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At least 541 records · Page 30Linked to original sources
PubMed1993

Efficiency and side effects of intracavernous injections of moxisylyte in impotent patients: a dose-finding study versus placebo.

We assessed the efficiency and tolerance of the alpha-blocking agent moxisylyte in 2 double-blind studies versus placebo performed in 12 neurogenic patients with spinal cord lesions and in 61 patients presenting with either psychogenic impotence (30) or erectile dysfunction that was predominantly neither psychogenic, hormonal nor neurogenic (31). In each etiological group patients were randomized (according to latin square method) to receive 3 single doses (10, 20 and 30 mg.) of moxisylyte and a placebo. The erectile response was determined 5, 10, 15, 20 and 30 minutes after each injection. Whatever etiology of impotence and dosage tested, the erectile response induced by moxisylyte was significantly higher than the placebo-induced response. No difference occurred among the 3 doses. In 93% of the patients moxisylyte induced an erectile response, including tumescence in 6, partial rigidity in 16 and complete rigidity in 46. Thus, in 62 of 73 patients (85%) the drug allowed initiation of erection adequate for intercourse. Placebo induced such erection in only 25% of the cases and in 55% there was no response. Tolerance was good and no priapism occurred. Only 4 patients (5%) reported mild pain during injection but erections were never painful, 1 presented with moderate and transient hypotension at the 20 mg. dose and a painless prolonged erection was observed in 1 case after the lowest dose. Drugs such as moxisylyte should be given before less well tolerated drugs.

Adult↗
PubMed1993

Intracavernous pharmacotherapy for impotence: selection of appropriate agent and dose.

We performed a retrospective analysis of 101 impotent patients using intracavernous self-injections as primary therapy for vasculogenic impotence. A total of 70 patients used an average of 5.58 micrograms prostaglandin E1 (95% confidence interval 4.83 to 6.34 micrograms) as a single agent, and 31 injected 0.40 ml. (95% confidence interval 0.342 to 0.457 ml.) of a combination of papaverine (12 mg./ml.), phentolamine (1 mg./ml.) and prostaglandin E1 (9 micrograms/ml.). We describe the procedure to establish the dosage for home use and discuss the implications of the low dosages relative to previous reports.

Adult↗
PubMed1993

Long-term results of penile vein ligation for impotence from venous leakage.

Between 1986 and 1991, 46 men with organic impotence documented by dynamic pharmacocavernosometry and cavernosography to have venous leakage underwent penile vein ligation. Despite initial improvement in erections allowing normal intercourse in 34 men (74%) within the first 6 months, long-term (more than 12 months) evaluation revealed sustained potency without adjunctive therapy in only 11 (24%). Of the remaining 35 men 6 (13%) progressed to a penile prosthesis, 8 (17%) required intracavernous vasoactive injection therapy and 21 (46%) have not sought further therapy despite continued impotence. Of the 14 patients who had isolated distal leakage 6 (43%) had sustained erectile function while only 5 of the 32 patients (16%) with proximal leakage maintained potency. Associated complications included penile shortening in 20 (43%) and penile hypoesthesia in 9 men (20%). Therefore, we conclude that the long-term success of penile vein ligation is poor, with only 24% of the patients able to have normal intercourse more than 1 year later, although those patients with distal penile shaft leakage appear to have a greater chance of success than those with more proximal leakage.

Adult↗
PubMed1992

The value of dynamic color duplex scanning in the diagnosis of venogenic impotence.

To determine the value of color duplex scanning in the diagnosis of venogenic impotence we examined 53 patients. The control population consisted of 26 psychogenically impotent men and 8 normal potent men who all had a firm erection after pharmacological stimulation. There was no significant difference in the values of duplex parameters between these 2 groups. The venous leak population was characterized by a bad erectile response to pharmacological stimulation despite a good arterial compliance and by a persistent diastolic flow as shown by duplex scanning. There was a significant difference with the control population for the parameters of resistance index after 10 minutes (p = 0.001), minimal resistance index (p = 0.016) and corporeal volume increase (p = 0.010). There was a good correlation between the results of duplex scanning and those of pharmacocavernosography-pharmacocavernosometry (93%). We conclude that dynamic color duplex scanning can be used as a screening procedure to diagnose significant venous leakage in an objective manner with the resistance index.

Aged↗
PubMed1992

The hemodynamic pathophysiology of impotence following blunt trauma to the erect penis.

