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PubMed1986

[Impotence].

The term impotence can be defined as "disturbances in sexual behavior and sexual feeling in males as evidenced by impaired or atypical genitophysiological reactions or the complete absence of such reactions." There are two main forms: erectile impotence and premature ejaculation. Differential diagnosis between "organic" and "psychogenic" impotence is very often impossible due to the fact that the causal factors of both areas can play a role in individual cases. Psychotherapy is not always necessary. Sexual counseling can be appropriate when sexual problems are the result of inadequate sex education, sexual inhibitions or minor conflicts with the partner. Depending upon the main causes for the sexual inadequacy, the specific psychotherapy is directed towards the problems in the partnership, towards the personality difficulties, or towards the sexual behavior itself. For the treatment of the latter, the behaviorally oriented therapyprogram of Masters and Johnson has been shown to be very successful.

Ejaculation↗
PubMed1986

Smoking and vascular impotence. A reason for concern.

Of the patients at an impotence clinic 39% were classified as having vasculogenic impotence. They were in a high age group and 93% smoked. The possible role of smoking in the pathogenesis of the impotence of ageing is discussed.

Adult↗
PubMed1978

Sexual impotence: the overlooked complication of a second renal transplant.

THE INCIDENCE OF SEXUAL IMPOTENCE IN 20 MEN WHO HAVE RECEIVED AT LEAST 2 KIDNEY TRANSPLANTS WAS 65 PER CENT COMPARED TO 10 PER CENT AFTER THE FIRST TRANSPLANT. The impotence was transient (2 to 4 months) in both affected men after the first transplant but permanent (2 to 10 years) in 6 men after the second operation. We attribute this increased percentage of impotance to the second end-to-end arterial anastomosis that requires division of the internal iliac arteries. We suggest that the second transplant be placed end-to-side into the common iliac artery.

Adult↗
PubMed1985

[Implant operation of penile inflatable prosthesis for a patient with erectile impotence due to radical cystectomy: a case report].

The hydraulically inflatable penile prosthesis consists of an inflate-deflate pump, a storage reservoir and paired cylinders and it is able to provided a more physiologically functional penis. We report our surgical experience of implant of an inflatable penile prosthesis for postoperative impotence. The patient was a 51-year-old male with impotence, who had received radical cystectomy and ilial conduit formation for transitional cell carcinoma of the bladder (G3, pT3NoMo.) 9 months earlier. There was nothing particular except for the postoperative status on physical, laboratory and X-ray examinations. He was diagnosed to have organic impotence (vasculogenic) by sexual functional tests. Auto-injection of the corpus cavernosum with papaverine HCl was attempted but an erection was not induced by the injection. So, implant operation of an inflatable penile prosthesis was performed by the lower abdominal approach. His postoperative course was uneventable and practice to deflate and inflate the cylinders was started at 2 weeks after the operation and he was able to have sexual intercourse at 5 weeks after the surgery. Now (3 months after the operation), he can have sexual intercourse with an orgasm but without ejaculation and he and his wife are both satisfied with the postoperative status.

Carcinoma, Transitional Cell↗
PubMed1980

Priapism and impotence in homozygous sickle cell disease.

A questionnaire study of Jamaican patients with homozygous sickle cell (SS) disease indicated a 42% prevalence of priapism, with a median age at onset of 21 years. Two predominantly different patterns of priapism were recorded: short "stuttering" episodes lasting less than three hours, with normal consequent sexual function, and severe prolonged attacks (generally more than 24 hours) commonly followed by impotence. Stuttering episodes were frequently a prodrome to a major attack. Over one fourth of those who had suffered priapism had some degree of impotence. Hematologic analysis indicated that priapism was significantly associated with low hemoglobin F levels and high platelet counts. Patients with severe attacks of priapism had lower hemoglobin F levels and reticulocyte count, and a higher mean corpuscular volume, than patients with only stuttering episodes. Priapism and impotence contribute to the morbidity of SS disease more frequently than previously recognized.

Adolescent↗
PubMed1977

Urological and behavioral approach to the treatment of secondary impotence.

