Faculty Bibliography

BACKGROUND:Limits on the frequency of PSA testing and an endpoint for the age of the screened population have not been established. The numbers of performed serum PSA tests, cost evolution, and utilization patterns by various subspecialties in one medical center were analyzed to gain insight into trends in screening for early detection of prostate cancer and gather information about the appropriate use of PSA testing. METHOD/METHODS:Computerized records were reviewed for numbers of PSA tests obtained, prostate biopsies performed, and prostate cancer cases diagnosed in the VA NJ-Health Care System from 1996 to 1998. In addition, PSA tests performed during two representative weeks in 1996 and 1997 were analyzed to evaluate a smaller cohort of patients with regard to age, consequences of the test results in their management, and subspecialties ordering the tests. RESULTS:PSA testing increased steadily between 1992 and 1998, with the most significant change (152% increase) between 1997 (9,410 tests) and 1998 (23,684). Prostate cancer diagnoses by biopsy were 164/434 (37.8%) in 1997 and 195/507 (38.5%) in 1998. For the 14,274 additional PSA tests obtained in 1998, 31 more prostate cancers were diagnosed. Prostate cancer diagnoses per PSA tests were 164/9,410 (1.8%) in 1997 and 195/23,684 (0.8%) in 1998. Primary care providers ordered 61% of the PSA tests. CONCLUSIONS:Most PSA tests at this institution were ordered by general practitioners, and the number of PSA tests ordered for men over 75 was high. The dramatic increase between 1997 and 1998 was not accompanied by a similar rise in the diagnosis of prostate cancer, raising the possibility of indiscriminate PSA testing or unnecessary repetition of testing. Guidelines for prostate cancer screening and continued PSA testing in the geriatric population may need further clarification.

Urologists and health care professionals treating erectile dysfunction face a significant challenge in caring for the HIV-positive patient who seeks restoration of normal sexual function. The encounter between the health care provider and the patient in this setting requires knowledge of HIV disease and potential drug interactions specific to this population, as well as thorough counseling on strategies aimed at reducing the infectiousness of HIV-1. The interaction extends beyond the immediate boundaries of the doctor-patient relationship and their respective rights, to include careful consideration of the rights of the partner/s and the society as a whole. This paper is a summary and analysis of presentations and discussions by medical, legal, nursing and bioethics specialists in an interactive seminar on this topic.

AIM/OBJECTIVE:An improved understanding of the relationship between radial and axial rigdity values would enable better appreciation of the clinical usefulness of RigiScantrade mark, the most widely utilized determination of erectile rigidity testing. Previous studies have shown that axial rigidity (measured by buckling forces) correlated well with radial rigidity (measured by RigiScantrade mark) for radial rigidity values below 60%. For radial rigidity exceeding 60%, there was poor correlation. Heretofore, there has been no physiologic explanation of this phenomenon. METHODS:During dynamic pharmacocavernosometry in 36 impotent patients, we investigated the relationship between axial buckling forces and RigiScan radial rigidity and, for the first time, how they both vary with pressure, (which we varied over over a wide functional range). In addition, we recorded multiple penile length and diameter values enabling us to relate, also for the first time, axial and radial rigidity to individual mechanical erectile tissue and penile geometric properties. RESULTS:Marked differences were found in the manner RigiScan radial rigidity units and axial buckling force magnitudes increased with increases in intracavernosal pressure values in each individual. The former asymptotically approached a maximum finite value while the latter increased continuously towards infinity. Based on data in this study, RigiScan radial rigidity values greater than 55% may be considered a necessary criteria for vaginal intromission capability in all partners but it is not a sufficient one. CONCLUSIONS:Axial and radial rigidity share a common dependency upon intracavernosal pressure, however, they are also dependent upon other unique physical determinants. For axial rigidity, additional dependent variables include cavernosal erectile tissue properties and penile geometry, while for radial rigidity, this may include tunical surface wall tension properties. Clinical devices which assess functional penile rigidity should utilize axial and not radial rigidity testing.

PURPOSE/OBJECTIVE:Scientific model systems for physiological evaluation and investigation of pathophysiologies in clitoral function have been limited. The aim was to develop a New Zealand White rabbit clitoral corpus cavernosum smooth muscle cell culture. METHODS:Clitoral corpus cavernosum erectile tissue was harvested and placed in culture. Clitoral smooth muscle cells which migrated out from explants were grown to confluence and subcultured. Characterizations were performed by morphological and biochemical analyses. RESULTS:The cells exhibited typical morphologic characteristics of smooth muscle cells. Indirect immunofluorescence studies confirmed the presence of a-smooth muscle cell actin. Androgen and estrogen receptors were detected by specific antibodies and binding studies. The cells expressed subtypes of TGF-beta receptors. Treatment with 80 pM TGF-beta 1 24 h resulted in induction and/or increased availability of TGF-beta receptors. CONCLUSIONS:An in-vitro cell culture system using rabbit clitoral smooth muscle cells was developed. These smooth muscle cells retain their biochemical and functional integrity. This in-vitro cell culture system may facilitate studies aimed at understanding the molecular basis of female sexual function.