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PubMed1988

Hyperprolactinemia and impotence.

One hundred impotent men and 15 sexually active male volunteers served as the source for this study. Serum prolactin was estimated in all cases using radioimmunoassay technique. Cases with hyperprolactinemia were treated with bromocriptine for 3 months. Hyperprolactinemia was detected in three patients only (3%), with no findings of pituitary tumors. Treatment with bromocriptine markedly reduced the level of serum prolactin together with improvement of sexual libido and potency. The mere presence of 3 cases only with hyperprolactinemia among 100 impotent subjects suggested that hyperprolactinemia is not one of the main causes of impotence.

Adolescent↗

PubMed1995

A comparison of the relaxation responses of isolated cavernosal smooth muscles by endothelium-independent and endothelium-dependent vasodilators in diabetic men with impotence.

This study was intended to explore the effects of endothelium-independent, direct smooth muscle relaxants(papaverine, verapamil) and endothelium-dependent vasodilators(acetylcholine, bradykinin, adenosine) on the isolated cavernosal smooth muscle strips taken from diabetic men with impotence. When smooth muscle contraction was evoked with norepinephrine for the study of relaxation to these vasodilators, the tension induced was similar in diabetic and non-diabetic men with importance. Papaverine showed the strongest relaxation response followed by verapamil, acetylcholine, bradykinin and adenosine both in non-diabetic and in diabetic men. Relaxation of the cavernosal tissues to endothelium-independent vasodilators was similar in non-diabetic and diabetic men. However, the relaxation response of the tissues to endothelium-dependent vasodilators was significantly reduced in the diabetic group compared with that in the non-diabetic group (p < 0.05). In conclusion, the impairment of endothelium-mediated relaxation of cavernosal smooth muscle seems to play a more important role in the pathogenesis of diabetogenic impotence rather than the problem of smooth muscle itself. This finding forms a rational basis for the use of intracavernosal injections of vasodilators to induce endothelium-independent relaxation of the cavernosal smooth muscle in the patients with diabetogenic impotence.

Adult↗

PubMed1997

The distribution of nitric oxide synthase in human corpus cavernosum on various impotent patients.

Recent evidence implicates NO (Nitric oxide) as the principal mediator in an erection. To investigate the role of NO in the human erectile function, we studied the distribution pattern of nitroxergic fibers in the corpus cavernosum specimens obtained from 38 men using nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry. Diffusely scattered delicate nerve fibers showing blue color reaction after NADPH-d histochemical staining were observed in normal control specimens from potent men. The neurogenic impotence group showed a statistically-significant decrease in the number of positive fibers compared to the normal control group. The number of positive fibers in the non-neurogenic impotence group was decreased compared to the normal control group but was statistically insignificant. With nitric oxide synthase (NOS) immunohistochemical stain, immunoreactive nerve bundles were easily seen in normal control specimens from potent men. NOS immunoreactive nerve bundles were contained within the corpus cavernosa which stained with NADPH-d reaction. Our results suggest that nitric oxide, a potent smooth muscle relaxing neurotransmitter in the autonomic nervous system, plays a physiologic role in erectile function and NADPH-d enzyme histochemical staining on the biopsied corpus cavernosum may be used as an important diagnostic method in the evaluation of neurogenic impotence.

Erectile Dysfunction↗

PubMed1992

Impotence in older men. A newly recognized problem.

Impotence is gaining recognition among the health-care professionals as a valid, complex problem. The prevalence of impotence increases with age. Treatment of impotence in older men is based on the results of extensive evaluation and individualized treatment. Nurses need to be aware of evaluative and treatment options and interpret these to clients, as well as provide a supportive atmosphere for discussion.

Aged↗

PubMed1990

[Basic and clinical research of impotence--its present situation and problems involved].

From detailed investigation of the vascular structure of the penis, it has been proposed that there exists a valvular structure, consisting of smooth muscle, located at a point immediately before the helicine artery, bifurcated from the deep artery, opens to the cavernous sinuses, an area where autonomic nerves are densely distributed, participating in opening and closing the valve. On the other hand, there is said to be no valvular structure in the vein outflowing from the cavernous sinuses, and blood flows into the dorsal penile vein by penetrating the albuginea obliquely or vertically after running parallel in the region immediately below the albuginea. It is considered that, when the valve of the helicine artery opens, blood flows into the cavernous sinuses, expanding them, and as a result the outflowing vein is compressed between the sinuses and the albuginea, or the albuginea itself, acting like a valve and therefore assuming an important function in maintaining erection by disturbing the reflux of blood flow. It is also presumed that the contracting of ishiocavernous muscle plays a part in developing the rigidity of the penis. It is considered, moreover, that the trabecula of the cavernous body consisting of smooth muscle also plays a part in the promotion and disappearance of erection. It is very important to run functional tests of erection when diagnosing impotence, and today many tests are available for differential diagnosis; including papaverine test, dynamic cavernosometry and cavernosography. As for therapy, treatments involving vasoactive agent infusion, such as papaverine or prostaglandin E1 into the cavernous body, have become common. For cases with venous impotence, ligation of the penile deep vein and crus of the penile cavernous body have come to be attempted. Furthermore, revascularization of penile artery can be performed to treat arterial impotence. For cases in whom these methods are not effective, implantation of various penile prostheses into the penis has been shown to be successful.

