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PubMed1981

Cystometry and mictometry as tools in diagnosing neurogenic impotence.

Thirty-six males with erective impotence underwent neurological and urological examinations. Six of the patients were known to have a neurological disorder at the time of referral (four multiple sclerosis, one myelomeningocele, one diabetic polyneuropathy). Four further cases of neurological disorders were found (one multiple sclerosis, one myelopathy of unknown cause, one Shy-Drager syndrome, one sequelae of sacral herpes zoster). Five of these 10 patients gave a history of urinary troubles, but in all of them objective signs of bladder dysfunction were found at cystometry and/or mictometry. Among the 26 patients with impotence and no indication of a neurological disorder all invariably had normal cystometrograms, though some had abnormal mictiograms, probably due to local urological disorders. A neurological examination should be included in the evaluation of patients with erective impotence. Cystometry and mictometry may be of value by giving additional indications that the impotence is neurogenic. This is explained by the fact that the anatomical structures regulating sexual function lie close to corresponding structures regulating bladder function at the spinal level.

Adult↗

PubMed1979

Diabetic impotence: studies of nocturnal erection during REM sleep.

Nocturnal erections were studied in 30 diabetic patients who complained of impotence and in 11 healthy volunteers. The maximum increase in penile circumference was measured by a penile strain-gauge and recorded on a portable tape-recorder; an external oculogram was recorded simultaneously to identify periods of rapid-eye-movement sleep. The technique gave reproducible results, was acceptable to patients, and was suitable for use in an oridnary hospital ward. Only six diabetics showed a maximum increase in penile circumference of under 15 mm, whereas all but one of the healthy subjects showed maximum increases above this value. Of the six diabetics, five complained of total impotence and had other features of autonomic neuropathy that suggested an organic basis for their impotence. The other patient complained of partial importence, which was probably caused by psychological factors. These findings suggest that the prevalence of organic impotence among diabetics has been overestimated.

Diabetes Complications↗

PubMed1987

Cavernosal venocclusive insufficiency in male impotence: evaluation of degree and location.

The author's experience with 72 patients with impotence, one patient with Peyronie disease (no impotence), and two healthy volunteers indicates that incompetence of the venocclusive mechanism of the corpora cavernosa is probably the most common cause of vasculogenic impotence. Manometric and angiographic studies are the key to diagnosis but only when performed while the venocclusive mechanism is activated. Activation is achieved by intracavernosal injection of a papaverine-phentolamine mixture. Pharmacomanometry, performed with the newly developed pharmacologic maintenance erectile flow (PMEF) method, enabled precise quantitation of the leak at a given cavernosal pressure. A new appreciation of the limited volume of normal flow in the cavernosal arteries indicates that cavernosal leak in the range of only 20 ml/min is probably capable of contributing to impotence. Pharmacocavernosography enabled identification of sites of leakage (key information in the planning of surgical correction) but was unreliable in the evaluation of the severity of leakage.

Aged↗

PubMed1999

Reasons of dropout from short- and long-term self-injection therapy for impotence.

OBJECTIVE: To define the satisfaction rate and the dropout causes of intracavernous self-injection therapy in impotent patients. METHODS: A total of 250 impotent patients treated with intracavernous injection of drugs from 1991 to 1997 were mailed a questionnaire about their experience with this method. If the patient discontinued therapy, eight possible explanations for discontinuation were tested to identify reasons for terminating therapy (multiple choices were allowed). The causes of impotence were correlated with the rates of patients continuing or discontinuing therapy. RESULTS: 144 of 250 patients (57.6%) returned the questionnaire. Of the 106 non-responding patients, 50% could not be reached due to relocation. The patients were divided into three groups according to the duration of injection use. In group I, 35 of 144 patients (24%) did not continue therapy at home because either they felt it was unnatural (20%), they were dissatisfied (20%), or they experienced improvement of spontaneous erections (15%). In group II, 57 of 144 patients (40%) continued therapy at home and dropped out after a mean duration of 6.9 (range 0.5-48) months due to dissatisfaction (22%), cost reasons (20%), or insufficient erection for penetration (19.4%). In group III, 52 of 144 patients (36%) were continuing therapy with a mean follow-up period of 19.8 (range 2-72) months. The mean ages were not statistically different in the three groups. Also the aetiologies of impotence were similar: 35% psychogenic, 25% organic, and 40% mixed psychogenic/organic. Patients with psychogenic aetiology seem to continue therapy more frequently than others. CONCLUSIONS: The long-term follow-up revealed a high attrition rate of intracavernous self-injection therapy. Patient dissatisfaction, cost, and insufficient erection for penetration were the major causes of dropout.

