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John M. Palmer, MD
JAMA. 1987;258(16):2291-2293. doi:10.1001/jama.1987.03400160145046.
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Recent advances in urology range from developments in basic science to progress in diagnosis and treatment and from disorders in the fetus to those in the elderly. Insights into the physiology of erection, for example, have profoundly influenced our ability to treat the impotent patient. Intracavernous injections of the powerful vascular smooth-muscle relaxant papaverine will induce an erection that may last several hours in patients with adequate penile blood supply. This occurs in most patients with neurogenic disease, but patients with vascular disease will have either delayed erections or none at all. Papaverine alone or with phentolamine mesylate is now being used in many centers to successfully treat patients with neurogenic and moderate vascular disease.1 Most patients are self-administering the regimen with no difficulty.

Over 200 000 patients worldwide have now been treated with electroshock wave lithotripsy (ESWL), which has proved to be safe and effective in fragmenting renal


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