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PubMed1994

Computerized measurement of penile elastic fibres in potent and impotent men.

Intracavernous elastic fibres may play a role in human erectile tissue compliance and elasticity. Using computerized image analysis we have measured objectively the percentage of elastic fibres in corpus cavernosum tissues in both potent and impotent men. Twenty-two penile biopsies were performed in 5 potent and 17 impotent patients due to vascular disease. The mean percentage of elastic fibres was 9% in normal patients. In 12 patients with venous leakage a significant decrease in the amount of elastic fibres of 5.1% was observed and in 5 patients with arterial disease it was 4.3%. No correlation between the reduction of the elastic fibre quantification and age was observed. Change in elastic fibre content may alter the relaxation properties of cavernosal tissue and play a role in the development of erectile dysfunction.

Adult↗
PubMed1994

Microstructural disorders of tunica albuginea in patients affected by impotence.

The role played by the tunica albuginea in the erection mechanism seems to be very significant in promoting the constriction of sub-albugineal venous reticulum and trans-albugineal effluent veins, as well as providing an inextensible protective structure to the arteriolae and to the intracavernous nerves. The passive function exerted by the tunica albuginea is a result of its structure, which is rich in collagenic fibers, linked by elastic fiber bridges. The presence of structural disorders in the tunica albuginea of 16 patients suffering from psychogenic, arteriogenic and venogenic impotence is evaluated. The results obtained show a significant decrease in elastic fibers in the tunica albuginea of impotent patients compared to a control group of 5 patients with normal erection activity. This structural disorder could result in tunica albuginea alteration and, therefore, in erection insufficiency.

Adult↗
PubMed1984

Natural killer cells are present in the normal human lung but are functionally impotent.

The lung is affected by disorders in which natural killer (NK) cells are thought to play an important defensive role. This study, however, demonstrated that normal lung lymphocytes actually express very little NK cell activity (P less than 0.001 compared with blood lymphocytes). This was true independent of the NK-sensitive target used (K562, U937, MOLT-3, or Daudi). This lack of lung lymphocyte NK activity occurred even though the proportions of lymphocytes in the normal lower respiratory tract with the morphology (large granular lymphocytes) and surface antigen markers of NK cells were similar to that of blood (P greater than 0.5). Although normal lung lymphocytes bound to known NK-sensitive targets, they did not lyse these cells (P less than 0.001 compared with blood), which suggested that the lack of lung NK cell activity resulted from a relative inability of lung NK cells to destroy their targets. While the mechanisms of this functional impotence of lung NK cells are not clear, normal human alveolar macrophages and lower respiratory tract epithelial lining fluid exerted a profound suppressive effect on blood NK cell activity (P less than 0.001 for both) by inhibiting their ability to lyse target cells after binding (P less than 0.001). Though impotent initially, when incubated for 24 h in medium alone, normal lung lymphocytes demonstrated markedly enhanced NK activity (P less than 0.02), which suggested that lung NK cells do have the potential to express NK activity. Interleukin-2 (IL-2) further augmented this effect (P less than 0.05), but gamma interferon did not (P greater than 0.2). Consistent with this observation, lung lymphocytes from patients with active sarcoidosis, a disease in which lung lymphocytes are spontaneously releasing IL-2, did express NK cell activity (P less than 0.01). These studies suggest that although NK cells are present in the normal lung, they are functionally inactive, due, at least in part, to local inhibitory influences. In the presence of IL-2, however, lung NK cell activity is expressed, which suggests that lung NK cell activity can be modulated.

Adult↗
PubMed1990

Pharmacocavernometry in the assessment of erectile impotence.

Thirty-three impotent men underwent pharmacocavernometry and cavernography. Ten patients had a good clinical response to 60 mg papaverine, nine had a moderate clinical response and in 14, the response was judged to be a poor one. Twelve patients had evidence of abnormal venous leakage from the corpora. Subsequent investigation with isotope phallography showed six patients to have arterial insufficiency and in three of these patients this was amenable to reconstructive vascular surgery. We conclude that pharmacocavernometry provides a useful, cheap and reliable method for the investigation of impotent men which may be performed on an outpatient basis.

