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At least 199 records · Page 11Linked to original sources
PubMed1976

Bulbocavernosus reflex in normal men and in patients with neurogenic bladder and/or impotence.

The bulbocavernosus reflex was investigated electrophysiologically in 14 normal adult male subjects and in 80 patients with neurogenic bladders and/or impotence due to various neurological causes as well as in patients with functional impotence. The glans penis was stimulated superficially by single electrical shocks and the reflex responses were recorded from the bulbocavernosus (BC) and the striated anal sphincter muscles by means of concentric needle EMG electrodes. In all normal subjects, the BC reflex was recorded from the BC muscle as a stable and constant response having a mean latency of 36.1 msec. A response from the external anal sphincter was obtained in only 21% of the subjects investigated. In 13 patients with cauda equina lesions, the BC reflex was either absent or was present with a prolonged latency. Twenty-two patients with polyneuropathy of various causes were also investigated; in these patients the latency of the BC reflex was significantly greater than in the normal controls, but the most abnormal results were obtained in cases of alcoholic polyneuropathy. In the 19 cases of spinal cord disease with spasticity the BC reflex response was very intense, often with after discharges but latency values were within normal limits. In the 16 cases with functional impotence, the BC reflexes were basically normal; but in 3 cases, the threshold of the reflex was significantly raised, and in 1 case a prolonged latency was observed. The value and the practical application of the BC reflex in the BC reflex in the differential diagnosis of bladder dysfunction and of impotence was stressed.

Adolescent↗
PubMed1988

Impotence and diabetes.

The link between impotence and diabetes has been suspected since the 1700s, but it has been only within the last few decades that it has been scientifically investigated and confirmed. Of the 5 million diabetic men in the United States, 30% to 60% suffer from impotence, a complication of their disease that many of them fear more than any other, including blindness. Diabetes is the leading physiologic cause of impotence, and it occurs in both insulin-dependent and non-insulin dependent patients. In most cases, there is no relationship between the control, the duration, or the severity of diabetes and the occurrence of impotence. Treatment methods range from adjustments in nutrition to penile implants.

Diabetes Complications↗
PubMed1984

Evaluating medical treatment of impotence.

The nocturnal penile tumescence study, bulbocavernosus reflex latency time, and ultrasonic blood flow studies have made possible a more objective determination of the success or failure of various means used to treat impotence. A group of 60 patients with a history of impotence and flat nocturnal penile tumescence readings were selected for evaluation. Thirty were diabetic and 30 had idiopathic impotence. These patients were treated with a vasodilator, told to stop smoking for six weeks, or both. The results indicate that greater than one third of the patients were able to have intercourse and show NPT activity after treatment. Our study indicates that there is a select group of diabetics, as well as patients with idiopathic impotence, who may respond to medical management.

Aged↗
PubMed1988

Utility of Rigiscan and papaverine in diagnosis of erectile impotence.

The Rigiscan machine was used to measure nocturnal penile tumescence and rigidity in 41 men referred for evaluation of erectile impotence. In 6 patients, the Rigiscan was compared with the Tumistore and Snap-Gauge bands. Two patients achieved significant tumescence as measured by Tumistore, and 3 had significant tumescence as indicated by the breaking of two or three of the Snap-Gauge bands. None of these men achieved sufficient rigidity for intercourse as measured by the Rigiscan. Fourteen patients with organic impotence received intracorporeal injections of papaverine and were then monitored by Rigiscan. Six of the 14 were noted to have a Peyronie plaque. Of the remaining 8, 6 of these men achieved lasting erections sufficient for intercourse. The other 2 had erections that lasted ten minutes and were considered to have venous leak impotence. All patients with Peyronie disease had tumescence after papaverine injection, but in 5 the penis became rigid only at the base. Complications of papaverine injection were uncommon and minor. The Rigiscan and papaverine are useful in the diagnosis and management of erectile impotency.

Erectile Dysfunction↗
PubMed1980

Impotence following the discovery of azoospermia.

Sixteen couples were interviewed after the male had been discovered to be infertile. Of these couples, 63% of the men had experienced a period of impotence and 87% of the women had experienced rage toward the husband, symptoms, and/or dreams which incorporated three themes: concern for the husband, a wish to be rid of him, and guilt over this wish. Husbands whose wives were symptom-free did not experience impotence. These findings suggest that impotence following the discovery of azoospermia is common and should be regarded as an interactional problem. Clinical management is recommended which includes reassuring the couple that the impotence is expected and that it will resolve within 3 months, and focusing on the couple's reaction to the diagnosis.

