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Radical Pelvic Surgery-Associated Sexual Dysfunction sence of erectile activity leads to a state of cavernosal hypoxia [9], although this concept is controversial and has not gained universal acceptance in the sexual medicine community In the accid state, the corporal bodies have a venous pO2, which has been shown in vitro to promote the secretion of brogenic cytokines such as transforming growth factor- (TGF- ) During erection, the corporal smooth muscle is oxygenated and this results (in vitro at least) in the secretion of endogenous prostanoids (prostaglandin E1, PGE1), which in turn, switch off brogenic cytokine production [9] Thus, the health of erectile tissue relies to some extent on the balance between erection and accidity In the patient who has no erectile activity, such as frequently occurs in the earliest phases post-radical prostatectomy, the balance shifts in favor of hypoxia and collagen production Sattar et al have elegantly demonstrated that there may be a correlation between corporal smooth muscle content and intracavernosal pO2 levels [10] Moreland has published a large body of work demonstrating in cell culture models that corporal smooth muscle cells, when exposed to hypoxic conditions, preferentially secrete TGF- , and this is altered to PGE1 once the cells are exposed to normoxic conditions [11 12] Sympathetic hyperinnervation (termed by some as competitive sprouting) refers to the concept that when autonomic nerves are injured, sympathetic bers are biologically primed to recuperate from injury and regenerate more quickly, resulting in un-antagonized sympathetic tone in the end organ [13] Following cavernous nerve injury, this phenomenon results in a state of hypertonia in the penis To synthesize these concepts into a working hypothesis, penile length changes can be divided into early and delayed changes In response to the neural injury that occurs intraoperatively the cavernous nerves undergo Wallerian degeneration and, early on when sympathetic nerve function is in the ascendancy, as stated above, the penis is a hypertonic organ an organ exhibiting sympathetic overdrive Given the fact that the penile smooth muscle is highly contractile in response to adrenergic tone, this results in a penis that patients often refer to as being drawn back in the body A clinical scenario supporting this is the circumcised male whose penis early. ssrs pdf 417 SSRS PDF417 2D Barcode Generator - IDAutomation
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excel macro generate qr code 19 Dec 2018 ... The PDF417 SSRS Barcode Generator for Reporting Services includes both a Native Barcode Generator that is custom code embedded into a ... after surgery appears incompletely circumcised or even uncircumcised The clue that these changes are not the result of permanent structural sequelae is that upon gentle penile stretch the penis readily elongates from its buried position It has been my experience that this hypertonic state is most pronounced within the rst 3 6 months after surgery More concerning are delayed structural changes These result from true irreversible structural alterations in the corporal smooth muscle These structural changes most probably result from a combination of factors (as described above) neural injury-associated denervation, apoptosis, as well as cavernosal hypoxia-induced collagenization in men who experience delayed return of erectile function The difference between these changes and early hypertonicity is evidenced by the reduced or absent penile stretch in the group with permanent smooth muscle alterations It is easy to appreciate how these alterations affect not only length but also girth Finally, whether the institution of a pharmacologic penile rehabilitation program early after RP can abrogate these alterations, remains unanswered at this time ssrs pdf 417 PDF417 Barcode Generator for .NET SQL Reporting Services ...
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