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PubMed1990

Effects of androgen treatment in impotent men with normal and low levels of free testosterone.

The relation between sexual function and serum free testosterone (fT) levels, which represent the active fraction of circulating testosterone, was evaluated. Two groups of impotent male subjects with mild hypogonadism were treated with oral testosterone undecanoate (TU); these men presented with tT/luteinizing hormone (LH) ratio and tT levels at the lower limits of normal. The first group had serum fT below 6.6 ng/ml, considered the lower normal value, according to our laboratory method, whereas the second group had normal fT limits. Administration of TU improved sexual function only in impotent men with low fT levels, but not in subjects with normal fT levels, even though the tT levels and the tT/LH ratio of the two groups were not significantly different. The results of our study suggest the presence of a minimum serum fT threshold, lying near the lower normal range, which determines the male sexual function. Moreover, serum fT levels were a more sensitive index than tT for identifying impotent men who can be successfully treated with androgens.

Adult↗
PubMed1983

Psychometric differentiation of biogenic and psychogenic impotence.

In a sequential clinical sample of 64 subjects exclusively diagnosed as either biogenically or functionally impotent, Minnesota Multiphasic Personality Inventory (MMPI) and California Psychological Inventory (CPI) standard scales and the Beutler, et al., MMPI signs were all found to be ineffective in reliably classifying patients into the correct diagnostic groupings. Specific item analysis of the MMPI and CPI did identify a significant number of significantly differentiating individual items. Most of these items were shown to be reliably characterizable as indicating either performance anxiety or somatic complaint. Using these classifications of the items, the performance anxiety items were shown, consistent with theory, to be clearly associated with the functional impotence group. The somatic complaint items were shown to be clearly associated with the biogenic impotence group, presumably reflecting the symptoms of physiopathology, such as diabetes, underlying the biogenic condition.

Diagnosis, Differential↗
PubMed1981

The role of nocturnal penile tumescence in differentiating between organic and psychogenic impotence: the first stage of validation.

A study was conducted to assess the validity of nocturnal penile tumescence (NPT) as a means of distinguishing between psychogenic and organic erectile failure (impotence). On the basis of independent clinical criteria, patients were assigned to one of four diagnostic categories--organic impotence, psychogenic impotence, mixed etiology, and uncertain etiology. The NPT characteristics of the patients in the organic and psychogenic groups were compared and decision rules formulated in order to provide optimal discrimination between the two diagnostic categories. A decision rule based on the maximum erectile response observed for each patient led to the correct diagnosis in 80% of cases. Accuracy was increased to 95% when a decision rule based on the maximum frequency of nocturnal erections was employed. The clinical value and limitations of NPT as a diagnostic procedure are discussed.

Adult↗
PubMed1982

Surgical treatment of male impotence.

There are numerous causes of male sexual impotence: these may be classified as organic or psychic. All possible clinical options should be explored before resorting to surgery for impotence. Many techniques are available for surgical correction of impotence. The authors have used Small-Carrion's implantation of a silicone prothesis with success in a number of patients, ranging in age from 28 years to 78 years.

Erectile Dysfunction↗
PubMed1989

The assessment of pelvic circulation after internal iliac arterial reconstruction: a retrospective study of the treatment for vasculogenic impotence and hip claudication.

The standard surgical treatment of vasculogenic impotence or hip claudication involves repairing vascular lesions, especially in the internal iliac arteries. It is difficult, however, to make a definite diagnosis or an accurate judgement of the therapeutic effects of this treatment due to the trouble in ruling out any other disorders. During the last five years, 19 patients with impotence and associated apparent internal iliac artery stenosis or occlusion and 2 patients with hip claudication, underwent internal iliac arterial reconstruction. The patients' ages ranged from 37 to 70 with a mean age of 63.7 and the main procedure performed in all patients was aorto-iliac to femoral bypass grafting, or abdominal aortic aneurysmectomy. A retrospective study revealed that 74 per cent of those treated regained penile erectile activity postoperatively, and that hip claudication disappeared completely in all cases. One of the patients received percutaneous transluminal angioplasty (PTA) for the treatment of vasculogenic impotence, after which his postoperative penile brachial pressure index (PBPI) improved, demonstrating a statistically significant difference compared to the preoperative value. Trans-anal Doppler measurement also proved useful in providing complication-free perioperative understanding of pelvic circulation.

Adult↗
PubMed1991

Dynamic cavernosography in the evaluation of impotence.

Dynamic cavernosography before and after papaverine injection into the corpus cavernosum of 6 sexually normal volunteers and 44 impotent patients was performed with digital subtracting angiography technique. The average infusion rates in 26 patients with venous leakage were 325.5 ml/min for induction of erection and 161 ml/min for maintenance. The results for the remaining 18 impotent patients without venous leakage were 128.8 ml/min for induction and 56.9 ml/min for induction and 58.3 ml/min for maintenance. After papaverine injection the average infusion rates decreased to 131 ml/min (induction) and 59 ml/min (maintenance) in patients with venous leakage, 38.4 ml/min and 14.6 ml/min in the impotent patients without venous leakage and 35 ml/min and 14.1 ml/min in the control group, respectively. It was also noticed that in the control group filling of the superficial and deep veins may occur during the flaccid phase which disappeared with induced erection. Therefore we suggest intracavernous papaverine injection with dynamic cavernosography. The digital subtracting technique eliminates unnecessary images, providing a more accurate diagnosis of venous incompetence.