Psychogenic impotence is far more common than organic impotence and may co-exist with or be a result of it. Psychological principles of therapy may be needed for all impotent patients treated by the urologist. These principles include 1) re-education in sexual function, 2) removal of pressure for male performance, 3) bringing existing performance fears to the surface for therapy, 4) teaching patients techniques to deal with the fears, 5) teaching the partner proper cooperation and 6) improving the communications between the 2 partners.

Erectile Dysfunction↗
PubMed1983

Impotence in medical clinic outpatients.

One thousand one hundred eighty men in a medical outpatient clinic were screened as to the presence of impotence. Four hundred one men (34%) were impotent, and of those, 188 (47%) chose to be examined for their problem. After a comprehensive evaluation the following diagnoses were obtained: medication effect, 25%; psychogenic, 14%; neurological, 7%; urologic, 6%; primary hypogonadism, 10%; secondary hypogonadism, 9%; diabetes mellitus, 9%; hypothyroidism, 5%; hyperthyroidism, 1%; hyperprolactinemia, 4%; miscellaneous, 4%; and unknown causes, 7%. The mean age of the impotent patients was 59.4 years, and the prevalence of alcoholism was 7%. Luteinizing hormone, follicle-stimulating hormone, testosterone, thyroxine, triiodothyronine (T3), T3 resin uptake, and prolactin studies were necessary to diagnose individual cases. We conclude that erectile dysfunction is a common and often overlooked problem in middle-aged men followed in a medical clinic.

Alcoholism↗
PubMed1982

Treatable impotence in diabetic patients.

The incidence of impotence in diabetic men is reported to be almost 50 percent. The prevailing view is that such impotence is due to organic factors. To investigate the validity of this notion we compiled the cases of 34 diabetic men having difficulty in penile erection. Our results suggest that impotency in men with diabetes is psychogenic in many cases and can be treated successfully by brief sex therapy.

Adult↗
PubMed1981

Surgery for impotence.

The role of surgery in the treatment of impotence has greatly increased during the last 5 years. The recognition and surgical correction of those mechanical derangements of the penis that prevent coitus have enabled many men to resume or commence intercourse. Men with irreversible impotence usually find it possible to resume coitus following the insertion of a Silastic penile prosthesis. The need to diagnose organic impotence has in turn stimulated the development of new diagnostic techniques and these have increased our knowledge of the pathophysiology of erectile function.

Coitus↗
PubMed1981

[The role of penile Doppler sonography in the diagnosis of vascular impotence. Preliminary studies].

Normal, potent arteriopathic and impotent arteriopathic subjects have been studied by means of the Doppler method for the determination of penile systolic pressure. A penile systolic pressure value less than 75 mmHg and a penisarm pressure index of than 0.55 were always associated with impotence. If present in the arteriopathic, impotence is not always caused by vascular factors.

Auscultation↗
PubMed1978

Nonsurgical treatment of impotence.

The most recent methods of distinguishing between organic and psychological impotence are reviewed. The old theory that 90% of impotence is psychological is disclaimed and the various nonpsychological causes are pointed out. The majority of impotent patients can be treated in a nonsurgical manner.

Adult↗
PubMedDate not supplied

Impotence is not always psychogenic. Newer insights into hypothalamic-pituitary-gonadal dysfunction.

The concept that impotence is psychogenic in 95% of cases is reconsidered. Screening serum testosterone levels of 105 consecutive patients with impotence showed that 37 patients had previously unsuspected disorders of the hypothalamic-pituitary-gonadal axis. Twenty patients had hypogonadotropic-hypogonadism, seven had hypergonadotropic-hypogonadism, eight had hyperprolactinemia, and two had occult hyperthyroidism. Once the specific defect was defined, appropriate therapy was instituted, and potency was restored in 33 patients. Screening serum testosterone levels is useful in identifying hypothalamic-pituitary-gonadal dysfunction in patients with impotence.

Adolescent↗
PubMedDate not supplied

The differential diagnosis of impotence. The measurement of nocturnal penile tumescence.

The literature on nocturnal penile tumescence (NPT) and impotence is briefly reviewed. Available evidence suggests that measurement of NPT provides objective data, which when combined with a thorough clinical evaluation can be helpful in distinguishing psychogenic from organic impotence in approximately 80% of those patients who present this differential diagnostic problem. Further research is needed to determine whether some psychogenically impotent patients may have impaired NPT. The interdisciplinary evaluation employed at our center is described, and clinical material illustrating the usefulness of this technique is presented. The potential errors that can result from the use of portable NPT monitoring devices are discussed.

