Search PubMed⌕ Search

Biomedical subjects

R Virag

Publications and source records attributed to R Virag.

At least 19 recordsLinked to original sources
PubMed2002

[Flow-dependent dilatation of the cavernous artery. A potential test of penile NO content].

BACKGROUND: Nitric oxide (NO) is now considered as the main contributor to elicit and maintain erection. It is also established that flow-dependent dilatation of conduit arteries is mediated by NO. The present study was designed to verify the possibility of assessing the penile NO content when measuring the post occlusive vasodilatation of the cavernous arteries. PATIENTS AND METHODS: Ninety five subjects, 22 with normal erections (control group) and 73 with various degrees of erectile dysfunction (ED), measured with the international index of erectile function (IIEF) and erectile activity index (IAE). Multidisciplinary evaluation helped to separate two subgroups: mainly organic (n=47) and mainly psychologic (n=26). The diameter of one of the two cavernous arteries was measured by duplex-scan before and after a five-minute complete occlusion of penile vascular flow. The criterion retained was the maximum percentage of dilatation achieved within 45 to 90 sec after the release of the occlusion. Means were compared in the clinical groups. Influences of IIEF, IAE, age, arterial risk factors, preocclusive diameter of the artery, testosterone and DHEA levels were evaluated. RESULTS: The mean percentage of increase in the control group was 65.2 +/- 26.3% vs 34.9 +/- 34.9% for the ED group (p=0.0003). The psychologic subgroup with 68.2 +/- 40% was similar to the control group as opposed to the organic group which showed a highly-significant difference (16.4 +/- 8.4; p=0.0001). In the control group and the psychological sub-group, subjects with arterial risk factors exhibited a less pronounced response (53.7 +/- 22) as compared to those free of any risk factors (80.3 +/- 30%) p=0.007. Age (r=0.29), preocclusion arterial diameter (r=0.3) and DHEA-S (r=0.56) as well as IIEF and IAE were correlated with the magnitude of the reaction. Sensitivity (100%) and specificity (92%) have been achieved in discriminating organic from psychologic DE. CONCLUSION: Flow-dependent vasodilatation of the cavernous artery is extremely strong. It is much stronger in control subjects and in patients with predominantly psychological ED. An increase of 30% seems to be a critical level since only patients in the organic group were below that level. Thus, organic ED seems to be linked to the decrease of NO production by the cavernous bodies. If these results were confirmed post occlusive vasodilatation of the cavernous artery might be proposed as a fully non-invasive diagnostic and prognostic test in the study of ED. We propose to call it PNORT (penile NO release test).

Adult↗
PubMed1999

Indications and early results of sildenafil (Viagra) in erectile dysfunction.

OBJECTIVES: To assess the acceptability, feasibility, and early results of sildenafil (Viagra) in a nonselected cohort of 316 patients (median age 58 years) who sought treatment for male sexual dysfunction during a 10-week period. METHODS: Erectile status and activity were evaluated by questionnaire; erectile function was assessed by pharmacologic testing and visual sexual stimulation. Cardiovascular contraindications were assessed. Patients selected for the trial received treatment for 2 months. Results based on the possibility of penetration and individual satisfaction (scale from 0 to 10) were classified as good, fair, or bad. Multifactorial analysis was performed to define factors influencing the response to sildenafil. RESULTS: Twenty-five percent of the patients from the initial cohort refused or did not meet the criteria for oral treatment; 25% of the remaining had a cardiovascular contraindication. At the end of the trial, 157 patients (88.7%) had completed the study; the efficacy of and satisfaction with sildenafil were considered good for 50 (31.84%), fair for 46 (29.29%), and bad for 61 (38.85%). Spontaneous nocturnal erections, organic etiologies, especially cavernovenous impotence, and previous treatment with self-intracavernous injections were significant factors influencing responses to oral treatment. Finally, 32% of the patients after completing the trial (17.2% of the initial cohort) were using sildenafil as their sole treatment, 34% chose self-intracavernous injections, and 25% decided to alternate between oral and local therapy. CONCLUSIONS: In the present study, sildenafil had a 60% efficacy rate and was chosen as the sole treatment by only 30% of the patients tested. We propose pretreatment tests to help to predict the response to this medication.

Adult↗
PubMed1998

[Exploration of the deep dorsal vein of the penis using pulsed Doppler ultrasonography. Preliminary study].

