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PubMed1981

[Doppler velocimetric study of the arteries involved in erection. A new diagnostic approach to sexual impotence of arterial origin].

With the aim of diagnosing possible arterial causes of sexual impotence, a Doppler study of the arteries of erection (dorsal arteries of the penis, left and right cavernous arteries) was performed according to an original protocol on 132 patients with cardiovascular disease. The Doppler study included recording of mean arterial flow and the measurement of the systolic pressure of the arteries of erection with a specially designed cuff connected to a manometer. In 60 out of 132 cases the investigation demonstrated an arterial component in the cause of the impotence and was able to determine whether the disease was uni- or bilateral. The disturbance of penile irrigation was constantly associated with a lengthening of the decceleration phase of the arterial flow curve. Aortography was carried out in 46 of these 60 cases and confirmed the results by showing arterial disease and its location: aortic bifurcation (33 cases) ischio-perineal trunk and/or the perineal branch of the hypogastric artery (7 cases), hypogastric artery (6 cases). Reliable and atraumatic, our protocol allows a precise diagnostic of possible arterial components in sexual impotence; it should therefore be an integral part of investigation of impotence of recent onset.

Adult↗
PubMed1981

Prolactin and impotence in diabetes mellitus.

A study was undertake to determine whether impotence in some diabetic patients might be due to a coincidental prolactinoma and therefore be potentially treatable. Of 83 consecutive men attending a diabetic clinic, three were found to have persistent mile to moderate hyperprolactinaemia. None of the three was impotent or taking any drug know to be associated with elevated serum prolactin, and anterior pituitary responses and pituitary fossa tomograms did not reveal any abnormality. The mean serum prolactin concentration of the 37 insulin-treated men was not significantly different from that of the 46 men on diet with or without anti-diabetic tablets, nor was there any significant difference between the mean serum prolactin concentrations of the 19 impotent men and of the 64 non-impotent men.

Adolescent↗
PubMed1980

Vascular surgery in the treatment of impotence; its present possibilities and prospects.

Five years ago we reported on a technique of direct arterial anastomosis with the cavernous bodies of the penis. At that time we expressed the hypothesis that in some cases impotence could be the result of organic changes in the arterial bed supplying the cavernous bodies. A histological study was therefore performed on postmortem material and a new arteriographic technique - phalloarteriography - was developed to visualize the internal pudendal artery, the penile artery and its branches. Bilateral examination carried out in 132 patients with erectile impotence established stenosis or occlusion of these arteries or aplasia of the deep penile artery in most of them. Stenoses or occlusions were either of traumatic (after pelvic fracture) or sclerotic origin in middle aged and older patients or were related to diabetes. In more than 20% of patients with occlusions in the arterial bed plastic induration of the penis (Peyronie's disease) was found. Phalloarteriography has become the basic technique of surgical indication and approach. Revascularization procedures consisted of anastomosis of the inferior epigastric artery to the dorsal penile artery or directly to the cavernous bodies. The results attained in the first 54 patients confirmed the vasculogenic origin of their impotence. The development of phalloarteriography and revascularization procedures contribute to surgical management of impotence and extend the use of vascular surgery.

Adult↗
PubMed1995

Incidence of erectile impotence secondary to transurethral resection of benign prostatic hyperplasia, assessed by preoperative and postoperative Snap Gauge tests.

In an attempt to assess the impotence rate secondary to transurethral resection of the prostate more objectively than by merely interviewing patients, potency was evaluated with the Snap-Gauge test. The test was used preoperatively to recruit patients with intact potency. The 98 patients studied underwent transurethral resection of the prostate and were retested during postoperative night 4. Of the 98 patients 64 remained potent while 34 did not. These 34 men were retested 3 months later, and 26 were potent and 8 were impotent. Therefore, 8 of 98 patients (8.3%) became impotent as a consequence of transurethral resection of the prostate. The risk specific to subgroups in cases of small (less than 10 gm. resectable tissue) and larger adenomas is 11.1% and 7.7%, respectively, for men older than 65 years, and 7.1% and 0%, respectively, for men younger than 65 years. A selective indication taking into account patient age and prostatic size might further lower the already low impotence risk of transurethral resection of the prostate.

Aged↗
PubMed1994

Reasons for high drop-out rate with self-injection therapy for impotence.

