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Early experience of corpora cavernosa electromyography in impotent patients after radical cystoprostatectomy.

OBJECTIVES: To assess the effects of autonomic nerve damage on the basis of cavernous electrical changes. METHODS: A study was carried out on the cavernous electrical activity in healthy volunteers (controls) and impotent patients after radical cystoprostatectomy using a specific electromyographical device, the 'SPACE-recorder 7500'. RESULTS: A significant reduction in the amplitude of potentials was recorded after pharmacological stimulation in both the controls and impotent patients. The healthy controls showed amplitude values which were significantly higher than the impotent patients after radical cystectomy (715 +/- 141 vs. 381 +/- 227 microV, p < 0.01). After 'nerve-sparing' radical cystectomy with a mean amplitude similar to controls (500-700 microV), the patients showed rigid erections after injection of intracavernous drugs in a high percentage of cases. CONCLUSION: In our experience, corpora cavernosa electromyography seems a reliable method which can directly point out damage in the cavernous smooth muscle and the penile autonomic nerves.

Adult↗

Color-coded duplex sonography in impotence: significance of different flow parameters in patients and controls.

The use of color-coded duplex sonography of the cavernous arteries in the assessment of arteriogenic impotence was evaluated in 70 consecutive men referred for erectile dysfunction. Controls were 16 of the men with an unequivocal nocturnal penile tumescence and rigidity. After intracavernous injection of prostaglandin E1, peak flow velocity was 26.8 +/- 12.5 cm/s in patients and 37.2 +/- 13.0 cm/s in controls (p less than 0.05). 50% of the patients, but none of the controls, had peak flow velocities of less than 20 cm/s in at least 1 cavernous artery. However, within the range of 20-40 cm/s, there was marked overlap between groups. The mean flow velocity and resistance index did not improve the discriminative value of peak flow velocity. Peak flow velocity after intracavernous injection of vasoactive drug enables the discrimination between impotent patients and controls. In a single patient, however, particularly one with a flow velocity of 20-40 cm/s, definition of arteriogenic impotence remains difficult.

Alprostadil↗

Male impotence: a possible beta-adrenergic dysfunction in some patients.

In some patients nocturnal penile tumescence (NPT) is abnormal, while the others diagnostic evaluations and medical history do not indicate any specific organic cause of impotence. Aim of this study was to evaluate heart rate variability during sleep in impotent patients with any demonstrable organic cause of impotence. We studied 50 patients: 26 were psychogenic and 24 organic on the basis of NPT and nocturnal rigidity. A lower orthosympathetic activity has been found in organic patients. Because beta-adrenergic receptors mediate relaxation of corpus cavernosum, it could be hypothesized a penile beta-adrenergic dysfunction in our organic patients.

Adult↗

The place of acupuncture in the management of psychogenic impotence.

Successful sexual functioning is a complex process involving psychological and social responses as well as neurological, biochemical and vascular processes. Today it is believed that more than 50% of the sexual dysfunction cases have an organic etiology. Reflecting the controversy over the management of psychogenic impotence, there are several different methods which are currently in clinical use. In this prospective study we aimed to evaluate the curative effects of acupuncture therapy in men with purely psychogenic impotence. Of the 29 patients treated with this procedure 20 patients demonstrated successful erections following a varying number of acupuncture sessions. In the light of our findings we may conclude that acupuncture may be an effective alternative in the management of purely psychogenic impotence.

Acupuncture Therapy↗

Impotence responsive to glyceryl trinitrate.

The author presents suggestive evidence that glyceryl trinitrate served to treat and diagnose atherosclerotic impotence in a man with psychogenic impotence. The prevalence of atherosclerotic impotence is not known but may be relatively high in older men. Vasodilators may be effective in diagnosing these patients, who do not have clear signs of arterial insufficiency of the lower extremities (e.g., Leriche's syndrome). The author postulates a pharmacological interaction between organic nitrates and imipramine.

Angina Pectoris↗

Nocturnal penile tumescence and diagnosis in diabetic impotence.

The authors conducted a study of nocturnal penile tumescence (NPT) in 35 diabetic men, aged 33 to 70, who complained of impotence and in 35 age-matched control subjects. EEGs and other measurements showed that the diabetic men as a group exhibited significant reductions in the total amount of NPT and in the amount and frequency of full erection, thus suggesting that impotence in this cohort was organogenic. Although NPT monitoring represents an advance over the less precise traditional procedures for the differential diagnosis of impotence, the authors stress the need for more research in this area.

