Erection involves cholinergic, adrenergic as well as non-cholinergic non-adrenergic nerves. Endothelial-derived relaxation factor plays an important role in mediating smooth muscle relaxation, which is crucial in initiating and maintaining erection. We previously showed that adenosine 5’-triphosphate (ATP) can induce significant relaxation in rabbit corporal cavernosal tissue. The present study presents effects of different neuron-transmitters and the role of endothelium in controlling the contractile/relaxant status of rabbit cavernosal tissue. These studies utilized isolated tissue strips prepared from the corpus cavernosum of sexually mature male New Zealand white rabbits. The results can be summarized as follows: (1) field stimulation caused relaxations with rebound contractions in most strips; (2) bethanechol (250 μM), isoproterenol (20 μM) and ATP (1 mM) all induced relaxations, though the relaxation induced by bethanechol was poorly sustained; (3) removal of the endothelium by rubbing decreased the relaxation to field stimulation and virtually eliminated the relaxation induced by bethanechol, but had no effect on the relaxation responses to isoproterenol and ATP; (4) methoxamine (200 μM) stimulated a sustained contraction of corporal cavernosal tissue, an effect unaltered by rubbing the strips; (5) low dose epinephrine induced relaxation, whereas higher concentrations contracted the tissue, and (6) β-adrenergic inhibition with propranolol (20 μM) was significantly more effective than mascarinic blockade with atropine (20 μM) in eliminating relaxation caused by field stimulation. Three conclusions can be drawn from this study: (l)ATP (purinergic innervation) may play an important role in erectile physiology, and its actions are independent of the endothelium, as well as cholinergic and adrenergic neurotransmission; (2) muscarinically induced cavernosal relaxation is endothelium-dependent, but constitutes a relatively minor portion of the relaxant response to electric stimulation, and (3) β-adrenergic stimulation constitutes a relatively prominent component of field stimulation-induced relaxation, and cavernosal β-adrenoceptors are more sensitive to low levels of adrenergic stimulation than α-adrenoceptors.

Metabolic syndrome induces increased expression of M2,3-muscarinic receptor mRNA and protein in the urothelium as well as the muscle layer of the bladder in 6-week fructose fed rats. The receptor alterations are associated with functional evidence of detrusor overactivity.

Objectives To determine the optimal surgical timing in high‐risk patients with Fournier's gangrene by the Simplified Fournier's Gangrene Severity Index. Methods From 1989 to 2018, 118 male patients diagnosed with Fournier's gangrene with complete medical records were retrospectively reviewed. Patients’ demographics, laboratory parameters at initial diagnosis, Fournier's Gangrene Severity Index and Simplified Fournier's Gangrene Severity Index, and the time interval from emergency room arrival to surgical intervention were collected. The Fournier's gangrene patients were categorized into low‐risk (Simplified Fournier's Gangrene Severity Index ≤2) and high‐risk groups (Simplified Fournier's Gangrene Severity Index >2). Differences between the variables within the two groups were analyzed. The optimal surgical timing was analyzed with the receiver operating characteristic curve in high‐risk Fournier's gangrene patients. Results The overall mortality of 118 Fournier's gangrene patients was 14.4%. After risk stratification with the Simplified Fournier's Gangrene Severity Index scoring system, the mortality of low‐risk and high‐risk Fournier's gangrene patients was 1.3% and 41.0%, respectively. In the high‐risk group, the time interval from emergency room arrival to surgical intervention was the only variable with a significant difference between survivors and non‐survivors (P = 0.039). The optimal surgical timing was determined at 14.35 h, which allowed the highest sensitivity (0.688) and specificity (0.762) to affect mortality. The mortality was significantly lower in high‐risk Fournier's gangrene patients with early surgical intervention compared with late intervention (23.8% vs 68.8%, P = 0.007). Conclusions The Simplified Fournier's Gangrene Severity Index is a quick and reliable screening tool for first‐line physicians to identify high‐risk patients with Fournier's gangrene (Simplified Fournier's Gangrene Severity Index >2) who have poor survival outcomes. We recommended early surgical intervention within 14.35 h to maximize the survival of high‐risk Fournier's gangrene patients.

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