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T F Lue

Publications and source records attributed to T F Lue.

At least 181 records · Page 10Linked to original sources

Spinal anesthesia and electroerection in dogs and monkeys.

We studied the penile erectile response to cavernous nerve electrostimulation in five monkeys and eight dogs before and during spinal anesthesia. Anesthesia was obtained by intradural injection (at L4-L5 level) of either xylocaine (two mg./kg. body weight) or tetracaine (0.2 mg./kg.). In monkeys, systolic blood pressure reduction (average 17.2%), slight elongation and tumescence of the penis, and increase of intracavernous pressure were noted after spinal anesthesia. Electrostimulation of the cavernous nerves resulted in longer erection and detumescence phases than obtained before anesthesia. In dogs, a similar blood pressure decrease (16.6% average) was noted after anesthesia. The response during anesthesia to electrostimulation of the erectile nerves was, however, variable. Changing the animal's position abolished the erectile response in three of four dogs while no change of erectile response due to anesthesia could be demonstrated in the remaining four dogs. We conclude that spinal anesthesia seems to enhance simian, but not canine, erectile response to electrostimulation of the erectile nerves, possibly via interference of the autonomic regulatory mechanism.

Anesthesia, Spinal↗

Local and systemic effects of chronic intracavernous injection of papaverine, prostaglandin E1, and saline in primates.

To compare the local and systemic effects of chronic intracavernous injection of papaverine, prostaglandin E1, and saline on erectile tissue, eight pigtail monkeys underwent 75 injections over a nine-month period. Monkeys were divided into three groups; each group received papaverine (10 mg.), prostaglandin E1 (20 micrograms.), or saline (one ml.). The erectile response was closely observed for two hours after each injection to monitor the onset, degree, and duration of erection. Liver function tests were performed every three months to detect early systemic metabolic changes. After sacrifice, the simian penises were perfused in situ and examined histologically with both light and electron microscopy. Papaverine resulted in an initially strong erectile response, but this was maintained throughout the length of the study in only two monkeys. In contrast, prostaglandin E1 resulted in tumescence that was maintained in all monkeys over the nine-month period. In addition, the papaverine group had elevated liver enzymes and significant histologic changes with loss of normal architecture on both light and electron microscopy. The other two groups showed only minimal histologic changes or none.

Alprostadil↗

The effect of subatmospheric pressure on the simian penis.

The effects of subatmospheric pressure on the simian penis were studied in nine monkeys under anesthesia. A plastic cylinder was placed over the penis and suction applied until the gauge pressure was -100 to -200 cm. H2O. The intracavernous pressure decreased within one to three seconds to between -60 and -120 cm. H2O followed by a gradual increase as a result of blood flow into the corpora cavernosa. The intracavernous pressure recovery was 50% after 17 seconds and 100% by 30 to 60 seconds. These effects could also be observed when the penile base was partially constricted with a rubber band before applying the partial vacuum. Tumescence resulting from suction disappeared immediately when suction was terminated unless the base of the penis was constricted before and after the application of vacuum. In the latter case tumescence was prolonged (cavernous pressure between 60 and 120 cm. H2O) after suction. The cross-sectional area of the penis expanded to more than 150% of the flaccid state. The increase of intracavernous pressure from intracavernous papaverine injection was similar to that after suction with a constricting rubber band in place at the base of the penis. Subatmospheric pressure induces an expansion of the penis followed by increased blood inflow. The additional volume can be kept in the penis only if a constriction device is placed at the base of the penis. The tumescence induced by suction is passive, occurring without evidence of smooth muscle relaxation or release of neurotransmitters.

Animals↗

Correlation of altered penile ultrastructure with clinical arterial evaluation.

We investigated the ultrastructural changes in the penile erectile tissue from 32 consecutive patients who underwent penile prosthesis implantation. Because most of the patients had undergone papaverine injection with or without duplex ultrasonography, we compared these results with the electron microscopic findings. In patients with a good arterial response and full erection after papaverine injection the ultrastructural findings were similar to those reported in normal men. In patients with moderate arterial disease a distinct increase in mitochondria with aggregation and cytoplasmic vacuolization in smooth muscle cells was noted. These findings could be interpreted as an active cellular attempt to respond to the altered environmental and nutritive situation. In patients with severe arterial insufficiency the cellular structure was markedly altered, the number of intracavernous smooth muscle cells was reduced and the density of the connective tissue separating individual cells was increased. These changes in the smooth muscle cells consisted of contour irregularity with fragmentation and loss of the basal lamina. The cytoplasm was largely devoid of contractile elements. The nuclei tended to be pleomorphic with unevenly distributed chromatin. The endothelium was also altered significantly in this group. A careful clinical evaluation of penile arterial function should be performed in all patients undergoing penile arterial or venous corrective surgery. If doubt remains, a penile biopsy may be indicated.

