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PubMed1991

[An attempt to classify vascular impotence using penile erection curve patterns].

Papaverine hydrochloride was administered to the cavernous body of the penis in a total of 262 patients who were diagnosed as impotent at our Reproduction Center, Toho University, during the 5 years' period from 1984 to 1988. The condition of erection was accurately recorded by the use of both a mercury strain gauge and rubber strain gauge to classify the erection curve, and papaverine hydrochloride outflow into the peripheral blood was concurrently measured in some of the cases in order to assess its relation with the erection curve pattern. As for the concentration of papaverine hydrochloride in the peripheral blood, it was found that the better the state of erection, the smaller the outflow of peripheral blood. An assessment of the relationship of the concentration of papaverine hydrochloride with the classification of erection pattern showed that the amount of outflow was smaller in the N type (normal) pattern and that the amount of outflow was increasingly larger in the following order: A type (arterial), N' type (arterial and venous) and V type (venous). The distribution of the erection curve patterns, in the 262 cases was: N type, 45%; A type, 10%; N' type, 22.5%; and V type, 22.5%. From the above findings, it is presumed that classification of erection curve pattern under papaverine hydrochloride loading is useful for the differentiation of vascular impotence, particularly for the diagnosis of disorders in the outflow system.

Adult↗
PubMed1992

[Implantation of self-contained non-inflatable penile prosthesis in patients with organic impotence].

Between April, 1988 and August, 1990, the OmniPhase penile prosthesis, a non-inflatable self-contained penile prosthesis, was implanted in 34 patients, aged from 37 years to 79 years, averaging 54.2 years. The etiologies of the impotence were radical surgery for bladder cancer or rectal cancer in 17 patients, diabetes mellitus in 7 patients, vascular abnormality in 3 patients, spinal injury in 2 patients, penile disorders in 2 patients and others in 3 patients. Penile prosthesis was implanted by subcoronal incision under spinal or general anesthesia. Clinical results were evaluated 12 weeks after surgery. Thirty-two patients (94.1%) could have intercourse postoperatively. Eighteen patients (52.9%) were completely satisfied and 14 patients (41.2%) were satisfied, whereas one patient (2.9%) had no improvement and another patient (2.9%) deteriorated. There was no serious complication. However, prosthesis was explanted because of skin erosion in one patient. Pain, which lasted for more than 10 days, was seen in 3 patients (8.8%), penile edema in 11 patients (32.4%), and acute epididymitis in one patient. The obtained results showed that implantation of OmniPhase penile prosthesis is a safe and useful procedure for treatment of organic impotence.

Adult↗
PubMed1993

[Transition of diagnosis and treatment for impotence].

Statistic study was made on 685 outpatients with erectile dysfunction during 13 years periods from 1979 to 1991 in the Department of Urology, Takamatsu Red Cross Hospital. The age distribution showed the highest frequency in the thirties decade (27.9%). 1. Diagnosis Nocturnal penile tumescence monitoring was the only method to distinguish organic impotence from functional impotence during the first 5 years. From 1984 we have been able to diagnose corporal veno-occlusive insufficiency (CVI) by papaverine test and dynamic infusion cavernosometry and cavernosography. Measurement of penile brachial index and pelvic angiography were performed to diagnose arterial insufficiency (AI). In neurological examination we have measured bulbo-cavernosus reflex latency and nerve conduction velocity of the dorsal penile nerve and performed microvibration measurement and sweat spots test. All diagnostic methods were established in 1987 and we have been able to classify about 80% patients. We classified 305 patients during the last 5 years from 1987 as follows: psychogenic; 31.1%, CVI; 20.0%, AI; 7.9%, neurogenic; 7.9%, others; 14.1%, drop-out and unknown; 19.0%. 2. Treatment In the beginning only counseling and drug therapy were performed. However we lately performed various suitable methods for individuals based on their diagnoses. We performed counseling, drug therapy and intracavernous injection of vasoactive drug therapy for recovery of spontaneous erection (vascular training) for psychogenic IMP. The efficacy rate of counseling was low (30.4%) but that of drug therapy was 41.6%, and that of vascular training, 64.2%. For CVI without other factors we performed venous surgeries. Only about 25% of them perform sexual intercourse with or without self injection of vasoactive drug (self injection).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1981

Impotence in progressively systemic sclerosis.

Five men with progressive systemic sclerosis presented with impotence as a significant initial feature of their disease. Endocrine, urologic, and psychiatric evaluations failed to reveal another cause for impotence. We suggest that male erectile dysfunction represents another manifestation of systemic sclerosis. Possible mechanisms for this phenomenon are discussed.

Adult↗
PubMed1999

Design and evaluation of nitrosylated alpha-adrenergic receptor antagonists as potential agents for the treatment of impotence.