Adult↗
PubMed1991

Evaluation of I-C papaverine in patients with psychogenic and organic impotence.

Forty men with organic or psychogenic impotence, who were highly motivated for treatment, were offered instruction in the intracavernosal (I-C) self-injection of papaverine and regular ongoing supervision by the investigator. Twenty declined immediately, citing a number of reasons, notably qualms about pain of the injection, side-effects and the unnaturalness of the method. Eleven patients discontinued the drug within 11 months; nine used it for at least one year, and all were continuing with it albeit less frequently at the time of assessment. Those who discontinued treatment differed significantly from those who did not; the latter initially used the drug less frequently (less than once per month), did not have a regular sexual partner or had a poor relationship with their sexual partner, and reported a decline in libido during use of the drug. The findings suggest that I-C papaverine, although effective in treating impotence, is not a panacea, and a large percentage of users (55% in our study) are likely to discontinue the drug within a relatively short period of time.

Adult↗
PubMed1976

Impotence: prognosis (a controlled study).

Sixty-five patients primarily referred for erectile impotence were investigated and treated in a psychiatric out-patient department. Information was obtained from patients and wherever possible from their partners. Subjects were treated either with chemotherapy or with a modified form of Masters and Johnson's technique. A controlled group were not given any specific treatment. Results indicated that neither chemotherapy or behaviour modification (modified Masters and Johnson's technique) were in any way superior to no treatment. The prognosis was related to the clinical features of the subjects rather than to the form of treatment. Subjects in whom impotence was caused by a specific psychological or physical trauma showed a much better prognosis than those who had an insidious decline in sexual potency without any discernible psychological or physical factors. The decline in these latter subjects with a very poor prognosis was possibly due to inherent physiological factors.

Adult↗
PubMed1982

The clinical features of diabetic impotence: a preliminary study.

Twenty-seven diabetic men with erectile impotence were given physical and psychosexual assessments. Physical assessment included vascular and neurological evaluation. Psychosexual assessment was by means of a semi-structured interview. Seven potent diabetic men formed a control group. Patients with erectile failure had a varied clinical picture which differed from the stereotype of diabetic impotence: morning erections were preserved in over a half (55 per cent), eight patients (30 per cent) had intact spontaneous erections, and sexual interest was reduced in 12 patients (44 per cent). In 13 patients (48 per cent) ejaculation was disturbed and a further four patients (15 per cent) described unusual disorders of sexual function. Within the group there were no differences in clinical picture between those with and without autonomic neuropathy, retinopathy or potential psychogenic factors.

Adult↗
PubMed1983

Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence.

Intravacernosal injection of phenoxybenzamine, in a dose too small to have significant general effects, caused full erection lasting between half an hour and 30 hours in 30 of 4 potent men (2 normal, 2 anorgasmic) and in 6 of 11 impotent men. In the remaining potent man and 3 of the remaining eleven impotent men have had sexual intercourse, for the first time for months or years, while under the drug. The practical implications of this new discovery are discussed.

Adult↗
PubMed1993

Psychometric assessment of diabetic impotence.

In a study of 23 diabetic men complaining of impotence, completion of physical tests, self-report psychometric testing, a rating of marital intimacy, and a semi-structured interview revealed that, of ten patients found to be at risk of psychogenic impotence secondary to marital or psychiatric morbidity, five were thought to have adequate erectile response and to have a psychogenic component to their problem. This seems to show high sensitivity, if not specificity, of the self-report questionnaires.

Adult↗
PubMed1989

Changes in the bioactivity to immunoreactivity ratio of circulating luteinizing hormone in impotent men treated with testosterone undecanoate.

