Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “IMPOTENCE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMed2000

Novel image analysis of corpus cavernous tissue in impotent men.

OBJECTIVES: To objectively evaluate the contents of corpus cavernous tissue in impotent men using an automated novel image analysis system. METHODS: Thirty-three impotent men and 2 normal potent men (controls) underwent corpus cavernous biopsies. The procedures were performed using a Biopty gun under local anesthesia. The obtained specimens were stained with Masson's trichome technique, and the collagen fiber contents were evaluated by a computerized morphometric analysis method. In addition, we estimated the intraobserver and interobserver reliability of this automated image analysis system. RESULTS: No major complication was noted during or after the biopsies. Of the 33 impotent patients, 3 were diagnosed as having psychogenic, 11 as having arteriogenic, 13 as having venogenic, 1 as having neurogenic, and 5 as having idiopathic impotence. The collagen fiber percentages in the 35 men were as follows: normal potent: 48.2% +/- 1.4%, psychogenic 55.2% +/- 11.6%, arteriogenic 73.2% +/- 4.4%, venogenic 66.5% +/- 4.2%, neurogenic 76.9%, and idiopathic 77.4% +/- 4.2%. Significant differences were found between the normal potent and arteriogenic groups (P <0.05) and between the normal potent and idiopathic groups (P <0.05). Patients older than 60 years had a higher collagen fiber content (70.4% +/- 3.7%) than those younger than 50 years old (58.6% +/- 5.2%). The interobserver and intraobserver variances were both negligible for this automated image analysis system. This method significantly reduced the amount of variation introduced by the intra-rater reliability of a technician compared with the manual method. CONCLUSIONS: The present automated image analysis system is believed to be a reliable, accurate quantitative measurement tool for studies of penile tissue. Cavernous biopsy is a rapid, safe, and representative modality to study penile disease. An increase in cavernous collagen fibers (or corporal fibrosis) is considered an important factor in impaired erectile function.

Adult↗
PubMed1984

Decrease of vasoactive intestinal polypeptide (VIP) in the penises from impotent men.

Vasoactive intestinal polypeptide (VIP)-containing nerves were depleted in the penises of 28 impotent men. The extent of the decrease in VIP-containing nerves broadly reflected the severity of erectile dysfunction. VIP-immunoreactive nerves were most depleted in those men with complete erectile impotence, irrespective of the aetiology of the dysfunction, whereas in those men in whom some erectile function persisted, loss of VIP-immunoreactive nerves was more variable and less complete. Conventional histology demonstrated only mild changes (muscle atrophy and occasional thickening of blood vessel walls). VIP levels, measured by radioimmunoassay of tissue extracts, were depleted by more than 80% in penises from impotent diabetics (43.4 +/- 9.9 pmol/g wet weight [mean +/- SEM]), when compared with 6 controls (189.9 +/- 45.9 pmol/g). These findings not only support the contention that VIP may be the principal neurotransmitter involved in penile erection, but also suggest that depletion of this powerful vasodilatory peptide may play a key role in the development of penile impotence.

Adult↗
PubMed1987

Double-blind trial of yohimbine in treatment of psychogenic impotence.

48 subjects meeting strict diagnostic criteria for psychogenic impotence took part in a 10 week placebo-controlled, double-blind, partial crossover trial of yohimbine (18 mg a day) for restoring erectile function. At the end of the first arm of the trial 62% of the yohimbine group and 16% of the placebo group reported some improvement in sexual function (chi 2 = 10.41, df = 2, p less than 0.05). 21% of the originally placebo-treated group noticed some improvement over pre-treatment levels when they were put on yohimbine in the second arm of the trial. Overall 46% of those who received yohimbine reported a positive response to the drug, a response rate very similar to that observed in a previous study of patients with organic impotence. Response to yohimbine thus seems to be unrelated to current groupings of the cause of impotence. Yohimbine is a safe treatment for psychogenic impotence that seems to be as effective as sex and marital therapy for restoring satisfactory sexual functioning.

Adolescent↗
PubMed1982

Arterial disease as a cause of impotence.