Adult↗
PubMed1996

Corpus cavernosum electromyography (CC-EMG): a new technique in the diagnostic work-up of impotence.

We have studied cavernous electrical activity in 42 subjects, healthy volunteer controls and groups of impotent patients using a nonspecific electromyographic device (PICO-MENFIS) and a specific one, the SPACE-recorder 7500 designed to achieve electric recordings from the corpora cavernosa. In all of the patients, we detected under basal conditions a mean amplitude of 583 +/- 323 microV, a mean duration of 4.9 +/- 7 s, a mean polyphasicity of 3.5 +/- 1.4. It should be emphasized that a significant reduction of potential amplitudes was recorded after pharmacological stimulation in both the controls and the impotent patients. The healthy controls showed amplitudes significantly higher than the impotent patients after radical cystectomy (715 +/- 141 microV versus 381 +/- 227 microV, p < 0.01). The patients after a "nerve-sparing" radical cystectomy with a mean amplitude similar to the controls (500-700 microV) reacted well to the intracavernous drugs in a high percentage of cases. In our experience, CC-EMG seems to be a reliable method which can pinpoint directly lesions to the cavernous smooth muscle and penile autonomic nerves. It has also been able to assess the effects of stress, anxiety and pain on the erectile mechanisms.

Adolescent↗
PubMed1988

Angiography of posttraumatic impotence.

Of 135 patients who underwent penile angiography at our institution, impotence was related to noniatrogenic trauma in 16. Impotence developed immediately following an isolated traumatic event in 14 patients, and months or years after repeated blunt perineal trauma in 2. Invasive vascular assessment facilitated diagnosis in all patients. Although the mechanism of trauma varied greatly, most patients had vasculogenic (arteriogenic or venogenic) impotence. Complete vascular assessment required selective magnification pharmacoarteriography in multiple projections, pharmacocavernosography, and pharmacocavernosometry. Therapeutic choices were based largely on the angiographic findings, and included venous ligation, arterial bypass or angioplasty, self-injection of papaverine, or insertion of a prosthesis.

Adolescent↗
PubMed1979

Role of the vascular diagnostic laboratory in the evaluation of male impotence.

Penile systolic pressures, penile volume waveforms, and postischemic reactive hyperemia were measured in 106 patients (38 potent and 68 impotent). With such testing the vascular laboratory can clearly identify those impotent patients in whom penile blood flow is normal and who would not benefit from direct arterial surgery. Unfortunately, abnormal results give no assurance that ischemia is responsible for a given patient's impotence and a multimodal approach is necessary to further evaluate such patients.

Adult↗
PubMedDate not supplied

Impotence in patients treated with clofibrate.

Three of our regularly controlled patients suffering from Type IV hyperlipoproteinemia and treated with clofibrate complained of impotence within one year after commencement of treatment with this drug. Two of the patients had previously suffered from myocardial infarction. Two patients observed improvement of the symptom 3 and 4 weeks after interruption of clofibrate therapy; one patient again complained of impotence when clofibrate therapy was resumed. The third patient continued intake of the drug up to the present day, and still complains of impotence.

Angina Pectoris↗
PubMed1980

Impotence after kidney transplantation.

Sexual performance was evaluated in 28 men, thirty to sixty years of age, with functioning renal allografts: 13 were potent (controls), 10 had moderate sexual dysfunction, 5 had marked sexual dysfunction. Penile blood pressures, serum hormone levels, plasma zinc levels, and penile venous angiography were evaluated in search of causes of impotence. Thirteen of 15 impotent transplant patients (87 per cent) had marked abnormalities in at least one of the four areas studied. Systematic search for etiologic factors may permit specific therapy for impotence, which occurred in 54 per cent of the 28 kidney transplant patients analyzed.

Adult↗
PubMed1983

Hyperemic stress test in diagnosis of vasculogenic impotence.

A hyperemic stress test was used to determine vasculogenic impotence in 100 men (50 potent, 50 impotent). Normal potent males had a resting penile:brachial index ratio of 0.75 and uniformly demonstrated a hyperemic response to the cuff occlusion stress test with a mean of 20 per cent increase in penile pressure. Penile blood pressure did not increase in impotent men, and often it decreased in response to the stress test.

Adult↗
PubMed1984

Surgical treatment of impotence caused by megalourethra.

A twenty-three-year-old impotence patient is presented who had never achieved penile erection and who suffered megalourethra and megaloureter. Through a penothermocurve the cause of impotence was diagnosed as megalourethra and extensively thickened penile skin. Plastic surgery was performed, and sufficient resection of the enlarged urethral wall and penile skin resulted in successful penile erection and satisfactory intercourse. The usefulness of the penothermocurve was demonstrated as a means for the differential diagnosis of impotence.

