BackgroundThe National Bariatric Surgery Registry (NBSR) is the largest bespoke database in the field in the United Kingdom.ObjectivesOur aim was to analyze the NBSR to determine whether the effects of obesity surgery on associated co-morbidities observed in small randomized controlled clinical trials could be replicated in a "real life" setting within U.K. healthcare.SettingUnited Kingdom.MethodsAll NBSR entries for operations between 2000 and 2015 with associated demographic and co-morbidity data were analyzed retrospectively.ResultsA total of 50,782 entries were analyzed. The patients were predominantly female (78%) and white European with a mean age of 45 ± 11 years and a mean body mass index of 48 ± 8 kg/m2. Over 5 years of follow-up, statistically significant reductions in the prevalence of type 2 diabetes, hypertension, dyslipidemia, sleep apnea, asthma, functional impairment, arthritis, and gastroesophageal reflux disease were observed. The "remission" of these co-morbidities was evident 1 year postoperatively and reached a plateau 2 to 5 years after surgery. Obesity surgery was particularly effective on functional impairment and diabetes, almost doubling the proportion of patients able to climb 3 flights of stairs and halving the proportion of patients with diabetes related hyperglycemia compared with preoperatively. Surgery was safe with a morbidity of 3.1% and in-hospital mortality of .07% and a reduced median inpatient stay of 2 days, despite an increasingly sick patient population.ConclusionsObesity surgery in the U.K. results not only in weight loss, but also in substantial improvements in obesity-related co-morbidities. Appropriate support and funding will help improve the quality of the NBSR data set even further, thus enabling its use to inform healthcare policy.

Priapism is defined as a penile erection that persists for 4 h or longer and is unrelated to sexual activity. Its identification is important as lack of timely treatment (particularly of the low flow/ischaemic subgroup) can result in persisting erectile dysfunction as a consequence of irreversible corporal fibrosis. This review describes the physiology and anatomy of the normal erection, the aetiology and pathophysiology of the different types of priapism, and the role of the radiologist in the management of the condition. The treatment of iatrogenic priapism following intracavernosal injection of pharmacostimulant is discussed.

ABSTRACT. Erectile dysfunction (ED) represents a common and debilitating condition with a wide range of organic and non-organic causes. Physical aetiologies can be divided into disorders affecting arterial inflow, the venous occlusion mechanism or the penile structure itself. Various imaging modalities can be utilised to investigate the physical causes of ED, but penile Doppler sonography (PDS) is the most informative technique, indicated in those patients with ED who do not respond to oral pharmacological agents (e.g. phosphodiesterase type 5 inhibitors). This review will examine the anatomical and physiological basis of penile erection, the method for performing PDS and features of specific causes of ED, and will also consider the alternative imaging modalities available. Erectile dysfunction (ED) represents a substantial burden upon public health. Studies have estimated that approximately 50% of the male population aged between 40 and 70 years will suffer from ED at some stage, with 10% of these affected severely [1]. On average, a general practitioner is estimated to see between one and five new cases of ED per month [2], and the impact upon the psychosocial health of the sufferer and his relationships may be considerable. ED is defined as the persistent inability to achieve or maintain penile erections of sufficient value to engage in satisfactory sexual activity [3]. Impotence tends not to be used as a descriptive terminology currently as it is felt to imply failure.Many physical causes of ED exist, with only 10-20% of sufferers believed to have a solely psychological cause [2]. There are many organic causes for ED, with the majority of these based upon vascular insufficiency. These organic causes are summarised in Table 1.Imaging in the investigation of ED is dominated by penile Doppler sonography and the main focus of this article will examine this technique. Alternative modalities such as MRI and angiography will also be explored, and the penile anatomy and the physiology of erection will be outlined. Penile anatomyThe central erectile structures are bilateral corpora cavernosa, seen as dorsolaterally placed low-reflectivity bodies on ultrasound, surrounded by the thick fibrous tunica albuginea (Figures 1 and 2). The corpora cavernosa are formed by multiple sinusoids composed of endothelium and smooth muscle. These sinusoids are capable of substantial volume expansion. The solitary ventrally located corpus spongiosum is enclosed by a thinner layer of tunica albuginea and surrounds the penile urethra. The spongiosum is anatomically independent of the cavernosa.The three corpora are enclosed by the more superficial Buck's fascia.The penile arterial supply displays slight variation in its anatomy [4,5]. The penis is usually supplied by branches of the internal pudendal artery, which continue as the penile artery. The bulbar artery supplies the proximal shaft and is the first branch of the penile artery, which then divides into the dorsal and cavernosal arteries (Figure 3). The cavernosal artery enters and ...

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