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Biomedical subjects

J P Pryor

Publications and source records attributed to J P Pryor.

At least 19 recordsLinked to original sources
PubMed1992

Müllerian duct (prostatic utricle) cyst: diagnosis and treatment in subfertile males.

Müllerian duct cysts causing ejaculatory duct obstruction were discovered in 26 subfertile males; 21 patients had either azoospermia or very severe oligozoospermia. Characteristic seminal findings were a small volume ejaculate with acid pH and little or no fructose. The lesions were demonstrated by vasography and treated by endoscopic incision. After surgery there was a distinct improvement in volume of the ejaculate and sperm concentration in 10 patients, although another 10 patients continued to have azoospermia or severe oligozoospermia due to either persisting obstruction or secondary epididymal blocks. Eight female partners became pregnant.

Adult↗
PubMed1992

Pre-operative assessment of Peyronie's disease using colour Doppler sonography.

Colour Doppler ultrasonography was used to assess 39 patients with Peyronie's disease with a suspected organic cause for their impotence. In 20 patients who complained of a uniform loss of erection, the impotence was likely to be functional in origin (90%) or occasionally venogenic (10%), the penile arterial blood flow being normal. However, patients who complained of distal flaccidity were likely to have an organic cause for their impotence (68%). This was due to proximal arterial disease (10%), plaque involvement of the distal vessels (37%), veno-occlusive dysfunction (5%) or to the soft glans syndrome (16%).

Adult↗
PubMed1992

Testicular prostheses: the patient's perception.

There is a paucity of data to determine if the insertion of a testicular prosthesis is effective in overcoming the psychological effects of an absent testis. A review of 25 patients who had had testicular prostheses showed a high overall level of satisfaction in the 19 patients who were traced. This satisfaction was subject to some qualification.

Adolescent↗
PubMed1992

The treatment of Peyronie's disease with tamoxifen.

This is a preliminary study of the treatment of 36 patients with Peyronie's disease who received tamoxifen 20 mg twice daily for 3 months. An improvement occurred in 16 of 20 patients with penile pain, in 11 of 31 patients with an erectile deformity and 12 of 35 patients had a plaque shrinkage of at least 1 cm. Some improvement occurred in 6 of the 8 patients with a histologically confirmed inflammatory infiltrate of the plaque but not in any of the 4 patients without an infiltrate. The inflammatory infiltrate was found in patients in whom the duration of the disease was less than 4 months.

Adult↗
PubMed1992

The culture of human epididymal epithelium and in vitro maturation of epididymal spermatozoa.

OBJECTIVE: To promote human sperm maturation in vitro. DESIGN: Spermatozoa from the proximal epididymis were coincubated with epididymal epithelial fragments. SETTING: Hospital and research institute. PATIENTS, PARTICIPANTS: Tissue samples were obtained from men undergoing epididymovasostomy procedures or vasectomy. INTERVENTIONS: Fragments of epididymal epithelium formed everted epithelial spheres that in the presence of androgen maintained cell integrity. Coincubation for up to 48 hours of caput epididymal spermatozoa with 3-day-old epithelial cultures from the cauda epididymis was undertaken. MAIN OUTCOME MEASURES: Morphology of epididymal epithelium was assessed by light and electron microscopy. Pulse labeling of tissue in vitro with 35S-methionine was performed with analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis technique and fluorography. Spermatozoa were assessed for progressive motility and their capacity to bind to salt-stored human zona pellucidae. RESULTS: Epididymal fragments formed everted epithelial spheres that maintained cell integrity and functional morphology for 5 to 7 days. Specific proteins were synthesized in culture, in particular, proteins of 20, 22, 40, and 66 kd. Coincubation of caput epididymal spermatozoa with cultures from the cauda epididymis induced a significant increase in progressive sperm motility and sperm binding to salt-stored human zona pellucidae compared with control cultures of epithelium incubated in the absence of androgens or overgrown with fibroblasts. CONCLUSIONS: Aspects of human sperm maturation processes can be mimicked in vitro using coculture techniques with epididymal epithelium. This method may be valuable for improving the fertilizing capacity of human spermatozoa retrieved from the proximal region of the excurrent ducts.