Adult↗

Erectile response to acute and chronic occlusion of the internal pudendal and penile arteries.

We designed two animal experiments to elucidate the effect of obstruction of the internal pudendal artery on erectile function. In five dogs the internal pudendal or penile artery was acutely clamped unilaterally or bilaterally with a non-crushing vascular clamp. In eight dogs, the internal pudendal or penile artery was ligated, unilaterally or bilaterally, and occlusion was maintained for two months. In both models, electrodes were implanted around the cavernous nerves for electroerection. In unilateral occlusion, blood flow in the contralateral internal pudendal artery was recorded via an ultrasonic probe. In both unilateral and bilateral occlusion, intracavernous pressure in both corpora cavernosa was recorded through a 21-gauge butterfly needle connected to a Statham transducer. In the chronic model, selective pudendal angiography was done after the erection study was completed; the dogs were then sacrificed and the penile tissue was examined histologically under light microscopy. Unilateral acute clamping of the internal pudendal or penile artery caused a compensatory increase in arterial flow in the contralateral pudendal artery with only moderate impairment of intracavernous pressure on the ipsilateral side, but bilateral occlusion resulted in a marked reduction in the intracavernous pressure response to neurostimulation. In contrast, chronic obstruction of penile vessels had a minimal effect on erectile function due to the development of a rich network of collaterals around the penis. Histological evaluation revealed mild local changes in the cavernous tissue with characteristic compensatory enlargement of branches of the cavernous artery on the control side in cases of unilateral occlusion.

Animals↗

Detailed anatomy of penile neurovascular structures: surgical significance.

In 10 formalin-preserved adult male cadavers, dissection of the penile veins, arteries and nerves revealed information of clinical importance. The main venous drainage of the corpora cavernosa is via the cavernous veins, with additional drainage through the circumflex, deep dorsal, and crural veins. The arterial supply of the cavernous bodies varied remarkably, and the incidence of an accessory internal pudendal artery was high. The cavernous nerves, previously believed to be microscopic structures, were in fact identifiable grossly, and we were able to follow them from the region of the hilum of the penis to the prostate. The nature of these nerves was then confirmed by serial histologic sectioning. This detailed knowledge of the venous drainage and arterial and nervous supply of the penis, as well as of the relationships among the cavernous structures in the hilum of the penis, can elucidate the cause of erectile dysfunction and provide a valuable guide for surgical correction of vasculogenic and neurogenic impotence.

Adult↗

Determination of erectile penile volume by ultrasonography.

A total of 58 men with organic erectile dysfunction underwent penile blood flow studies with a 10 MHz. high resolution ultrasonogram and pulsed Doppler analysis after papaverine injection. The average volume increase for the entire group was 52.62 cc (445.9 per cent). No statistical differences in volume increase were noted among 3 groups separated by age. The average volume increase in 23 patients with venous insufficiency was greater than that in 20 patients with primary arterial insufficiency (p less than 0.033). Eleven patients who had erections satisfactory for vaginal penetration after papaverine injection had a statistically greater increase in penile length but no difference in volume increase than those with a poor response. The 10 MHz. high resolution sonogram provides the most accurate assessment of penile volume, which if measured at specific intervals after papaverine injection should allow an accurate assessment of penile flow. Patients with venous insufficiency may have weakness of the tunica, allowing greater volume expansion. A satisfactory erection is not associated with a significant increase in volume.

Adult↗

Acetylcholine as a possible neurotransmitter in penile erection.

We investigated the erectile response to intracavernous injection of increasing doses of acetylcholine (0.5 to 500 micrograms.) in 10 monkeys. To differentiate between nicotinic (ganglionic) and muscarinic (parasympathetic postganglionic) effects, acetylcholine was likewise administered after 1.6 mg. trimethaphan camsylate and 0.1 mg. atropine, alone or sequentially. Erections were induced by cavernous nerve stimulation before and after atropine. Acetylcholine induced a dose-dependent, triphasic erectile response: a first tumescence phase followed by contraction and a subsequent second phase of tumescence. Atropine reduced but did not abolish the erectile response to acetylcholine: attainment of maximal intracavernous pressure after neurostimulation was both delayed and reduced (mean 25 cm. H2O). Only after combined nicotinic and muscarinic blockade was the erectile response to acetylcholine completely abolished. Histologic staining for acetylcholinesterase in five additional monkeys that had not received acetylcholine showed dense staining within the cavernous erectile tissue and around the cavernous arteries. Our data suggest that acetylcholine is a possible neurotransmitter for penile erection in monkeys.