The traditional views on the aetiology of impotence, attributing more than 90 per cent of all cases of impotence to psychic pathogenesis, have changed. Measurement of penile blood pressure, nocturnal penile tumescence studies (NPT) and especially new techniques of arteriographic examination of the arterial bed supplying the cavernous bodies have shown that the majority of cases have an organic basis affecting the haemodynamics of erection (limitation of arterial inflow into the cavernous bodies and/or their excessive venous drainage). Arterial disease, which is the most frequent affection in the middle-aged and elderly male population, is also largely implicated in the pathogenesis and aetiology of impotence. Recognition of this role of arterial disease is important not only with respect to the treatment of impotence but above all with respect to prevention of even more serious complications of the former condition such as IHD and MI, cerebrovascular disease and stroke, or intermittent claudication and gangrene.

Adult↗
PubMed1982

Sexual counselling of diabetic impotence.

A study of 54 diabetic men was conducted to determine the incidence of impotence, the nature of the sexual counselling they received, and their referral routes. Health providers associated with diabetes care also were interviewed to determine how they perceived professional responsibility for counselling about sexual dysfunctions in their clients. In the diabetic men studied, 48.1% had experienced primary impotence and 16.7% secondary impotence. Only 11.5% of the diabetic men received any sexual counselling, which each had initiated because of their personal concerns. Generally neither information about sexual dysfunctions nor even anticipatory warnings were given by members of the care-giving team. A discussion of impotence including etiology for the diabetic patient and sexual therapy as it relates to patient counselling is explored. Inclusion of this type of counselling for the male diabetic can contribute to continuity of care.

Adolescent↗
PubMed2001

Sildenafil improves nocturnal penile erections in organic impotence.

We studied the effects of sildenafil on nocturnal penile erections. We prospectively evaluated 36 patients with organic or psychogenic impotence and 5 normal, potent men. All patients completed 3 sessions of consecutive nights using the RigiScan Plus device. The first two nights the patients were asked to take placebo before the session and to take 50 mg of sildenafil before the third session. In the organic impotence group the use of sildenafil induced a significant improvement in time of rigidity 60-100%, rigidity and tumescence activity unit values and rigidity and tumescence activity unit values per hour in the tip and base. In the psychogenic impotence group it caused significant improvement only in rigidity activity unit per hour in the tip. In the potent men, changes were statistically insignificant. Sildenafil improves nocturnal penile erectile activity in organic impotence. Our study shows that phosphodiesterase inhibitors can improve penile erections not induced by sexual stimulation.

Adult↗
PubMed1998

Preoperative and operative factors to predict incontinence, impotence and stricture after radical prostatectomy.

The purpose of this study was to determine the incidence of patient-self reported post prostatectomy incontinence, impotence, bladder neck contracture or stricture, better, same or worse quality of life and willingness for same treatment again in a large group of radical prostatectomy (RP) patients and to determine if these morbidities are predictable with demographic, surgical or prostate cancer (PC) factors. Methods: A patient self-reporting questionnaire was completed and returned by 374 out of 458 eligible (81.7%) RP patients from one center, 267 (72.2%) have been operated since 1990 and all of whom were a minimum six month postoperative (75%>1 y). Questionnaire results were independently analyzed by a third party and correlated to demographic, operative, and tumor factors in an ongoing comprehensive PC database. Results: The patient self-reported incidence of post prostatectomy incontinence (any degree), impotence, and bladder neck contracture or stricture was 72.2, 87.4, and 25.9%, respectively. The reported rate of incontinence requiring protection was 39.0% and only 2.4% had persistent bladder neck contracture/stricture. Pathologic stage (continuous variable) was the only factor to significantly predict incontinence and no factor could predict impotence or bladder neck contracture/stricture in univariate analysis. No factor was predictive of morbidity by multivariate analysis. Despite incontinence and impotence significantly affecting QOL self-reporting (P=0.001, 0.001, respectively) and willingness to undergo RP again (P=0.001, 0.067, respectively), the majority of patients would choose surgery again. Conclusions: Although radical prostatectomy morbidity is common and affects patient-reported overall QOL, most patients would choose the same treatment again. Demographic, preoperative, operative, and tumor factors did not reliably predict patient-reported morbidity in this series.