Adult↗

Pentoxifylline in the treatment of vascular impotence--case reports.

Vascular impotence is a common medical problem for which available therapies are limited. Three impotent patients observed in the authors' practice who were receiving pentoxifylline for treatment of claudication of the lower extremities spontaneously reported improved sexual function. A controlled trial of pentoxifylline for vascular impotence may be warranted.

Aged↗

Stearyl-norleucine-vasoactive intestinal peptide (VIP): a novel VIP analog for noninvasive impotence treatment.

The present report relates to pharmaceutical composition for the treatment of male impotence. The transdermal application of a potent derivative of vasoactive intestinal peptide (VIP) coupled to a suitable hydrophobic moiety (e.g. stearyl-VIP) in a suitable ointment composition (e.g. Sefsol) enhances sexual activity and erection formation in a variety of impotence models in rats (sterile rats, diabetic rats, and animals with high blood pressure). Furthermore, exchange of the methionine in position 17 with norleucine enhances biological activity. Thus, stearyl-Nle17-VIP may be considered useful for the treatment of impotence.

Administration, Cutaneous↗

Impotence associated with low biological to immunological ratio of luteinizing hormone in a man with a pituitary stone.

Quantitative reduction in LH secretion resulting from hypothalamic-pituitary dysfunction is a known cause of impotence. Qualitative abnormalities of secreted LH, however, have not been described under these circumstances. During evaluation of a 39-yr-old man with impotence and a calcified pituitary mass (pituitary stone), we detected a qualitative abnormality of LH characterized by a low ratio of bio- to immunoactivity (B:I). Initial work-up revealed basal morning serum testosterone levels of 2.14, 3.18, 3.97, and 3.11 ng/ml on 4 separate days, low to low normal urinary LH (300, 200, and 478 mIU/h), and normal GH, TSH, PRL, and ACTH secretion after provocative testing. The response of impotence to testosterone but not placebo in a double blind trial confirmed the clinical significance of the borderline low androgen levels. These findings prompted a systematic analysis of 24-h LH pulses as well as clomiphene and GnRH responsiveness. By RIA, mean serum LH levels [9.1 +/- 0.3 (+/- SE) mIU/ml] and all other response parameters were normal. In striking contrast, mean serum LH by bioassay was low (9.9 +/- 0.4 mIU/ml vs. 41.4 +/- 5.7 in normal subjects), as were B:I ratios (1.0 +/- 0.03 vs. control values of 3.1 +/- 0.5 to 5.3 +/- 0.3). Only during maneuvers designed to increase GnRH were B:I ratios increased to 3.3 +/- 0.22 (exogenous GnRH) and 1.8 +/- 0.12 (clomiphene). Mean testosterone levels before and after exogenous GnRH treatment were 3.28 +/- 0.24 and 4.76 +/- 0.16, respectively (P less than 0.001). The results suggest an association between the low LH B:I ratio and the anatomical disruption of the hypothalamic-pituitary portal system by the pituitary stone. The increased B:I ratio during GnRH or clomiphene administration indicates a functional link between pituitary GnRH exposure and the greater potency of the LH secreted.

Adult↗

Sexual dysfunction and erectile impotence in chronic obstructive pulmonary disease.

We studied 20 men (ages 46 to 69, mean 45 years) with chronic obstructive pulmonary disease (FEV1 of 0.55 to 2.1 L), to determine the relative importance of pulmonary impairment vs other occult physical or psychologic factors in the genesis of sexual dysfunction. Seven subjects had ceased sexual activity concomitant with worsening of their pulmonary symptoms; six because of erectile impotence and one due to dyspnea. Frequency of intercourse for the remaining 13 was 16 percent of prelung disease levels, and libido was decreased to 25 percent of premorbid levels. Nocturnal penile tumescence monitoring disclosed that six subjects had organogenic erectile impotence (OEI). None of the subjects showed signs of peripheral vascular disease as assessed by Doppler examination of peripheral pulses (including penile). The mean bulbocavernosus reflex latency (BCRL) for the OEI group (N = 5) was 40.2 msec, while that for the group with full nocturnal erections (N = 10) was 34.5 msec (P less than 0.005). Four subjects had occult diabetes mellitus evident on oral glucose tolerance tests, and one had evidence of an androgen deficit. The correlation coefficient for rank by sexual dysfunction vs pulmonary impairment and age was 0.66 (P less than 0.005) and 0.24 P greater than 0.05), respectively. Subjects with OEI tended to have the worst pulmonary function test results and the highest T-scores on the hypochondriasis, depression, and hysteria scales of the Minnesota Multiphasic Personality Inventory. Data suggest that sexual dysfunction worsens as lung disease worsens and that chronic obstructive pulmonary disease may be associated with male impotence in the absence of other commonly known causes.