Testosterone undecanoate was administered orally (80 mg twice daily) for 30 days to 10 impotent men with mild Leydig cell failure, age 28 to 42 years. Placebo was administered for 30 days both before and at the end of testosterone undecanoate therapy. Serum levels of bioactive LH, immunoreactive LH and testosterone were determined in basal conditions (day zero), 30 days after the first placebo administration, at the 15th and 30th day of testosterone undecanoate therapy, and at the end of the second treatment with placebo (90th day). Bioactive LH was measured by a sensitive and specific in vitro bioassay based on testosterone production by mechanically dispersed mouse Leydig cell preparations. Immunoreactive LH and testosterone were determined by a double-antibody RIA technique. The results were compared with those obtained in 30 untreated normal young men. In the basal state, serum concentrations of immunoreactive LH were significantly higher in the patients (P less than 0.02) than in control subjects, whereas testosterone levels were significantly lower (P less than 0.001) in the impotent men. In contrast, bioactive LH levels and the bioactive LH to immunoreactive LH ratios were similar in the two groups. In the patients, at the 15th day of treatment with testosterone undecanoate, serum levels of testosterone and bioactive LH were significantly higher (P less than 0.01) than basal values, whereas immunoreactive LH concentrations showed no significant changes. Consequently, the bioactive LH to immunoreactive LH ratios rose significantly (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The role of imaging in the diagnostic evaluation of impotence.

This article serves to highlight the recent advances that have been made in the workup and differential diagnosis of erectile dysfunction, focusing particularly on the role of imaging in this diagnostic assessment. Intracavernosal injection of vasoactive agents, duplex sonography with pulsed Doppler analysis, penile arteriography, and dynamic infusion pharmacocavernosometry/cavernosography are among the techniques discussed. With the development and availability of nonprosthetic treatment options, identification of the specific underlying cause of a patient's impotence (as determined by these methods) allows the formulation and institution of a therapeutic plan based on the patient's underlying pathophysiology and appropriate for the individual's case. On the basis of our experience, we present a practical and cost-effective algorithm for the diagnostic evaluation of the impotent patient.

Angiography↗
PubMed1989

Duplex and color Doppler sonographic evaluation of vasculogenic impotence.

One hundred eighty patients with suspected vasculogenic impotence were evaluated with conventional penile duplex sonography with spectral analysis and color Doppler imaging. Measurements of mean peak systolic and end-diastolic velocities were obtained from the cavernosal arteries before and after intracavernosal injections of papaverine. Sixty-one patients were examined with dynamic cavernosography and cavernosometry, and 12 patients were studied with selective internal pudendal and penile arteriography. All five patients with abnormal arteriography had mean peak systolic velocities in the cavernosal arteries of less than or equal to 25 cm/sec (sensitivity, 100%; 95% confidence interval, 48-100%) after the injection of papaverine. Six of the seven patients with normal arteriography had mean peak systolic velocities of greater than 25 cm/sec (specificity, 85.7%; 95% confidence interval, 42-100%) after injection of papaverine. By using data from a receiver-operating-characteristic curve, we determined that end-diastolic velocities in the cavernosal arteries of greater than or equal to 5 cm/sec after the injection of papaverine correctly identified patients with excessive venous leakage on cavernosometry; the sensitivity was 90% (95% confidence interval, 77-97%) and the specificity was 56% (95% confidence interval, 30-80%). The addition of color Doppler sonography made the detection of vessels easier and the correction of the Doppler angle more accurate, resulting in more rapid and accurate acquisition of data. Penile duplex sonography with spectral analysis and color Doppler imaging are sensitive and noninvasive means of examining patients with potential vasculogenic impotence.

Adolescent↗
PubMed1991

Radiologic assessment of impotence: angiography, sonography, cavernosography, and scintigraphy.

Recent advances in the understanding of erectile dysfunction have led to new treatments for vasculogenic impotence and a need for improved imaging techniques. Although much controversy still exists in this evolving field, we provide a review of the concepts and techniques currently used in cavernosography, sonography, scintigraphy, and angiography to evaluate the impotent patient.

Diagnostic Imaging↗
PubMedDate not supplied

Impotence as a presenting symptom of presumed prolactinoma in a patient with diabetes mellitus.

Impotence in diabetic men is usually considered to be due to neuropathic factors or vascular insufficiency. However, factors unrelated to diabetes may occasionally produce sexual dysfunction in these patients. Recently, a diabetic patient presented to our clinic with the complaint of impotence. In this patient, macroprolactinemia was discovered. With appropriate therapy, the sexual dysfunction improved and this case is reported here.