A total of 19 patients provided a history of impotence following blunt trauma to the erect penis during intercourse or masturbation, or after accidents. Corporeal veno-occlusive dysfunction was the most common hemodynamic abnormality (16 of 19 patients, or 84%). A site-specific leak, which consisted of abrupt filling of the dorsal vein and/or corpus spongiosum from a focal site on the penile shaft, was demonstrated in 15 patients (79%). Cavernous artery insufficiency was found less often (7 of 19 patients, or 37%). A focal mid shaft cavernous artery occlusion was demonstrated in 5 patients (28%). It is hypothesized that the aforementioned hemodynamic abnormalities are caused by tunica and intracavernous vasculature injuries induced by the marked short-term pressure increases, which approach or exceed the tunica tensile strength during acute abrupt loading of the erect penis. This hypothesis is supported by direct recording of intracavernous pressures that exceeded 450 mm. Hg in response to angulation and manual compression of the penile shaft. Further evidence was created by a biomechanical model that was based on previously published intracavernous pressure--circumference patient data during dynamic infusion pharmacocavernosometry. Using a typical patient data set a 60% diminution of circumference at the site of abrupt loading was calculated to induce a 15% increase in circumference in the nonloaded portion of the penile shaft and an elevated intracavernous pressure exceeding 900 mm. Hg. The site-specific hemodynamic abnormalities were found to occur not only in patients with a classical penile fracture history but also in patients with injuries during masturbation or following accidents who had no acute penile swelling or ecchymosis. Thus, the erect penis is at risk for injury during any acute loading situation. It is likely that this erect trauma-induced hemodynamic pathology occurs more frequently than previously appreciated and that this type of impotence may be the underlying basis for many cases of idiopathic Peyronie's disease.

Adolescent↗
PubMed1992

Transcutaneous registration of cavernous smooth muscle electrical activity: noninvasive diagnosis of neurogenic autonomic impotence.

Registration of cavernous electrical activity was shown to be a possible method for the evaluation of cavernous autonomic innervation. Recent studies in patients with normal erectile function showed that cavernous electrical activity is synchronous throughout the entire cavernous bodies. Therefore, we examined the feasibility of transcutaneous registration of cavernous electrical activity in 8 normal and 62 impotent patients. In the sitting patient cavernous electrical activity was recorded with a 2-channel electrophysiological unit. Recording was done with a coaxial needle electrode in the proximal left cavernous body and with surface electrodes bilaterally on the penile shaft. In 7 of 8 normal patients swelling of the penile shaft after circumcision resulted in a dramatically decreased amplitude of the potentials. In 41 of 62 impotent patients recordings were similar. In 10 of 62 patients no recording or markedly decreased amplitudes were noted with the surface electrodes and in these patients a small penis or penile retraction with consecutive electrode displacement was found. Careful repositioning of the surface electrodes with the patient in the supine position resulted in similar recordings in 9 (inconsistently in 4). In 11 of the 62 patients more information was obtained with the surface than with the needle electrode. Our results show that recording of cavernous electrical activity can be done in a completely noninvasive manner using surface electrodes with similar or even better information obtained than with needle electrodes.

Action Potentials↗
PubMed1991

Cigarette smoking: an independent risk factor for atherosclerosis in the hypogastric-cavernous arterial bed of men with arteriogenic impotence.

We investigated the relationship between cigarette smoking and atherosclerosis of the hypogastric-cavernous arterial bed by evaluating arteriograms of young impotent men referred for selective pudendal angiography. Those patients with hemodynamically significant atherosclerosis had smoked more pack-years than had patients without arterial disease. These differences were statistically significant (p less than 0.05) for the common penile artery (32.8 pack-years, 40 patients versus 22.3 pack-years 57 patients) and the dorsal artery (31.3 pack-years, 48 patients versus 22.0 pack-years, 49 patients). The effect of cigarette smoking as an independent risk factor for atherosclerotic disease in the hypogastric-cavernous arterial bed was evaluated as well. When controlled for age, trauma history, hypertension and diabetes, cigarette smoking was independently associated with atherosclerosis in the internal pudendal artery (p less than 0.05). The relative risk (and 95% confidence interval) of developing internal pudendal artery atherosclerosis for each 10 pack-years smoked was 1.31 (1.05 to 1.64). A third analysis investigated the potential interactive effects of cigarette smoking and pelvic or perineal trauma. A significantly higher incidence (p less than 0.05) of cavernous artery atherosclerosis was found among smokers with a history of chronic perineal trauma (33 patients) compared to nonsmokers with a similar history (25 patients). The findings of this study indicate that cigarette smoking is an independent risk factor in the development of atherosclerotic lesions in the internal pudendal and common penile arteries of young impotent men. Cigarette smoking appears to predispose these patients to early atherosclerotic lesions in the cavernous artery following chronic perineal trauma.