Diagnosis, Differential↗

PubMed1992

[Results of deep dorsal vein ligation for venogenic impotence].

We treated seventy venogenic impotence with ligation of the deep dorsal vein of the penis. Their corporal veno-occlusive function was evaluated by dynamic infusion cavernosometry and cavernosography (DICC). Under local anesthesia, we made a longitudinal skin incision at the base of the penis. The deep dorsal vein was ligated and also a portion of this vein of 1.5 cm long was resected together with branches surrounding the vein. After the operation, the infusion rate determined by DICC was confirmed to be decreased in almost all patients. Thirty nine out of seventy cases had their erectile capability restored and reported that they could achieve sexual intercourse. Sixty one of the seventy cases showed full erection together with an intracavernous papaverine injection. However fifty percent of the sixty one patients who became capable of obtaining erection with the treatment had lost their erectile capability again within one year of the operation, however the other fifty percent were shown to maintain their erectile capability for up to three years. As four years after the treatment only thirty percent of those who had achieved the initial erectile capability still remained potent. This operation is easy to perform without any major complications, and its outcome is as good as that achieved by other more invasive venous ligation in the treatment of patients with venogenic impotence. We therefore conclude that penile deep dorsal vein ligation and partial resection of the vein one of the most useful treatments currently available for venogenic impotence and should be the treatment of choice.

Adult↗

PubMed1992

[Double-blind trial of oral prostaglandin E1 on impotence].

The effect of oral prostaglandin E1 (limaprost) on erectile function was studied in a double-blind placebo controlled trial. Fifty one patients who agreed to participate were examined for their subjective symptoms and nocturnal erection was recorded using an erectometer at the beginning of the study, after an initial 6 week period, and again after a second 6 week period. Patients were randomly assigned to a group which received placebo followed by limaprost or to a group which received limaprost followed by placebo. Ten cases dropped out. In the remaining forty one patients, NPT during the limaprost phase was significantly different from that during the placebo phase. Patients with the history of diabetes mellitus, hypertension, or pelvic surgery showed relatively poor responses to oral prostaglandin E1. Oral prostaglandin E1 achieved 42.9% effectiveness in the psychogenic impotence, and this effectiveness is significantly higher than that of placebo. Oral prostaglandin E1 was suggested as an additional or alternative therapy in the management of psychogenic impotence. Psychogenic impotent who didn't respond to sex therapy and patients with slight organic causes would seem to benefit from oral prostaglandin treatment.

Administration, Oral↗

PubMed1992

[Assessment of autonomic nervous function in impotence using sweat response induced by intradermal injection of acetylcholine].

It is important to evaluate the autonomic nervous function which controls penile erection. One method utilizes intradermal injection of acetylcholine to produce localized sweat response. The sweat response depends on the peripheral autonomic nervous supply. Therefore, the response can be used to detect peripheral autonomic nervous dysfunction. We tried to evaluate the peripheral autonomic dysfunction in 29 impotence using a sweat spots test. We classified the 29 impotence into 6 groups with standard tests such as the papaverine test, nocturnal penile tumescence monitoring, recordings of bulbocavernous reflex, etc. The results were as follows: psychogenic IMP; 8, neurogenic IMP; 8, arterial insufficiency; 5, corporeal veno-occlusive insufficiency; 6 neurogenic with arterial insufficiency; 1, and neurogenic with corporeal veno-occlusive insufficiency; 1. The score of sweat spots test was 25.3 +/- 10.9, being in normal, nineteen severe in 3 and slightly abnormal in 7. Many cases of severe and slightly abnormal patients were DM patients classified into neurogenic IMP. We found 2 cases that were not detected by bulbocavernous reflex but found to be abnormal by sweat spots test. Therefore we conclude that this test effective to detect the autonomic nervous dysfunction in impotence.

Acetylcholine↗

PubMed1993

[A case of penile revascularization by Hauri's method for arteriogenic impotence].