Adult↗
PubMed1984

Artificial erection in diagnosis and treatment of impotence.

The use of artificial erection (AE) for the diagnosis and treatment of erectile failure was studied in 180 impotent males selected from a group of 440 men who underwent a complete multidisciplinary approach including nocturnal penile tumescence (NPT), arterial, neurologic, hormonal, and psychologic studies. Five groups were identified: (1) nonorganic (15.3%) impotence considered as a control group for AE normal values; (2) arterial (26.6%); (3) neurologic (12.2%); (4) arterial and neurologic (19.4%); and (5) a group of 47 remaining patients (26.1%) with abnormal NPT and normal arterial and neurologic studies who had the highest flow to obtain and maintain erection and were classified as "venous incompetence." Results of AE flows of patients of groups 2, 3, 4, and 5 are presented and discussed in the focus of erectile physiology, pathophysiology of erectile failure, and surgery. Patients of groups 2 and 4 with normal flows had a 26.6 per cent rate of improvement due to AE. Results and comments indicate that AE ranks as a major procedure in the diagnosis and treatment of impotence.

Blood Pressure↗
PubMed1989

Cerebral-evoked response from stimulation of dorsal nerve in impotent men.

Cerebral-evoked responses from 128 uncategorized, impotent men were compared with responses from 17 healthy age-height matched controls, after stimulation of two penile sites, and one tibial nerve at the ankle. Our goal has been to establish a simple screening test to identify neurogenic impotence in patients with normal superficial sensation. High-frequency stimulation at 5.7 c/s and minimal repetitions (300) per trial, allowed thirty to forty minute sessions in alert subjects. With these methods, the amplitudes of cerebral responses at N2 were most informative. All volunteers had measurable amplitude while 11.9 percent of patients did not. An additional 4.5 percent of patients had amplitude suppression of 2 SD compared with the control mean, suggesting that as many as 16.4 percent of such patients may have neural damage. Prolonged latencies alone were rare and not included in this total. Ninety-two of these 128 patients had Doppler flow studies, and only 2 showed both Doppler and electrical abnormalities. This suggests that neurogenic problems may often be independent of vascular disease. This evoked-response screen of the entire genitocerebral neuraxis offers a safe method of identifying a portion of those patients with neurogenic impotence.

Diabetes Mellitus↗
PubMed1990

Cavernosometry: corroboratory method to surgical treatment of impotence due to venous leakage.

There are still controversies about the mechanism of penile erection. Arterial aspects of impotence have received considerable attention, but just recently the venous component became widely recognized. Twenty patients with abnormal cavernosometry (flow rate over 280 mL/min) and no rigid erections (intracavernosal pressure lower than 80 mm Hg) were analyzed. Surgical ligation of the dorsal veins was performed in 12 cases, 9 of which also required ligation of the crus of each corpus cavernosum. After these ligations, erection improved sufficiently to allow satisfactory intercourse in 9 of 12 patients. Two patients became impotent after eight months of normal sexual performance. The 3 failures showed persistently high flow rates and one leakage by the crural edge which had not been ligated at surgery. In selected patients with organic impotence the venous abnormalities should be assessed routinely and dorsal veins and the crural edge of the corpus cavernosum should be ligated in an attempt to restore erectile function.

Erectile Dysfunction↗
PubMed1990

Role of serum prolactin determination in evaluation of impotent patient.

Hyperprolactinemia is a recognized cause of impotence. The discovery of elevated prolactin levels in impotent men is very important since pharmacotherapy in this instance is highly successful. We review our experience with prolactin determinations in impotent men, and a population is defined that may benefit from routine prolactin determination. In our experience, the predominant symptom associated with hyperprolactinemia in men is loss of libido.

Adult↗
PubMed1991

Multiphasic diagnostic evaluation of arteriogenic, venogenic, and sinusoidogenic impotency. Value of noninvasive tests compared with penile duplex ultrasonography.

Fifty patients with a mean age of fifty-five years (range 25 to 75 years) in whom vasculogenic impotency was suspected clinically were evaluated to determine the type of vascular lesion involved: arterial insufficiency, venous leak, or sinusoidal dysfunction. All patients underwent first, noninvasive diagnostic tests including penile brachial index, penile brachial subtraction index, and penile plethysmogram, followed by penile duplex ultrasonography with papaverine and phentolamine injection. Patients with abnormal ultrasonography were divided into two groups: One group with suspected sinusoidal dysfunction and those with either arteriogenic or venogenic insufficiency but not considered candidates for surgery; they were not subjected to further studies. Another group with suspected proximal arteriogenic lesions and those with suspected venous leakage considered candidates for surgical correction were subjected to angiography and cavernosometry-cavernosography, respectively. The findings of the noninvasive tests were compared with those provided by the invasive tests. The results indicated that noninvasive tests can predict whether or not impotency is arteriogenic in approximately 90 percent of cases. The noninvasive tests, however, were less accurate in predicting venogenic and sinusoidogenic impotency, for which penile duplex ultrasonography seems to be the choice.

Adult↗