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PubMed1994

The change of penile blood thromboxane B2 and prostacyclin after intracavernous injection of vasoactive drugs for the treatment of arteriogenic impotence.

Penile hypercoagulability during erection may predispose to aging vascular changes and, eventually, arteriogenic impotence. The relationship of penile blood thromboxane B2 and 6-keto-prostaglandin F1 alpha in both psychogenically and arteriogenically impotent patients after intracavernosal treatment with papaverine plus phentolamine or prostaglandin E1 was evaluated. No significant change in penile blood thromboxane B2 was observed with treatment of these vasoactive drugs. On the other hand, penile blood 6-keto-prostaglandin F1 alpha was significantly increased with the injection of 30 mg of papaverine plus 0.5 mg of phentolamine, and of 20 micrograms prostaglandin E1. Furthermore, the prostacyclin-to-thromboxane A2 ratio for the patient who received papaverine plus phentolamine was significantly lower than that for the same individual receiving prostaglandin E1. Our preliminary findings suggest that penile blood prostacyclin may participate in the pathogenesis of arteriogenic impotence and priapism.

6-Ketoprostaglandin F1 alpha↗
PubMed1993

[The clinical effect of slow releasing nicotinate on hyperlipemic impotent patients].

Perycit (Pentaerythriol Tetranicotinate), a slow releasing drug, is one of the drugs used for treating hyperlipemia. Patients with erectile dysfunction (impotence) associated with hyperlipemia increasingly seek help at urological services. This study investigates the clinical effect, both objective and subjective of Perycit on anti-hyperlipemia as well as on impotence. Twenty patients with a more than one year history of impotence with hyperlipemia were enrolled in this randomized, single-blind study. Decrease of total cholesterol, and triglyceride, as well as the increase of high density lipoprotein cholesterol in the study group (Perycit, 500 mg, tid, for 3 months) were significantly different from the pre-treatment period and in the control group (Trental, 100 mg, tid, for 3 months) (p < 0.05 or p < 0.01). Moreover, improvement in sexual function was shown to be better in the study group than in either the pretreatment period and control groups, objectively and subjectively (p < 0.05 or p < 0.01). Tolerable facial flush was found in 3 of these 20 patients, but no major side effects were encountered. In conclusion, this study indicates Perycit is effective for anti-hyperlipemia as well as for aiding improvement of sexual dysfunction. Since it is a slow-releasing preparation, the side effect is minimal. It is recommended for patients with hyperlipemia alone, or those who suffer from combined erectile dysfunction.

Delayed-Action Preparations↗
PubMedDate not supplied

Use of prostaglandin E1 in the treatment of sexual impotence after heart transplantation: initial clinical experience.

Many patients report problems of impotence after heart transplantation, which definitely impairs their quality of life. Ten men, with a mean age of 41 years, were evaluated for persistent erection problems after heart transplantation by measurement of nocturnal penile tumescence using a Rigiscan. Three men had a positive response, and their disturbances were therefore considered to have a psychological basis; seven men had a negative or only weakly positive response, and their impotence was attributed to organic causes. To all patients, intracavernous injections of an initial dose of 10 to 20 micrograms of prostaglandin E1 were administered as first-choice treatment. Nine patients obtained a firm, lasting erection 2 to 5 minutes after injection, with no relevant side effects. The patients were then instructed to self-administer the drug before intercourse, and some were able to return to spontaneous sexual activity at various intervals. Intracavernous injection of prostaglandin E1 seems to be an effective treatment of erectile impotence in heart transplant recipients; it is well tolerated with no side effects and considerably improves the patient's quality of life.

Adult↗
PubMed1993

[Revascularization of the penis in cases of male impotence of vascular origin].

In arteriogenic erectile dysfunction, representing about 80 percent of all organic forms of impotence, a purely arteriogenic impotence is distinguished from a venous leakage. The former can be treated with promising results by means of arterial revascularization. In this respect it is worth mentioning that this form of impotence may also occur following pelvic surgery. Furthermore, diabetes mellitus at an early stage may be responsible for erectile dysfunction. A venous leakage, however, is not a disease of the veins but of the cavernous tissue. In most cases ischemic diseases are due to arterial lesions. In our experience have found that this disease can be treated with the chance of good results by means of our technique of arterial revascularization combined with penile banding.

Arteries↗
PubMed1995

Vacuum constriction device and topical minoxidil for management of impotence.

