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PubMed1992

Non-invasive management of impotence with transcutaneous nitroglycerin.

Nitroglycerin plasters were applied to the penis in 10 impotent men and the erectile effect assessed. During laboratory testing all patients achieved an erectile response. Self-administration of nitroglycerin patches restored potency in 4 patients and was preferred to papaverine auto-injection by 3. Headache was a common side effect during initial administration. An attempt to treat impotence with nitroglycerin plaster seems worthwhile before starting extensive investigations or invasive treatment.

Administration, Cutaneous↗
PubMed1992

Vacuum constriction devices: second-line conservative treatment for impotence.

Intracavernosal pharmacotherapy is not a universally successful treatment of impotence. Vacuum constriction devices are reported to be an effective non-operative alternative. This study investigated the value of these devices in 45 impotent men who had failed to become established on intracavernosal papaverine. Although 38 were able to obtain an erection-like state using a vacuum constriction device, only 12 were able to enjoy satisfactory sexual intercourse and, of these, just 7 men found them of sufficient benefit to warrant purchase. Success is not predicted by aetiology. Vacuum constriction devices are of some use, but a trial period of use should be allowed to each patient before purchase.

Adult↗
PubMed1994

Vacuum constriction devices in erectile dysfunction: acceptance and effectiveness in patients with impotence of organic or mixed aetiology.

OBJECTIVE: To investigate the value of vacuum constriction devices in the treatment of erectile dysfunction. PATIENTS AND METHODS: A total of 67 patients were treated with vacuum constriction devices. The impotence was of organic origin in 36 men (54%) while in the remaining 31 (46%) it was of mixed aetiology (organic and psychological factors). Forty-seven patients continued to use the device at home for the duration of the practice period. RESULTS: All 67 patients underwent a vacuum test which resulted in nearly half of them achieving an erection sufficient for intercourse. Adequate erections were achieved in 34 of 47 (72%) patients who used the device at home during the practice period. In the group of patients with organic impotence (venous leakage), rigidity was better and the frequency of intercourse higher than in patients with diabetes and in those with neurogenic disorders. CONCLUSION: These findings support further the role for vacuum devices for the treatment of erectile dysfunction in carefully selected patients.

Adult↗
PubMed1989

Supernatural impotence: historical review with anthropological and clinical implications.

The historical and cultural background of the belief in supernatural impotence is presented, emphasizing its possible implications for clinical practice. A brief historical survey of the concept in Judaism and Christianity is followed by a short anthropological survey of supernatural impotence in different ethnic subcultures in Israel. A case demonstration exemplifies the connection between understanding the patient's cultural background and beliefs and the clinical competence of the therapist. The relationship between the clinical-therapeutic process in psychiatric practice and knowledge of the patient's cultural background and beliefs is stressed.

Adult↗
PubMed1970

Impotence in farm workers using toxic chemicals.

Four out of five members of a team of farmworkers who had been using various herbicides and pesticides in intensive agriculture became impotent. Sexual function recovered after further contact with the chemicals was stopped and hormone therapy had been given, though in one case this took about a year. We have not been able to incriminate one particular substance, but with the circumstantial evidence and the lack of any other obvious cause it seems likely that the impotence was due to the toxic effects of one or more of the chemicals being used.

Adult↗
PubMed1987

Impotence: treatment by autoinjection of vasoactive drugs.

One hundred and twenty five men with psychogenic or organic impotence used autoinjection of the penile corpora cavernosa with either papaverine or papaverine and phentolamine for a mean period of 10.5 months (range 1-24 months) to achieve penile erection for sexual intercourse. Prolonged (over four hours) painless erection resulted from 34 of the 3513 self administered injections. This seems to be a highly effective approach to treating impotence irrespective of the aetiology.

Adult↗
PubMed1992

Neurological risk profile in organic erectile impotence.

Thirty men who presented with erectile impotence to the urological department underwent a thorough urological, angiological, and neurological examination with complementary neurophysiological tests of somatosensory and sympathetic and parasympathetic function. Most had vascular and neurological abnormalities. Clinical findings and electrophysiological tests for autonomic dysfunction had the highest yield of abnormal results. Nerve conduction studies and pudendal nerve somatosensory evoked potentials were far less informative. The lack of correlation between vascular and general neurological abnormalities emphasises that patients must be screened for both vascular and neurological dysfunction to prevent unrewarding vascular operation in impotent men.

