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PubMedDate not supplied

[Bulbocavernosus reflex and somatosensory evoked potential of the pudendal nerve in diabetic impotence].

The present study investigated the sensitivity of the bulvocavernosus reflex (BCR) and the somatosensory evoked potential (SEP) of the pudendal nerve in neurogenic impotence, the study comprised 22 males with diabetes type II. Of these, 11 had neurogenic impotence. The SEP was found to be normal in all cases, whereas BCR changes were observed in 36.4% of the patients who were not impotent and in 63.6% of the impotent males. This difference, however, is not statistically significant. The results show that in diabetic pelvic neuropathy compromise of the vegetative fibers does not necessarily mean injury to the somatic.

Diabetes Mellitus, Type 1↗
PubMed2005

Traditional herbal remedies used in the management of sexual impotence and erectile dysfunction in western Uganda.

BACKGROUND: The utilisation of ethnobotanical indigenous knowledge is vital in male sexual reproductive health care delivery in western Uganda. Reproductive health care is the second most prevalent health care problem in Africa. However, this concept of reproductive health care has been focusing mainly on women disregarding men. Thus, some diseases such as sexual impotence and erectile dysfunction that deserve mention are regarded as petty though important in economic productivity, family stability and sexually transmitted diseases control including HIV/AIDS. OBJECTIVE: This study was carried out mainly to document medicinal plants used in the treatment of sexual impotence and erectile dysfunction disorders in western Uganda. METHODS: The medical ethnobotanical indigenous knowledge were collected by visiting traditional healers and documenting the medicinal plants used and other socio-cultural aspects allied with sexual impotence and erectile dysfunction. The methods used to collect the relevant information regarding the medicinal plants used included informal and formal discussions, field visits and focused semi-structured interviews. RESULTS: Thirty-three medicinal plants used in the management of sexual impotence and erectile dysfunction were documented and Citropsis articulata and Cola acuminata were among the highly utilized medicinal plants. CONCLUSION: From the researchers' point of view, the usage of herbal remedies in managing male sexual disorders is useful because of long cultural history of utilisation and the current renewed interest in natural products to sustain health globally. As a way recognising the values and roles of traditional medical knowledge in health care provision, further research into the efficacy and safety of herbal remedies in male sexual disorders is precious in Uganda and beyond. More so, the establishment of rapport between relevant government department in Ministry of Health, modern health workers through collaborative and networking ventures with traditional healers under close supervision and monitoring of herbal treatments is noble.

Erectile Dysfunction↗
PubMedDate not supplied

[Echo-Doppler duplex combined with intracavernous injection of prostaglandin E1 in the diagnosis of impotence].

Sixty-two patients that had consulted for impotence were evaluated by intracavernal injection of prostaglandin E1 and duplex echo-Doppler. The internal diameter and the mean flow of the cavernosal arteries were determined by echo-Doppler in the flaccid state. Thereafter 20 micrograms of PGE 1 was injected intracavernously and the erectile response was evaluated clinically after 5 to 15 minutes. Another Doppler evaluation was performed during tumescence to study the changes of the internal diameter and the mean flow increase of the cavernal arteries. Twenty-nine patients (46.7%) achieved normal erection after intracavernal PGE 1 and the Doppler study was normal in all but 2 patients (3.2%). The remaining 33 patients (53.1%) failed to achieve normal erection following intracavernal injection of PGE 1. The Doppler study, however, was normal in 7 of these patients (11.2%), which indicates venous leak to be the underlying cause of impotence. There were minor complications (19.3%) presented a small hematoma at the site of injection and 12.9% referred moderate pain at the time of injection) and no patient has a sustained erection for more than 3 hours. The hemodynamic mechanisms and the current concepts relative to the neurologic aspects of erection are discussed. We believe duplex echo-Doppler combined with intracavernal PGE 1 to be a very reliable method in the diagnosis of impotence of a vascular origin. It can distinguish those patients that cannot achieve erection following intracavernal PGE 1 with a normal arterial tree whose impotence can be ascribed to venous leak.

Adult↗
PubMed1990

The role of vascular surgery in arteriogenic and combined arteriogenic and venogenic impotence.