Journal Article↗
PubMed2000

The role of adrenomedullin in varicocele and impotence.

OBJECTIVE: To assess the levels of adrenomedullin (a vasodilatory peptide) in penile blood before and after injection with papaverine in impotent men, and in the internal spermatic vein in infertile patients with varicocele, comparing the results with levels in the brachial vein in the same patients. PATIENTS AND METHODS: Intracavernosal levels of adrenomedullin were determined in 14 impotent men (with no vascular pathology, as assessed by colour Doppler ultrasonography) before and after papaverine-induced penile erection. The effect of needle puncture alone was assessed in eight control patients. The level of adrenomedullin was also measured in the internal spermatic vein and brachial vein in 14 infertile men with varicocele. RESULTS: The mean (SD) intracavernosal adrenomedullin levels in the 14 impotent men were significantly different between the flaccid and papaverine-induced erectile state, at 93.5 (33.0) and 135.8 (34.9) pmol/mL, respectively, (P < 0.05). Needle puncture alone had no effect on adrenomedullin levels. In men with varicocele, the adrenomedullin level of 139.0 (34.3) pmol/mL within the internal spermatic vein was significantly higher than that in the brachial vein, at 103.9 (37.6) pmol/mL (P < 0.05). CONCLUSION: Injection with papaverine increases adrenomedullin release into penile blood; this release may be responsible for the increase in penile blood flow and penile erection. Higher levels of adrenomedullin within the internal spermatic vein of patients with varicocele may result from the retrograde flow of venous blood from the left adrenal gland and kidney. Further studies are needed to determine the role of adrenomedullin in male infertility and impotence.

Adrenomedullin↗
PubMed1989

Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence.

Relaxation of the smooth muscle of the corpora cavernosa of the penis is necessary for penile erection. To determine the relation of impaired relaxation to impotence in diabetic patients, we performed an in vitro examination of corpus cavernosum tissue obtained at the time of implantation of a penile prosthesis in 21 diabetic and 42 nondiabetic men with impotence. Contraction was induced in isolated strips of corporal smooth muscle by norepinephrine; then relaxation was assessed with electrical stimulation of autonomic nerves and with the administration of three agents: acetylcholine, which is known to be mediated by endothelium-derived relaxing factor; papaverine; and sodium nitroprusside. The latter two act directly on smooth muscle (i.e., they are endothelium-independent). Autonomically mediated relaxation with electrical stimulation was less pronounced in the smooth muscle from diabetic men (n = 18) than in the smooth muscle from nondiabetic men (n = 24; P = 0.001). The degree of impairment increased with the duration of diabetes (r = 0.61, P = 0.007). Endothelium-dependent relaxation was also impaired, as evidenced by a lower degree of muscle relaxation after the administration of acetylcholine in the tissue from diabetic men (n = 16) than in that from nondiabetic men (n = 22; P = 0.001). The adverse effects of diabetes persisted after we controlled for smoking and hypertension. Endothelium-independent relaxation after the administration of nitroprusside and papaverine was similar in tissue from the diabetic and nondiabetic men. We conclude that diabetic men with impotence have impairment in both the autonomic and the endothelium-dependent mechanisms that mediate the relaxation of the smooth muscle of the corpora cavernosa. These findings may provide a rationale for the treatment of diabetic men with impotence by intracavernosal injection of vasodilators to induce endothelium-independent relaxation of the smooth muscle.

Acetylcholine↗
PubMed1997

Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy.