Adult↗
PubMed1979

Impotence in the bull: (2) occlusion of the longitudinal canals of the corpus cavernosum penis.

Lack of penile erection was diagnosed in nine bulls (Poll Hereford three; Aberdeen Angus two; Friesian two; horned Hereford; Sussex). Five had previously served successfully but four had proved impotent when first put to use. In each bull, the dorsal longitudinal canal of the corpus cavernosum penis (ccp) was occluded by fibrous tissue and this was considered to be the immediate cause of impotence. The ventral canals were also occluded in four bulls. In every case, the lesions were so extensive that treatment would not have been likely to succeed. In two bulls the dorsal canal and the tunica albuginea were ruptured proximal to the sigmoid flexure. Radiography of the cavernous spaces and veins during life, and anatomical injections of post mortem specimens, showed that in four bulls the ccp was drained by the dorsal venous system at or distal to the sigmoid flexure. The aetiology and the diagnosis are discussed and the possible physiological implications of occlusions of the canals are considered in terms of the functional anatomy of the ccp.

Animals↗
PubMed1986

Cavernosography and differential diagnosis of impotence in the bull.

A new indirect radiographic technique is described for the differential diagnosis of erectile impotence in the bull. Two cases of impotence have been investigated in this way. In the first, occlusion of the dorsal longitudinal canal of the corpus cavernosum penis in an 18-month-old Hereford bull was diagnosed. In the second, distal venous drainage of the corpus cavernosum penis was demonstrated in a five-year-old Hereford bull. Post mortem examination of the reproductive tract confirmed the diagnosis in each case.

Angiography↗
PubMed1991

Age-dependent alterations in the efficacy of phenylephrine-induced contractions in vascular smooth muscle isolated from the corpus cavernosum of impotent men.

Steady-state contractile responses elicited by phenylephrine activation of the alpha 1-adrenergic receptor subtype were studied in vascular smooth muscle strips isolated from the corpus cavernosum of impotent men. The dissociation constant of phenylephrine was determined by the method of partial irreversible receptor inactivation over a wide range of alpha 1-adrenergic receptor alkylation levels. Statistical analysis of mean population values revealed a significantly greater mean efficacy for phenylephrine-induced contractions in older patients (60-73 years old) than in younger patients (40-59 years old), in the absence of similar alterations in the mean phenylephrine dissociation constant (affinity). In addition, there was no significant effect of the diabetic state on the mean phenylephrine affinity or efficacy estimates. However, despite the absence of age- or pathology-dependent variations in agonist affinity, as assessed by group mean calculations, a detailed examination of all isolated tissues on an individual basis revealed that the phenylephrine affinity estimates varied over a range of almost two orders of magnitude. Furthermore, a linear regression analysis revealed a highly significant positive correlation between agonist affinity and the location of the phenylephrine concentration-response curve, which was characterized by a slope significantly less than unity. In conclusion, an increased efficacy of phenylephrine-induced contractions in vitro is consistent with the hypothesis that augmented corporal vascular smooth muscle contractility in vivo may contribute to the pathophysiology of impotence in older patients.

Adrenergic alpha-Agonists↗
PubMed1982

Investigation of impotence by internal pudendal angiography: experience with 73 cases.

Angiography of the ileopudendal vascular tree was performed for the evaluation of impotence in 73 patients. This technique proved useful in identifying those cases caused by vascular lesions in major arteries and small penile vessels. Organic diseases cause a much higher proportion of impotence than in generally suspected, with vascular occlusions causing the greatest number of cases. Nocturnal penile tumescence (NPT) studies are the best screening procedure in the author's view. In this series, NPT was followed by angiography, which provided the definitive diagnosis.

Adult↗
PubMed1994

Impotence associated with the Charcot-Marie-Tooth syndrome.

We report 7 men (ages 45-61 years) with impotence associated with the Charcot-Marie-Tooth syndrome (CMT). The range of onset of erectile dysfunction varied from 38 to 55 years of age. One patient had classic CMT 1A with autosomal dominant inheritance, slow motor nerve conduction velocities and the 17p DNA duplication. One had probable type-II hereditary motor and sensory neuropathy. None of the patients had diabetes. There was some benefit from papaverine injection therapy or penile implants. The association of impotence with CMT is likely to be more common than previously recognized.

Adult↗
PubMed1990

Sympathetic skin potentials and bulbocavernosus reflex in patients with chronic alcoholism and impotence.