We designed and evaluated a new class of molecules, nitrosylated alpha-adrenergic receptor antagonists, as potential agents for the treatment of impotence. In in vitro studies with human and rabbit corpus cavernosum strips in organ chambers, the alpha-adrenergic receptor antagonists (alpha-ARAs) moxisylyte and yohimbine and their corresponding nitrosylated compounds, SNO-moxisylyte (NMI-221) and SNO-yohimbine (NMI-187), concentration-dependently relaxed endothelin-induced contraction. The nitrosylated compounds were significantly more potent than the parent alpha-ARA. In human tissues, the specific phosphodiesterase type 5 inhibitor zaprinast potentiated the relaxing effects of the nitrosylated compounds. Only nitrosylated compounds induced accumulation of cyclic GMP in rabbit corpus cavernosum strips. Yohimbine and NMI-187 demonstrated a potent alpha2-blocking activity, with no significant differences in pA2 values (8.9 versus 8.2, respectively). Moxisylyte and NMI-221 showed moderate potency in antagonizing phenylephrine contraction, with comparable pA2 values for both molecules (6.5 versus 6.6, respectively). alpha-Adrenergic receptor-binding studies showed similar binding affinities for the alpha-ARA and their corresponding nitrosylated compounds. In vivo, intracavernosal injection of nitrosylated molecules caused greater increases in intracavernosal pressure (NMI-221 versus moxisylyte) that were more long lasting than those of moxisylyte or yohimbine. There were no significant differences between nitrosylated and non-nitrosylated compounds in the magnitude of systemic mean arterial pressure decrease after intracavernosal injection. alpha-ARA and the nitrosylated compounds showed no pain-inducing activity as evaluated with the paw-lick model in mice. In summary, nitrosylated alpha-ARA have the dual functionalities of nitric oxide donors and alpha-ARA. These drugs induced penile erection in animals, suggesting their possible therapeutic value as agents for the local pharmacological treatment of impotence.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

[A case of primary central nervous system lymphoma with the onset of impotence].

A 51-year-old man suffered from impotence for 10 months. Five months before he developed difficulty in urination and walking because of his both leg weakness. He was admitted to the hospital because of urinary incontinence, paraplegia and occipital headache. Neurologic examination revealed neck stiffness and Lhermitte's sign. The cranial nerves were intact with the exception of choked disc. He had weakness of lower extremities and right arm, and sensory loss on the right side including face. The plantar responses were extensor bilaterally. MR images revealed diffuse swelling in the cervical and thoracic spinal cord on a T 1-weighted image without enhancement by Gd-DTPA and diffuse high intensity of the spinal cord on a T 2-weighted image. MR image of the brain revealed the low intensity in the left temporal and occipital lobe with slightly enhancement by Gd-DTPA, the high intensity in the left temporal and occipital lobe white matter on a T 2-weighted image. Diagnosis of malignant lymphoma (B cell type) was made by brain biopsy. Combined chemotherapy was performed and his symptoms resolved and the lesions on MRI disappeared. The number of cases of primary spinal intramedullary malignant lymphoma was very rare and the majority of the cases had weakness or sensory impairment in the lower extremities in the initial symptoms. This is the first case which had impotence as the initial symptom. In addition, it must be taken into consideration of this disease when the patient has myelopathy with unknown etiology.

Brain Neoplasms↗
PubMed1999

[Revascularization of the corpora cavernosa in vasculogenic impotence].

The vasculogenic erectile impotence, caused by occlusion and/or stenosis of arteries supplying the penis, is the most common cause of erectile failure in men over 40 years. The vasculogenic impotence is more found by peripheral vasculopathies like diabetes mellitus and nicotine abuse. It is important that the precise site of vascular lesion is established with selective arteriography of the hypogastric-internal pudendal axis. The specific aim of surgery is to increase the cavernosal arterial perfusion pressure and blood inflow in patients with vasculogenic erectile dysfunction secondary to pure arterial insufficiency. There have been multiple revascularization techniques described for the treatment of proximal or distal occlusion with variable results. Microsurgery is important for distal lesions and we think that the best candidates for the Michal II procedure seem to be those with localized obstruction of the internal pudendal, while venous arterialization is the preferred procedure for patients with pathological cavernous or dorsal penile arteries. In this paper the most important procedures to restore physiological erection are presented; however no single revascularization procedure has been generally accepted as a definitive answer to this problem. There is a need for further prospective studies with longer follow-up and more objective investigations.

Erectile Dysfunction↗
PubMed1975

Impotence.

The first and most important assistance the physician can give to the patient who complains of impotence is to take him seriously. In most cases organic causes can be ruled out. Primary or total psychogenic impotence is also a rarity, and most cases are secondary and amenable to appropriate therapy.

