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$3, 660, 500 97, 500 $ 101, 667 $ (4, 167)*

numerous case reports are cited Currently, this intervention is reserved for patients who do not wish to pursue expectant management, and who are either poor candidates for angioembolization, do not want this procedure, or where it is not technically feasible or where angioembolization fails after at least one repeat attempt Which clot material is optimal is a matter of debate without any robust data to answer this question Shapiro et al reported on two cases requiring surgical ligation of the stula In each patient, angiographic embolization was attempted but abandoned because the distal artery feeding the stula could not be safely catheterized Both patients were de nitively treated with surgical ligation of the arteriovenous stula, guided by intraoperative ultrasound Two surgical approaches were used, one extracorporal and the other transcorporal, with successful preservation of erectile function Kim et al reported on two patients with arterial priapism that occurred after blunt perineal trauma and lasted for a mean duration of 38 days Cavernous arterial blushes were demonstrated on selective internal pudendal arteriograms and angioembolization was achieved by autologous clot Both patients experienced return of pre-morbid erectile function and no local or systemic complications occurred

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$3, 159, 000 $ $ 97, 500 87, 750 9, 750

$2, 700, 000 $0, 000, 000 $2, 700, 000 $ 1, 500, 000 9, 750

Document accurately, including timing and dating of all records Obtain informed consent before surgical intervention Arterial priapism is not emergent and may be managed conservatively Diagnosis is best made by penile/perineal duplex Doppler ultrasound Angioembolization represents rst-line intervention Where angioembolization fails or is contraindicated surgical ligation is reasonable

*Impact on earnings per share is antidilutive; therefore, options are excluded from weighted average shares outstanding 1 ($765,000 3) 60 = $153,000 2 97,500 (average options outstanding) $30 3 ($900,000 + $570,000) 2 = $735,000 4 Under FASB Statement No 123, the tax deduction based upon average market price ($6 per option) is less than the cost recognized for nancial statement purposes ($9 per option); therefore, there is no tax bene t upon assumed exercise that would be credited to paid-in capital Under APB Opinion No 25, the tax deduction of $6 for each of the 97,500 average outstanding options at a tax rate of 40% would result in a tax bene t of $234,000 5 ($765,000 3) 60 = $153,000 Exhibit 3915 Continued

39 56

More than 20 years ago the vascular surgeon Vaclav Michal from Prague recognized that chronic arterial disease, compromising the blood ow in the cavernous arteries, can be a signi cant cause of ED [11] Atherosclerosis appears to be the most common cause of vasculogenic erectile dysfunction Smoking, hypertension, diabetes mellitus and dyslipidemias have been shown to initiate the cascade of events resulting in atherosclerosis These include endothelial injury, cellular migration, and smooth-muscle proliferation [12] These same risk factors leading to the manifestation of ED are shared with coronary artery disease (CAD) Studies suggest ED as a strong predictive factor for CAD [13,14] Vasculogenic impotence has been reported to be the rst sign of a generalized arteriopathy suggesting that physicians should check ED patients for ischemic heart disease, which can be diagnosed by stress ECG or other investigations prior to starting treatment for ED [15,16] The presence of silent co-existing myocardial ischemia should be considered in men who present with ED, particularly when they have other cardiovascular risk factors [17]

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