Adolescent↗
PubMed1989

Treatment of impotence by intrapenile injections. A comparison of papaverine versus papaverine and phentolamine: a double-blind, crossover trial.

The efficacy of papaverine, and a combination of papaverine and phentolamine as a pharmacological treatment of impotence was compared in a double-blind, crossover trial. A total of 40 impotent men received intracavernous injections of papaverine (40 mg.) or a combination of papaverine (20 mg.) and phentolamine (0.5 mg.) at monthly intervals. Observations at 20 minutes after injection demonstrated that papaverine caused full erections in 27 per cent of the men and partial erections in 65 per cent. The combined injection resulted in full erections in 48 per cent of the men and 52 per cent had partial erections. The difference was significant (Z equals 2.29, p less than 0.05).

Adult↗
PubMed1990

Prostaglandin E1 therapy for impotence, comparison with papaverine.

The efficacy of prostaglandin E1 as a pharmacological treatment of erectile dysfunction (impotence) was compared with the standard treatment, papaverine, in a single blind, crossover trial. A total of 129 impotent men received intracavernous injections of either prostaglandin E1 (5 micrograms) or papaverine (18 mg.) 1 month apart. Observations by 1 observer recorded 10 to 20 minutes after injection demonstrated that prostaglandin E1 generated a better erection in 72 men (55.8%) compared to papaverine. Papaverine was more effective than prostaglandin E1 in 23 men (17.8%, chi-square 6.26, p less than 0.025). Subjective assessment by the patients who detected a difference showed that 71 (55%) preferred prostaglandin E1 and 35 (27%) preferred papaverine (chi-square 11.56, p less than 0.001). A total of 34 men achieved full erections with prostaglandin E1 compared to 17 who used papaverine.

Adult↗
PubMed1990

Correlation between penile angiography and duplex scanning of cavernous arteries in impotent men.

During the diagnostic evaluation of patients with vasculogenic impotence duplex scanning has been proposed as a reliable noninvasive method to evaluate the cavernous arteries. However, the sensitivity and specificity of this test have never been elucidated. To provide insight into the clinical value of this test 25 men who presented with impotence and failed to respond to 60 mg. intracavernous papaverine were evaluated with duplex scanning and the results of this modality were compared to penile angiography. The cavernous arteries were considered normal by duplex scanning if the artery demonstrated either a 60% or greater increase in diameter and/or a peak flow velocity of greater than 25 cm. per second 5 minutes after papaverine injection. Penile angiography was considered normal if both cavernous arteries were visualized and appeared to be normal radiographically (after intracorporeal papaverine). In the 25 patients studied there was no significant difference in peak flow velocity between patients with normal or abnormal cavernous arteries by angiography. In addition, arterial dilatation (more than 60%) after papaverine injection did not correlate with the results of the angiogram. These data demonstrate that duplex scanning of the cavernous arteries does not correlate well with what is observed by penile angiography in a selected population of men with vasculogenic erectile dysfunction. Since penile angiography itself has limitations in the evaluation of the penile arteries, the reliability of duplex scanning to identify cavernous artery dysfunction needs additional confirmation.

Adult↗
PubMed1989

Vacuum constriction device for management of erectile impotence.

A mechanical device for treatment of impotence based on the concept of entrapment of blood in the penis following vacuum-assisted tumescence is described and more than 15,000 units have been marketed. A total of 1,517 users who acquired the device between 1974 and 1987 completed a questionnaire concerning the system. Of these patients 92 per cent either achieved an erection or an erection-like state that was satisfactory for intercourse and 77 per cent had intercourse at least every 2 weeks. No serious ill effect from use of the device has been reported a and it is particularly effective in the management of partial impotence. In selected patients the device is an alternative to either surgical placement of a penile prosthesis, intracavernous injection of vasoactive drugs or sexual abstinence.

Adult↗
PubMed1989

Intracavernous injection of prostaglandin E1 for the treatment of erectile impotence.

We administered intracavernous injections of 20 micrograms. prostaglandin E1 to 135 patients with impotence, and evaluated the effects and side effects. Among 135 patients who underwent intracavernous injection of prostaglandin E1 complete erection was observed in 83 (62 per cent), while incomplete erection was noted in 33 (24 per cent). In both groups the erection was sufficient for sexual intercourse. Tumescence without rigidity was noted in 12 patients and no response was obtained in 7. Poor response was seen frequently in patients with disorders of the vascular system and/or damage to the cavernous body of the penis. Priapism after the injection was not observed. Moreover, we never observed any other severe side effects. Intracavernous injection of prostaglandin E1 could be applicable to the therapy of impotence, especially that due to neurogenic disturbance. Since prostaglandin E1 acts quickly and loses its validity rapidly it is considered to be a more suitable agent than other vasoactive drugs.