BACKGROUND: The age-adjusted rate of radical prostatectomy, the most common treatment of early (nonmetastatic) prostate cancer, increased almost sixfold between 1984 and 1990. This increase was due in part to reported improvements in postoperative sexual potency after the use of newly developed "nerve-sparing" procedures. However, published estimates from physicians of impotence following various types of radical prostatectomy may be low, since not all patients may report treatment-related complications accurately and completely to their doctors. In contrast, direct surveys of patients indicate much higher rates of postoperative sexual and urinary dysfunction. One problem with most physician and patient surveys is that they have been performed retrospectively, and pretreatment impotence and incontinence prevalent in older men cannot be assessed accurately in retrospective studies. PURPOSE: This study was initiated in a cohort of men before they underwent radical prostatectomy to assess treatment-related effects on impotence and incontinence. METHODS: The study population consisted of 94 men enrolled in a cohort study of treatment for early prostate cancer. The patients completed questionnaires about sexual and urinary functions before surgery and at 3 and 12 months after surgery and had adequate information to assess the type of surgical technique used (non-nerve-sparing, unilateral nerve-sparing, or bilateral nerve-sparing). Because items assessing sexual function were inadvertently omitted from the questionnaire in the initial months of the study, information on sexual function for all time periods was available for only 49 men. RESULTS: Compared with men who had not been treated with a nerve-sparing procedure, men who underwent nerve-sparing radical prostatectomy, particularly of the bilateral type, were younger and had better prognostic features, indicating less advanced cancers. Before surgery, nine (75%) of 12 men not treated with a nerve-sparing procedure reported erections that were usually inadequate for sexual intercourse compared with six (33%) of 18 men and one (5%) of 19 men who underwent unilateral and bilateral nerve-sparing prostatectomies, respectively. At 12 months after surgery, most men reported inadequate erections, including 15 (79%) of the 19 men who had bilateral nerve-sparing surgery; unilateral nerve preservation provided no apparent benefit. In general, nerve-sparing surgery was associated with more use of absorbent pads at 3 and 12 months following treatment, and this approach was associated with substantial urinary incontinence at 3 months but not at 12 months following surgery. CONCLUSIONS: Nerve-sparing prostatectomy, particularly when performed unilaterally, improves postoperative sexual function to a lesser extent than previously reported. Because men with preoperative impotence and more advanced cancers receive nerve-sparing surgery less often, some of the previously reported benefit of nerve preservation may be the result of patient selection and not of the technique per se.

Aged↗
PubMed1980

Theoretical and technical problems in the measurement of nocturnal penile tumescence for the differential diagnosis of impotence.

Theoretical and technical problems in using Nocturnal Penile Tumescence (NPT) measurements for the differential diagnosis of impotence are discussed and possible solutions are offered: 1) The basic assumption that NPT measurements can distinguish psychogenic from organic impotence has never been demonstrated in patients shown to be psychogenically and organically impotent independent of the NPT measurements themselves. Studies attempting to do this are necessary to determine definitively the limits of the clinical applicability of this important diagnostic tool. 2) Evidence is presented showing that though a direct observation of one of the patient's fullest erections is required for an adequate NPT evaluation, this is not always done. The danger of misdiagnosis if this step is omitted is illustrated with a case report. 3) Disagreements in the literature about NPT criteria for diagnosing psychogenic impotence are discussed and criteria are suggested that are based on demonstrating the intactness of the physiological mechanisms required for erection rather than on values recorded in normal subjects.

Anthropometry↗
PubMed1998

Impotence and the use of the internal iliac artery in renal transplantation: a survey of surgeons' attitudes in the United Kingdom and Ireland.

BACKGROUND: In 1996, a court in the United Kingdom ruled against a plaintiff who claimed that: (1) division of both internal iliac arteries at separate renal transplant operations had made him impotent and (2) the risk of his becoming impotent was sufficiently high that he should have been warned. The court ruled that there was not enough evidence in the medical literature to allow his claim to succeed. METHODS: A survey of the views of transplant surgeons in the United Kingdom and Ireland on attitudes toward using the internal iliac artery for transplantation was conducted. RESULTS: A 100% response rate was received. In a potent male patient, 11% of surgeons would never use the first internal iliac artery and 52% would use it infrequently. If one internal iliac artery had already been used, 61% would never use a second and 34% would use it infrequently. Eighty-nine percent believed the risk of impotence when the second internal iliac artery was used was 25% or higher, and 91% thought the risk should be explained to the patient. CONCLUSION: A very strong opinion exists among transplant surgeons in the United Kingdom and Ireland that the second internal iliac artery should not be used to revascularize a kidney transplant when the first has already been divided. The risk of impotence, if the second internal iliac artery is used, is greater than 25% and should be explained to the patient. This represents a very clear statement of currently accepted practice.