Adult↗

PubMed1981

24-Hour studies of prolactin and growth hormone levels in diabetic impotence.

Serum prolactin and growth hormone levels were measured hourly over 24 h in 8 insulin-treated diabetic males, 4 of whom were impotent. All patients showed normal sleep-related peaks of both hormones during the night. The mean 24-hour concentrations of prolactin and growth hormone were similar in patients with impotence (9.4 +/- 1.0 ng/ml and 3.8 +/- 0.4 microIU/ml, respectively) and without it (10.5 +/- 1.0 ng/ml and 4.7 +/- 1.1 microIU/ml, respectively). The mean prolactin and growth hormone concentration during the day time (7.00 a.m. to 7.00 p.m.) and the night time (7.00 p.m. to 7.00 a.m.) were also similar in patients with and without impotence. These results suggest that impotence in diabetic patients is not mediated by abnormalities of prolactin and growth hormone secretion.

Adult↗

PubMed1988

Diagnosis of male impotence after intracavernous papaverine test.

The diagnosis and treatment of male impotence have been radically modified by the introduction of intracavernous injections of papaverine. Papaverine treatment can solve more than 70% of male impotence cases, so that the real clue to the diagnosis of impotence is to discriminate between patients who can be treated by papaverine alone and patients deserving thorough investigation. The association of papaverine injection plus video sexual stimulation for this purpose was adopted in our last 250 unselected patients and represents a valuable tool. 115 of 250 achieved successful treatment for their impotence according the following percentages: intracavernous papaverine injections at the practice or at home 75.8%; prosthesis, 19.1%; venous surgery, 3.4%, and arterial surgery, 1.7%.

Adult↗

PubMed1992

Study of the changes in collagen of the tunica albuginea in venogenic impotence and Peyronie's disease.

We identified the collagen type and content of the tunica albuginea in Peyronie's disease and venogenic impotence compared with the tunica albuginea from the donor of the renal transplant and patients with penile injury. Type III collagen was detected obviously in Peyronie's plaque and was also present in venogenic impotence. It can be hardly found in normal controls. The ratios of type III to type I collagen were significantly higher in Peyronie's plaque while there was a moderate increase in venogenic impotence. The scarcity of type V collagen was noted in human tunica albuginea. The decreased percentage of glycine and alanine in Peyronie's disease and venogenic impotence implied the abnormal composition of collagen or presence of noncollagen protein. The results suggest the biochemical aberration of the tunica albuginea might interfere with the normal function of the penile drainage system.

Amino Acids↗

PubMed1994

Deep dorsal vein arterialization in vascular impotence.

33 patients underwent a penile deep dorsal vein arterialization (DDVA) (11 venous leak, 8 pure arteriogenic impotence, 14 mixed arterial and venous impotence). The mean follow-up was 12 months. Surgery was considered successful when the patients had permeable anastomosis and were able to achieve satisfactory erections resulting in normal intercourse. 92% of the patients with venous leak, 62.5% of those with arteriogenic impotence and 58% with mixed lesions had a successful results. Due to antithrombotic therapy, there was no graft occlusion. Glans hypervascularity occurred in 3 patients and was treated by arterial banding. The role of DDVA in vascular impotence and its functional mechanism are discussed.

