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PubMed1993

Use of vacuum tumescence device for impotence secondary to venous leakage.

The causes and treatment of venogenic impotence are still controversial. From September 1989 to April 1991, 317 men complaining of impotence were evaluated in our Erectile Dysfunction Clinic. Seventy patients were suspected of having venous leakage, and all men had dynamic cavernosography performed. Forty-seven of these 70 men (67%) had venous leakage, and a vacuum tumescence device was recommended as initial treatment for all of them. A questionnaire was later mailed to all 47 patients. A response to the questionnaire was obtained from 45 men (96%). Twenty-nine patients had purchased a vacuum tumescence device (Osbon ErecAid). A satisfactory result was obtained in 20 patients (69%) with venous leakage. Since the use of the vacuum tumescence device is relatively safe and noninvasive, and the results are as good as or better than venous ligation, we recommend its use as the initial treatment of venogenic impotence until a consistently reliable treatment for this condition is found.

Erectile Dysfunction↗
PubMedDate not supplied

Restoration of sexual function and fertility by fetal hypothalamic transplant in impotent aged male rats.

The purpose of this study was to observe whether fetal hypothalamic transplant can restore the neuroendocrine and reproductive function in impotent aged male rats. Eighteen to 20 month old impotent male rats received an anterior hypothalamus removed from a 17-19 day old fetus and placed into the anterior third ventricle. Controls were either without surgery (UC) or grafted with cerebral cortex (CG). Before and 2 to 3 months after transplantation, blood samples were collected from the aged rats for testosterone and LH measurement. Before and one to two months after transplantation, each hypothalamic grafted animal (HG) or control rat was put overnight into a cage which contained four, 10 to 12 week old proestrous female rats. Vaginal smear of each female was monitored early the next morning. Sperm seen in the vaginal smear was regarded as copulation and ejaculation. The test was repeated twice, one week apart, and the higher score represented the sexual function and fertility of the males. Seven of 10 HG males restored their sexual function, impregnated 9 females and fathered 106 pups. None of 7 UC restored their reproductive function and only one of 4 CG males impregnated one female which delivered 6 pups. Serum testosterone, LH and pituitary LH in the HG rats, which showed restoration of reproductive function, were significantly higher than those of the controls (UC and CG). These results indicate that the fetal hypothalamic grafts can survive and develop in the brain of impotent aged male rats and restore neuroendorince and reproductive function in senescent rats.

Aging↗
PubMed1989

Apomorphine: clinical studies on erectile impotence and yawning.

1. The erectile response to the short-acting dopamine (DA) receptor agonist, apomorphine (Apo) HCl (0.25, 0.5, 0.75 and 1.0 mg sc), and placebo was evaluated in 28 impotent patients and penile circumference monitored using a mercury strain gauge and strip chart recording. 2. A full erection (increment in penile circumference greater than 2 cm and lasting at least one minute) occurred in 17 patients with Apo; no erection developed after placebo. An erection occurred in 6/8 patients with impaired glucose tolerance, 2/6 patients with diabetes mellitus and in both patients on lithium. 3. Nine patients who responded to Apo were treated in an open trial with bromocriptine; 6 reported improvement in potency. 4. Impairment in DA function may play a role in idiopathic impotence and in impotence associated with impaired glucose tolerance and diabetes mellitus. 5. An erectile response to Apo may predict therapeutic response to bromocriptine or other long acting dopaminergic agents. 6. Lithium, which inhibits DA-sensitive adenylate cyclase, does not prevent Apo-induced erections. This provides further support indicating that Apo induces erections by an effect on D2 receptors. 7. The yawning response to placebo and four doses of Apo HC1 (3.5, 5.0, 7.0, and 10.5 ug/kg sc) was evaluated in five normal men using a polygraphic technique. The yawning response was also assessed in normal young (less than 30 yrs; N = 16) and elderly (greater than 60 yrs; N = 12) volunteers. 8. Under experimental conditions of study, placebo induced spontaneous yawning. This was antagonized by 3.5 and 5.0 ug/kg Apo HC1 but increased by 7.0 ug/kg Apo HC1. These observations are compatible with the view that Apo HC1 in doses of 3.5-5.0 ug/kg stimulates presynaptic DA receptors whereas 7.0 ug/kg stimulates postsynaptic DA receptors. 9. Spontaneous and Apo-induced yawning were significantly decreased in the elderly which suggests that D2 receptor function declines with normal aging.

Adult↗
PubMed1985

A study of penile circulation before and after radiation in patients with prostate cancer and its effect on impotence.