Adult↗
PubMed1994

Oral androgens in the treatment of hypogonadal impotent men.

A study was designed to assess the effect of supplemental oral methyltestosterone in the treatment of impotence associated with low total serum androgen levels. A total of 22 hypogonadal impotent men underwent a comprehensive investigation of erectile dysfunction, including an evaluation of the pituitary-gonadal axis. The patients then received a 1-month course of 2 different commercial preparations of oral methyltestosterone. Hormonal changes induced by the medication were assessed on days 15 and 30 of treatment. The patients kept daily records of sexual activity, and completed visual analogue scales to assess energy levels, mood and sensation of well being on a weekly basis. Supra-physiological levels of total serum testosterone were achieved in every patient but the free fraction of the hormone did not increase proportionally and in many cases a marked decrease was recorded. In all but 1 subject there was a decrease in circulating sex hormone binding globulin. Pituitary gonadotropin levels showed a marked decrease at the end of treatment. The clinical response was disappointing. Only 9% of the patients reported a complete recovery of sexual function. Visual analogue scales did not reveal noticeable changes for any individual in the levels of energy, mood or feeling of well being between pretreatment and posttreatment assessments. Oral methyltestosterone is of limited effectiveness in men with hypogonadal impotence. The positive responses in this study were recorded in men with the most profound deficiency. Exogenous administration of androgens to impotent men should be limited to those with profound hypogonadism as documented by at least 2 abnormal serum free testosterone determinations.

Administration, Oral↗
PubMed1992

Vascular impotence: focal or diffuse penile disease.

Using computerized image analysis the percentage of smooth muscle fibers was measured in several biopsies of the penis from 10 cadavers and 5 patients with vascular impotence. No significant difference was observed between the proximal and distal areas, and/or between the peripheral and central areas in 1 corpus cavernosum, and between the 2 corpora cavernosa for each patient or cadaver. The percentage of smooth muscle fibers was less in impotent patients in comparison with the cadavers, in which the erectile status was not known, and this reduction occurred throughout both cavernous bodies. Vascular impotence is a diffuse penile disease. Therefore, a cavernous body biopsy can be used to study the penile structure in the assessment of vascular impotence.

Adult↗
PubMed1992

Dual radioisotopic study: a technique for the evaluation of vasculogenic impotence.

Arterial and venous systems are the main points for the evaluation of vasculogenic impotence. To evaluate both of these systems in the same study we propose a dual radioisotopic study in which 99mtechnetium (99mTc) and 133xenon (133Xe) were used. The changes in 99mTc and 133Xe radioactivities administered intravenously and intracavernously, respectively, were monitored before and after intracavernous papaverine injection. These changes were determined as time activity curves, which were generated from the region of interest over the penis. A 99mTc penogram index derived from the 99mTc time activity curve was significantly different in the control and arteriogenic impotence groups (131.67 +/- 74.6 versus 62.94 +/- 51.6, p less than 0.01). A meaningful correlation between 99mTc penogram index results and duplex ultrasonographic findings were observed (r = 0.905). 133Xe penogram index, derived from the 133Xe washout curve was significantly different in the control and venogenic impotence groups (-25.65 +/- 24.9 versus -56.09 +/- 13.4, p less than 0.01). Also, a meaningful correlation was obtained between pharmacocavernosometry and 133Xe penogram index results of venogenic impotent patients (r = 0.86). These findings suggest that the dual radioisotopic study will be a useful technique in the evaluation of the entire vascular system of the penis, since it is a noninvasive method.

Adult↗
PubMed1992

Norepinephrine involvement in response to intracorporeal injection of papaverine in psychogenic impotence.

The levels of catecholamines in penile blood during a papaverine test were measured to investigate whether the secretion of endogenous catecholamines is involved in response to intracorporeal papaverine injection. The level of norepinephrine was higher in patients with psychogenic impotence than in the normal controls and patients with vasculogenic impotence (p less than 0.01), and it was significantly higher in negative responders than in positive responders in the psychogenic impotence group (p less than 0.001). There was no significant difference in the level of epinephrine among the groups. The false negative response to the papaverine test in psychogenically impotent men is believed to be derived from secretion of cavernous norepinephrine, which overwhelms the action of cavernous smooth muscle relaxation by papaverine.