Adult↗

PubMed1975

A study of 65 impotent males.

Sixty-five patients primarily referred for erectile impotence were investigated. Information was obtained from patients and their partners. The demographic data are compared with those from a non-impotent psychiatric out-patient group, matched for age. Results indicate that impotent cases do not form a homogeneous population and can be classified into three fairly distinct groups. These groups differ in age, marital status, sex drive, pre-marital and post-marital relationships, duration of illness, etc. Group 1 develop impotence because of anxiety in sexual situations. Group 2 react to the sexual response and personality of their partners, while Group 3 decline, perhaps from inherent constitutional causes. Factors such as religious restrictions, sexual taboos, alcoholism and homosexuality do not appear to be of any aetiological importance.

Adult↗

PubMed1990

Secondary hypogonadism in older men: its relation to impotence.

The relation of the reproductive endocrine system to impotence in older men was examined by measuring the concentrations of testosterone (T), bioavailable testosterone (BT), LH, and PRL and body mass index (BMI) in 57 young controls (YC), 50 healthy potent older controls attending a health fair (HF), and 267 impotent patients (SD). The SD and HF had markedly reduced mean T and BT values compared to YC. When adjusted for age and BMI there was no difference in BT between potent and impotent older men. The percent BT was much higher in YC than in the older groups. While the percent BT rose significantly with increased T in YC, it was inversely related to T in the older subjects, suggesting that increased sex hormone-binding globulin binding was a primary event leading to a low BT. Forty-eight percent of HF and 39% of SD were hypogonadal, as defined by a mean BT of 2.5 SD or more below the mean of YC (less than or equal to 2.3 nmol/L). Ninety percent of these had LH values in the normal range, suggesting hypothalamic-pituitary dysfunction. Thirty-four SD and six each of YC and older control volunteers (OC) underwent GnRH testing. Older subjects showed impaired responsiveness to GnRH compared to YC. A low basal LH level correlated very highly with hyporesponsiveness to GnRH. Thus, secondary hypogonadism and impotence are two common, independently distributed conditions of older men.

Aged↗

PubMedDate not supplied

Impotence in elderly men.

Impotence is a highly prevalent condition occurring in 10 million American men over the age of 18 years. Alterations in vascular supply, hormonal changes with age, neurological dysfunction and the use of a variety of medications may combine and contribute to impotence. Impotence should not be considered a normal part of the aging process. Careful attention to evaluation for the aetiology of impotence will lead to making appropriate therapeutic choices.

Aged↗

PubMed2002

UK department of health guidance on prescribing for impotence following the introduction of sildenafil: potential to contain costs in the average health authority district.

OBJECTIVES: To evaluate the effectiveness at containing service costs of the UK's Department of Health (DoH) guidance on prescribing for impotence implemented after the introduction of sildenafil and taking effect from 1 July 1999. DESIGN: A pragmatic economic analysis of the impact of the DoH guidance on specialist-care activity and costs and primary-care prescribing costs from the perspective of the UK National Health Service. Primary-care prescribing costs and specialist-care activity and cost data were collected for 12-month periods before and after the introduction of the guidance. SETTING: Portsmouth and South East Hampshire Health Authority. RESULTS: Specialist-care activity and associated costs fell by 70% in the first year following the introduction of the DoH guidance while primary-care prescribing costs doubled. The overall cost for providing impotence services in Portsmouth and South East Hampshire in 1999-2000 was pound 232,619, and is similar to the cost incurred in 1998-1999 of pound 225,108 (uplifted to 1999-2000 values). CONCLUSIONS: The DoH guidance on prescribing for impotence has effectively reduced specialist-care activity and costs in Portsmouth and South East Hampshire. It offers the potential to allow the overall costs of impotence services in the district to be contained even with the use of higher cost drugs, such as sildenafil.

