suspensory ligament was divided and the CN searched for in the area bounded by symphysis pubis, penile crura and urethra. A bipolar platinum electrode was implanted around CN and connected to a subcutaneous receiver. Implantation was performed bilaterally in eight subjects and unilaterally in seven. Two weeks after the operation, the CN was stimulated. CN stimulation at 10 Hz frequency led to penile tumescence but no rigidity; intracavernous pressure increased (P < 0.01). Upon increase of stimulation frequency, the penile tumescence as well as rigidity and pressure increased until full erection was achieved at 60 Hz. The latency and stimulation phase decreased with increase of stimulation frequency. Unilateral nerve stimulation induced erection as well. In conclusion, CN stimulation induced full erection in ED. The technique is extrapelvic and safe.

Adult↗

PubMedDate not supplied

Effect of distension of the pharynx and esophagus on the stomach in dogs: experimental evidence for a pharyngoesophagogastric reflex.

PURPOSE: To study the effect of pharyngeal and esophageal distension on the pressure within the stomach aiming at assessing the stomach condition during passage of food boli through the pharynx and esophagus. METHODS: 12 dogs (mean weight 16.2 +/- 3.3 kg) were studied. With the animal under anesthesia, a 4-Fr manometric catheter was introduced into the stomach and a 2-Fr balloon-tipped catheter into the pharynx. The gastric pressure response to pharyngeal and esophageal distension, each at a time, was recorded. Distension was performed in increments of 2 ml of water up to 6 ml. The test was repeated while the pharynx, esophagus or stomach were separately anesthetized using 2% xylocaine. Bilateral truncal vagotomy was done in 4 dogs and the gastric response to pharyngoesophageal distension studied. RESULTS: Pharyngeal distension produced a significant pressure drop of the corpus of the stomach (p < 0.05); the pyloric antrum showed no response. Upper, middle or lower esophageal distension produced gastric response similar to that evoked by pharyngeal distension. The gastric response was abolished on distension of the anesthetized pharynx or esophagus, when the corpus was anesthetized, or after bilateral vagotomy. CONCLUSION: The proximal gastric dilatation on pharyngeal and esophageal distension postulates a reflex relationship between the two actions which we call 'pharyngoesophagogastric reflex'. This reflex is suggested to dilate the proximal stomach preparatory to receiving food boli from the esophagus; it was abolished after anesthetizing its possible two arms arising from the pharyngoesophagus and the stomach, or after vagotomy.

Animals↗

PubMedDate not supplied

Percutaneous peripheral neuromodulation in the treatment of fecal incontinence.

BACKGROUND/AIMS: To assess the results of peripheral neuromodulation for the treatment of fecal incontinence (FI) resulting from uninhibited rectal contraction (URC) or uninhibited anal sphincter relaxation (UASR). METHODS: The work comprised 32 patients (age 38.2 +/- 6.7 years; 22 women) with FI in whom conventional therapy had failed before enrollment in the study. Twenty-six had URC and 6 UASR. Peripheral neurostimulation was effected by posterior tibial nerve stimulation using a Stoller Afferent Nerve Stimulator (UroSurge, Coralville, lowa, USA). The needle was introduced into the skin cephalad to the medial malleolus. Stimulation (parameters: 0.5-10 mA, 200 micros, 20 Hz) was performed every other day for 4 weeks. Functional assessment was done by a questionnaire (incontinence score: 0-20) and physiologic studies. RESULTS: Group 1: 17 patients (13 URC, 4 UASR) had FI improvement, recording a mean score of 1.7 of 20. Group 2: 10 patients (8 URC, 2 UASR) had fair improvement (score 8.6). Group 3: 5 patients had poor results (score 14.8). Rectometric recording showed improvement in groups 1 and 2. Recurrence of symptoms occurred in 8 patients; 6 improved after retreatment. CONCLUSIONS: A percutaneous access to the S(3) spinal region was achieved through the posterior tibial nerve. Improvement of FI was achieved in 78.2%. The technique is simple, easy, without complications and cost-effective. It can be done as an outpatient procedure or by the patient at home. The results need to be reproduced on a large number of patients.

Adult↗

PubMedDate not supplied

Electromotor activity of the cecum and ascending colon: the concept of 'individual pacemakers'.