Adult↗
PubMed1989

Topical nitroglycerin: a potential treatment for impotence.

The effect of 2 per cent nitroglycerin paste applied to the penile shaft of impotent subjects was evaluated in a placebo controlled double-blind study under laboratory conditions. After application of nitroglycerin paste or a placebo ointment base, penile tumescence was recorded through a strain gauge transducer while subjects viewed an erotic video presentation. Relative to the placebo paste the number of subjects demonstrating an increase in penile circumference after nitroglycerin (18 of 26) was significantly different than all other outcome possibilities (p less than 0.05). Noninvasive vascular assessment by ultrasonography demonstrated an increase in diameter and blood flow in the cavernous arteries after application of nitroglycerin paste. Nitroglycerin paste increases blood flow in the cavernous arteries and improves tumescence after erotic stimulation. This agent may represent a new therapy for impotence.

Administration, Topical↗
PubMed1989

Prostaglandin E1 versus phentolamine/papaverine for the treatment of erectile impotence: a double-blind comparison.

The use of intracavernous prostaglandin E1 was studied in 48 organically impotent men. Eight men with previous chemical priapism did not have chemically induced priapism at up to 4 times the minimum effective dose of prostaglandin E1. Of 15 men with arteriogenic impotence who had failed prior intracavernous phentolamine and papaverine therapy 10 had adequate erections with prostaglandin E1. A total of 25 men received intracavernous prostaglandin E1 and phentolamine plus papaverine in a double-blind fashion. Erections with prostaglandin E1 were equal or superior to those with phentolamine plus papaverine in each case.

Alprostadil↗
PubMed1988

Snap-Gauge band versus penile rigidity in impotence assessment.

We examined the ability of the Snap-Gauge band to differentiate rigid from nonrigid erections in men complaining of impotence. A total of 80 patients was measured by a Snap-Gauge band and via technician assessment of erectile rigidity while undergoing nocturnal penile tumescence testing. The Snap-Gauge band correctly diagnosed 77.5 per cent of the patients with a sensitivity of 70 per cent and specificity of 80 per cent. The Snap-Gauge band is inexpensive compared to sleep laboratory testing and it is relatively reliable. We conclude that the Snap-Gauge band has a role in impotence assessment and it can function as a screening device in evaluation of this problem.

Erectile Dysfunction↗
PubMed1988

Intracavernous injection of prostaglandin E1 in impotent men.

Intracavernous injection of prostaglandin E1 was used in 210 men as a screening test for the differential diagnosis of vasculogenic impotence. Of these 210 patients 112 entered an autoinjection protocol for treatment of erectile dysfunction. Prostaglandin E1 appears to be effective in the diagnosis and treatment of nonvasculogenic impotence because it is a physiological agent that is metabolized locally within the cavernous tissue. Additionally, in our series neither systemic reactions nor priapism occurred, nor was fibrosis of cavernous tissue or scar formation observed after up to 90 injections.

Alprostadil↗
PubMed1988

Patient acceptance of and satisfaction with vasoactive intracavernous pharmacotherapy for impotence.

Patient acceptance of and satisfaction with a trial of vasoactive intracavernous pharmacotherapy for impotence among 372 men were retrospectively analyzed. Drop out from the dosage determination phase and the training for injection phase was similar, 9.7 and 8.4 per cent, respectively, while 31.4 per cent of the patients dropped out of the home injection phase. Tachyphylaxis, inconvenience of the procedure or the frequent followup visits required, side effects and concern about unknown long-term effects were the main reasons patients cited for dropping out of the trial. The degree of satisfaction among patients who entered the home injection phase was high. Only 55 patients who dropped out of the trial chose implantation of a penile prosthesis. Vasoactive intracavernous pharmacotherapy is an effective treatment for impotence of various etiologies, and in a carefully selected group of patients the acceptance of and satisfaction with this therapy are high.

Clinical Trials as Topic↗
PubMed1988

Measurement of impotence by laser Doppler flowmetry and conventional methodology.

The problem of vasculogenic impotence was evaluated by laser Doppler flowmetry with the LD5000 capillary perfusion monitor to determine cutaneous penile blood flow in 25 men defined previously as impotent by Doppler ultrasound with penile brachial ratios of 0.63 +/- 0.14. Erotic visual stimulation for 1, 2 and 4 minutes did not statistically change the cutaneous flow as measured by laser Doppler flowmetry from its baseline of 20 mv. The dynamics of skin microcirculation in the penis may reflect changes in the deeper vessels and represent an alternate, dependable method to evaluate capillary perfusion.

Adult↗