Adult↗

PubMed1993

Diagnosis of arteriogenic impotence: efficacy of duplex sonography as a screening tool.

OBJECTIVE: The results of duplex sonography of the cavernosal artery were compared with the results of pharmacoarteriography in a series of impotent men in order to assess the validity of sonography as a screening tool for the diagnosis of arteriogenic impotence. SUBJECTS AND METHODS: Duplex sonography was performed in 30 impotent men after intracavernosal injection of papaverine and phentolamine. Maximal acceleration, peak systolic velocity, and resistive index were determined for the cavernosal artery. All patients had selective pharmacoarteriography and cavernosometry, which were used to diagnose arterial disease (bilateral hemodynamically significant stenoses or occlusions), suspected arteriolar dysfunction (inconspicuous helicine arterioles), or venoocclusive insufficiency (pharmacologic maintenance erectile flow greater than 25 ml/min). Seventeen patients had arterial insufficiency, four had arteriolar dysfunction, and nine had no significant arterial disease. RESULTS: Significant differences in Doppler measurements were found between patients without significant arterial disease and those with arterial insufficiency, including peak systolic velocity (50 +/- 25 cm/sec vs 33 +/- 17 cm/sec, p = .04), acceleration (524 +/- 261 cm/sec2 vs 199 +/- 111 cm/sec2, p < .001), and resistive index (88 +/- 12% vs 73 +/- 11%, p = .002). Differences were also noted between the group without significant arterial disease and the group with arteriolar dysfunction. When peak systolic velocity of less than 25 cm/sec or acceleration less than 400 cm/sec2 was used as an indication of inadequate arterial patency, the sensitivities were 35% and 100%, the specificities were 61% and 46%, and the negative predictive values were 42% and 100%, respectively, in the diagnosis of arterial insufficiency. CONCLUSION: Duplex sonography of the cavernosal arteries may be a useful screening tool in patients with suspected arteriogenic impotence only when acceleration is evaluated in addition to peak systolic velocity. The specificity of the method may be partially limited by the inability to distinguish between arterial and arteriolar disease.

Adolescent↗

PubMedDate not supplied

Prevalence and pathogenesis of impotence in one hundred uremic men.

In a study of dialysis patients 79% of men complained of sexual dysfunction and 61% erectile impotence following uremia and the onset of regular dialysis therapy. Plasma testosterone levels were significantly higher in patients treated by continuous ambulatory peritoneal dialysis (p = 0.001) but the incidence of sexual dysfunction was not different from patients treated by hemodialysis. Although follicle-stimulating hormone levels were higher (p = 0.001) and penile blood pressure index levels lower (p less than 0.05) in patients with impotence, sexual function was not improved by exogenous testosterone, and vasculogenic impotence was identified in only 6% of patients. These findings suggest that a major component of uremic impotence is unrelated to primary testicular failure or penile vascular insufficiency.

Adult↗

PubMed1998

[New animal models for psychogenic impotence: an ethological approach to copulatory disorder induced by social stress].

Although various experimental models of mental illness, such as anxiety and depression, have been developed, little attention has been paid to male psychogenic impotence. Since sociopsychological factors are presumed to play an important role in many cases of human impotence, an animal model of psychogenic impotence is needed to satisfy such validity. From an ethological viewpoint, we have recently developed new animal models for psychogenic impotence using sociopsychological manipulations, that is, social deprivation and social conflict. This review focused only on the methodology and the actions of drugs on such copulatory disorder induced by social stress. Possible brain mechanisms underlying stress-induced copulatory disorder were also considered.

Animals↗

PubMed2000

Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy.