Currently, the only procedure that may be ready for clinical application in arteriogenic impotence is the retrograde revascularization operation for patients who have been shown to have localized obstruction of the internal pudendal artery. This applies almost exclusively to young healthy men with impotence due to pelvic trauma. The concept that perineal trauma causes localized obstruction of the penile artery is controversial. Because the best candidates for penile revascularization are young healthy men with localized, rather than diffuse, arterial pathology and with the absence of vascular risk factors, the overall role for treatment of arteriogenic or combined arteriogenic and venogenic impotence by penile revascularization is very limited. For patients with impotence following pelvic and possibly perineal trauma, as well as occasional patients with arteriosclerosis who wish to be considered for penile revascularization, evaluation should begin with screening intracavernous pharmacodiagnosis using papaverine with or without phentolamine, or prostaglandin E1. If a poor response occurs, identification of venous pathophysiology by cavernosometry and identification of arterial pathophysiology by dynamic infusion cavernosometry and/or duplex sonography of the corpus cavernosum should be undertaken. If there is no venous pathology, penile arteriography must be done to design an anatomically rational revascularization operation. In the future, improved results of penile vascular surgery may occur if we can develop a clearer understanding of the physiology and pathophysiology of erection, improved diagnostic techniques, and a better selection of surgical candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Erectile Dysfunction↗
PubMed1990

Diagnosis and treatment of impotence.

Among the common procedures used in the diagnosis of impotence, neither nocturnal penile tumescence testing nor inhome monitoring devices designed to measure tumescence or rigidity is regarded as reliable for evaluating impotence. Plethysmography as a nonspecific test of vascular competence is increasingly being supplanted by Doppler ultrasound as a safe and effective diagnostic modality. Arteriography, cavernosography, and cavernosometry are established techniques for evaluating penile vasculature. Intracavernosal injection of smooth muscle relaxing drugs, endocrine assays, and electrophysiological testing are widely used for the diagnosis of impotence. Excluding implanted devices, and intracavernosal injections. Aortoiliac reconstruction, endarterectomy, or arterial dilatations are regarded as safe and effective for the treatment of proximal occlusive lesions, and venous leakage surgery is regarded as investigational. Intracavernosal injections are widely employed in clinical environments and for self-injection at home. However, this currently represents the use of FDA-approved drugs for an unlabeled indication. The use of external vacuum devices has achieved widespread use and is regarded as being safe and effective for the treatment of impotence.

Angiography↗
PubMed1989

[Critical evaluation of hidden organic factors causing impotence].

Many studies have pointed out the possibility of "masked" organic factors in erectile impotence, detectable only by means of laboratory investigations: mild hypogonadism, hyperprolactinemia, occlusions selectively located at the site of the sexual arteries, venous incompetence, subclinical neuropathies. This paper critically reviews these conditions, and the methods proposed to diagnose them. Impotence is a multifactorial disorder, involving in most cases psychological factors. Among the preceding conditions only severe venous incompetence can induce impotence only by itself. The other masked organic factors play only a partial role in most cases and need to be potentiated by another organic or psychological factor. In our experience, masked organic factors are present in 50% of the impotent males. But they play a significant role in only 25%.

Endocrine System Diseases↗
PubMed1989

Recording of penile tumescence and rigidity in impotence.

A new method of continuous and simultaneous recording of nocturnal penile tumescence and rigidity was used in 70 men (38 normal and 32 impotent). The RigiScan test provided several findings concerning nocturnal penile erection in impotent men. Of 32 impotent men, 9(28.1%) had normal patterns, 2(6.3%) had normal penile tumescence without rigidity, and 6(18.7%) had a dissociation of rigidity between the tip and base of the penis. Of 9 patients (28.1%) with a shortened duration of erection in the RigiScan test, 6 had undergone cavernosography, and all were proved to have venous incompetence. Low amplitude of rigidity (6.3%) and flat tracing (12.5%) were also seen. The RigiScan test is superior to other available methods of assessing erectile response. It produces an objective, accurate record of rigidity as well as tumescence, thus aiding in differentiating psychogenic from organic impotence.

Adolescent↗
PubMed1989

[Measurement of penile brachial index (PBI) in patients with impotence].

PBI was measured in 555 patients chosen at random from those who visited our impotence clinic between October 1984 and September 1986. Of 555 patients with impotence 29 (5.2%) showed a low PBI level of less than 0.6. On the basis of carefully taken history, risk factors causing the disturbance of penile blood flow were found in 13 (44.8%) of these 29 patients. They included diabetes mellitus, hypertension, surgery of pelvic organ, vertebral injury, vascular disorder of brain and gangliosympathectomy. Although penile angiography is necessary to make the definite diagnosis of vasculogenic impotence, hospitalization is usually required to perform the examination. Measurement of PBI is useful as a screening test to detect vasculogenic impotence at an outpatient clinic, because this examination is noninvasive and technically easy.

Adolescent↗
PubMed1988

Evaluation and treatment of impotence: a pragmatic approach addressing organic and psychogenic components.