Acetylcholine↗

Neurophysiological aspects of penile erection: the role of the sympathetic nervous system.

Recent studies have revealed that the initiation, maintenance and rigidity of penile erection are under parasympathetic and somatotopic control. The mechanism of penile detumescence is still under debate. Single and combined cavernous and hypogastric nerve stimulation was used to study the influence of the sympathetic nervous system on penile erection and to identify the mechanism of penile detumescence. Penile arterial flow and intracorporeal pressure recordings during various stimulation patterns indicated that erection induced by stimulation of the cavernous nerve could be blocked by excitation of the upper hypogastric nerves. Venous outflow studies demonstrated that the inhibitory effect of the sympathetic nervous system was due to active vaso- and corporeal smooth muscle constriction. It was concluded that subsidence and suppression of erection is a sympathetic function. Previous studies have shown that the neurophysiology of erection can be explained by 3 major inhibitory (sympathetic). Our findings are of clinical importance, since a better appreciation of the basic erectile mechanism is essential for successful management of erectile dysfunction.

Animals↗

Penile venous drainage in erectile dysfunction. Anatomical, radiological and functional considerations.

To elucidate further the penile venous anatomy and its role in the haemodynamics of erection, we performed pharmacological cavernometry and cavernography in 95 patients with venogenic impotence and in 12 patients with psychogenic impotence. The findings were correlated with those of dissection in 10 adult male cadavers. Cavernography confirmed that the main venous drainage of the corpora cavernosa is via the cavernous veins, with additional drainage through the crural, circumflex and deep dorsal veins and demonstrated that, in patients with venogenic impotence, the cavernous veins are the common site of leakage. Cavernometry provided valuable parameters for the quantification of the degree of venous leakage. Detailed knowledge of the penile venous system and cavernometry and cavernography are essential for the proper diagnosis and treatment of patients with venogenic impotence.

Erectile Dysfunction↗

Possible role for acetylcholine as a neurotransmitter in canine penile erection.

In 15 adult dogs, the possible role of acetylcholine as a parasympathetic neurotransmitter in canine penile erection was investigated. Intracavernous injection of increasing dosages of acetylcholine (0.1-100 micrograms) induced a dose-dependent erectile response with increased arterial flow, cavernous smooth muscle relaxation, and venous occlusion. This erectile response was completely abolished after muscarinic blockade by intracavernous injection of 0.1 mg atropine. After cavernous nerve stimulation, atropine injection significantly reduced the pudendal arterial flow (by 25%) and likewise caused a significant reduction in cavernous outflow restriction. Histologic staining showed acetylcholinesterase-positive fibers around the cavernous arteries and within the cavernous erectile tissue.

Acetylcholine↗

Comparison of penile vascular effect induced by intracavernous injection of papaverine and prostaglandin E1.

An intracavernous injection with papaverine or prostaglandin E1 (PGE1) combined with duplex ultrasonography is an objective technique to conduct a penile blood flow study (PBFS). Three hundred patients with impotence underwent papaverine (9-60 mg) induced PBFS at the University of California School of Medicine, San Francisco (UCSF), U.S.A. and another 80 patients with impotence received PGE1-induced (20 micrograms) PBFS at Veterans General Hospital-Taichung (VGH-TC), R.O.C. Preliminary evaluation of age, duration of disease and pre-injection diameter of cavernous arteries disclosed no significant difference in these 2 series. It was interesting to find that almost all parameters of vascular response to pavaverine vs PGE1 differed significantly, such as onset of response (6.5 +/- 6.5 vs 11.7 +/- 6.4 min, slower in the PGE1 group, p less than 0.001); post-injection diameter of cavernous arteries (right: 0.73 +/- 0.20 vs 0.79 +/- 0.18 mm, p = 0.03; left: 0.74 +/- 0.20 vs 0.82 +/- 0.21 mm, p = 0.005); diametral increment of cavernous arteries (right: 0.23 +/- 0.17 vs 0.33 +/- 0.17 mm, p less than 0.001; left: 0.24 +/- 0.17 vs 0.36 +/- 0.19 mm, p less than 0.001) and peak velocity (right: 27.5 +/- 16.1 vs 42.0 +/- 20.1 cm/sec, p less than 0.001; left: 28.9 +/- 15.9 vs 39.7 +/- 17.9 cm/sec, p less than 0.001). The side effects, primarily injection pain (23.8%, 19/80) in the PGE1 group and dizziness (3.0%, 9/300) in the papaverine group, were minor in these 2 series. Prolonged erection was not encountered in either series; however, immediate treatment was performed if a papaverine-induced erection lasted over 60 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Functional evaluation of penile arteries with duplex ultrasound in vasodilator-induced erection.