Aged↗

Diagnostic discrimination between organic and functional impotence by radioisotope penogram with 99mTcO4.

Since the half-life of 99mTc is only 6.04 hr, its massive dosing for an elevation of diagnostic accuracy is possible with reduced radiation exposure to the body. On 11 impotent cases, radioisotope penogram was performed with 99mTcO4. The results indicate that the penogram curves obtained are satisfactorily favorable for diagnostic discrimination between organic impotence and functional impotence.

Adult↗

Comparative tolerability and efficacy of treatments for impotence.

Modern pharmacological treatment of impotence is determined by the presenting symptoms. Since this involves symptomatology with a heterogenous aetiology, many different drugs are involved in the treatment of impotence. Drugs used for libido and arousal problems include testosterone, yohimbine, trazodone and apomorphine. Since patient self-assessment is the only parameter that can be used to measure the result of treatment and positive results are seldom affirmed, no positive benefit of these agents can be assumed at present. Oral medications for erectile dysfunction include yohimbine, trazodone, apomorphine, phentolamine, arginine and sildenafil. Of these drugs, sildenafil has been the most systematically studied for effectiveness, but long term safety data await the results of post-marketing surveillance. Of the ejaculation disorder therapies, treatments for premature ejaculation are the best studied. Favourable results have been obtained with clomipramine, paroxetine and fluoxetine. The safety of these medications has been assessed through their long term use in psychiatry. Intracavernous self-injections for erectile disorders are performed using a variety of drugs and drug mixtures. Only alprostadil and the combination of papaverine with phentolamine are widely used. Alprostadil is very well tolerated; however, penile pain is a serious problem in a significant proportion of patients. Papaverine in combination with phentolamine is effective, but penile fibrosis and priapism occur more often than with the use of alprostadil. Several new developments in this area are currently under way. Alternative routes for medication for erectile dysfunction include ointments and patches to the penile skin and the glans. Only transurethral alprostadil, 'MUSE' (medicated urethral system for erection) has been shown to be effective in large trials. Long term safety still has to be demonstrated, but the 1-year safety profile is encouraging. In general, the end points of impotence treatment studies are very diverse so efficacy data can only be assessed in comparative studies. However, long term comparison studies have not been performed. Safety demands must be set very high for this type of treatment since the disorders being treated present no threat to the patient's health.

Aphrodisiacs↗

Impotence and peptic ulcer.

Two hundred and eighty male patients were examined for either peptic ulcer or impotence. Thirty-six of these suffered from impotence in association with duodenal or stomach ulcer. Surprisingly, all thirty-six patients, having been afflicted with both conditions, complained about only one of them, those with ulcers not having been disturbed by their impotence and vice versa.

Adult↗

Sexual impotence caused by vascular disease: diagnosis with duplex sonography.

We used duplex Doppler sonography to assess the hemodynamic function of the penis in patients with impotence to determine if there is arterial disease or if the veins are incompetent. The penis was scanned in the flaccid state, then again after erection was induced by intracorporal injection of papaverine. The diameter of each cavernosal artery was measured before and after injection and, by using Doppler sonography, the maximal systolic velocity in each cavernosal artery was measured. The Doppler gate was placed over the dorsal vein to detect any flow in that vein signifying venous leakage. The Doppler gate then was placed over the cavernosal veins in an attempt to detect cavernosal venous incompetence. Forty-five men with impotence were included in the study. In 39 patients, the cause of impotence was confirmed by other studies. The diameter of the cavernosal arteries and the increase in diameter of these arteries after induction of an erection were similar in all diagnostic groups. The peak systolic velocity, however, was decreased in patients with arterial insufficiency as compared with the velocity in normal subjects. In normal subjects, the mean peak velocity was 47 +/- 9 cm/sec; in patients with mild to moderate arterial insufficiency it was 35 +/- 16 cm/sec; in patients with severe arterial insufficiency it was 7 +/- 8 cm/sec. The difference in peak velocities between the right and left cavernosal arteries after papaverine injection (asymmetric arterial response) was significantly larger in patients with mild to moderate arterial insufficiency than in other diagnostic groups. Four patients with venous incompetence had detectable flow in the dorsal vein, but no flow could be detected with Doppler sonography in the cavernosal veins in any patients, including those who were proved to have significant cavernosal venous leaks. Our findings suggest that Doppler measurement of maximal systolic velocity in the cavernosal arteries after papaverine injection is an accurate indicator of arterial function. Asymmetric flow in the cavernosal arteries also suggests some degree of arterial insufficiency. Diameters of the cavernosal arteries and their increase after injection are not predictive of arterial patency. Doppler sonography cannot show cavernosal venous leakage, but in some cases it can show dorsal venous incompetence.

