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PubMed1990

[Neurophysiological studies in 200 impotent men: the value of the bulbocavernous reflex and of penile evoked potentials].

After having investigated 200 males with impotence, the authors conclude that the study of the bulbocavernous reflex and the penile evoked potentials are of a certain importance when a neurological origin is suspected as the cause of the impotence. The usual urological investigations during the work-up of impotence should always be carried out in order to improve the insight into the relationships between the different examinations.

Erectile Dysfunction↗
PubMedDate not supplied

[The treatment of male organic impotence of vascular origin].

Two cases are presented, of male sexual impotence of vascular origin. In one case presenting with obstruction of the pudenda artery revascularization of the penis was achieved by anastomosis of the inferior epigastric artery to the deep dorsal vein of the penis. In the second case the insufficient erection was due to a rapid venous drainage of the cavernous bodies, and a venous disjunction was carried out, involving all the superficial veins of the penis and the deep dorsal vein. The results obtained were good. The importance is stressed of the test to papaverin for the differentiation of patients with psychogenic impotence, and the value of the Doppler study for the evaluation of the arterial deficiency of the penis, that should be confirmed by selective angiography. Finally the authors stress the importance of cavernography and of cavernometry for the diagnosis of impotence due to the venous loss.

Arteriovenous Shunt, Surgical↗
PubMed1990

Impotence after prostatectomy.

Reportedly, 4 to 30 per cent of patients suffer impotence after prostatectomy. Some cases of neurovascular impotence can be attributed to the surgical technique. The author examines the incidence and mechanisms of such impotence and outlines the evaluation and treatment options.

Erectile Dysfunction↗
PubMed1990

[Intracavernous pharmacotherapy for organic impotence in the elderly].

Vasoactive intracavernous pharmacotherapy (VIP) has become an important tool for the treatment of erectile impotence. The average age of patients treated has been only 59 years and the oldest, 79. We describe the results of VIP in the oldest group of patients described. 28 men, 65-84 years old (average 70), were treated for organic impotence with intracavernous injections of a mixture containing 25 mg/ml papaverine HCl and 0.83 mg/ml phentolamine. Treatment was started with an injection of 0.25 ml of the mixture, with increments of 0.25 ml until there was functional erection, or untip a total of 1.5 ml was injected. Full erection was obtained in 46.5%, while in 40.0% there was a mild nonfunctional erection and in 13.4% no reaction to treatment. The response to the injection was similar in the different etiologic groups. There were no complications, such as prolonged erections or adverse reactions to the drugs injected. We conclude that elderly men seek help in order to have normal sexual function. We therefore think that VIP has a definite place in the treatment of impotence of the elderly.

Aged↗
PubMed1989

[Diagnosis and treatment of impotence with administration of chemical prosthesis using real-time mechanical sector duplex scanner--with special reference to diabetic patients].

The usefulness of a chemical prosthesis was studied for the diagnosis and treatment of 20 patients with erectile impotence (14 due to diabetes, 2 due to pelvic surgery and 4 due to psychogenic factors) using papaverine hydrochloride and phentolamine mesilate. Absolute erection was observed in 16 patients (80%) and coital penetration was possible in all 9 patients who actually tried sexual intercourse. Penile arterial blood flow was measured in 15 patients using a real-time mechanical sector duplex scanner (Diasonics DRF/400V) just before and after the chemical prosthesis, and a marked increase in blood flow was observed in all patients after administration. From these results, it is considered that measurement of the penile blood flow using a mechanical sector duplex scanner is useful in the diagnosis and monitoring of impotence. Furthermore, a chemical prosthesis is suitable mainly for the treatment of impotence due to diabetes, by adjusting the dosage and administration.

Adult↗
PubMed1989

Intracavernosal injection of pharmacological agents in the diagnosis and treatment of impotence.

This study details our initial experience with pharmacologically induced penile erections in the diagnosis and therapy of patients with impotence. Intracavernosal injections of papaverine were performed in 5 normal volunteers, 5 patients with psychogenic impotence and 2 patients with penile venous incompetence. The patients were first investigated extensively to determine the etiological basis for their erectile dysfunction. It was observed that the patients with psychogenic impotence and the normal volunteers showed a good response whereas the patients with venous incompetence failed to achieve erection in response to intracavernosal injection. A new drug, Prostaglandin E1 was also tried for the first time for comparison. It appears that this drug has potential advantages over the currently used agent papaverine for the production of pharmacological erections.

Adult↗
PubMed1989

[Pharmacocavernosography: a worth-while examination in the evaluation of venogenic impotence].