BACKGROUND/AIMS: The cecum is described as differing anatomically from the ascending colon (AC); yet their similarity or difference in terms of motile activity has not been studied sufficiently. The cecum is separated from the AC by the cecocolonic junction (CCJ) which contains a cecocolonic sphincter. We assumed that the motile activity of the AC is different from that of the cecum and hypothesized that both the AC and the cecum might have different pacemakers which initiate the motile activity. This hypothesis was investigated in the current study. METHODS: The study was performed in 10 subjects (mean age 41.6 +/- 12.8 SD years; 7 women) during the repair of huge abdominal incisional hernias. The electric activity was recorded from 2 monopolar electrodes applied each to the cecum, CCJ and AC. The CCJ was then anesthetized by xylocaine and the electric waves of the cecum, CCJ and AC were registered after 10 and 90 min. The test was repeated using normal saline instead of xylocaine. RESULTS: Electric waves were recorded from the cecum, CCJ and AC in the form of monophasic pacesetter (PPs) and action potentials (APs). The PPs occurred regularly and the APs randomly. The frequency, amplitude and conduction velocity of the waves recorded from the CCJ and AC had higher readings than those from the cecum (p < 0.05). The CCJ and AC showed similar frequency and conduction velocity (p > 0.05). Ten minutes after CCJ anesthetization, electric waves were recorded from the cecum but not from the CCJ or AC; however, electric activity returned after 90 min. Saline injection did not affect the electric activity of the cecum, CCJ and AC. CONCLUSION: The electric wave parameters of the cecum differed from those of the CCJ and AC, suggesting that the motile activity of the CCJ and AC is not a continuation of the motile activity of the cecum and that it might be evoked by 2 different pacemakers. The similarity in frequency and conduction velocity of electric waves of the CCJ and AC, however, most likely denotes that the AC waves are a continuation of those of the CCJ, and that both are evoked by the same pacemaker probably located in the CCJ. The higher amplitude of cecal waves might be due to the thicker cecal musculature compared to that of the AC.

Adult↗

PubMedDate not supplied

Effect of different types of textile fabric on spermatogenesis: electrostatic potentials generated on the surface of the human scrotum by wearing different types of fabric.

This study was conducted to evaluate the effect of the electrostatic potentials generated on the surface of the scrotal area when different types of textile fabric were worn. Twenty-one healthy volunteers were divided into three equal groups. The first group was dressed in underpants made of 100% polyester, the second wore underpants of 100% cotton, and the third wore a 50/50% polyester/cotton mixture. With an electrostatic kilovoltmeter, the electrostatic potentials were measured 1 h after wearing the pants once during the day and a second time at night. The test was repeated 4 times, each on a separate day. No electrostatic potentials were detected on the cotton underpants. The polyester pants showed the highest potentials (mean 338.9 +/- 25 SD V/cm2), while the mixed polyester/cotton pants produced less than half that level (mean 148.3 +/- 16 SD V/cm2). The readings during the day were higher than those at night, probably due to the higher temperature during the day. This study could explain the cause of diminished spermatogenesis in dogs dressed in polyester pants. A new theory is put forward holding that the polyester underpants create an "electrostatic field" across the scrotal sac that disturbs the testicular and/or epididymal function.

Adult↗

PubMedDate not supplied

Pudendal canal decompression in the treatment of erectile dysfunction.

The results of the treatment of 7 patients with neurogenic erectile dysfunction (ED) by pudendal canal decompression are presented. Ages ranged from 46 to 56 years. Patients had penile, perineal, and scrotal hypoesthesia or anesthesia. EMG of the external urethral sphincter and levator ani muscle revealed diminished activity. There were increased bulbocavernosus and pudendal nerve terminal motor (PNTML) latencies. Patients tested normal for endocrine assays, Doppler examination of the penile arteries penobrachial pressure index, and cavernosometry. Nocturnal penile tumescence activity was absent. These findings pointed to neurogenic ED due to pudendal canal syndrome (PCS). Pudendal canal decompression was done through a para-anal incision. The inferior rectal nerve was followed to the pudendal nerve in the pudendal canal, which was slit open. Mean followup was 19.6 months. No complications were encountered. ED improved in 6 of the 7 patients 2-6 months postoperatively. Sensory and motor changes also improved. It is suggested that chronic straining at stool in these patients led to levator subluxation and sagging, and to pulling on the pudendal nerve with a resulting entrapment in the pudendal canal, pudendal neuropathy, and PCS. ED results from involvement of the penile and perineal branches of the pudendal nerve. To conclude, PCS may cause ED, which improves with pudendal canal decompression.

Adult↗