OBJECTIVES AND METHODS: This was an open preliminary study of 36 unselected men suffering from erectile dysfunction (DE) for the evaluation of the deep dorsal vein of the penis (VDP) by duplex scan (EDP). All men had an intravenous injection (IIC) with a vaso active agent: alprostadil (Edex) (n = 24), a mixture of papaverine ifenprodyl tartrate (Vadilex) (n = 4) or papaverine, ifenprodyl tartrate and alprostadil (n = 7). The deep dorsal vein was evaluated, with a 13 mHz mechanical probe 5 and 10 minutes after the injection, during visual sexual stimulation (SSV) carried on for 10 mn, and 3 mn after having stopped SSV. The influence of deep breathing and contraction of the ischio and bulbo-cavernous muscles was recorded at each of the periods. RESULTS: The deep dorsal vein was identified in all cases. After pharmacological stimulation flow was present in 61% of the cases, with a statistically significant difference between alprostadil (80%) and both mixtures (20%). The addition of sexual stimulation caused flow to disappear in 64% of the cases (91% for the mixture and 44% for alprostadil). There was a range of variation under breathing and muscular contraction which deserves further evaluation. CONCLUSIONS: 1) The deep dorsal vein is easily studied under duplex scan and should be part of the routine examination of the vascular component of erection during erectile dysfunction. 2) The vein is subjected to modification of flow after intracavernous injection and sexual stimulation which varies with the agent injected and the clinical condition of the patients. 3) Absent flow early after injection seems to be predictive of the possibility of a prolonged erection.

Adult↗
PubMed1997

[Nosology, epidemiology, clinical quantification of erectile dysfunctions].

After a review of the literature and of our own data base this article specifies: the nosology of erectile dysfunction (ED) defined as an inability to achieve enough rigidity for a satisfactory intercourse. This lack of firmness is frequently associated with a loss of libido (37%), performance anxiety (37%), and premature ejaculation (40%). The prevalence of ED in the overall French population, age 18 to 70 years is 39% (11% presenting permanent ED defined as a rate of failure to perform of 50%). This rate increases with age to 52 and 25% respectively. A quantification of the symptomatology is proposed scoring three different aspects of sexual activity during intercourse, erectile activity in absence of intercourse, patient's satisfaction, and partner satisfaction. Figures of normal subjects and patients with ED are presented.

Adult↗
PubMed1997

[Vascular and functional evaluation of erectile dysfunctions using erection provocation tests].

The provoked erection test (TEP) consists in exploring successively, the sexual arteries, the penile volume and rigidity charges after pharmacological and sexual visual stimulation. Quantified arteria were proposed to evaluate the arterial flow and the caverno venous component obtained though a global appraisal of the erectile function. From these, TEP allows a quick approach to the diagnosis of erectile dysfunction for an early therapeutic decision.

Alprostadil↗
PubMed1997

[Clinical models and decisional algorithm in the management of erectile disorders].

The diagnosis of erectile dysfunction (ED) needs an appropriate evaluation of global function and specific component of the erection. We have used a quantified methodology to grade each of the specific factors: arterial, venous, neurologic, endocrine, psychological and anxiety, in four groups of increasing severity. With this information each patient is them classified organic, psychological or mixed. The prevalence of "mixed" aetiology appears in the statistical objective offered by two different retrospective studies with a 76% rate of psychological prevalence and a 85% of organic prevalence. In two out of three of the patients both factors are present.

Adult↗
PubMed1997

[Intracavernous injections and new medical treatments of impotence].

Intracavernous injections (IIC) of vasoactives drugs is the most frequent treatment of erectile dysfunction (ED). Indications, technique and immediate as well as long term results are presented here. A retrospective quantified study of the follow up at 5 years of use shows that 94% of the patients who still use the treatment are satisfied, comparing with 48% who have stopped, and 21% who have never taken it. The overall rate of patients cured (i.e.; having a normal sexual life, without using the treatment) is 26.6%. The drop out rate linked to the treatment itself is 25%. Complications are seldom and benign: 7% of prolonged erection episodes, all solved by a medical regimen, mostly administered by the patient itself; nodules are present in 3% of the patients or do not interfere with the efficacy of the treatment; they are 1.6% Peyronie's like plaques. Perspectives opened by new treatments such as the Muse system and oral therapy by sildenafil or apomorphine are discussed.

Administration, Oral↗
PubMed1997

[Prevention and treatment of erectile disorders in sickle cell disease].

Priapism is a frequent and serious cause of morbidity in males with sickle cell disease. Acute priapism (AP) is preceeded in two-thirds of the cases by repeated minor events called stuttering priapism (SP). Since 1994, we have used a specific approach to prevent the commonly devastating effects of AP, using the alpha adrenergic agent etilefrine. Treatment of AP has been simplified (drainage without aspiration followed by one or two intracavernous injections (ICI) of 10 mg of etilefrine, until detumescence). For SP lasting more than one hour or causing pain, we use oral etilefrine and/or self ICI. This strategy was effective in five patients seen having AP, 21 patients with SP; it is simple, cheap, and avoids surgical procedure and transfusion. Moreover, erectile dysfunction, present in three patients, has been treated safely by ICI of protaglandins.