PURPOSE: We determined the incidence of patient self-reported post-prostatectomy incontinence, impotence, bladder neck contracture and/or urethral stricture, sexual function satisfaction, quality of life and willingness to undergo treatment again in a large multicenter group of men who underwent radical prostatectomy. We also determined whether the morbidities of sexual function satisfaction, quality of life and bladder neck contracture and/or urethral stricture are predictable from demographic and postoperative prostate cancer factors. MATERIALS AND METHODS: A self-reporting questionnaire was completed and returned by 1,069 of 1,396 eligible patients (77%) who underwent radical prostatectomy between 1962 and 1997. Of the respondents 868 (85.7%) underwent surgery after 1990 and in all prostatectomy had been done a minimum of 6 months previously. Questionnaire results were independently analyzed by a third party for morbidity tabulation and the association of patient reported satisfaction. RESULTS: The patient self-reported incidence of any degree of post-prostatectomy incontinence, impotence and bladder neck contracture or urethral stricture was 65.6%, 88.4% and 20.5%, respectively. The incidence of incontinence requiring protection was 33% and only 2.8% of respondents had persistent bladder neck contracture or urethral stricture. Although incontinence and impotence significantly affected self-reported sexual function satisfaction, quality of life and willingness to undergo treatment again (p = 0.001), 77.5% of patients would elect surgery again. This finding remained true even after adjusting for demographic variables, and the time between surgery and the survey by multiple logistic regression. CONCLUSIONS: Although radical prostatectomy morbidity is common and affects self-reported overall quality of life, most patients would elect the same treatment again. Impotence and post-prostatectomy incontinence were significantly associated with sexual function satisfaction, quality of life and willingness to undergo treatment again. Bladder neck contracture and/or urethral stricture was associated with willingness to undergo treatment again after adjusting for demographic variables and time from surgery to the survey.

Adult↗

PubMedDate not supplied

[Impotence in pelvic fractures. Report of 16 cases].

The authors study impotence secondary to a pelvic fracture on the basis of a retrospective series of 16 cases. All these patients had a lesion of the membranous urethra and seven of them underwent a deferred emergency urethral repair. Although the constancy of the urethral lesion is probably related to the fact that this series was recruited from a urology department, impotence is classically considered to be more frequent in the presence of a urethral lesion than in the absence of such a lesion. Two patients presented with incomplete impotence and fourteen with complete impotence. Ten of these sixteen patients spontaneously regained satisfactory erections. When erections were not obtained, the authors analysed the various therapeutic possibilities available, stressing the arterial factor which is usually insufficiently investigated.

Adolescent↗

PubMed1992

[Impotence from the 70's through the 90's: 20 years of evolution of diagnosis and therapy].

The surgical treatment of vascular impotence has evolved as our understanding of the haemodynamics of erection advanced. In the early Seventies the direct revascularization techniques which create an anastomosis between an artery and the corpora cavernosa came to be so much in use that an era of so-called "pure arteriogenic impotence" seemed to be dawning. An arterial role in the pathogenesis of importance gained increasing support during that decade, as the use of a number of techniques for the diagnostic assessment of penile haemodynamics becomes widespread (Doppler ultrasound, determination of the penile-brachial index, selective hypogastric arteriography, penile radionuclide scan, penile plethysmography). Corpora cavernosa-direct revascularization techniques, such as the Epigastric-Corporal and Femoro-Corporal trans-Saphena anastomoses, were developed, the latter being proposed by Michal in 1973. By the late Seventies, however, most Authors had abandoned these techniques. Severe haemodynamic side-effects, such as uninterrupted intra-cavernous high pressure and attendant permanent tumescence of penis, were found to induce the microfibrosis of erectile tissues and the thrombosis at the site of the anastomosis. In this period, "venous leakage" became, with the advent of cavernosography, a recognized factor in the pathogenesis of impotence. However, the concept of venogenic impotence, characterized as it is by transient erection, and featuring pathological cavernosograms as well as high cavernometric figures, belongs more appropriately to a clinical syndrome and is, therefore far from being unambiguous. Arterial-arterial bypass and selective veins ligation were then introduced to treat cases of "pure" arteriogenic or venogenic insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Erectile Dysfunction↗