Cells, Cultured↗
PubMed1991

Ejaculatory duct obstruction in subfertile males: analysis of 87 patients.

OBJECTIVE: To study the causes, presentation, and treatment of ejaculatory duct obstruction in subfertile males. DESIGN: Collaborative retrospective study of clinical experience collected by two urologists over a 15-year period. SETTING: National Health Service and Private Care Hospitals. PATIENTS, PARTICIPANTS: Subfertile males with azoospermia (n = 67), very severe oligozoospermia (n = 17), oligozoospermia (n = 1), or normal sperm concentration (n = 2) in small volume ejaculates with acid pH and little or no fructose. INTERVENTIONS: Exploration of scrotum with vasogram and testicular biopsy, plus reconstruction if possible. MAIN OUTCOME MEASURES: Follow-up seminal analysis and occurrence of pregnancy in female partners. RESULTS: The causes were: müllerian duct cyst (n = 17); wolffian duct malformation (n = 19); previous surgical trauma (e.g., imperforate anus) (n = 15); previous genital infection (n = 19); tuberculosis (n = 8); megavesicles (pathological dilatation of vesicles and ampullae of unknown cause) (n = 8); and carcinoma of prostate (n = 1). After incision of Mullerian duct cysts, five pregnancies were produced. Five pregnancies occurred in the other groups using a variety of surgical techniques. CONCLUSIONS: Routine vasography has shown that ejaculatory duct obstruction is not as rare as previously thought. The diagnosis should not be missed because the condition is simple to correct surgically in certain cases.

Constriction, Pathologic↗
PubMed1991

The human penis: an unusual penetration of NPY-immunoreactive nerves within the medial muscle coat of the deep dorsal vein.

The deep dorsal penile vein was obtained from seven patients undergoing surgery for erectile dysfunction. The veins were studied histologically and immunohistochemically for serotonin, dopamine beta-hydroxylase, vasoactive intestinal polypeptide, neuropeptide Y, substance P, calcitonin gene-related peptide, somatostatin, and [Leu]- and [Met]enkephalin. Histologically, the deep dorsal vein was found to be a large muscular vein with a thin endothelial lining. The tunica media was composed of an inner longitudinally and an outer circularly arranged smooth muscle layer. Numerous vasa vasorum (up to 30 in a single transverse section) were found in the tunica adventitia. The greatest density of nerves supplying the deep dorsal vein and vasa vasorum were neuropeptide Y-immunoreactive nerves followed (in a decreasing order) by vasoactive intestinal polypeptide- and dopamine beta-hydroxylase-immunoreactive nerves. Substance P-, calcitonin gene-related peptide- and somatostatin-immunoreactive nerves, but not serotonin-, [Leu]- and [Met]enkephalin-immunoreactive nerves, were occasionally found around the deep dorsal vein. All these nerve fibers were confined to the adventitial-medial border except neuropeptide Y-immunoreactive nerves which in addition penetrated the tunica media to the subendothelial layer of the deep dorsal vein. In contrast, neuropeptide Y-immunoreactive nerves supplying the vasa vasorum were always confined to the adventitial-medial border. The possible function of the medial innervation of the deep dorsal vein by neuropeptide Y-immunoreactive nerves is discussed.

Adult↗
PubMed1991

Treatment of organic impotence.

A review of 86 patients referred to a urological clinic with impotence showed that in 58% the causation was predominantly psychogenic. These patients were managed with psychosexual counselling. The various treatment options were discussed with those patients with organic impotence and 14 underwent the implantation of a penile prosthesis. A review of 130 patients who received penile prostheses in the period 1983 to 1987 was carried out to compare the complications and results obtained with the various types of prosthesis. The overall satisfaction rate was 81%; dissatisfaction usually arose as a result of complications of surgery. These were highest in patients with diabetes and priapism. The complications were also related to the type of prosthesis used.

Bacterial Infections↗
PubMed1990

Comparison of prednisolone and placebo in subfertile men with antibodies to spermatozoa.