Adolescent↗
PubMed1997

[Ambulatory treatment and prevention of priapism using alpha-agonists. Apropos of 172 cases].

From 1985 to 1995, 172 patients (149 on self intracavernous injection of vasoactive drugs, 16 with Sickle cell disease, 6 surgical patients under heparin therapy, and 1 after oral administration of trazodone), having experienced one or several episodes of priapism, lasting from 3 h to 8 days have been treated or submitted to self medication with alpha-agonist agents (eprephrine, phenylephrine or etilefrine) with an eventual drainage of the corporae. All episodes have disappeared and sexual function was preserved. A conservative treatment of priapism has been designed using corporal drainage and intracavernous etilefrine for acute priapism; as well as preventive treatment for those of the patients exposed to Sickle cell disease to avoid surgery and its frequent fribrotic sequelae, leading to impotence in 50% of the cases.

Adolescent↗
PubMed1996

Preventive treatment of priapism in sickle cell disease with oral and self-administered intracavernous injection of etilefrine.

OBJECTIVES: Priapism is a common and currently unsatisfactorily managed complication of sickle cell disease (SCD). In June 1994, 6 SCD patients received a new therapeutic regimen to prevent the occurrence and recurrence of priapism. METHODS: The patients (5 with SS and 1 with SC) were adults and had frequent episodes of stuttering priapism (SP), and two of them had had acute episodes (AP) lasting more than 3 hours. The treatment consists of preventive oral administration of the alpha-adrenergic agent etilefrine, and self-administered intracavernous injection (SICI) of the same agent to reverse episodes lasting more than 1 hour. RESULTS: Since the beginning of treatment, all patients were protected against AP, 4 patients had no recurrence with the oral treatment alone, 2 had to use SICI, 1 occasionally and 1 constantly. There was no modification of sexual activity and no complications. Blood pressure was unaffected. CONCLUSIONS: This treatment is simple, cheap, and self-administered. It should be proposed to all patients with SCD in all geographic areas as part of an educational program for active prevention of this severe complication.

Administration, Oral↗
PubMed1993

Dynamic echography of the penis in the follow-up of impotent patients treated with intracavernous injections.

Dynamic echography of the penis (DEP) after pharmacological stimulation of erection has been designed to evaluate the albugineal wall thickness (AWT), the cavernosal appearance in the normal penis and corporeal changes in patients treated with intracavernous injections presenting with haematomata, hyperechoic images, prolonged erection and Peyronie's disease. DEP was performed in 973 patients who had had an average number of 89 (+/- 16) intracavernous injections for 16.7 +/- 11.7 months. A total of 1424 DEP examinations were performed. Transducer positioning, erectile condition, clinical recording and computer retrieval methods were adapted to gather ultrasonography data. The standard average AWTs recorded in patients free from Peyronie's disease and who were untreated were 0.11 cm at the septum, 0.17 and 0.15 cm at the dorsal root and the tip of the albuginea respectively, 0.14 cm ventrally and the diameter of the corpus cavernosum averaged 1.61 cm. Intracavernous therapy brought an increase in AWT of 15.38% to the septum, 11.76% and 10.53% to the dorsal tip and root respectively and 12.5% ventrally. Frequent haematomata induced greater increase, while prolonged erections did not. Patients with untreated Peyronie's disease were found to have greater AWT which decreased after treatment with intracavernosal injections. Before treatment abnormal penile hyperechoic images were found in 3.18% (intracavernous images) and 3.31% (albugineal nodules) of DEP, and in 7.09% and 7.54% respectively post-treatment.

Erectile Dysfunction↗
PubMed1991

Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8-year experience with 615 cases.

Of 615 patients with impotence of varying etiologies who were followed from 12 to 96 months after the institution of intracavernous self-injection therapy with vasoactive drugs (papaverine alone, papaverine and alpha-blockers, and Ceritine, a new multilevel acting drug) 87% (533 patients) returned for followup visits or were regularly contacted. Of these patients sexual activity was restored in 91%. The dropout rate was 11.25%. The 114 episodes of prolonged erections among 51 patients (4.57%) represented less than 3 per 1,000 of the 34,875 recorded injections. All patients were treated without complications. The percentage of patients suffering from nodules or permanent deformations was 2.8%. There were no cases of intracavernous fibrosis. The percentage of satisfied patients (satisfaction index 7 or greater) was 84.8%. Improvement in spontaneous erections during sexual intercourse was obtained in 65% of the cases: 15% no longer needed self-injections and 50% only used them occasionally while 35% remained entirely dependent.

Adrenergic alpha-Antagonists↗