Fifteen chronic alcoholic male patients with impotence have been investigated with the electrophysiological method of sympathetic skin potentials recorded from the genital skin and with the electrically induced bulbocavernosus reflex. Both electrophysiological tests did not differ from those of normal controls. It was proposed that there is no obvious role of the peripheral neuropathic factors in the pathogenesis of impotence in chronic alcoholism.

Adult↗
PubMed1991

Penile venous surgery in impotence: results in highly selected cases.

Currently, indications for penile venous surgery are dynamic pharmacocavernosographic findings in impotent patients who fail to respond to intracorporeal application of vasoactive substances and who demonstrate unimpaired arterial perfusion. We used pharmacocavernosometry to measure penile intracorporeal maintenance flow rate in 48 impotent men: 20 had maintenance flow rates higher than 30 ml/min, 12 of the 20 had leakage mainly via Santorini's plexus. In 7 of this 12, venous ligation procedures were initially successful, and in 6 of them erectile function returned. After a mean follow-up, seven of the 12 eventually had to be treated with penile implants. Another 4 used self-injection of prostaglandin E1; only 1 patient reported spontaneous erections sufficient for intercourse. Poor long-term results of surgery and recent data on active mechanisms in venous outflow restriction raise doubts as to whether penile venous surgery can ever cure so-called venous incompetence.

Adult↗
PubMed1993

Penile blood flow study in diabetic impotence.

Seventy-eight male diabetics with sexual dysfunction were evaluated by a thorough history, general physical, psychological, neurological and urological examinations, routine laboratory tests, and a duplex ultrasound scan with intracavernous injection of prostaglandin E1 (PGE1). The mean patient age was 55.9 years, and the average onset of sexual dysfunction was 10.0 years after the diagnosis of diabetes. Sixty-eight patients (87.2%) had moderate or severe cavernous arterial insufficiency. Older patients and those having a longer duration of diabetes had a higher incidence of cavernous arterial insufficiency. Cigarette smoking, hypertension, and alcohol abuse were also related to cavernous arterial insufficiency. There was no significant difference in cavernous arterial insufficiency between the insulin-dependent and the insulin-nondependent groups. There were significant differences of diameters and peak blood flow velocities of cavernous arteries between 78 diabetic impotent patients and 10 controls. These findings strongly suggest that the cavernous arterial insufficiency is closely related to the diabetic impotence. In addition, the prevalence of cavernous arterial insufficiency increases with age, duration of diabetes, cigarette smoking, hypertension and alcohol abuse, but it is not definitely correlated with the type of diabetes management.

Adult↗
PubMed1993

Duplex Doppler scanning with high-dose prostaglandin E1 stimulation in the diagnosis of arteriogenic impotence.

The aim of this study was to find out the normal range of penile duplex Doppler parameters with pharmacostimulation of 40 micrograms prostaglandin E1 and to assess the repeatability and clinical value of the method. Maximal systolic velocity increase (SVImax) is presented as a new flow parameter. 10 potent and 82 impotent patients were investigated. Peak systolic velocity values were significantly higher when recorded at proximal than at distal penis. Repeatability of SVImax was fairly good (coefficient of variation = 0.18). SVImax ranged from 32 to 100 cm/s in 10 control subjects. The distribution of SVImax values in patients grouped according to the number of arteriosclerotic risk factors indicates that this parameter may be useful in the diagnosis of arteriogenic impotence.

Adolescent↗
PubMed1992

Role of penile nocturnal tumescence and rigidity measurement in the diagnosis of erectile impotence.

Reviewing a group of 100 patients undergoing nocturnal penile tumescence and rigidity measurement (NPTR), we tried to define normal values and compared these results with those of other authors. We also tried to answer two important questions: Is an abnormal NPTR registration always a proof of biogenic impotence? Is a normal NPTR always a proof of psychogenic impotence?

Erectile Dysfunction↗
PubMed1994

Penile electromyography in the diagnosis of impotence.

Cavernous electromyography of the flaccid penis was done in 93 impotent patients that were evaluated with several types of electrodes. We found that the potentials are generated by the cavernous tissue and are not the reflections of distant electromyographic events. Using monopolar needle electrodes, accurate interpretation of the electromyographic tracings seems possible. Our results confirm the value of penile electromyography as a way to objectivate penile smooth muscle atrophy as well as pelvic autonomic neuropathy with subsequent penile smooth muscle desynchronization. A neuromuscular dysfunction may be the causative factor in 39% of our impotent patients.

Electrodes↗