In a 35 year old arteriogenic impotent patient without a history of hypertension, arteriosclerotic disease, or diabetes mellitus, the corpus cavernosum of the penis was revascularized using Hauri's method. Before surgery, erection after the intra-cavernous injection of 20 micrograms of prostaglandin E1 was very weak. In a color ultrasonography the peak systolic velocity of the cavernous arteries was recorded as being only 18 cm/sec. Furthermore, no artery except the right dorsal artery was evident even with a digital subtraction angiography. Accordingly he was diagnosed as having arteriogenic impotence, and we carried out the corpus cavernosum revascularization using Hauri's method under microscopic magnification. The dorsal artery and the deep dorsal vein were anastomosed side-to-side, and the hypogastric artery and dorsal artery were anastomosed end-to-side. After the revascularization surgery, the peak systolic velocity of cavernous arteries returned to normal (53 cm/sec), and the penis showed complete erection after an intracavernous injection of 20 micrograms of prostaglandin E1. Before surgery this patient had no experienced sexual intercourse, but he could achieve full sexual intercourse 2 weeks after the surgery. His erectile ability has been maintained for 4 months since the surgery. This is the 1st case of arteriogenic impotence treated using Hauri's method in Japan.

Adult↗

PubMed1980

Diagnosis of erectile impotence in diabetes mellitus. An objective and specific method.

Objective procedures for both the differential and specific diagnosis of erectile impotence were applied in a study of 13 diabetic men. Monitoring of nocturnal penile tumescence provided evidence of patients' erectile capacity and allowed differential diagnosis of organogenic impotence. Follow-up evaluations of penile blood pressure, bulbocavernosus reflex response latency, and plasma concentrations of testosterone and prolactin allowed localization of probable organic deficits. Bulbocavernosus function was compromised in nine patients, and penile systolic blood pressure was abnormally low in five. Hormone levels were typically within the normal range. These procedures are recommended for comprehensive assessment of impotent diabetic persons in both clinical and research settings.

Adult↗

PubMed1976

[The Small-Carrion penile prosthesis for erectile impotence (author's transl)].

The insertion of two silicone rods into the penile corpora cavernosa (Small-Carrion penile prosthesis) is a considerable procedure for operative management of erectile impotence. Of 61 treated patients, 55 had a satisfactory anatomical and functional result, most of them regained the same sexual activity as prior to onset of impotence. Their partners were satisfied, too. Preoperative evaluation of causes of impotence is particularly important. Type and number of complications in this operative procedure are reported in detail.

Adult↗

PubMed2001

Penile implants in the treatment of organic impotence.

OBJECTIVE: To evaluate the reliability and safety of penile implants in the treatment of organic impotence at the Saudi Aramco - Dhahran Health Center. METHODS: A series of 108 cases of organic impotence that underwent 125 penile implantation procedures between 1988 and 1997 was reviewed. The follow-up period ranged between 6 months and 10 years. The mean age was 57.9 years (range 26-76). The prostheses used were AMS (American Medical System) inflatable (92 cases) and malleable (16 cases). RESULTS: There were no complications in 86 patients, (80%) who had functioning prostheses all through the follow-up period. Revision of the implants was required in 13 patients (14%). The causes of revision were severe infection, intolerable pain from an oversized malleable prosthesis, and dysfunction of the inflatable prostheses. Removal of the implant was necessary in severe infection, intolerable pain, and extrusion of the prosthesis. All 9 patients (8%) had inflatable prostheses and refused a second implant. There was no single mortality among our series. The overall procedure complications involved 26 out of 125 procedures (21%). It was shown that malleable penile prostheses have significantly lower procedure complications than the inflatable ones (p<0.05). CONCLUSION: Penile implants are reliable and safe modality of treatment for organic impotence with acceptable morbidity.

Adult↗

PubMed2003

Recent data upon impotence, incontinence and quality of life issues concerning radical prostatectomy.

OBJECTIVE: To present recent data dealing with the two major post-radical prostatectomy complications incontinence and sexual dysfunction, and investigate if they affect the quality of life of the patients. METHODS: We evaluated recent data available on Medline, from different series examining the incidence, pathophysiology, evaluation and treatment of incontinence and impotence after radical prostatectomy. We also evaluated the effect upon quality of life of these complications. RESULTS: Many experienced surgeons observe low incidence rates of incontinence and sexual dysfunction after radical prostatectomy and it seems that meticulous surgical technique might prevent these devastating complications. However, there are many papers in the literature, which show a great variety of results with incontinence ranging from to 0.3 to 65.6% and potency rates from 11.6 to 86% among treated patients. Depending on the individual's opinion incontinence is a minor problem and does not have a great impact upon their quality of life. Impotence affects more frequently these men and seems to be the most disturbing complication after radical prostatectomy affecting the quality of life. CONCLUSIONS: Today avoidance of major complications after radical prostatectomy depends mostly upon high quality surgical technique. Post-radical prostatectomy incontinence does not seem to be a frequent event and when it occurs it does not dramatically affect patients' quality of life. Impotence although most annoying for the majority of the treated patients can be effectively managed by various methods when the neurovascular bundles are preserved.