From November 1988 till July 1989, a total of 78 patients consulted our OPD with a chief complaint of impotence. These patients underwent evaluation with pharmacocavernosography alone, or combined with color duplex sonography (Acuon 128). Sixty-three (80.8%) patients were found to have abnormal venous drainage which, in one case, was associated with peyronie's disease. Among these patients, the sites for the contrast medium in the venous drainage system from the penis were determined as follows: the preprostatic plexus for 53 (67.9%) patients, the proximal (cavernosal or crural) vein for 50 (64.1%) patients; the internal pudendal vein for 46 (58.9%) patients; the deep dorsal vein for 31 (39.7%) patients; the glans of the penis for 8 (10.3%) patients; the external pudendal vein for 8 (10.3%) patients and the corpus spongiosum for 3 (3.8%) patients. So the venous ligation for venogenic impotence had to include all these visible veins, especially the proximal vein. Among the 52 patients who once had received duplex scanning, 43 (82.7%) patients had abnormal venous drainage. So the duplex sonography did not seem to influence the population of venous leakage and 12 patients exhibited moderate to severe degree of arteriogenic insufficiency. Pharmacocavernosography in these patients was less valuable. No severe complications, such as priapism, were found. We found pharmacocavernosography to be a simple, practical and useful tool for evaluating patients suspected to have venogenic impotence. It can determine the sites of venous leakage (the key information for planning venous ligation) and provides good morphological information in the study of cavernous bodies. But it was not reliable in the evaluation of the severity of venous leakage.

Adult↗
PubMed1989

Impotence and aging.

Taking into account the normal changes that occur with aging and the large number of pathologies, pharmacologic agents, and social situations that the elderly are subject to, it is perhaps more surprising that 25 per cent of those over 80 years of age do report normal sexual functioning. Loss of erectile capability appears to be multifactorial in many patients, although the exact degree is uncertain due to unsystematic assessment in the majority of current studies. Unfortunately, impotence is often ignored by the patients' physicians. Physicians do not routinely ask about erectile functioning in their patients, perhaps because they do not know how to systematically evaluate and treat the complaint. Any follow through that might result from a complaint is often chaotic. And, rarely are treatment possibilities systematically and clearly presented to the patient. This is particularly true for the elderly patients whose physicians may be surprised that an elderly patient would still be interested in sexual behavior. No matter how subtle, this "dirty old man" response by the physician does not foster a good therapeutic environment. Inappropriate and unsystematic evaluations of impotent patients leads to a literature replete with contradictory statements. Because of the prevalence of impotence in the elderly, as a group they are hurt the most by unsystematic evaluation techniques and therefore have the most to gain from the application of systematic evaluation and treatment procedures.

Adult↗
PubMedDate not supplied

Serum prolactin concentration in impotent African males.

Serum prolactin concentration, measured by radioimmunoassay, was significantly higher (p less than 0.005) in 49 patients with impotence than in a control population of 16 normal subjects. 26.5% of the impotent patients had hyperprolactinemia. Their serum testosterone was also significantly lower (p less than 0.05). Bromocriptine suppressed the raised prolactin, normalised testosterone in seven treated hyperprolactinemic patients, and restored potency in five of them. These results suggest a possible role for hyperprolactinemia in a substantial proportion of African patients with impotence. Further studies in more affected patients are in order.

Adult↗
PubMed1989

[Impotence of vascular origin].