One hundred and eighty patients, average age of 58 years (range 24-75) were evaluated for impotence and were advised to undergo pharmacologic self-injection therapy with either papaverine/Regitine (90%) or prostaglandin E1 (10%). Follow-up was available from 2 months to 3 years (average 11 months). The cause of impotence was determined by hormonal testing, Rigiscan and psychological testing. The etiology of impotence was organic (70%), psychogenic (20%), and mixed (10%). After the initial test injection 22% of patients did not enroll in the self-injection program or were lost to follow-up. The group with psychogenic impotence had the highest satisfaction/usage rate at 42%. Overall only 20% of patients were satisfied long-term and were actively using self-injection therapy. Of the 140 patients available for follow-up, 112 patients (80%) discontinued self-injection therapy. The reasons for discontinued usage were alternate treatment (prosthesis or vacuum device) 15%, return or improvement of erections 8%, partner dissatisfaction or loss of partner 10%, or complications of injection therapy 10%. Cost was not a factor for discontinued use. Loss of interest caused 57% of patients to stop using self-injection therapy. Although pharmacologic self-injection therapy is initially promising there is a high drop-out rate at long-term follow-up.

Adult↗
PubMedDate not supplied

[Clinical and ultrasonic validation for the intracavernous use of papaverin hydrochloride for the test screening of patients with arterial erectile impotence].

Intracavernous administration of 2% papaverine hydrochloride solution, 4 ml, was conducted in 25 patients with various arterial erectile impotence and 25 patients with psychogenic impotence. The efficiency of the solution was judged from clinical findings and results of penile blood flow estimation via ultrasonic Doppler graphy 10 minutes after injection. Ultrasonic Doppler graphy involved calculation of the pulse wave acceleration measure and penile-brachial index of acceleration. In patients with psychogenic impotence the penile blood flow after intracavernous papaverine hydrochloride assumed the features of great blood flow, whereas it remained reduced in patients with arterial erectile impotence. In Doppler sonography, basic parameters were determined, viz assessment of the form of a Doppler wave, initial blood flow velocity, maximum blood flow velocity and their difference.

Adult↗
PubMed1993

[Reevaluation of impotence following TURP].

Impotence following transurethral prostatectomy is one of the main complications that still has a controversial origin. Many authors, reporting their experience, have demonstrated that this complication is due both to psychological problems and to organic causes. We review retrospectively 68 patients submitted to TURP. All patients (53 to 65 years old) were asked about their sexual efficiency before and after TURP, 6-12 months after surgery. Those who complained of erectile failure have been studied using this diagnostic protocol: plasmatic dosage of FSH, LH, Testosterone and Prolactin; penile Doppler ultrasound, polysomnographic recording of nocturnal tumescence test (NPT Test); angiography of the pudenda arteries has been performed in only one patient with pathological penile Doppler ultrasound (IPP < 0.7). The examinations demonstrated an organic impotence not secondary to vascular damage in 10 patients following surgery (incidence 15.6%). Our high incidence of this complication is, according to us, significant even if it should be considered in excess since in our study we used anamnestic criteria alone in the evaluation of sexual efficiency before surgery. In 1984 T. Lue demonstrated, through accurate histological preparations, that cavernous nerves run contiguously to the prostatic capsule at 5 and 7 hours in correspondence of the glandular apex. He suggested that impotence following TURP is due to iatrogenic lesions of these nervous structures during endoscopic resection. Similarly, we have conducted an anatomopathological study on prostate specimens taken from autopsies. We demonstrated the presence of nervous structure contiguously to the prostatic capsule in correspondence with the glandular apex. Thus, impotence following TURP probably occurs after an iatrogenic heat lesion of the periprostatic plexus caused by resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Computerized image analysis of smooth muscle fibers in normal Chinese men and impotence patients.

Smooth muscle fibers are considered very important in penile erection and relaxation. The reduction of intracavernosus smooth muscle fibers can provoke impotence. The percentage of smooth muscle fibers in corpus cavernosum specimens was studied quantitatively in normal men and impotence patients by means of computerized image analysis. The percentage of smooth muscle fibers in the specimens of 14 normal men, ranged from 41% to 61% (average 50%) and in 12 impotence patients, it was 22% to 46% (average 31%). A decrease of smooth muscle fibers and an increase of collagen fibers were noted in impotence patients.

Adult↗
PubMed1996

Fixation of asthma and sexual impotence at different pregenital stages.