Twelve patient referrals for evaluation of impotence comprise the subjects of a pilot study examining psychogenic and biogenic factors of erectile dysfunction. A structured interview format (KCII) was developed which allowed the clinician to estimate the likelihood of the presence of three organic factors (hormonal, neurological, cardiovascular) and three psychogenic factors (intrapsychic, relational, and behavioral) as well as the presence of relevant lifestyle factors (alcohol, smoking, exercise patterns). The results demonstrated a good ability of the KCII to accurately identify impotent patients (on the basis of history) who would have positive or negative signs of hormonal factor or neurological factor confirmed by laboratory results or physical examination. The sample of patients who had significant vascular findings did not allow for adequate comparison with interview findings. The majority of patients had significant psychogenic components to their impotence and might have been incorrectly classified as "solely psychogenic" if they had not been simultaneously evaluated for organic factors. The most important finding was that impotence, in most cases, involved multifactorial etiological components and required a comprehensive evaluation and treatment program.

Adult↗
PubMed1988

["Hidden" organic causes of impotence. Diagnostic methods and critical evaluation of their responsibility].

In five per cent of impotent, sexual dysfunction obviously results from an organic factor which can be today qualified as "classical". "Hidden" organic factors have also been implicated in a variable ratio of the other cases. This paper constitutes a critical review of the role they play in impotence, and of the methods allowing their detection. On one hand, methods allowing evaluation of the respective responsibilities of organic and psychogenic factors (the most important of which remain nocturnal penile tumescence monitoring); on the other hand, specific investigations of each factor. It is no longer possible to deny the existence of "hidden" organic factors in impotence. These factors intervene to varying degrees in one third of cases. Among them erectile failure only by themselves. Hyperprolactinaemia, moderate hypogonadism, infraclinical neuropathies, arterial stenoses and moderate venous leakages seem to play a partial role of organic starter or cofactor, the sexual consequences of which are amplified by psychological factors, partly secondary to the initial sexual failures. Nevertheless, the conjunction of several "hidden" organic factors may probably be sufficient to induce an impotence without involvement of psychological factors.

Erectile Dysfunction↗
PubMed1987

Testing of brain-stem function in 134 patients complaining of impotence.

To determine the cause of brain-stem dysfunction for impotence, we studied the brain-stem function in 134 patients complaining of impotence and compared the results with their clinical records, erectile function tests, a papaverine test, dynamic cavernography and measurement of the penile brachial index. We found brain-stem dysfunction in 43% of the patients with impotence. Brain-stem dysfunctions tended to show characteristic differences in underlying disease and erectile dysfunction. We discuss the testing and direct treatment of the brain-stem dysfunction, and postulate it to be one cause of the impotence.

Adult↗
PubMed1987

[Impotence in diabetes mellitus. Etiological factors and therapeutic possibilities].

The neurovascular causes of diabetic impotence are presented. 55 men presenting impotence and diabetes mellitus were examined in an extended diagnostic program. Nocturnal penile tumescence and Papaverin-test showed psychogenic impotence in 10 of these men, which lead to psychosexual therapy of the couple. Because of regional erectile lesions (Mb. Peyronie, penile trauma, inborn penile deviation, Priapism) 8 further diabetics were successfully operated. The remaining 37 patients with diabetes mellitus showed vascular erectile lesions (increased venous drainage in 7 and decreased arterial inflow in 30 men) and were operated upon with the following methods: Microsurgical arterialisation of the penile vein via a V. saphena-graft to the iliaque artery was done in 4 patients. There was an amelioration in 2 and a longterm failure in the remaining 2 men. Vein ligation of both internal iliaque veins and lateral penile veins in 7 patients resulted in 2 short term improvements and 5 failures. Flexible penile prostheses (AMS- and Jonas-prostheses) in 26 patients showed good results in 24 and infectious complications in 2 of them (Explanation of both prostheses, ones partial penile amputation). Vascular interventions for diabetic impotence seem to be of questionable value and therefore the implantation of penile prostheses should be preferred. In diabetics, infection of the alloplastic implants is particularly dangerous and may lead to septicemia and penile amputation.

Adult↗
PubMed1985

Changes in the corpora cavernosa of impotent diabetics: comparing histological with clinical findings.

In our study, the histological findings showed significant pathological fibrosis affecting the penile arteries and erectile tissue, but no direct damage to the penile nerve fibers. Forty percent of our patients with clinical evidence of penile neuropathies showed no histological evidence to support a neurogenic mechanism of their impotence. In addition, to the consistent vascular lesion found in 90 percent of impotent diabetics in our study, a fibroproliferation of the erectile tissue was predominantly found as well. Our histopathological study seemed to correlate with our previous clinical finding. Does this confirmation of the vascular etiology as a primary cause of impotence in diabetics have practical application? The answer must be "yes". If new diagnostic developments contribute to making an earlier diagnosis of this disease, then more conservative or aggressive treatment of the impotent diabetic will become a reality.