Erectile Dysfunction↗
PubMed2000

Logistic regression and survival analysis of 450 impotent patients treated with injection therapy: long-term dropout parameters.

PURPOSE: We report the dropout rate associated with intracavernosal self-injection for erectile dysfunction at long-term followup, and determine parameters related to dropout. MATERIALS AND METHODS: Of 2,252 impotent patients evaluated during 9 years 450 (20%) enrolled in our self-injection program. Papaverine and phentolamine were given in 53% (initial treatment), prostaglandin E1 in 21%, and papaverine, phentolamine and prostaglandin E1 (triple mixture) in 26% of cases. Average injection volume for the 3 injection types was 0.52 cc. Data were retrospectively reviewed for patient dropout versus nondropout, specifically for type of drug, volume injected, changing treatment (from 1 drug and/or dosage to another), patient age, marital status, ethnic group, impotence duration and diabetes. RESULTS: Patient age ranged from 23 to 79 years (mean age 55). Of the patients treated at least 4 months 155 (35%) dropped out of the study. Mean treatment duration was 3.5 years. Logistic regression suggested that type of drug, changing treatment during the course of therapy and dosage (volume injected) were the only significant (p <0.05) parameters influencing dropout. Papaverine and phentolamine were twice as likely to lead to dropout as triple mixture or prostaglandin E1, and injection greater than 0.5 cc was more than twice as likely to lead to dropout. Demographic, ethnic, age and etiological factors had no significant effect on the overall dropout rate. CONCLUSIONS: The effectiveness of injection therapy was an underlying factor determining the long-term dropout rate for patients with erectile dysfunction. Other parameters or combinations of parameters that may influence patient dropout remain to be explored.

Erectile Dysfunction↗
PubMed2000

Anatomical basis for impotence following haemorrhoid sclerotherapy.

Impotence has been reported as a rare but important complication of sclerotherapy for haemorrhoids. The relationship between the anterior wall of the rectum and the periprostatic parasympathetic nerves responsible for penile erection was studied to investigate a potential anatomical explanation for this therapeutic complication. A tissue block containing the anal canal, rectum and prostate was removed from each of six male cadaveric subjects. The dimensions of the components of the rectal wall and the distance between the rectal lumen and parasympathetic nerves in the periprostatic plexus were measured in horizontal transverse histological sections of the tissue blocks at the level of the lower prostate gland (i.e. the correct level for sclerosant injection). The correct site of sclerosant in the submucosa was on average 0.6 mm (SD 0.3 mm) deep to the rectal mucosal surface and only 0.7 mm (SD 0.5 mm) in thickness. The nearest parasympathetic ganglion cells were a mean of only 8.1 mm (SD 2.0 mm) deep to the rectal lumen. The close proximity of the rectum to the periprostatic parasympathetic nerves defines an anatomical basis for impotence following sclerotherapy. This emphasises the need for all practitioners to be particularly careful when injecting in this area and for strict supervision of trainees.

Aged↗
PubMed1975

Impotence after fractures of the pelvis.

Sexual impotence after an injury causing a fracture of the pelvis occurred in sixteen of ninety male patients. Three men of fifty-nine had this complication without having an associated injury to the urethra, but impotence was more commonly associated with urethral injury (thirteen of thirty-one cases). Litigation did not seem to be associated with the problem.

Adult↗
PubMed2003

[Henry IV of Castilla (1454-1474). An exceptional urologic patient. An endocrinopathy causing the uro-andrological problems of the monarch. Impotence and penile malformation (III)].

OBJECTIVES: To review, in accordance to contemporary and current chronicles and manuscripts, all data known about impotence and presumptive penile malformation suffered by Henry IV of Castile. Although currently the monarch's homosexuality is almost totally rejected, because according to many authors slandering, mainly of the sexual kind, was used as a political arm to discredit him by his enemies, it is yet to be demonstrated if his erectile dysfunction and presumptive genital anomaly were also slanderly disseminated by his detractors to avoid recognizing his daughter Juana "La Beltraneja" as successor to the throne. METHODS: We reviewed a total of 10 chronicles, 5 contemporary texts and manuscripts, and 25 books about the figure of Henry IV published before year 2000, analyzing medical works in detail, particularly those from Marañon, Eisenberg, and Irvine and Mackay, who studied both pathologies trying to differentiate if both diseases could be justified by the kind of endocrinopathy the monarch suffered. RESULTS: Although it is understandable that the study could be mistaken by document manipulation undertaken during Henry IV's life and posteriorly during the reign of the "Catholic Kings", and due to the lack of impartiality of some of his chroniclers, it is my opinion that the most probable cause of Enrique IV's erectile dysfunction was a GH and prolactine producing hypophyseal tumor, that he suffered from his youth producing complete impotence and acromegaly. It is not well documented if the Monarch also suffered a congenital penile anomaly.