Adult↗
PubMedDate not supplied

[Impotence following stripping].

Among the iatrogenic complications of the surgery of varicose veins, the author has encountered several cases of impotence following stripping of the internal saphenous. Without rejecting the possibility of a psychogenic impotence due to the operation itself, he raises the question of the possible mechanism of this complication. Alter considering the vascularization of the erectile body and the haemodynamic process of erection, he reviews the arterial and venous causes of impotence and sets out the hypothesis which he feels to be the most plausible. Under the arch of the internal saphenous passes the external pudendal artery; injury to this does not usually produce any significant damage, since the erectile body of the penis is vascularized by the internal pudendal artery. But if as a result of a congenital anomaly of the internal pudendal, the supply derives from the external pudendal, ablation of the latter, sometimes carried out by surgeons in the course of ligature of the arch of the internal saphenous vein, could explain this complication. If this hypothesis proves correct, it would be necessary to require surgeons to touch the external pudendal artery in order to avoid this complication, which though exceedingly rare, is psychologically traumatic.

Erectile Dysfunction↗
PubMed1993

[Impotence of arterial origin: experimental models and evaluation of sexual behavior in rats].

Work on the vascular anatomy and on the physiology of the penis have allowed developing new procedures to treat impotence. This study has dealt with four experimental models of impotence of arterial origin in rats. The assessment was based on sexual behavior tests and on the measurement of the erection capacity index (ECI) measured from the second to the fifth week after interruption of the arterial flow. Four groups of eight rats each were formed. Group A underwent unilateral ligation of the common iliac artery, group B bilateral ligation of the common iliac artery, group C bilateral ligation of the internal iliac arteries and group D ipsilateral ligation of the common iliac and internal iliac arteries. In group A, the percentage of true coituses was 72.7 and 83.3% on the second and third week, respectively. In group B the percentage of false coituses was higher with 82.3%, 90% and 81.2% on the second, third and fourth week, respectively. In group C, the percentage of true coituses ranged from 7.7% to 35.7% during the whole period of observation. The erection capacity index was of 0.24 in group B and 0.23 in group C, with a higher percentage of false coituses in groups C and B. These models can be used to study the physiopathology of impotence of arterial origin.

Animals↗
PubMed1995

Non-invasive management of organic impotence.

OBJECTIVE: To establish the efficacy of a vacuum device (ErecAid) in the management of organic impotence. DESIGN: Cohort study; questionnaire before and after a 6-month study period. SETTING: Groote Schuur Hospital, Cape Town. PARTICIPANTS: A total of 19 men with organic impotence, 8 diabetic and 11 with previous pelvic surgery or radiotherapy. INTERVENTION: Vacuum device (ErecAid, Osbon Medical Systems). OUTCOME MEASURE: Efficacy of ErecAid. RESULTS: Six of 8 diabetics and 6 of 11 non-diabetics reported successful intercourse, while 16 of the participants would recommend the device to others. Some difficulty with the device was experienced by 11 and only 9 described an increase in self-esteem. CONCLUSION: Although some difficulties may be experienced in the use of the ErecAid, it clearly has a role to play in the management of patients with organic impotence, who ideally should be able to select their preferred form of therapy.

Adult↗
PubMedDate not supplied

[Evaluation of clinical usefulness of direct drug injections for increasing local circulation, into cavernous bodies of the penis for treatment of erection impotence in patients with diabetes mellitus].

The study aimed at comparing an effectiveness of drugs increasing local blood flow injected into cavernous bodies of penis in the treatment of erective impotence in diabetic patients. Fifteen diabetic patients aged between 33 and 60 years with impotence lasting for 4 years have been selected. Patients have been treated with papaverine HCl in the dose of 20-40 mg, papaverine HCl in the same dose combined with phentolamine 5 mg, and prostaglandin E1 in the dose of 20 micrograms. Each patient has been all tested drugs. The most favourable results, i.e. most effective and without adverse reactions (priapism), have been produced by prostaglandin E1 which seems a drug of choice in the treatment of erective impotence in patients with long-lasting diabetes mellitus.

Adult↗