Decrease in penile blood flow has been implicated as the cause of erectile impotence in patients receiving pelvic irradiation. To determine any changes in the penile circulation secondary to pelvic irradiation, we measured the penile blood flow before and 6-9 months following completion of irradiation in six patients with prostate cancer. None of these patients had hormonal manipulation. The non-invasive techniques of Penile Brachial Index (PBI) and Penile Flow Index (PFI) were used to study penile circulation. Two patients developed impotence 2 to 4 1/2 months following completion of irradiation. There was no significant change in penile blood flow following irradiation in any of the six patients studied. The etiology of post-irradiation impotence is probably multifactorial and it may be an oversimplification to attribute it to a single organic cause.

Aged↗
PubMed1991

Radionuclide studies in impotence.

Impotence may be of physiological origin with causes including vascular or neurological pathology. Alternatively, it may be of psychogenic origin. Clinicians can distinguish between psychological and organic impotence by observing nocturnal penile tumescence. Non-radionuclide investigations for organic impotence include penile plethysmography or pulse Doppler analysis for arterial supply, cavernosometry for venous drainage, and biothesiometry or evoked potentials for neurological pathology. Radionuclide studies are primarily based on the use of technetium 99m-pertechnetate, 99mTc-red blood cells, or xenon 133 to study the blood flow, with or without pharmacological intervention, commonly papaverine.

Alprostadil↗
PubMed1993

Colour flow and spectral Doppler imaging after papaverine-induced penile erection in 220 impotent men: study of temporal patterns and the importance of repeated sampling, velocity asymmetry and vascular anomalies.

Of 220 impotent men studied, 52 demonstrated venous leakage, 85 had arterial insufficiency and 65 showed normal vascular response. Persistent diastolic velocity > 7 cm/s diagnosed venous leakage with a sensitivity of 94% and a specificity of 69%, using cavernosography as the reference standard. Using clinical response as the reference standard maximal systolic velocity of 30 cm/s identified normal penile arterial response with a sensitivity of 96% and specificity of 82%. There was a good correlation between penile arterial insufficiency and a strong history of arteriopathy. Time to peak systole > 0.1 s was a reliable predictor of arteriogenic impotence and Pulsatility Index (PI) < 300 was discovered only in patients with either venous leakage or arteriogenic impotence. Peak systolic velocity (Tmax) occurred between 5.2 and 6.5 min after injection, and diastolic velocity was minimal at 9 min with only the normal responders showing reversed diastolic flow. However, 22% had a delayed response (Tmax range 1-18 min). Velocity asymmetry was equally common in the three groups and unilateral sampling would have misdiagnosed 6% of patients studied. Vascular anomalies were seen in 13%, particularly a single feeding artery, dorsal vein flow or collateral arterial flow.

Adult↗
PubMed1997

Testosterone supplementation for hypogonadal impotence: assessment of biochemical measures and therapeutic outcomes.

PURPOSE: Although hypogonadism is a rare cause of erectile failure, impotent men are frequently treated with supplemental androgens. The results of such treatment and the individual merits of available formulations remain controversial. A series of hypogonadal men participated in a trial of oral testosterone undecanoate to assess the effectiveness of the medication, and use of biochemical and clinical outcome measures. MATERIALS AND METHODS: A consecutive sample of 23 hypogonadal impotent men received testosterone undecanoate orally for no less than 60 days. Serum levels of gonadotropins, testosterone, estrogens and sex hormone-binding globulin were measured before, during and after the trial. Sexual response and feeling of well-being were measured by daily diaries and visual analogue scales. RESULTS: Testosterone undecanoate produced restoration of plasma testosterone levels in all patients but a measurable improvement in sexual attitudes and performance in only 61%. Visual analogue scores were effective discriminants of the therapeutic response but none of the conventional biochemical measures predicted or correlated with clinical outcome. CONCLUSIONS: Testosterone undecanoate is an effective agent for treating hypogonadism. In hypogonadal impotent patients the most appropriate outcome measure for androgen supplementation is individual response to therapy, while conventional biochemical hormone determinations lack predictive value and fail to correlate with response.

Adult↗
PubMed1993

Evaluation of penile deep arteries in psychogenic impotence by means of duplex ultrasonography.

Echo Doppler flowmetric investigation in patients with erectile insufficiency represents an effective method for hemodynamic evaluation of the penis. The detection of referential standard parameters is helpful to understand the pathogenesis of the disease, since patients with erectile insufficiency due to psychogenic factors cannot be distinguished from normal subjects by means of current diagnostic techniques. Echo Doppler flowmetry applied to rigorously selected subjects with psychogenic impotence allowed for detection of hemodynamic parameters in the penis after corpora cavernosa stimulation with 10 micrograms. prostaglandin E1. Flowmetric investigation was performed only on the deep cavernous artery, since it is well known that the penile dorsal artery does not undergo hemodynamic alterations after stimulation with drugs. A statistically meaningful difference existed between the systolic flow in the psychogenic impotence subjects (group 1) and the controls (group 2, p < 0.0001). In the same manner, the diastolic flows (right and left cavernous arteries, p < 0.0002 and p < 0.0001, respectively) and diameter increase rates of the investigated arteries following stimulation were also different. According to these results, echo Doppler flowmetry could represent the only instrumental method able to detect patients with psychogenic impotence.