Diabetes Complications↗
PubMed1985

[The evaluation, classification and management of 300 impotent patients].

Three hundred impotent patients were evaluated by a general and sexual questionnaire, clinical examination, hormonal assay, penile blood pressure measurements, erectiometry, urodynamic studies and ultrasonography of the corpus cavernosum. The patients were classified according to the cause of the impotence; 44% had a psychogenic basis, 13% a neuropathy, 39% a vasculogenic cause and 4% a combination of neuropathy and angiopathy. Psychogenically impotent patients were referred for further treatment. Twenty penile prostheses were implanted in the organic group; 19 patients were satisfied with the result. This diagnostic approach to impotence classification and treatment according to the cause and the careful selection of patients for surgery improved the success rate.

Adult↗
PubMed1978

[Organic impotence. Diagnostic and therapeutic aspects (author's transl)].

Organic impotence is far more frequent than usually thought. Diagnosed frequently on clinical grounds, organic impotence is confirmed by more sophisticated and invasive techniques (Multi Modal Psychologic interview: MMPI, Nocturnal penile tumescence detection, pelvic angiography). Apart from local and neurogenic factors, vasculogenic impotence seems very frequent although its treatment has not met with the anticipated success. Intracavernous prosthesis remains the best form of palliative treatment in cases of organic impotence.

Adult↗
PubMedDate not supplied

ACTH 1-17 effects in psychogenic impotence.

The purpose of this study was to investigate the effects of repeated administrations of ACTH 1-17 (Syncrodyn 1-17) on sexual and endocrine function in men with psychogenic impotence. Twenty adult impotent men from 21 to 48 years volunteered for this study; organic causes of erectile impotence were excluded in each subject. Ten subjects were treated with ACTH 1-17 (100 micrograms i.m. daily for 15 days during 6 consecutive months), whereas saline was injected in the control group (10 subjects) following the same protocol. Clinical and endocrine evaluation were performed before and at the end of treatment. Serum levels of LH, FSH, PRL, testosterone (T) and cortisol were measured by RIA methods. To investigate diurnal rhythms of T and cortisol, blood samples were taken at 0800 and at 1800. In ACTH 1-17-treated men a significant improvement in sexual function was shown when compared with the control group (p less than 0.05); moreover, both anxiety and fatigability were lowered by ACTH 1-17 administration. ACTH 1-17 did not affect basal levels of LH, FSH, PRL, T and cortisol, whereas the diurnal variation of T, which was absent before treatment in both treated and control group, was restored. No changes in clinical and endocrine parameters were shown after placebo injections. Our data emphasize that the chronopharmacological action of ACTH 1-17 may positively affect sexual function and circadian T rhythmicity in men with psychogenic impotence.

Adrenocorticotropic Hormone↗
PubMed1983

[Sexual impotence of vascular etiology in arterial obstructive disease of the legs].

In order to demonstrate the relationship between sexual impotence and penile-brachial index 142 patients with arteriosclerotic disease of the legs and 15 control patients have been studied. Penile-brachial index has been evaluated by Doppler ultrasound, while sexual impotence has been graded on the basis of clinical history. Patients with arteriosclerotic disease have been further divided into 2 groups: patients with normal sexual potence and patients with sexual impotence. Penile-brachial index resulted 0,87 +/- S.D. 0,16 in the former group, while it resulted 0,59 +/- S.D. 0,22 in the latter. The present data seem to suggest that in patients with arteriosclerotic disease of the legs a positive relationship exists between penile-brachial index greater than 0,80 and a normal sexual potence, while a penile-brachial index less than 0,60 strongly indicates the possibility that the main factor responsible for sexual impotence is vascular insufficiency.

Adult↗
PubMed1982

Pelvic hemodynamics and male sexual impotence after renal transplantation.

Sexual impotence has been reported to increase sixfold after sequential renal transplantations. This study examined the effects of age, diabetes mellitus, systemic hypertension, uremia, arteriosclerosis, penile blood flow, and patency of hypogastric arteries on impotence. Sixty-one male transplant patients were followed up from six to 108 months. An age of greater than 40 years was the only factor deleterious to potency (P = .006). Interruption of both hypogastric arteries is not necessarily related to impotence. Post-transplantation male impotence is perhaps best treated by penile prosthesis insertion. A hemodynamic classification is proposed.

Adolescent↗