Most psychoanalytic writers believe that both asthma and sexual impotence depend on fixations at the early stages of the Oedipus complex. Through psychoanalytic study of patients with both disorders, the author believes that this problem may be considered from another angle whereby the fixation of sexual impotence is situated at the early stages of the Oedipus complex, while asthma depends on fixations at the level of the breast although its character is also triangular. It is the author's opinion that in studying the psycho-pathogenesis of these afflictions it is important to distinguish between basic and defensive phantasies, since it is the former which reveals the level of object relations where the malady is situated. Defensive phantasies include, owing to regressive and progressive movements, objects and defences from other levels and therefore cannot be used for the investigation of levels of fixation. In the cases presented, the aim of the psychosomatic symptom is, in asthma, to avoid the collapse of the self while, in impotence, it is to avoid castration anxieties, when the introjected object does not provide sufficient cohesion to the self or is experienced as persecutory. At first the patient uses manic defences but should these fail, further defences are resorted to (contraction of the bronchioles in asthma and inhibition in sexual impotence), and these give rise to the psychosomatic symptom.

Adult↗
PubMed1997

[Current status of the study of genital sympathetic evoked potentials in the assessment of impotence].

OBJECTIVE: To determine the usefulness of penile sympathetic skin response (PSSR) in the study of impotence. METHODS: The PSSR, hand sympathetic skin response (HSSR), filling videocystography and SPACE (single potential analysis cavernous electromyography) were performed in 39 patients referred for study of impotence. RESULTS: A relationship between not obtaining PSSR and an open bladder neck (60%) in the videocystography at filling, and between a closed bladder neck and obtained PSSR (81%) was demonstrated. The percentage of normal hand sympathetic potentials was similar for patients with obtained and not obtained PSSR. The relationship between the degree of activity of the SPACE and the type of PSSR could not be demonstrated. CONCLUSION: The determination of the PSSR allows us to evaluate the sympathetic cavernous innervation. This would obviate performing a filling videocystography in the study of the neuroandrologic profile in impotence. The information obtained by PSSR is independent of that obtained from SPACE, therefore both procedures complement each other in the neuroandrologic study of impotence.

Electromyography↗
PubMed1997

[Usefulness of electromyographic techniques of the bulbocavernosus muscle in the diagnosis of neurogenic impotence].

OBJECTIVE: To analyze the utility of electromyographic study of the bulbocavernosus muscle. METHODS: 126 impotent patients were evaluated by physical examination and neuroandrologic profile. The physical examination consisted in an exploration of the anal tone and the bulbocavernosus reflex. The neuroandrologic profile consisted in selective electromyography of the bulbocavernosus muscle, the determination of the S2-S4 evoked potentials, somatosensory potential of the pudenal nerve, electromyography of cavernous smooth muscle (SPACE) sympathetic skin response and cystometry. RESULTS: The results of the bulbocavernosus electromyography and S2-S4 evoked potentials were different from the data obtained from the physical examination of the anal tone and the bulbocavernosus reflex. Selective bulbocavernosus electromyography showed a sensitivity of 57% and a specificity of 84%. The S2-S4 evoked potentials showed a sensitivity of 61% and a specificity of 100%. The diagnostic value of the S2-S4 evoked potentials increased at 39 msec cutoff (sensitivity = 66%; specificity = 95%). Exploration of the anal tone is very specific for neurologic lesion in impotence (93%), but has a low sensitivity (30%). The clinical bulbocavernosus reflex showed a good specificity (85%) and sensitivity (75%) in the diagnosis of pudendal efferent lesion, but is less useful in the diagnosis of neurogenic impotence. CONCLUSIONS: The highest diagnostic value was obtained with the S2-S4 evoked potentials. Selective electromyography of the bulbocavernosus muscle showed a moderate diagnostic value. Physical examination of peripheral pudendal innervation does not appear to be useful for screening for neurologic lesion in impotence because of its low sensitivity, which may be due to existing incomplete nervous lesions.

Autonomic Nervous System Diseases↗
PubMed1998

[The woman and the new methods of treatment of male sexual impotence].