Adult↗
PubMed1978

Hyperprolactinaemia and impotence.

Clinical, laboratory and radiological findings were evaluated in twenty-nine men who had raised serum prolactin concentrations and pituitary tumours. Twenty-one had functionless pituitary tumours ('prolactinomas') and eight had acromegaly. Supraseller extension was detected in twenty of the twenty-six men who had lumbar airencephalography. Three patients were studied before, sixteen before and after and ten only after pituitary ablative therapy. Seventeen of these men complained of complete lack of libido and impotence and six had impaired libido and sexual potency; only six patients in this series denied reproductive symptoms. Thirteen of the impotent subjects had small soft testes, ten reduced facial and body hair and three had marked gynaecomastia. No features of hypogonadism were noted in the six patients without reproductive symptoms and none of the patients had galactorrhoea. Serum prolactin concentrations were higher and serum testosterone concentrations lower in the impotent men compared with those with normal sexual potency. Serum LH and FSH (both basal and in response to LHRH) oestradiol and oestrone concentrations were not different between the two groups and, except in those with post-operative hypopituitarism, were within the normal range. Following successful lowering of prolactin concentrations by surgery or bromocripitine or both, serum testosterone rose and potency returned; by contrast failure to lower prolactin concentrations was associated with persistent impotence and hypogonadism. The endocrine profile of low serum testosterone concentrations with gonadotrophins which had not risen into the range usually seen in primary hypogonadism (together with the parallel increase of LH and testosterone in one patient studied sequentially during treatment which suppressed prolactin levels to normal), suggested that the impaired gonadal function was caused by a prolactin-mediated disturbance of hypothalamic-pituitary function.

Acromegaly↗
PubMedDate not supplied

Pituitary gonadal function in diabetic male patients with and without impotence.

Assessment of pituitary function was undertaken in diabetic male patients with and without impotence, and in normal subjects, using a combined gonadotropin releasing hormone (GnRH) and thyrotropin releasing hormone (TRH) test. Basal plasma levels of testosterone, gonadotropins, PRL and TSH were similar in the diabetic patients and controls. Following the administration of I.V. GnRH 150 microgram and TRH 500 microgram, diabetic patients with impotence demonstrated a lower LH response at 30 and 150 minutes and an increased PRL response at 20 minutes, which was statistically significant when compared to controls. FSH and TSH were similar in the diabetic patients and controls. The GnRH and TRH test was repeated in impotent diabetic patients while receiving 0.8-1 mU/kg/hr of insulin through an infusion pump. No difference in LH and PRL response could be demonstrated. These results demonstrate that following GnRH and TRH test, diabetic patients with impotence have a significantly different LH and PRL response than controls. In these patients acute control of hyperglycemia using an insulin infusion pump did not reverse the abnormal response.

Adult↗
PubMed1992

Combined papaverine test and radionuclide penile blood flow in impotence: method and preliminary results.

The investigation of vascular impotence requires a simple, reliable and non-invasive method of estimating penile arterial supply. A method for measuring flow to the dependent portion of the penis has been developed using technetium-labelled red blood cells (99mTc-RBC). Its use, in conjunction with the intracavernous injection of papaverine, was investigated in 32 patients with various causes of impotence. Intracavernous papaverine was administered and a pneumatic cuff was inflated around the base of the penis both to isolate the penile circulation and to prevent dispersion of papaverine. The remaining blood pool was labelled with 99mTc-RBC. A gamma camera was used to produce a time-activity curve for the penis following release of the cuff. Penile blood flow was calculated from the initial gradient of the time-activity curve. Papaverine-stimulated penile blood flow was significantly greater in patients without evidence of arterial insufficiency. None of the subjects with arterial disease achieved flows greater than 20 ml/min/100 ml, while flow in patients without arterial disease exceeded this value. Flow estimation without the use of papaverine was not able reliably to discriminate between the 2 groups. There was no difference in papaverine-stimulated blood flow between impotent subjects with veno-sinusoidal leakage, in the absence of arterial disease, and a control group who achieved full erection with papaverine. It was therefore possible, by assessing the response to papaverine and measuring arterial blood flow, to distinguish between arterial insufficiency, veno-sinusoidal leakage and non-vascular causes of impotence. The method requires little skill and can be modified for use with inexpensive equipment.