Between 1977 and 1986, 3,500 patients were examined for the symptom of impotence; 1,250 of them received multidisciplinary investigation permitting the diagnosis of a pure organic or mixed disorder in 85% of cases, including 62% of vascular disease subdivided into arterial (40%) and venous (22%). For 1,062 patients, 1 or several of the following therapies were used: intracavernous infusion of vasoactive drugs (N = 725), auto-injections (N = 235), vascular surgery (N = 357) and prostheses (N = 23). The diagnostic approach, formerly analytical and making use of multiple non-invasive methods, such as nocturnal erection plethysmography (NPT) and invasive methods (artificial erection, arteriography) have been transformed by the use of pharmacological tests associated with visual sexual stimulation (VSS) which enable, together with Doppler velocimetric examination, simple screening of vascular impotence based on the study of 4 parameters: penile pressure index (PPI) when less than 0.91 is always a sign of an arterial problem, the severity of which is directly proportional to the lowering of this index and the association with maintenance insufficiency; the initial intracavernous flow rate (IICF) depends overall on the maintenance flow and the state of erectile tissue, resulting from pharmacological stimulation by a low dose of papaverine (8 mg); penile rigidity attained by the combined action of pharmacological and visual sexual stimulation, reflecting the functional erectile capacity; the duration of the rigidity thus obtained on stoppage of VSS indicating the capacity for maintenance of erection. In the event of suspicion of an isolated venous leak or in association with arterial problems, it is the artificial erection with cavernosography, carried out after pharmacological stimulation, which enables the severity of the leak to be assessed. The following specific investigations are carried out to investigate a specific associated etiology: electromyogram for neurological disorders, hormone assay for endocrine disorders and psychological study using the MMPI questionnaire (Multiphasic Minnesota Personality Inventory). One can thus distinguish several groups of patients suffering from vascular impotence depending on the degree of arterial involvement: minor (PPI between 0.75 and 0.9), moderate (PPI between 0.65 and 0.75) and severe (PPI less than 0.65); depending on the degree of venous leaking: absent (MI less than 0.3 and/or MF less than 25 ml/min), minor (MI between 0.3 and 0.5 and MF between 30 and 50 ml/min), moderate (MI between 0.5 and 75 ml/min) and severe (MI greater than 0.75 and/or MF greater than 75 ml/mn).(ABSTRACT TRUNCATED AT 400 WORDS)

Erectile Dysfunction↗
PubMed1989

[Impotence in the diabetic].

Two-hundred-and-two impotent diabetic patients gave their consent to be investigated. Impotence is linked to diabetes mellitus in 58.9% of patients so all the other etiologies have to be systematically eliminated. Neuropathy or arteriopathy, when isolated, are found with the same frequency, but these 2 etiologies are often associated (47 patients). No statistical difference between IDDM and NIDDM was found. Mercury strain gauge plethysmography and venous occlusion coupled to ECG allows detection of arterial lesions in diabetic impotence. Patients agreed to submit to all of the various therapeutic possibilities. Combination of alpha-blockade and good glycemic control induced the best results.

Adult↗
PubMed1989

[Intracorporeal injection of papaverine for diagnosis of impotence: clinical evaluation of 120 patients].

Intracorporeal papaverine injections were performed for evaluation of penile erection on 120 patients with sexual impotence. This diagnostic technique was found to be simple, objective, realistic, and more precise in the differentiation of sexual dysfunction in men. In addition to observing the onset and duration of erection after papaverine injection, we could also classify the erectile rigidity by measuring the erectile angle while standing. The penile deformity after erection that possibly contributed to the etiology of patient's impotence could also easily be detected after papaverine injection. Thus we could differentiate 120 cases of impotence into the following types: psychogenic (26 cases), neurogenic (2 cases), mild vasculogenic (including physiologic) (33 cases), severe vasculogenic (54 cases) and pure venous leakage syndrome (5 cases). None of our patients developed fatal complications during or after the papaverine intracorporeal injection test; however, we experienced 5 cases of priapism requiring emergency management. Therefore, the injection must be done under the supervision of an experienced urologist.

Adult↗
PubMed1988

Injection therapy for impotence.

Injection of vasoactive drugs is an effective form of treatment for selected patients with impotence from virtually all causes. The two most commonly employed drugs in the United States are either papaverine alone or various combinations of papaverine and phentolamine. Patients with organic and mixed impotence are best suited for injection treatment, but selected patients with psychogenic impotence also benefit from therapy. After the patient is selected for injection therapy, he undergoes a series of trial injections in the physician's office. The incidence of priapism will be minimized if the initially administered doses are low and the patient is titrated to an appropriate dose level. Uncontrolled trials have revealed that injection treatment produces a satisfactory erection in 65 to 100 per cent of patients for a follow-up period of as long as 2 years with minimal side effects, but the dropout rate is high. If priapism does occur, it almost always responds readily to treatment with aspiration, low doses of an alpha-adrenergic agent, or both. The other common side effects are bruising or ecchymosis and nodule formation at the injection site. This latter complication has not been noted to cause significant abnormal penile curavature necessitating cessation of the program.

Clinical Trials as Topic↗
PubMed1988

[Several techniques proposed for the differential diagnosis of diabetic impotence].