New treatments for male impotence are now available, mainly sildenafil (oral) and prostaglandin 1 (intraurethral). These new treatments, which will be easier to use for men, raise problems of acceptability by women. Schematically, women adopt certain behaviours in relation to male sexuality, which can be characterized as "castrating", "infantile", "not interested", or "narcissistically wounded". New treatments, which will certainly be better accepted by patients and their partners, must not mask the ubiquitous participation of a psychogenic component in all forms of male impotence, including so-called "organic" impotence. The management of male impotence can therefore only be conceived in a context of a "couple project" after having defined the contribution of medicine and the patient's personal investment in finding a solution to his problem. The blind prescription and use of a drug wrongly considered to be a "male youth pill" could lead to major and probably harmful sociological changes in the context of the ever-evolving male-female relationships and in a context of ageing of the population.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed1993

Male sexual impotence in diabetes mellitus: vasculogenic versus neurogenic factors.

In an attempt to understand better the role of vascular and neurogenic alterations in the pathophysiology of diabetic impotence, 29 impotent male patients with diabetes mellitus (DM) were investigated by means of doppler ultrasound examination (DUE) of penile arteries, sacral evoked responses (SERs), peripheral nerve conduction studies, and, in most cases, nocturnal penile tumescence monitoring (NPTM). Fourteen patients showed isolated alterations of penile vascular supply, four isolated alterations of penile segmental innervation, and seven combined vasculogenic and neurogenic abnormalities; finally, in four patients, DUE, SERs, and NPTM were normal. One patient, in spite of the presence of marked vasculogenic and neurogenic alterations, showed nocturnal penile erections. Results confirm that vascular obstruction, more than nerve damage, plays a primary role in the pathophysiology of diabetic erectile failure, and stress the importance of psychogenic factors. The observation that some patients presented marked involvements of both arterial supply and neurological pathways only a few years, or even 1 year, after the diagnosis of the disease, indicates the need of an early screening of the vascular and neurological status, even in asymptomatic patients. Furthermore, all patients with altered SERs had peripheral neuropathy; on the other hand, six patients with peripheral neuropathy had normal SERs. This result stresses the diagnostic importance of the electrophysiologic studies of sacral segmental innervation and indicates further that in a comprehensive diagnostic protocol of diabetic impotence the study of SERs should be performed only in patients with peripheral neuropathy.

Adult↗
PubMed1995

Scanning electron microscopy of the tunica albuginea of the corpora cavernosa in normal and impotent subjects.

The tunica albuginea (TA) of the penis is thought to play a major role in the erection mechanism. It functions by compressing the subalbugineae venulae, which promotes the slower venous flow during erection, and provides a fibrous frame to give an inextensible support for the vessels and nerves. It acts as the inextensible enclosing structure which contains the erectile tissue and gives the erect penis its shape. The functions of the TA result from its structure, consisting for the most part of collagenic and elastic fibers. This study investigated, with the aid of scanning electron microscopy (SEM), the microarchitecture of the TA and the spatial relation of its fibers in ten impotent patients and in six control subjects with normal erectile function. The arrangement of elastic fibers in the TA seems to account for their function, which is to prevent the overstretching of collagenic fibers during maximum intracavernous pressure. In impotent patients, a reduction in the elastic fibers in the TA appears to produce disorders in the arrangement of the collagenic fibers. These alterations in the architecture of the TA in impotent patients can give rise top erection disorders.

Adult↗
PubMedDate not supplied

Role of radioisotope penile plethysmography in the evaluation of penile hemodynamics in impotent patients.

Nineteen impotent patients were included in the study. Radioisotope penile plethysmography using technetium-99m-labelled RBC was performed on each patient before and after intracavernosal injection of prostaglandin E1 (PGE1) for quantitating the penile hemodynamic change. The peak penile blood flow (PPF) and penile blood volume change (dPV) were evaluated. The results revealed that (a) the PPF values (mean 2.24 +/- 1.38 ml/min) of all patients were lower than that of the patients with no arterial changes previously reported, and (b) there was good correlation between PPF and dPV (r = 0.75). We conclude that quantitative radioisotope penile plethysmography coupled with intracavernosal injection of PGE1 is a valuable method for the objective evaluation of the penile erectile response of impotent patients, and that the PPF values of the impotent patients with arterial insufficiency might be a reliable parameter of penile volume change.

Alprostadil↗
PubMed1997

Intracavernosal forskolin: role in management of vasculogenic impotence resistant to standard 3-agent pharmacotherapy.