In 657 impotent patients in whom erection was induced by intracavernous injection of papaverine, we evaluated changes in the pulsation, diameter, and blood flow velocity of the penile arteries by duplex sonography and pulsed Doppler spectrum analysis. An additional 18 patients who were proved to have good erection by nocturnal tumescence testing were used as controls. All patients were studied before achieving full erection after papaverine injection. In the flaccid state, the inner diameter of the deep penile arteries averaged 0.51 mm, and blood flow velocity was rarely measurable. The normal arterial reaction to papaverine was an initial increase in the inner diameter of the scanned segment of the cavernous artery with good concentric pulsations and a mean peak blood flow velocity of 34.8 cm per second and a mean diameter of 0.89 mm. With this technique, we assessed the functional capability of each deep and dorsal artery. Arterial and erectile response allowed indirect evaluation of the venous system. Of the 657 patients, 48 had neurogenic or psychogenic impotence or both. In 97, impotence could be ascribed to venogenic causes, in 210 to arteriogenic causes, and to mixed arteriogenic and venogenic causes in 282 patients. The exact cause of impotence in the remaining 20 patients could not be determined. Statistically, patients who were older or had diabetes mellitus or coronary artery disease tended to have smaller penile arteries and lower peak blood flow velocity after papaverine injection.

Adult↗

Penile venous surgery.

Excessive venous flow during erection is an acknowledged cause of impotence. At the turn of the century, Wooten and Lydston reported a cure rate of roughly 50 per cent after ligation of the deep dorsal vein of the penis. In 1979, Ebbehoj and Wagner restored potency in three of four patients with venous leakage. Later, Virag reported the diagnostic technique of dynamic cavernosography and proposed deep venous ligation. In 1985, Wespes and Schulman reported an 80 per cent success rate for correction of venogenic impotence by ligating the deep dorsal vein and its tributaries. Since then, Bennett and associates have achieved success in six of eight patients, and Lewis and Puyau report a 50 to 75 per cent success. With the technique described above, after careful selection and proper diagnostic testing, impotence has resolved or erection improved in more than 80 per cent of our patients.

Erectile Dysfunction↗

Fundamentals and hemodynamics of penile erection.

Human penile erection is a complex phenomenon mediated through the coordinated interaction among the nervous, vascular, and musculosystems. For social and ethical reasons, the mechanism and hemodynamics of this essential human function remained speculative and controversial for many years. In the past decade, however, advances in technology, together with a marked increase in clinical and research activity, have resolved some of the controversy and have provided a better understanding of erectile physiology. In this essay, we will review traditional concepts, as well as the new and exciting findings from many different research centers, concerning the physiologic mechanisms of penile erection that involves the arterial, venous, and nervous systems.

Arteries↗

The diagnosis of venogenic impotence: dynamic or pharmacologic cavernosometry?

In an attempt to refine the diagnosis of venogenic impotence, we evaluated different techniques of cavernosometry in 10 dogs. Saline was perfused intracavernously in five dogs to induce erection. Regardless of the amount required for induction, a mean flow rate of 23.4 ml./min. was necessary to maintain an intracavernous pressure level of 110 cm. H2O. In seven dogs, a leak was created by intracavernous insertion of a 19-gauge needle. When erection was induced by either cavernous nerve stimulation or a combination of papaverine injection and saline perfusion, the mean flow through the needle was significantly less than when erection was induced by saline perfusion alone (1.73, 1.78, and 8.77 ml./min., respectively). Sympathetic trunk stimulation at the level of L5 could reduce the intracavernous pressure by 90% in erections induced by neural stimulation or papaverine plus perfusion but had no effect on erection induced by saline perfusion alone. Our findings show that cavernosometry after intracavernous injection of papaverine will provide more valuable information in patients in whom venogenic impotence is suspected.

Animals↗