Adult↗
PubMed1992

Is routine endocrine testing of impotent men necessary?

Endocrine screening of impotent men is performed in an effort to identify a treatable cause of impotence. However, the prevalence of endocrinopathy in this patient population is low. We determined whether any historical or physical findings obtained during the initial office visit would identify a subgroup of patients at risk for endocrinopathy to decrease the cost of endocrine screening. The results of routine endocrine screening of 330 consecutive impotent patients formed the basis of this study. A total of 7 patients (2.1%) had endocrinopathy. Testicular atrophy was observed in 5 of these 7 patients and 6 reported decreased libido. All of the patients with endocrinopathy had either decreased libido or bilateral testicular atrophy. Our results indicate that the cost of impotence evaluation can be decreased by screening only those patients with clinical signs of hypogonadism, that is either decreased libido or bilateral testicular atrophy.

Diagnostic Tests, Routine↗
PubMed1991

Venogenic impotence following dermal graft repair for Peyronie's disease.

Peyronie's plaque excision with dermal grafting generally offers good cosmetic results for patients who require surgical intervention for Peyronie's disease. However, postoperative impotence has been reported in 12 to 100% of such patients. The mechanism of impotence in this setting is not well defined. We present 3 men who had venogenic impotence after plaque excision and dermal grafting for Peyronie's disease. One patient has subsequently responded well to dorsal vein ligation, 1 has chosen an effective nonoperative method of management and 1 continues to consider the options. We report venous leak as an organic cause of impotence after plaque excision and dermal grafting for Peyronie's disease, and its successful management by dorsal vein ligation. The implications of these findings in the surgical management of Peyronie's disease are discussed.

Adult↗
PubMed1990

Dysfunctional penile cholinergic nerves in diabetic impotent men.

Impotence in the diabetic man may be secondary to a neuropathic condition of the autonomic penile nerves. The relationship between autonomic neuropathy and impotence in diabetes was studied in human corporeal tissue obtained during implantation of a penile prosthesis in 19 impotent diabetic and 15 nondiabetic patients. The functional status of penile cholinergic nerves was assessed by determining their ability to accumulate tritiated choline (34), and synthesize (34) and release (19) tritiated-acetylcholine after incubation of corporeal tissue with tritiated-choline (34). Tritiated-choline accumulation, and tritiated-acetylcholine synthesis and release were significantly reduced in the corporeal tissue from diabetic patients compared to that from nondiabetic patients (p less than 0.05). The impairment in acetylcholine synthesis worsened with the duration of diabetes (p less than 0.025). No differences in the parameters measured were found between insulin-dependent (11) and noninsulin-dependent (8) diabetic patients. The ability of the cholinergic nerves to synthesize acetylcholine could not be predicted clinically with sensory vibration perception threshold testing. It is concluded that there is a functional penile neuropathic condition of the cholinergic nerves in the corpus cavernosum of diabetic impotent patients that may be responsible for the erectile dysfunction.

Acetylcholine↗
PubMed1990

Impotence following delayed repair of prostatomembranous urethral disruption.

A group of 26 patients with pelvic fracture and disruption of the prostatomembranous urethra were evaluated for impotence. Impotence was defined as inability to achieve an erection firm enough for vaginal penetration. Of the patients 25 were potent before the injury, whereas 1 was only 7 years old at injury. Seven patients admitted to being potent after the injury but before the final urethral anastomosis. Four patients became potent after urethroplasty. The definitive operation to the urethra was done approximately 6 months after the injury. Only 11 of the 26 patients (46%) reported erections adequate for vaginal penetration. No patient who had adequate erections before urethroplasty became impotent postoperatively. We believe that the impotence was caused by damage to the neurovascular supply to the penis at injury.

Adult↗
PubMed1988

Prevalence of corporeal venous leakage in impotent men.

To provide insight into the prevalence of corporeal venous leakages as a factor in impotence, 44 consecutive impotent men who failed to achieve an erection after intracorporeal papaverine injection underwent dynamic infusion cavernosometry and cavernosography. If venous leakage is defined as either a failure to increase intracorporeal pressure greater than the systolic blood pressure or a rapid decrease in intracorporeal pressure after cessation of saline infusion during cavernosometry, 30 of the 44 men (68 per cent) fall into this category. If cavernosography (43 men) is used to define the presence of a venous leakage in these impotent patients 37 (86 per cent) fall into this category. These data support recent observations that there is a high incidence of venous leakage as defined by these criteria in men with organic impotence. The significance of these findings can be determined only once a similar study in age-matched potent men is performed.