43 subfertile men with circulating antibodies to spermatozoa entered a double-blind crossover trial and received soluble prednisolone (20 mg twice daily on days 1-10 of the female partner's menstrual cycle, followed by 5 mg on days 11 and 12) or matching placebo tablets for 9 months each. 9 pregnancies were produced by men during prednisolone treatment, compared with 2 by men randomised to placebo (although only 1 was actually taking the placebo). No serious complications were produced, although 60% of those receiving prednisolone experienced mild side-effects.

Agglutination Tests↗
PubMed1990

Vasa aplasia and cystic fibrosis.

Bilateral vasa aplasia is considered an invariable finding in cystic fibrosis, but such patients are rarely seen in male infertility clinics. The improved survival beyond 20 years of age is likely to change this. In a clinical study of a group of male cystics the vasa were absent in 8 of 11 boys and epididymal abnormalities were palpable in the majority. The main cause of infertility appears to be mechanical obstruction. Whether the absence is due to a primary failure of mesonephric duct development or secondary to luminal obstruction and subsequent atrophy is not known.

Adolescent↗
PubMed1989

The incidence and influence upon fertility of antisperm antibodies in seminal fluid following vasectomy reversal.

Seminal plasma samples from men undergoing vasovasostomy were analysed for antisperm antibodies using the indirect immunobead test. A pre-operative assessment showed antisperm antibodies of either IgA or IgG class to be present in 9/27 (33.3%) men. A significant increase (P less than 0.05) in the post-operative incidence of the antibodies was seen in the men who achieved patency (27/45, 60%) but not in those men for whom no sperm were seen in the ejaculate (4/10, 40%). After follow-up for a minimum of 1 year, conception rates for couples in which the male partner had achieved patency were similar in the groups with no antibodies detected post-operatively (12/18, 66.7%) or with IgA alone (2/3, 66.7%), but was reduced significantly in the presence of IgG (1/9, 11.1%; P less than 0.05) or IgA + IgG (3/15, 20.0%; P less than 0.01).

Autoantibodies↗
PubMed1989

Pharmacocavernometry: a modified papaverine test.

The papaverine test has become established in the investigation of impotence. Although a full response to papaverine excludes a significant vascular lesion, failure to respond may be due to either arterial deficiency or venous leakage. Pharmacocavernometry, which combines the papaverine test and an artificial erection test, was performed in 126 patients. Intracorporeal pressure was monitored following the intracorporeal injection of 80 mg papaverine; 10 min later, saline was infused to determine the presence of a venous leak. Five different responses were observed. Patients with a Type 1 or 2 response were psychogenic or neurogenic. Patients with a Type 3 response were arteriogenic and patients with a Type 4 or 5 response had significant venous leakage. The modified papaverine test permits more information to be gained concerning the aetiology of the impotence.

Adult↗
PubMed1988

The value of testing for unmyelinated fibre, sensory neuropathy in diabetic impotence.

Measurement of thermal thresholds provides a means of assessing neurological deficit and in particular of recognising a neuropathic process affecting unmyelinated and small myelinated fibres of the peripheral nerve. These groups of fibres cannot be tested by nerve conduction studies but are particularly susceptible to disease in diabetes. Thresholds for thermal sensation on the sole of the foot were measured in 33 men presenting with erectile dysfunction. All 15 men with erectile dysfunction, which had been considered on clinical grounds to be neuropathic, had abnormal thermal thresholds. Diabetics with non-neuropathic erectile dysfunction had normal results. Whereas tests of unmyelinated sensory fibre function were abnormal in all those with neuropathic erectile dysfunction, electrophysiological measurement of the bulbocavernosus reflex was normal in five of nine men with diabetic neuropathic impotence.

Adult↗
PubMed1988

Surgery for impotence.

Many men presenting with impotence can be cured by surgical intervention. Psychosexual counselling is always beneficial but surgery may be indicated when there is irreversible organic erectile impotence or when there is an anatomical abnormality of the penis preventing coitus. The diagnosis and management of such disorders are summarized.

Erectile Dysfunction↗