Adult↗
PubMed1993

Cardiovascular reflexes in the neurological evaluation of impotence.

Testing of the autonomic cardiovascular reflexes (single breath beat-to-beat variation and orthostatic blood pressure change) was performed in 542 patients with erectile dysfunction who were grouped according to aetiological factors and their response to visual sexual stimulation and the papaverine test. Age-related normal values for autonomic tests were determined in the group of 124 patients with psychogenic impotence. Abnormal cardiovascular reflexes were associated with ageing and organic impotence, indicating autonomic dysfunction as a major contribution to impotence. Single breath beat-to-beat variation, as a simple non-invasive test, is useful in the clinical evaluation of impotence, especially in patients with diabetes and a history of alcohol abuse.

Aging↗
PubMed1990

The diabetes physician and an assessment and treatment programme for male erectile impotence.

The feasibility has been investigated of a physician in a district general hospital implementing an assessment and treatment service for male erectile impotence. Over an 8-month period a questionnaire was given to 200 men attending a diabetes review clinic. There were 50 replies declaring a problem of impotence, 34 of whom expressed interest in discussing treatment. These men and 17 others who spontaneously mentioned an impotence problem were further assessed with a view to treatment. After a full assessment and discussion the following treatments were agreed and successfully implemented: no treatment 30 (59%), self-injection of papaverine 12 (24%), urology referral 4 (8%), psychosexual clinic referral 2 (4%), vacuum devices 2 (4%), adjustment of drug therapy 1 (2%). Only 18% of questionnaire respondents ultimately opted for active treatment compared with 88% of the spontaneous complaints. A successful impotence assessment and treatment service, including self-injection of vasoactive drugs, can be provided by a physician as part of the diabetes care service. Active treatment is gratefully accepted. The numbers involved are manageable if resources are concentrated on those spontaneously mentioning the problem. Our experience suggested self-injection of vasoactive drugs to be the most successful treatment option.

Adult↗
PubMed1992

Impotence in diabetes: aetiology, implications for treatment and preferred vacuum device.

In an assessment of the contributions of autonomic neuropathy and vascular disease to the aetiology of male impotence in diabetes, evidence of autonomic neuropathy was identified in 23/39 (59%) individuals complaining of impotence. Thirteen of 26 men aged < 60 years tested with an intracorporeal injection of papaverine experienced little or no response and seven had tumescence but no rigidity. Radioisotope phallography demonstrated vascular disease in six of these seven, suggesting evidence of a vascular component in 19/26 (73%). Only one patient had non-organic impotence. Overall, evidence of vascular disease alone was demonstrated in 10/26 (38%), vascular disease plus autonomic neuropathy in 9/26 (35%), and autonomic neuropathy alone in 6/26 (23%). Many diabetic men complaining of impotence appear to have a significant vascular component which renders intracorporeal papaverine treatment ineffective. We compared the performance of a vacuum constriction-band (Erecaid) and condom-type (Synergist) device in 10 randomly selected men from this group. The devices, provided in random order for 5 months each, were assessed by questionnaire and interview of both the patient and partner. Two couples defaulted and another could use neither device. Although erectile capacity could be restored in the remainder, subsequent intercourse was only deemed satisfactory to both partners in five couples, who unanimously preferred the constriction-band device. In treatment with vacuum devices the constriction-band type seems to be the device of choice; the condom type should probably be reserved for those unable to use the constriction-band type.

Diabetes Mellitus↗