PURPOSE: We investigated forskolin, a direct adenylate cyclase activator, as an intracavernosal vasoactive agent in management of vasculogenic impotence. MATERIALS AND METHODS: Concentration responses for forskolin and prostaglandin E1 induced relaxation of phenylephrine precontracted strips of human corpus cavernosum smooth muscle were constructed in vitro. Cyclic adenosine monophosphate (cAMP) synthesis was determined with papaverine, phentolamine, prostaglandin E1 and forskolin in human corpus cavernosum smooth muscle cell cultures. Dose-dependent hemodynamic responses to intracavernosal forskolin (5 to 20 micrograms) were evaluated in a New Zealand White rabbit model. Safety and efficacy outcome data were obtained in vasculogenically impotent patients who signed informed consent and met strict inclusion and exclusion criteria that included having had standard self-injection therapies fail. RESULTS: In vitro forskolin and prostaglandin E1 alone caused concentration dependent relaxation with an EC50 of approximately 200 nm. and 16 nm., respectively. When the 2 agents were combined, the concentration response curve for relaxation shifted to the left. cAMP production was highest in cells treated with prostaglandin E1 and forskolin and was unaffected by papaverine or phentolamine. In 3 animals, equilibrium intracavernosal pressure and duration of erection had a dose dependent increase. Clinical investigation in 31 patients showed no adverse events with a mean of 14 +/- 4, range 11 to 18 months of followup. Overall 61% reported improvement in rigidity and/or erection duration using intracavernosal forskolin (98 micrograms./ml.), papaverine (29 mg./ml.), phentolamine (0.98 mg./ml.) and prostaglandin E1 (9.8 micrograms./ml.). CONCLUSIONS: Forskolin is a United States Food and Drug Administration nonapproved vasoactive agent that acts in synergism with prostaglandin E1 to induce smooth muscle relaxation. In combination with other vasoactive agents, forskolin has demonstrated preliminary safety and efficacy in patients with vasculogenic impotence resistant to standard 3-agent pharmacotherapy.

Alprostadil↗
PubMed1997

Biochemical alterations of the tunica albuginea in impotence.

PURPOSE: The objectives of this study were to quantify the immunohistochemical stainings of collagen types I, III and IV, and investigate the value of glycohistochemical staining with 3 lectin types specific to a particular glycan structure, Arachis hypogaea, Triticum vulgare and concanavalin A, as a method of defining possible changes in the collagen structure of the tunica albuginea in potent and impotent patients. MATERIALS AND METHODS: The study involved 4 normal men, 4 with pure venous leakage and 4 with pure arterial disease. Collagen types I, III and IV, and lectins Arachis hypogaea, Triticum vulgare and concanavalin A were studied using a cell image processor. The labeling index relates to the percentage of staining and mean optical density relates to the staining intensity. RESULTS: Mean labeling index values for the 3 types of collagen and lectins were similar (p > 0.05). Mean optical density value relating to collagen type I was significantly higher in the arteriogenic group than in the other groups (p < 0.05), while mean optical density value of collagen type IV was significantly higher in the venogenic group than in the 2 other groups (p < 0.05). Mean optical density values relating to the 3 lectin types were similar in the 3 clinical groups (p > 0.05). CONCLUSIONS: An alteration in the distribution and structure of the various collagen types and lectins in the tunica albuginea of impotent patients has been shown that may interfere with normal function and lead to impotence.

Adult↗
PubMed1995

Evaluation of penile arteries with color-coded duplex sonography: prevalence and possible therapeutic implications of connections between dorsal and cavernous arteries in impotent men.

Penile revascularization for cases of arteriogenic impotence is based on the assumption of hemodynamically relevant connections between the dorsal penile and cavernous arteries. In 325 clinically impotent patients color-coded duplex sonography was performed with the penis flaccid and tumescent after intracavernous injection of 10 micrograms prostaglandin E1. We measured peak flow velocity, end diastolic flow velocity and resistance in the dorsal arteries, deep cavernous arteries and connections perforating the tunica albuginea between the 2 systems. Of our patients 14% had at least 1 such anastomosis with a peak flow velocity exceeding 25 cm. per second after stimulation. Peak flow velocities less than 20 cm. per second were noted only in arteriogenically impotent patients, while those exceeding 25 cm. per second without later rigid erection occurred only in patients with venous occlusive dysfunction and end diastolic flow velocity exceeded 5 cm. per second. We conclude that penile revascularization should be contemplated only if hemodynamically relevant connections are detected, peak flow velocity in the cavernous arteries is less than 20 cm. per second and end diastolic flow velocity is less than 5 cm. per second.

Alprostadil↗