Coupling of alpha(1)-Adrenoceptors to ERK1/2 in the Human Prostate

Introduction: alpha(1)-Adrenoceptors are considered critical for the regulation of prostatic smooth muscle tone. However, previous studies suggested further alpha(1)-adrenoceptor functions besides contraction. Here, we investigated whether alpha(1)-adrenoceptors in the human prostate may activate extracellular signal-regulated kinases (ERK1/2). Methods: Prostate tissues from patients undergoing radical prostatectomy were stimulated in vitro. Activation of ERK1/2 was assessed by Western blot analysis. Expression of ERK1/2 was studied by immunohistochemistry. The effect of ERK1/2 inhibition by U0126 on phenylephrine-induced contraction was studied in organ-bath experiments. Results: Stimulation of human prostate tissue with noradrenaline (30 mu M) or phenylephrine (10 mu M) resulted in ERK activation. This was reflected by increased levels of phosphorylated ERK1/2. Expression of ERK1/2 in the prostate was observed in smooth muscle cells. Incubation of prostate tissue with U0126 (30 mu M) resulted in ERK1/2 inhibition. Dose-dependent phenylephrine-induced contraction of prostate tissue was not modulated by U0126. Conclusions: alpha(1)-Adrenoceptors in the human prostate are coupled to ERK1/2. This may partially explain previous observations suggesting a role of alpha(1)-adrenoceptors in the regulation of prostate growth. Copyright (C) 2011 S. Karger AG, Base

Increased frequency and nocturia in a middle aged male may not always be due to Benign Prostatic Hypertrophy (BPH): a case report

Primary signet ring cell carcinoma of urinary bladder is a rare type of bladder tumor and carries a very high mortality rate. It may have a clinical presentation similar to common diseases like Benign Prostatic Hypertrophy (BPH) and the management options are extremely limited. We report a case of 58 year old Caucasian male who presented with a 5 month history of increased frequency of urination, nocturia and weight loss without any fever or hematuria. He was found to have an increased creatinine of 2.8 mg/dl and a prostate specific antigen level of 0.18 ng/ml. His azotemia was thought to be secondary to BPH. A foley catheter was initially placed with a plan for outpatient follow up. On removal of the catheter his problems persisted and he returned to the hospital. Diagnostic work up including abdominal ultrasonography, computed tomography (CT) scan, retrograde pyelogram, cystography and cystoscopic biopsies revealed the diagnosis of primary signet ring cell carcinoma of urinary bladder. Although cystectomy was planned, our patient passed away before this could be done

COMBINED INTRACAVERNOUS INJECTION OF PAPAVERINE AND STIMULATION (CIS) TEST

The inhibitory effect of the overactivity of the sympathetic nervous system that results from outpatient clinical conditions leads to poor erectile response to intracavemous injection of papaverine. The effects of self manual genital stimulation for improvement of erectile quality in insufficient papaverine response were investigated in 171 impotent men. Twenty-nine (63.04%) of 46 patients who had a normal vascular system showed partial response to papaverine. Following self manual genital stimulation, full erection was achieved in all of them. Better erections were achieved in 28 of 42 patients with arterial disease. In patients subclassified as having slight, moderate, and severe arterial disease, improved erections were noted in 100%, 71.42%, and 64.28%, respectively. In the mixed vascular (arterial + venous) disease group (n = 46), the combined intracavernous injection of papaverine and stimulation (CIS) test led to a better erection in only 41.30%, whereas in the pure venogenic group (n = 37), this percentage was 66.66%. The inhibitory effect of the overactivity of the sympathetic nervous system is significantly reduced by the CIS test

Intratunical bupivacaine and methylprednisolone instillation for scrotal pain after testicular sperm retrieval procedures

Aim: To investigate the effect of intratunical instillation of bupivacaine and methylprednisolone for scrotal pain, swelling and peritesticular fibrosis due to testicular sperm retrieval procedures. Methods: A total of 65 patients were randomly divided into two groups. In the instillation group (GI), 34 patients were administered 2.5 mL of 0.5 % bupivacaine combined with 10 mg/mL methylprednisolone before closure of the tunica vaginalis. In the control group (GC), 31 patients only received analgesics postoperatively by intramuscular route. The pain (by visual analogue scale, VAS) and duration of pain-free period after surgery between the two groups were evaluated at 2 and 4 h and at days 2 and 7 postoperatively. Results: The mean pain scores were significantly lower in the GI than in the GC group at 2 and 4 h after surgery (P<0.05 and P<0.01, respectively). The mean duration of pain free interval after the procedure was 47.8 +/- 16.9 (12-72) h in GI, which was significantly longer than that in GC [(9.9 +/- 3.6; 4-20) h]. Besides, in the GI, 29 % of patients were completely free from pain and 67 % had no scrotal swelling, but in the GC, all the patients required additional NSAID injection due to pain and only 3 % had no scrotal swelling. Conclusion: This study confirms that direct intratunical instillation of bupivacaine and methylprednisolone around the testis reduces the postoperative pain, scrotal swelling and peritesticular fibrosis

Evaluation and therapeutic approaches of voiding and erectile dysfunction in neurological Behcet's syndrome

Purpose: Behcet's syndrome is a progressive inflammatory disease which involves multiple systems. It is characterized by 3 main symptoms of iridocyclitis, and oral and genital ulcerations, Nervous system involvement is seen rarely in this clinical entity and is known as neurological Behcet's syndrome. Inflammation usually occurs in the brain stem, cerebellum and medulla spinalis. Voiding and erectile dysfunction can be due to progressive inflammatory reactions in the nervous and vascular systems. We prospectively evaluated the dysfunctional bladder and penis, and therapeutic options were evaluated prospectively

Does the positive intracavernous papaverine test always indicate a normal penile vascular system?

Objective: A positive intracavernous papaverine test has been presumed to determine normal erectile hemodynamics. Recently, positive erectile responses to intracorporeal injection tests were reported in patients with penile arterial insufficiency. Methods: This hypothesis was assessed by obtaining hemodynamic data using color Doppler ultrasonography in 417 patients with erectile dysfunction aged between 20 and 73 years (mean 43.06 +/- 13.66). A normal penile vascular system was found in 95 patients (22.79%), veno-occlusive dysfunction in 76 (18.22%), arteriogenic erectile dysfunction (ED) in 113 (27.10%) and mixed-type ED in 133 (31.89%). Results: A positive erection response was achieved in 176 patients with combined intracavernosal injection of 60 mg papaverine and self-manual genital stimulation (CIS) test, while a negative response was observed in the remaining 241 (57.79%). Color Doppler ultrasonography combined with pharmacological erection has proved a normal penile vascular system in 94 (53.41%) and penile arterial insufficiency in 82 (46.59%) patients of those who gave a positive response to the CIS test. Also, a positive CIS test response was observed in all patients with unilateral arterial insufficiency (n = 31) and in 51 patients (62.19%) out of 82 with bilateral arterial insufficiency. Conclusion: A positive intracavernous papaverine test indicates veno-occlusive dysfunction competence but does not necessarily signify a normal penile arterial system. The CIS test should be combined with color Doppler ultrasonography in order to determine the vascular component of ED, since the differentiation is not possible between slight penile arterial insufficiency and psychogenic or neurogenic impotence with the CIS test