Clinical Trials as Topic↗

PubMed1992

[Color doppler echography in the exploration of vasculogenic impotence].

102 patients with suspected vasculogenic impotence were evaluated with color doppler sonography. Measurement of normal systolic and diastolic velocities were obtained from the cavernosal arteries of patients responding by a full erection after intra-cavernosal injection of 20 mg of Papaverine. A correlation with cavernosometry was obtained in 61 patients and with selective internal pudendal arteriography in 11. The 10 patients with abnormal arteriograms had a systolic velocity < 25 cm/sec. 13 out of the 15 patients with an end diastolic velocity > 5 cm/sec had a venous leak defined by a maintenance flow rate of erection during cavernosometry > 25 ml/mn. End diastolic velocity is an excellent index of the function of the veno-occlusive system, provided the systolic velocity remains at a normal value. In case of arterial insufficiency, a diastolic flow < 5 cm/sec is of no value and cavernometry is mandatory to detect a mixed arterio-venous impotence. The addition of color doppler sonography permitted a more rapid detection of vessels and an easily reproducible measurement of velocities which makes color doppler sonography an excellent screening test for examining patients with potential vasculogenic impotence.

Adult↗

PubMed1992

[Ultrasound-color Doppler in the study of sexual impotence].

Male impotence is a relatively frequency disease. To define the correct aetiology of this disorder is important to plan a right diagnosis to difference organic, psychological and psycho-organic causes. From June 90 to June 91 fifty-four patients with male impotence of different degree were observed and went through diagnostic investigations. The patients were classified in four groups (A, B, C, D) as clinical results of the pharmacological test (intracavernous injection of PGE1 alpha 15 micrograms). A and B groups showed normal and nearly normal hemogenic finding. C group showed either low arterial flow increase after FIC or venous leakage. D group showed very low haemodynamic increase. The analysis of Eco-doppler studies was performed 5'-10'-20' after intracavernous injection of PGE1 alpha obtaining three haemodynamic markers: the systolic top flow (Vs) the diastolic ending flow (Vd) resistance flow index. The Authors discuss the results obtained considering the Eco-color-doppler the most important stage in the haemodynamic evaluation of sexual impotence.

Adolescent↗

PubMedDate not supplied

[Impotence and cardiovascular disease: a new perspective in the health-care compromise of the urologist].

OBJECTIVES: To review the evidence currently available to establish the pathogenic connection between erectile dysfunction (ED) and cardiovascular disease (CVD), and the effects this scientific progress has introduced in the classical impotence urology clinic. METHODS: We reviewed the most recent publications about this disease (2000-2004) and the concept of endothelial dysfunction by appropriate MEDLINE searches, with specific selection of reviews and clinical practice guidelines. RESULTS: The fact that ED and CVD share risk factors is confirmed; the pathogenic unity of both processes having endothelial dysfunction as the underlying problem; anticipation of ED over CVD in time of presentation; notable increase of research about this issue over the last two years; the change of scenario in the impotence urology clinics due to these findings. CONCLUSIONS: The number of cases in which ED is not an organ disease but an early symptom of endothelial dysfunction forces changes in the extent and depth of the diagnostic, prognostic and follow-up strategies in the urology impotence clinics of extraordinary importance from both the individual and health-care politics point of view.

Cardiovascular Diseases↗

PubMed1992

Treatment of impotence due to venous leakage by resection of the deep dorsal vein of the penis.

Ligation and resection of the deep dorsal vein of the penis is a surgical approach to restore potency in venogenic impotence. Between December 1989 and December 1990, we treated 25 men with venogenic impotence by this technique. Additionally, the Nesbit operation was performed in 3 cases due to penile curvature and in 1 case a penile plaque was excised. The patients were asked to come for control 1, 3, 6 and 12 months after surgery. In 14 patients the rigidity and duration of erections were improved 3 months after surgery but, in 21 of the 25 men, erectile dysfunction recurred 6-15 months (average 9.4 months) following surgery and penile prostheses were implanted in 7 cases. The complications were orchiepididymitis in 1 case, penile edema and hyperemia which lasted for 1 week in 1 patient and numbness near the incision site in 10 cases. We conclude that, in patients who had erectile impotence due to venous leakage, resection of the deep dorsal vein of the penis could provide a transient satisfactory result, but should not be considered as a long-term treatment modality.

Adult↗

PubMed1991

The use of prostaglandins for diagnosis and treatment of erectile impotence.

The authors present their experience in using PGE-1 for the assessment of 77 impotent patients. This drug can be safely used as a screening test for vasculogenic impotence but is also useful in more invasive diagnostic tests. PGE-1 is probably the only natural product that can be used commonly for the treatment of erectile impotence, because it is a safe and effective drug.

Alprostadil↗