OBJECTIVE: We report our preliminary experience with a vacuum constriction device and topical minoxidil for the management of impotence. METHODS: We evaluated 18 patients, 8 with neurogenic and 10 with psychogenic impotence with a vacuum constriction device and topical minoxidil (1 ml 2% solution). RESULTS AND CONCLUSIONS: All patients responded to treatment but 100 cases refused home use because of psychological impact. Twelve patients did not need the application of the constrictive ring because of the erection facilitation effect of minoxidil. No side effects were observed. In our opinion the association of the vacuum constriction device with topical minoxidil might be useful in the treatment of impotence; however, several factors must be evaluated in selecting patients. Application of minoxidil before vacuum constriction device might be useful to reduce the time of device application, to increase the efficacy of the device and in some cases to avoid the use of the constrictive ring.

Administration, Topical↗
PubMed1977

Nocturnal erections, differential diagnosis of impotence, and diabetes.

In this study it is shown that monitoring of nocturnal penile tumescence (NPT) is an objective method for determining the erectile status of patients who complain of impotence. The characteristics of 11 diabetic patients with abnormal NPT, 11 patients with normal NPT and no medical disorders, and 11 normal men are presented. Also described are several sociodemographic characteristics of the first 100 patients undergoing an NPT evaluation as part of a screen for patients seeking implantation of a penile prosthesis. It is suggested that NPT monitoring should be a component of the differential diagnosis procedure for every patient who complains of impotence and that it provides a tool for the concentrated study of the mechanisms of erection and impotence.

Adult↗
PubMed1996

Value of nocturnal penile tumescence and rigidity (NPTR) recording in impotent patients with multiple sclerosis.

The etiology of impotence in patients with multiple sclerosis (MS) is difficult to assess due to the possibility of normal nocturnal penile tumescence and rigidity (NPTR) recording despite neurologic involvement. Sixteen patients with MS and impotence were studied with Rigiscan, cavernous artery doppler, neurophysiological tests and intracavernous injection of PGE1. When more restrictive criteria of normality than usual are used for Rigiscan (rigidity > or = 80% and/or duration > 30 minutes), an inverse relationship between NPTR recording and sexuality score or PGE1 dose is reported. No significant difference is noted for neurophysiological tests. With such criteria, Rigiscan alone or combined with intracavernous PGE1 is a valuable means to differentiate neurogenic from psychogenic impotence in MS patients. Neurophysiological tests are of limited clinical value.

Adult↗
PubMedDate not supplied

[The intracavernous injection of Edex (prostaglandin E1) in the treatment of erectile impotence in persons in older age groups].

Erectile impotence may be of neuropathic, vascular, psychogenic and hormonal origin or may be caused by their combination. This impotence occurs in up to 10% of sexually active men. The injection of prostaglandin E1 (PGE1) into the penile cavernous bodies results in venous occlusion warranting maximal erection. Edex (PGE1) was given to 23 patients aged 43-68 years (mean age 58.9 years) suffering from impotence as a result of prostatic cancer (5 cases), postprostatic adenomectomy condition (8 cases), chronic prostatitis (4 cases), diabetes mellitus (4 cases), chronic alcoholism (1 case), spinal trauma (1 patient). The dose (from 5 to 20 micrograms) was adjusted individually. Good, satisfactory and poor effects were achieved in 86.2, 13.0 and 4.3% of the patients, respectively. In prostatic cancer males on hormone therapy and after adenomectomy the effect was obtained in 76.9% (in 10 of 13 males). An old age is not a contraindication for intracavernous injections of Edex.

Adult↗
PubMedDate not supplied

[Impotence in traumatic urethral strictures].

According to the author, impotence associated with traumatic urethral strictures arises rather due to operative intervention than primary trauma. Inaccurate manipulations of the surgeon may cause destruction of the bulbocavernous muscles and blood vessels reaching the penis at bulbar level. Another cause of impotence is chronic prostatitis which may follow long-term bougienage. Adequate operation allowing for anatomic and functional features of the perineum does not entail impotence.

Erectile Dysfunction↗
PubMedDate not supplied

[Neuroandrologic considerations in impotent patients with Peyronie's disease].

OBJECTIVE: To asses the neuroandrologic profile of impotent patients with Peyronie's disease. METHODS: We conducted a pharmacological erection test and a study of the neuroandrologic profile of 13 impotent patients with Peyronie's disease. Eight patients hhad associated conditions and no associated disease was demonstrated in the remaining 5 patients. The neuroandrologic profile was based on bulbocavernous EMG, S2-S4 evoked potentials, somatosensorial potentials of pudendal nerve, cavernous smooth muscle electromyography (SPACE), sympathetic skin response, and cystometrogram. RESULTS: SPACE was altered in all the cases. In the patients with no associated disease, all other data of the neuroandrologic profile were normal. Patients with associated conditions demonstrated more alterations in all other data of the neuroandrologic profile and significant differences were observed in 7 cases. No differences in the type of alterations of SPACE were observed in 7 cases. No differences in the type of alterations of SPACE were observed between both groups. CONCLUSION: The impotence associated with Peyronie's disease could be due to an intrinsic lesion of the erectile smooth muscle.