Erectile Dysfunction↗
PubMed1992

A comparative study with intracavernous injection of prostaglandin E1 versus papaverine for the diagnostic assessment of erectile impotence.

The intracavernous injection of vasoactive drugs is a valuable diagnostic aid and an important tool for the treatment of erectile failure. A comparative study with intracavernous injection of prostaglandin E1 (PGE1) and papaverine was performed in 60 patients with impotence. We evaluated the efficiency and side effects of both agents. The overall positive response rate was 85.0% in the PGE1 group and 65.0% in the papaverine group which suggests PGE1 has a stronger vascular effect. The mean onset of maximal erection was after 9.6 minutes in the PGE1 group and after 6.5 minutes in the papaverine group. The mean maintenance of erection was for 53.2 minutes in the PGE1 group and for 38.6 minutes in the papaverine group. There were no systemic side effects of either agent. Three instances of injection pain and 2 of burning sensation in the penis were noted in the PGE1 group, while in the papaverine group, there were 21 reports of injection pain, 4 of prolonged erection and 2 of burning sensation in the penis. These results suggest that PGE1 is a more desirable vasoactive alternative for the diagnosis of impotence.

Adult↗
PubMedDate not supplied

Impotence.

The National Institutes of Health Consensus Development Conference on Impotence was convened to address (1) the prevalence and clinical, psychological, and social impact of erectile dysfunction; (2) the risk factors for erectile dysfunction and how they might be used in preventing its development; (3) the need for and appropriate diagnostic assessment and evaluation of patients with erectile dysfunction; (4) the efficacies and risks of behavioral, pharmacological, surgical, and other treatments for erectile dysfunction; (5) strategies for improving public and professional awareness and knowledge of erectile dysfunction; and (6) future directions for research in prevention, diagnosis, and management of erectile dysfunction. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) the term "erectile dysfunction" should replace the term "impotence"; (2) the likelihood of erectile dysfunction increases with age but is not an inevitable consequence of aging; (3) embarrassment of patients and reluctance of both patients and health care providers to discuss sexual matters candidly contribute to underdiagnosis of erectile dysfunction; (4) many cases of erectile dysfunction can be successfully managed with appropriately selected therapy; (5) the diagnosis and treatment of erectile dysfunction must be specific and responsive to the individual patient's needs and that compliance as well as the desires and expectations of both the patient and partner are important considerations in selecting appropriate therapy; (6) education of health care providers and the public on aspects of human sexuality, sexual dysfunction, and availability of successful treatments is essential; and (7) erectile dysfunction is an important public health problem deserving of increased support for basic science investigation and applied research.

Erectile Dysfunction↗
PubMedDate not supplied

[Clinical and instrumental evaluation of erectile impotence: a proposal of a diagnostic protocol].

There has been increasing interest in recent years in patients complaining of erectile dysfunction. This has prompted research and the development of diagnostic procedures aimed at allowing increasingly rapid characterization of the type of impotence involved (psychogenic or organic) and thus the most effective treatment. In this preliminary study, we present our study methodology in patients with erectile dysfunction, emphasising in particular the diagnostic procedures best suited to revealing the presence of an organic cause in the pathogenesis of impotence.

Erectile Dysfunction↗
PubMed1992

Love and male impotence.

This paper deals with male impotence in relation to love. A detailed clinical presentation attempts to show how the symptom was embedded in faulty processes of separation-individuation, whereby regression in the service of intercourse, passion and love is hindered by the fears and fantasies underlying merging experiences. These problems are examined as they appear interwoven in transference and counter-transference phenomena. The clinical case presentation is followed by a discussion of different forms of male impotence from a more general viewpoint; its relation not only to castration and phallic anxiety, but also to earlier developmental aspects. Finally, some reflections about male and female gender differences in relation to symbiotic experience.

Countertransference↗
PubMed1992

The vacuum erection device. A noninvasive treatment for impotence.

In 30 men we have tested the vacuum device after determining the cause of their impotence. 90% achieved penile rigidity sufficient for vaginal penetration. 10% didn't want to use it. Of the 30 men 20 (66%) reported that they used the device regularly after at least 6 months. In 4 patients the development of ecchymoses and petechiae was the reason to stop using the device. The vacuum device appears to be a safe, noninvasive and effective treatment for all causes of impotence.

Adult↗
PubMed1992

Management of impotence after treatment of carcinoma of the prostate.

Impotence commonly occurs as a result of treatment of carcinoma of the prostate. We review the etiology, evaluation, and treatment options available for these patients as well as our experience with fifty prostate cancer patients who underwent placement of penile prostheses. Several excellent alternatives are available for patients with impotence resulting from treatment of carcinoma of the prostate.

Cost-Benefit Analysis↗