Intracavernous injection of papaverine hydrochloride with phentolamine mesylate rapidly produces transitory penile tumescence, which can be followed by erection and coitus provided there is sexual stimulation. Coital penetration was possible in 59 of 62 patients with impotence of divers etiologies (vascular, diabetic, iatrogenic and Peyronie's disease) who underwent injection and were sent home to attempt coitus. One patient had a prolonged erection that was treated successfully with aspiration of a corpus. When coitus was successful the patient was offered training in self-injection. With self-injection 18 patients have had satisfactory coitus without a noteworthy complication; 5 for more than 12 months. The long-term effects of intracavernous injections remain unknown. Intracavernous injection of vasoactive substances (chemical prosthesis) may become a useful alternative treatment. Administration should be restricted to urologists able to manage the possible complication of priapism.

Portosystemic venous collaterals were studied with sonography in 40 patients with known portal hypertension. Eight patients had technically inadequate scans, while 32 had optimal scans. Sixty groups of venous collaterals were identified. At least one collateral pathway was seen in 28 patients, for a sensitivity of 88% for the 32 patients with optimal scans and 70% for the total group. The overall sensitivity for detection of coronary-gastroesophageal collaterals was 80% and 64%, respectively. The small size of the coronary-gastroesophageal varices in early portal hypertension seems to be the most important factor limiting detection in patients suitable for sonography.

Renal oncocytomas are benign tumors arising from proximal tubular epithelial cells. They appear radiographically as solid masses which are vascular on angiography. Angiograms of 13 cases of renal oncocytomas were reviewed, as well as those of 155 renal-cell carcinomas. The classic angiographic findings for the oncocytoma include a spoke-wheel pattern, a homogeneous nephrogram, and a sharp, smooth rim. The finding of a homogenous blush and/or a spoke-wheel pattern greatly increases the possibility of an oncocytoma, though a renal-cell carcinoma may have any or all of the classical findings described for an oncocytoma.

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