Aged↗
PubMed1998

[Measuring nocturnal tumescence--value in diagnosis of impotence].

Nocturnal penile tumescence monitoring (NPT) is a non-invasive method to differentiate between organic and psychogenic impotence. The routine use of NPT monitoring in the evaluation of impotence is not effective due to its moderate sensitivity and specificity with small therapeutic benefit and relatively high costs. Patient's selection by intracavernous pharmacotest can improve the efficiency of the investigation, so the method can help to secure the diagnosis of a psychogenic impotence and then take effect on adequate therapy.

Diagnosis, Differential↗
PubMed1997

Effects of ultraviolet light on the tension of isolated human cavernosal smooth muscle from non-diabetic and diabetic impotent men.

The effects of ultraviolet (UV) light (310 nm) on human cavernosal smooth muscles were investigated. Cavernosal strips were obtained from men during penile prosthetic surgery. When the cavernosal strips were irradiated with UV light in an organ bath, after precontraction by norepinephrine (100 nM) for 10, 20, 40 and 90 s at intervals of 3 min, the contracted cavernosal smooth muscles from the impotent men without vascular risk factors (controls) showed relaxation depending on the duration of irradiation. However, the relaxation was not found when the strips were pretreated with methylene blue (10 microM) or their epithelia were denuded. The relaxation response of the cavernosal strips from the patients with diabetogenic impotence was significantly reduced compared with that of the controls. Photorelaxation of human cavernosal strips therefore seems to be dependent on endothelium.

Adult↗
PubMed1999

Diabetes and vascular impotence: does insulin dependence increase the relative severity?

AIM OF THE STUDY: Diabetes is a well documented risk factor for vascular erectile dysfunction (ED). We evaluated the relative roles of insulin dependence (IDDM) vs oral agent controlled diabetes (NIDDM) in predicting the etiologies and severity of ED: arterial insufficiency (AI), venous leakage (CVOD), and mixed vascular disease. The impact of additional risk factors were also analyzed: hypertension (HTN), coronary artery disease (CAD), and smoking (SM). METHODS: Retrospective data on 105 patients complaining of impotence who underwent pharmacotesting with PGE1 (Caverject) and color duplex Doppler was reviewed. Penile blood flow study (PBFS) data following a period of privacy and self-stimulation was compared. PBFS diagnostic criteria were: AI for peak systolic velocity (PSV) < 25 cm/s; CVOD for PSV > or = 35 cm/s and resistive index (RI) < 0.9; mixed vascular disease for PSV > or = 25 cm/s, PSV < 35 cm/s and RI > 0.9. Consistent dosing of PGE1 was used; 6 mcg for age < 60 y and 10 mcg for age > or = 60 y. Patients were NIDDM (79 out of 105) and IDDM (26 out of 105). Mean ages for NIDDM and IDDM were respectively 60, and 55 y. The relative significance of insulin dependence was assessed by Student's t-test. RESULTS: The most common etiology of ED was arterial insufficiency: mean PSV's did not significantly vary and were: 23.5 cm/s for NIDDM, and 21.6 cm/s for IDDM. PBFS parameters did not vary significantly for the risk factors of SM or HTN and diabetes. Mean peak systolic velocities were significantly different among diabetics with coronary artery disease: NIDDM/CAD, 22.9 cm/s compared to IDDM/CAD, 14.8 cm/s (P = 0.006). CONCLUSIONS: We found among the 105 diabetics the most common etiology of vascular ED based on Doppler criteria was arterial insufficiency, 64%. Statistical analysis of additional risk factors (SM, HTN, CAD) suggested that patients with IDDM and CAD have more severe cavernosal arterial insufficiency than patients with NIDDM and CAD. This data tends to support the theory that microangiopathy is the predominant factor in diabetic impotence, and that insulin dependent diabetes with 'large vessel' coronary heart disease have a similar pathology in the 'small vessels' regulating penile inflow which is unfortunately worse than their non-insulin dependent counterparts.

Alprostadil↗
PubMed1998

Non-prosthetic surgery in the treatment of erectile dysfunction. A retrospective study of 45 impotent patients in the University of Oulu.

The purpose of this retrospective study was to assess the outcomes of the patients with total erectile impotence who have undergone non-prosthetic surgery in our hospital and to make a decision concerning the continuation of this treatment modality. The study series consisted of 45 operated patients, 21 of whom had undergone venous leakage surgery and 24 revascularization of the penis. The follow-up time was at least 12 months. The outcome of venous surgery after 6 months was initially good in 16 patients (76%) but declined in such a way that 12 months after the operation it was good only in 6/21 patients (29%). Despite this, 11/21 patients were capable of intercourse after a prostaglandin E1 injection 1 year from the operation. Altogether 17/21 patients (81%) benefited from venous surgery after 12 months. The outcome of arterial surgery was good in 11/24 patients (46%) 12 months after the operation. A moderate outcome was obtained in another 8/24 patients (33%), who were capable of intercourse after a prostaglandin E1 injection. Minor complications occurred in 20% of the venous surgery patients; 25% of the patients with arterial surgery had complications and half of these were severe, resulting in glans hypervascularization. Our findings indicate that non-prosthetic surgery continues to have an established position in the treatment of severe impotence when all conservative treatment modalities have been used.