The measurements of changes in penile circumference during nocturnal erection is commonly used to differentiate between organic and psychogenic impotence. Unfortunately, this measuring technique do not record variations in penile rigidity which may be insufficient to achieve coitus despite a normal circumference. We carried out a study with a penile cuff to measure penile rigidity. The validation of this penile cuff as a measurement device of penile rigidity permits us to determine the criteria of normality of penile rigidity and, subsequently, to differentiate more accurately between organic and psychogenic dysfunctions. Measurement of the bulbocavernous reflex (BCR) is widely used to diagnose underlying neurologic disorders in erectile dysfunctions. A prolonged BCR latency, more than 45 ms, or absence of a reflex response of the BC muscles during electrical stimulation of the glans penis, is considered like a sign of neurologic disease. We recorded the BCR in 90 subjects. Nineteen had abnormal BCR latencies. Furthermore, eight of these 19 subjects had normal nocturnal erections, thus confirming the diagnosis of psychogenic impotence. These results cast doubt on the validity of BCR measurements of the diagnosis of organic erectile dysfunction due to a neurologic disease. We recorded the BCR in 90 subjects. Nineteen had abnormal BCR latencies. Furthermore, eight of these 19 subjects had normal nocturnal erections, thus confirming the diagnosis of psychogenic impotence. These results cast doubt on the validity of BCR measurements for the diagnosis of organic erectile dysfunction due to a neurologic disease.

Diabetes Complications↗
PubMed1988

Erectile impotence: evaluation and management.

Dramatic progress in the understanding and treatment of erectile impotence has occurred over the past decade. Most cases have an organic cause that is related to vascular (arterial or venous) supply, innervation, or the hormonal milieu of the penis. Multifactorial causes of organic impotence are common and include diabetes mellitus, alcoholism, renal failure, and liver failure. Medications may cause impotence by a variety of mechanisms. The history and physical examination, along with simple laboratory tests, are the mainstay of evaluation and may be performed appropriately by family physicians. Successful new forms of nonsurgical treatment include penile self-injection with papaverine (sometimes with phentolamine) and penile-suction devices. Penile prostheses have been improved greatly in recent years. The patient may select among semirigid, multicomponent inflatable, and self-contained inflatable devices. New surgical treatments include penile arterial revascularization (for atherosclerosis) and ligation of the dorsal vein of the penis (for venous leak).

Erectile Dysfunction↗
PubMed1986

Predictive power of penile/brachial index in diagnosing male sexual impotence.

To evaluate the diagnostic power of penile/brachial index (PBI) in patients studied for male sexual impotence, we prospectively interviewed 503 patients referred to our vascular laboratory for PBI measurements. Since the predictive values of diagnostic tests are affected by the prevalence of the disease in the population studied, we calculated the independent likelihood ratio for various PBI levels obtained. For the purpose of this analysis, "organic" impotence was defined as occurring in patients who had no nocturnal erections, whereas "clinical" impotence was defined as occurring in those patients who could not achieve penetration during intercourse. The patients were divided into four groups by the presence or absence of risk factors, including peripheral vascular disease (PVD) and diabetes mellitus. Patients taking medications that may affect potency (n = 175) were excluded from this analysis. The results show that the predictive power of PBI is less in diabetic patients with PVD and least in those without either PVD, diabetes, or drugs. In patients with PVD but no other risk factors, PBI is highly diagnostic with a sharp cut-off point at 0.6. Thus, the diagnostic power of PBI can be improved by considering the risk factors in the patients studied.

Adult↗
PubMed1987

Diabetes-related impotence and its treatment in the middle-aged and elderly: Part II.

Primary care treatment of diabetes-related impotence frequently revolves principally around patient referral and counseling. Sex or marital counseling or psychotherapy has a moderately high success rate for patients with psychogenic impotence. However, penile prosthesis implantation in properly selected patients with irreversible diabetic impotence has a final success rate, in terms of patient and partner satisfaction, of approximately 90%. Intracorporal self-administered papaverine alone or in combination with phentolamine has a limited role in producing erections satisfactory for intercourse.

Aged↗
PubMed1978

Pituitary-testicular axis in diabetic men with and without sexual impotence.

In nine impotent diabetics (ID), eight diabetics with normal sexual function (ND), eight impotent non diabetics (IN) and seven normal patients (NN), we found normal basal FSH and LH levels. Plasma testosterone (T) values were significantly lower in ID and IN in comparison with NN and ND. After LHRH injection, plasma T increased in ID up to normal values. In non diabetic patients (NN and IN), LHRH induced a slight but significant rise in blood glucose. Post LHRH gonadotropins response was in the normal range for all groups and the amplitude of the response was highly correlated with basal levels except for LH in ND. Mean blood glucose during the test and LH response to LHRH were not inversely correlated in the patients studied. We conclude that impotence in diabetic patients is a neurological complication and that low testosterone levels are probably secondary to a decreased coital frequency. ID and IN probably share a common pattern of inadequate hypothalamic feedback control in the presence of low testosterone levels.

Adult↗