Diabetes Mellitus, Type 1↗
PubMed1983

Epigastrico-cavernous anastomosis in the treatment of arteriogenic impotence.

During the period August 1980--January 1982 nine patients were treated for erectile impotence due to arterial insufficiency in the penis, with epigastrico-cavernous anastomosis. Two patients had no effect of the operation. Two patients developed priapism postoperatively and one of these lost his potency probably because of delayed treatment, while the other remained potent. Of the remaining five patients three lost the regained potency within one year, and two are still potent 21 and 24 months after the operation. It is concluded that the long term results of the epigastrico-cavernous anastomosis is unsatisfactory and that new approaches for revascularization of the cavernous bodies in arteriogenic impotence are required.

Adult↗
PubMed1993

Morphodynamic assessment of penile circulation in impotent patients: the role of duplex and color Doppler sonography.

Duplex and color Doppler sonography were used to assess the vascular status of 240 impotent patients. The tests were performed before and after intracorporal injection of a standard dose of a vasoactive mixture and measurements were done both at the crura and at the midshaft of the penis. Particular care was taken in the evaluation of cavernosal arteries diameter, wall pulsatility, morphology of spectral waveform, blood flow acceleration, systolic and diastolic flow velocity and flow volume. Resistance and pulsatility indexes of the cavernosal arteries were also measured. Flow along the deep dorsal vein was quantified when possible. Cavernosal artery peak systolic flow velocity, flow volume and acceleration were the best indicators of arterial penile circulation. Persistently elevated (> 10 cm/s) diastolic flow in the cavernosal arteries positively correlated with a diagnosis of venogenic impotence obtained by dynamic infusion cavernosometry--cavernosography in almost 80% of cases. Duplex and color Doppler sonography permit to thoroughly evaluate cavernosal arteries function and seem to have a promising role in the study of the veno-occlusive mechanism of the corpora cavernosa.

Blood Flow Velocity↗
PubMed1990

Intracavernous papaverine in the management of psychogenic impotence.

Intracavernous papaverine has found an important place in the management of male erectile failure. The effect of this mode of therapy was studied in 48 patients with psychogenic impotence. The average follow-up for this group of patients ranged from 7 months to 37 months (mean 16.3 months). All the patients in this group were advised sex therapy as an initial mode of therapy. On refusal to undergo sex therapy, they were offered an option of intracavernous papaverine injection. Papaverine appears to break the performance anxiety erectile failure cycle and was noted to have good results. Overall 57.9% patients expressed complete satisfaction with this mode of therapy. One patient (2.1%) developed priapism, which was adequately treated with intracavernous epinephrine. Use of low dosage of papaverine is suggested as an additional mode of therapy in the management of psychogenic impotence.

Adult↗
PubMedDate not supplied

Hollow and fenestrated penile prosthesis: a new implant for treatment of impotence.

Penile implants are used for erectile dysfunction (ED). Their main disadvantage is that the cavernous tissue is destroyed and replaced by fibrous so that implant replacement is difficult and the penis loses its erectile function permanently. This paper describes a novel prosthesis which is hollow and fenestrated to preserve, as much as possible, the cavernous tissue. The fenestrated implant was used in 18 men with ED, while the solid Small-Carrion implants were used in 14 impotent men who matched the 18 men in age and cause of impotence and acted as controls. Routine erectile function tests suggested that the ED was neurogenic. The fenestrated prosthesis was a hollow semisolid silicone rod with multiple openings (2-3 mm in diameter) along its whole length. The mean follow up of the patients was 43 +/- 12 SD months. No complications were encountered. Vaginal penetration was successful in the fenestrated and Small-Carrion implant groups. A total of 14/18 patients of the fenestrated prosthesis group experienced spontaneous erections upon sexual arousal, while none of the Small-Carrion prosthesis group did. During the sexual act the penis became tumescent in the patients of the former group but not in those of the latter. It is suggested that the residual cavernous tissue after insertion of the hollow fenestrated implant regenerates through the fenestrae into the implant lumen. This might explain the spontaneous erections upon sexual arousal and the tumescence during the sexual act, but this hypothesis remains to be proved histologically.

Adult↗