Adult↗
PubMed1995

Long-term results with penile vein ligation for venogenic impotence.

Penile vein ligation for venogenic impotence was performed on 15 patients between 1989 and 1992. Preoperative evaluation included color flow Doppler ultrasound, and dynamic infusion cavernosogram and cavernosometry with vasoactive substance injection. All operations were performed by 1 surgeon via an inguinoscrotal incision by excising the deep dorsal, cavernous and, if necessary, crural veins. All patients were interviewed using a structured telephone questionnaire from 19 to 45 months (mean 29) postoperatively. Postoperative potency was defined as erections sufficient for unaided coitus on more than 75% of attempts and was present in 9 patients (60%). The 2 failures had temporary improvement within the first 6 months. The only significant preoperative variable in assessing postoperative potency was the duration of erectile dysfunction before penile vein ligation: median 60 months (range 48 to 120) in the impotent group and median 24 months (range 12 to 168) in the potent group (p < 0.05, Mann-Whitney test). No correlation was found with systolic and diastolic arterial flow or resistive index as assessed by color flow Doppler evaluation, sites of leakage or patient age at operation. Similarly, no correlation was found with preoperative dynamic infusion cavernosometry maintenance rates. The most common complication was contracture of the penis in 6 patients (40%), although only 1 complained of a functional disturbance. We demonstrated favorable long-term results with an extensive venous ligation. While preoperative assessment with color flow Doppler ultrasound, dynamic infusion cavernosography and cavernosometry, and vasoactive substance injection establishes a diagnosis of corporeal veno-occlusive dysfunction, this evaluation provides no predictive indicators for successful outcomes in penile vein ligation.

Adult↗
PubMed1994

Preliminary report--combined surgical and radiological penile vein occlusion for the management of impotence caused by venous-sinusoidal incompetence.

OBJECTIVES: To combine surgical and radiological penile vein occlusion therapy in the treatment of patients with venogenic impotence, to try to improve on the results of either treatment used separately. PATIENTS AND METHODS: Fourteen patients, with a mean age of 46 years (range 25-71), with pure venous-sinusoidal impotence were treated by surgical ligation of accessible veins and embolization of surgically inaccessible veins. The preliminary results over a follow-up period of at least 8 months are reported for each patient. RESULTS: Venous embolization was considered complete in 11 patients. Overall, 13 had improved erectile function. Post-operatively, eight patients developed spontaneous erections and four (aged < 40 years) have maintained this for 8-24 months. CONCLUSION: Combined surgery and radiology treats the end result of the failure of the sinusoidal smooth muscle to relax. Although some patients, the majority of whom are young (aged < 40 years), will achieve short-term benefit, all individuals need to be fully counselled with regard to the likelihood of long-term benefit before undergoing this invasive method of treatment.

Adult↗
PubMed1994

Multidisciplinary evaluation of diabetic impotence.

Patients referring to the Urology and/or Endocrinology Departments of Ankara Medical School with complaints of diabetes mellitus (DM) and related complications were evaluated during the last year. A detailed history was obtained and all of the patients were questioned especially about sexual function problems. Following this evaluation, all patients were divided into two main groups, i.e. patients with sexual disorders, and those with normal sexual function. Factors such as BPH, cerebrosclerosis and other important vascular-neurologic pathologies which may play a role in the etiology of impotence were excluded from the study and 38 patients with sexual dysfunction and 15 with normal sexual activities have undergone further evaluation. Following routine blood and urine analyses, serum hormone levels (testosterone, FSH, LH, prolactin) were determined. Penile color-flow doppler analysis, cavernosometry, cavernosography, bulbocavernous reflex latency time and evaluation of somatosensory evoked potentials were performed. Additionally, all patients were evaluated from the psychiatric aspect using the Hamilton depression scale and MMPI questionnaire. The presence of vascular or neurologic pathology in 89.4% of our patients and of both pathologies in 39.4% of the patients, indicated the importance of multifactorial evaluation of diabetic impotence in order to plan a complete and efficient therapy program.

Adult↗
PubMed1999

[New treatments for impotence].

The development of new oral drugs and the poor results of the reconstructive vascular surgery has modified the therapeutical approach of the impotent patient. The doctor has to be aware of these changes in the management of impotence.

3',5'-Cyclic-GMP Phosphodiesterases↗