Adult↗
PubMed1987

Is yohimbine effective in the treatment of organic impotence? Results of a controlled trial.

Yohimbine is an alpha-adrenoceptor blocker that has been used in the treatment of erectile dysfunction. Adequate trials of this substance in a clearly defined organically impotent population are not available. We conducted a randomized, controlled study with partial cross-over of yohimbine versus placebo in 100 organically impotent men. The first phase of the study showed a positive response in 42.6 per cent of the patients receiving yohimbine versus 27.6 per cent in the placebo group. Although favorable to the test medication these values did not reach statistical significance (p equals 0.42). A similar pattern was noted in the second phase of the study. The over-all response rate of 43.5 per cent was consistent with a previous noncontrolled trial but it was much lower than previous studies. The response rate of organically impotent patients to yohimbine is at best marginal. Owing to its ease of administration, safety and modest effect it still is used in those patients who do not accept more invasive methods. Adrenoceptors are involved in the erectile process, although other neurotransmitter systems also are putative modulators of penile erection, including cholinergic, dopaminergic and vasoactive intestinal polypeptide pathways. It is beyond reasonable expectation that a single agent be of value for all cases of organic impotence. However, yohimbine has shown modest effectiveness at the doses used in this trial (18 mg. per day). Higher doses or a different route of administration may produce different effects.

Clinical Trials as Topic↗
PubMed1983

Penile elongation: a method for the screening of impotence.

Circumferentially assessed penile responses less than 10 per cent of maximal tumescence usually are regarded as random variation. However, several investigators have hypothesized that one of the initial responses to sexual stimulation is a lengthening of the penile shaft. Circumferential measurements detect this lengthening as a decrease in penile circumference. Two experiments were conducted to investigate this hypothesis. During the first experiment penile circumference changes were monitored at 2 levels of voltage sensitivity. A reliable voltage decrease was observed for all subjects immediately after the introduction of an erotic stimulus. In the second experiment the penis was videotaped to determine the magnitude of penile lengthening that occurred during the circumferential decrease. The results indicated that a substantial penile length change occurred (mean 34.5 per cent of the total erection length change) before any diameter increase was evident. A small number of impotent patients with a clear etiology were investigated using this new test. The results suggest that penile elongation occurs in the absence of full erections in patients with psychogenic impotence, while circumferential and longitudinal changes do not appear after visual erotic stimuli in organically impotent patients. The penile elongation test may prove useful in the etiological screening of impotent patients.

Adult↗
PubMed1981

Significance of impaired penile tumescence and associated polysomnographic abnormalities in the impotent patient.

Of 15 consecutive patients with secondary impotence 7 (46 per cent) had varied degrees of abnormal nocturnal penile tumescence and 1 or more of the following sleep-associated events: frequent apnea and hypoventilation, myoclonus and a slow but remarkably stable heart rate even during episodes of respiratory impairment. All nocturnal penile tumescence measurements, except circumference change at the glans, were significantly lower than in patients with psychogenic impotence or normal subjects. These findings, not described previously, suggest probable central nervous system etiology of organic impotence in some patients. Skilled nocturnal penile tumescence assessment in conjunction with a comprehensive polysomnographic study is an essential diagnostic procedure in the evaluation of the impotent patient.

Adult↗
PubMed1991

Cigarette smoking and other vascular risk factors in vasculogenic impotence.

A total of 132 consecutive patients with erectile impotence underwent extensive evaluation, including vascular evaluation with intracavernous injection of papaverine and penile duplex ultrasonography, to determine the etiology of impotence. Three vascular risk factors, smoking, diabetes mellitus and hypertension, were investigated for their impact on vasculogenic impotence. The patients were divided into four groups: one with no risk factors, one with one vascular risk factor, one with two vascular risk factors, and one with all three risk factors. The results of penile vascular evaluation in these patient groups were compared. The incidence of penile vascular impairment was found to be higher in patients with one vascular risk factor than in those with none. The proportion of abnormal penile vascular findings significantly increased as the number of risk factors increased. These data confirm the important role of vascular risk factors, smoking, diabetes mellitus, and hypertension, in the pathogenesis of organic impotence.

Diabetes Mellitus↗