Blood Flow Velocity↗

Luteinizing release hormone tests in impotent diabetic males.

Assessment of pituitary-gonadal function was made in impotent diabetic males using luteinizing hormone-release hormone tests. Serum testosterone, sex-hormone-binding globulin capacity, and basal and incremental gonadotrophin concentrations in the impotent diabetics were similar to those in control diabetics, suggesting a primary neurologic rather than an endocrine defect as the cause of the impotence.

Adult↗

Relationship of psychiatric illness to impotence in men with diabetes.

Clinical data from 37 adult males with diabetes mellitus (insulin dependent, n = 22; non-insulin dependent, n = 15) who had undergone psychiatric diagnosis and peripheral nerve conduction studies were reviewed to determine whether psychiatric illness was significantly related to complaints of sexual dysfunction. Main-effects testing revealed that impotence was associated with both neuropathy (P less than 0.01) and psychiatric illness (P less than 0.001). Logistic regression analysis was then used to determine the independent relationships of these two variables with impotence. After controlling for the effects of neuropathy, psychiatric illness (generalized anxiety disorder and depression) remained significantly associated with sexual dysfunction (P less than 0.01). These data allow for the hypothesis that psychiatric illness may be an important contributor to impotence in diabetic men, as it is in nondiabetic men, even when neuropathic complications of the disease are present.

Adult↗

Trial of pentoxifylline for diabetic impotence.

OBJECTIVE: To test the effectiveness of pentoxifylline as a therapy for diabetic impotence. RESEARCH DESIGN AND METHODS: A 3-month placebo-controlled double-blind treatment study was conducted at a single center. Therapeutic response was assessed subjectively by serial self-appraisals of erectile function and objectively by nocturnal penile tumescence (NPT) monitoring. RESULTS: This cohort of impotent diabetic men displayed substantial neurological and penile vascular dysfunction. Age, body mass index, duration of diabetes, duration of impotence, glycemic control, mode of therapy for non-insulin-dependent diabetes, mean testosterone, mean prolactin, and penile brachial indexes were similar in the treatment (n = 34) and placebo groups (n = 26). NPT monitoring revealed infrequent erectile events, diminished average rigidity, and decreased tumescence. Pentoxifylline did not alter overall glycemic control and did not improve neurological, vascular, or erectile function. In fact, a slight decrease in average percent rigidity from 22 +/- 3 to 17 +/- 2% (mean +/- SE, P < 0.05) was observed in the pentoxifylline-treated group. Although eight (24%) pentoxifylline-treated and five (19%) placebo-treated men reported benefit, no objective improvement was observed in nocturnal tumescence. CONCLUSIONS: Pentoxifylline is not an effective treatment for diabetic erectile dysfunction.

Aged↗

Penile blood pressure in erectile impotence following cystectomy.

Penile systolic blood pressure and systolic and diastolic brachial blood pressure were measured in 17 men who had undergone cystectomy and prostatectomy for cancer of the bladder. After the operation, 13 patients reported erectile impotence, while 4 retained sexual potency. Comparisons were made with 7 healthy, potent controls. The systolic penile blood pressure was significantly lower and the systolic pressure gradient between brachial and penile pressure was significantly higher in the men with erectile impotence than in the potent men. Reduced penile blood pressure after such operations may arise from vascular trauma. A surgical technique that protects penile blood vessels may conceivably reduce the risk of erectile impotence following cystectomy.

Adult↗