Adult↗
PubMed1993

Posttraumatic impotence: magnetic resonance imaging and duplex ultrasound in diagnosis and management.

In 15 patients, impotent as a result of prostatomembranous urethral disruption consequent to pelvic crush injuries, magnetic resonance imaging (MRI) and duplex ultrasound were used to establish anatomical and pathophysiological criteria for accurate diagnosis and appropriate management. All patients were initially treated by suprapubic cystostomy diversion for at least 3 months, after which urethral reconstruction was performed. All men were potent before the pelvic trauma, with loss of sexual function immediately thereafter. Preoperative MRI demonstrated prostatic displacement in 13 cases (86.7%) and cavernous injury in 12 (80%). Duplex ultrasound revealed the cause of erectile failure as vasculogenic in 12 patients (80%) and neurogenic in 3 (20%). Treatment of impotence was deferred for at least 18 months after injury. Of the neurogenic group 2 patients were started on intracavernous injection therapy and 1 refused treatment. Of the vasculogenic group 3 patients underwent successful revascularization, 2 are on injection therapy and 1 had a penile prosthesis inserted. The detailed anatomical information obtainable with pelvic MRI and the functional data provided by duplex ultrasonography enabled us to identify the individual organic components of posttraumatic impotence and to select effective cause-specific therapy.

Adolescent↗
PubMed1992

False diagnoses of venous leak impotence.

Tests for erectile dysfunction using intracavernous injections of vasoactive drugs are currently popular and have resulted in frequent diagnoses of venous leak impotence. Tests used to make this diagnosis, however, have not been validated by study in control subjects. We present 2 cases of false diagnoses of venous leak impotence. Anxiety mediated through the sympathetic nervous system may block the action of intracavernous smooth muscle relaxants. The resulting incidence of false diagnoses of venous leak impotence is unknown.

Adult↗
PubMed1991

Evaluation of penile dorsal arteries and deep arteries in arteriogenic impotence.

The dorsal and deep arteries are the 2 main blood supplies to the penis. High resolution ultrasonography was used to evaluate the role of these 2 sets of arteries in erection. A total of 44 impotent patients entered this study. We used duplex ultrasonography (Diasonic DRF/400) to assess the role of the dorsal and deep arteries in arteriogenic and nonarteriogenic impotent patients. Vascular velocity, as well as the change in diameter, was recorded before and after an intracavernous injection of 60 mg. papaverine. In the arteriogenic impotence group (28 patients, 63.6%), the velocity increments were 37.1 +/- 23.6 (right side) and 35.4 +/- 17.5 (left side) cm. per second in the dorsal arteries, and 8.3 +/- 5.9 (right side) and 12.6 +/- 5.6 (left side) cm. per second in the deep arteries. In the nonarteriogenic group (16 patients, 36.4%) the velocity increments were 46.5 +/- 25.2 and 41.1 +/- 22.4, respectively, in the dorsal arteries, and 37.3 +/- 16.5 and 37.5 +/- 15.8, respectively, in the deep arteries. Comparison of the velocity increments between the arteriogenic and nonarteriogenic groups revealed no difference in the dorsal arteries (p greater than 0.1) but a significant difference was noted in the deep arteries (p less than 0.01). Similar findings were also encountered when the velocities and diameter increments were compared. This study indicates that the deep arteries have an important role in erectile response, while the dorsal arteries are less important.

Adult↗
PubMed1991

Minoxidil versus nitroglycerin: a prospective double-blind controlled trial in transcutaneous erection facilitation for organic impotence.

A new type of topically applied drug (minoxidil) to facilitate erection is presented. Minoxidil acts directly on arterial smooth muscles via relaxation. This drug (1 ml. of a 2% solution) was studied under strict laboratory conditions in a double-blind controlled trial on 33 patients (4 with neurogenic plus arterial, 10 with neurogenic and 19 with arterial impotence) and compared to placebo and nitroglycerin (2.5 gm. of a 10% ointment). The application sites were the penile shaft (nitroglycerin) or glans penis (minoxidil and placebo). Increases in diameter and rigidity were measured with the RigiScan device and arterial flow was evaluated by conventional Doppler sonography. Side effects were considered as well. This drug proved to be more active than nitroglycerin and placebo in increasing diameter, rigidity and arterial flow of the penis. The highest activity proved to occur in neurogenically impotent patients. Fewer side effects also were found with minoxidil than with nitroglycerin. For these reasons minoxidil is proposed as a long-term therapeutic agent for organic impotence.

Administration, Topical↗
PubMed1991

Single potential analysis of cavernous electrical activity in impotent patients: a possible diagnostic method for autonomic cavernous dysfunction and cavernous smooth muscle degeneration.

Cavernous electrical activity was recorded in 214 patients with erectile dysfunction and in 39 normal patients. In 34 of the 39 normal patients potentials of a uniform shape were recorded during flaccidity. At cutoff frequencies of 0.5 to 500 Hz. the duration was 8 to 18 seconds (mean 12.8 +/- 2.8, seconds, standard deviation), the amplitude was 250 to 750 microv. (mean 444 +/- 109 microv.) and the polyphasity was 8 to 22 (mean 13.8 +/- 3.3). With increasing tumescence and rigidity during audiovisual sexual stimulation, high frequency potentials of low amplitude and short duration were found in the normal patients. In impotent patients with an upper motor neuron or peripheral lesion specific types of potentials were observed. In 11 of 14 impotent patients with insulin-dependent diabetes for more than 20 years and with clinical findings of cavernous myopathy the potentials showed low amplitude, irregular shape and slow depolarizations. Abnormal findings of cavernous electrical activity were recorded in 51.6% of the consecutive impotent patients. Our clinical study suggests that single potential analysis of cavernous electrical activity may be useful in the diagnosis of cavernous autonomic neuropathy and cavernous smooth muscle myopathy.

Adult↗
PubMed1991

Computerized analysis of smooth muscle fibers in potent and impotent patients.

Reduction or dysfunction of the intracavernous smooth muscle fibers can provoke impotence. Computerized digital image analysis of corpus cavernosum biopsies was performed in potent and impotent patients to quantify the percentage of smooth muscle fibers. In 5 normal patients the smooth muscle area represented 40 to 52% of the specimen, in 20 patients with cavernous dysfunction it was 10 to 36% and in 10 patients with arterial disease it was 13 to 25%. This method appears to be important to understand better certain mechanisms of impotence and to approach the potential treatment.

Adolescent↗
PubMed1991

Ultrastructural changes in impotent penile tissue: a comparison of 65 patients.

To determine whether impotence is caused by specific and consistent changes in erectile tissue, we compared the ultrastructure of the corpora cavernosa in 6 controls with that in 59 patients undergoing implantation of a penile prosthesis. The impotent patients were divided into groups based on a medical history of hypertension (10), pelvic surgery (9), alcoholic smokers (8), hypertensive alcoholics (3), hypertensive alcoholic smokers (3), smokers (3), diabetics (8), diabetic smokers (3), Peyronie's disease (3), spinal cord injury (3) and isolated causes (6). Our data demonstrate that different behavioral and/or medical conditions produce similar degenerative tissue responses. There is no single or specific cause of impotence that is manifest by consistent changes in erectile tissue.

Adult↗
PubMed1989

Alpha-adrenoceptor function in isolated penile circumflex veins from potent and impotent men.

Alpha-adrenoceptor functions were investigated in isolated human penile circumflex veins from six potent and four impotent men. Contractions elicited by noradrenaline and phenylephrine were inhibited by prazosin, yohimbine, phentolamine and papaverine. No differences were found between vessels from potent and impotent men. The results suggest that alpha-adrenoceptors in penile circumflex veins are of both alpha 1- and alpha 2-type, and that no changes in alpha-adrenoceptor function occur in impotence associated with an increased penile venous outflow.

Adult↗
PubMed1990

Impotence following childhood priapism.

Priapism in childhood, although an uncommon event, generally is believed to be associated rarely with future impotence in adulthood. These beliefs may be a reflection of under-reporting or a lack of long-term followup. We present a case of a 23-year-old impotent man who had a history of priapism as an 8-year-old child. Even though a review of the literature reveals that impotence following childhood priapism is an infrequently reported phenomenon we believe its incidence to be significant and since it can occur aggressive treatment is essential.

Adult↗
PubMed1990

Patient acceptance of and satisfaction with an external negative pressure device for impotence.

Patient acceptance of and satisfaction with an external negative pressure device as a treatment for impotence were retrospectively analyzed among 100 men. The over-all satisfaction rate was 68%. Reasons for dissatisfaction with and discontinuing the use of the device included premature loss of penile tumescence and rigidity, pain or discomfort either during application of suction or during intercourse and inconvenience. Negative pressure therapy is an effective treatment for impotence of various etiologies and should be among treatment options offered to the impotent patient.

Consumer Behavior↗