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At least 667 records · Page 37Linked to original sources
PubMed1992

Deep dorsal vein arterialization in vasculogenic impotence: our experience.

We describe our experience of surgical therapy for vasculogenic impotence, using a technique of arterialization of the deep dorsal vein. This technique was chosen because vascular anastomosis can easily be performed, and because of the possibility of inducing haemodynamic mechanisms which favour the maintenance of rigidity, using venous arterialization. The operation was performed on 22 selected subjects with positive results. 12 patients (55%) reported erections which enabled them to have satisfactory sexual relations one year after follow-up. From the data reported we can conclude that penile revascularization, using the technique of arterialization of the deep dorsal vein, in well selected cases of vasculogenic impotence, should be considered a valid alternative to a penile prosthesis implant.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

[Treatment of impotence with implantation of penile prosthesis].

The authors have presented results and importance of the treatment of impotence by implantation of different types of penile prostheses in 46 patients. The aim of the study was to evaluate success in recovery of potency with modern types of prostheses. Problems related to characteristics of prostheses and risk groups of patients for this kind of treatment have been recognized. It has been concluded that penile prostheses are very good means for solving the problem of impotence which is exclusively or mainly of the organic origin when other methods are not suitable for a patient or have not given favourable results.

Adult↗
PubMed1991

[Intracavernous pharmacotherapy for treatment and evaluation of impotence].

Impotence affects about 10% of all men. During the past decade it has been treated with self-injection of vasoactive drugs into the erectile tissue. In 1982 Virag reported experience with intracavernous injection of papaverine. Since then other vasoactive drugs, such as prostaglandin E1 (PGE1), have been used successfully, and self-injection has been advised. Between 1987-1989 we evaluated 550 patients with erectile dysfunction and 95 aged 21-79, mean 53.7, were found suitable for this treatment, of whom 80 were entered into an autoinjection protocol, of 74 were treated with a mixture of papaverine and regitine and 6 with PGE1. The volume of the injections ranged from 0.1 to 1.0 ml, and erections lasted from 15 minutes to 8 hours. 72% of the patients continued autoinjection during a mean follow-up of 9.9 months and were satisfied with the results. There were 5 cases of corporal fibrosis, and 3 cases had prolonged erections, usually after the papaverine test. The method is simple and inexpensive, and allows many impotent men to resume sexual life. It is a good alternative to the insertion of a penile prosthesis.

Adult↗
PubMed1991

Radionuclide imaging clinical study. Corporeal 133Xe washout for detecting venous leakage in impotence.

A quantitative test, corporeal 133Xe washout, was developed to detect venogenic impotence. Data were acquired in frame mode after intracorporeal injection of 0.1 ml (1-2 mCi or 37-74 MBq) of 133Xe in saline on one side of the midline just behind the glans in the flaccid state for 20 min. A time-activity curve (TAC) was generated from the region of interest (ROI) at the site of injection and a computer routine was then used to calculate clearance half-time (T1/2) in minutes and flow rate (Q) in ml/100 g tissue/min from corporeal 133Xe clearance. The data from 12 controls and 21 patients with venous leakage were analysed. In patients with venogenic impotence, T1/2 (mean +/- S.D.) was greatly increased (24.4 +/- 10.7 min vs 10.7 +/- 4.6 min in controls, P less than 0.005) whereas Q markedly decreased (2.4 +/- 1.3 ml/100 g tissue/min vs 5.4 +/- 2.3 ml/100 g tissue/min in controls, P less than 0.005). The sensitivity and specificity for detecting venous leakage at the optimal threshold of T1/2 equal to 13 min and Q equal to 3.7 ml/100 g tissue/min were 95 and 75%, respectively. The corporeal 133Xe clearance half-time and flow rate are two simple and clinically useful indices for detecting venous leakage.

Adult↗
PubMed1991

[A clinical evaluation of AMS Hydroflex in the treatment of impotence].

The AMS Hydroflex penile prosthesis was implanted in 34 organic impotence patients between June 20, 1986 and Aug. 6, 1990. Patients ages ranged between 26 and 71 with an average of 50.5. The causes of impotences were; 17 cases of post-radical pelvic surgery, 7 cases of injury, 6 cases of diabetes and 4 of others. First evaluation was made after 12 weeks of implantation in terms of patient satisfaction with sexual intercourse and post operative complication. Sixteen patients (47.1%) were highly satisfied with intercourse, 13 (38.2%) satisfied with intercourse, 2 (5.9%) slightly dissatisfied even with successful intercourse, 1 (2.9%) with no improvement and 2 (5.9%) could not follow. Utility of the prosthesis, e.g. effectiveness and safety was; high utility in 20 (58.8%), good utility in 11 (32.4%), slight utility in 1 (2.9%), no favorable in 1 (2.9%) and no judgement in 1 (2.9%). The overall effectiveness and safety of the Hydroflex was demonstrated based on the above findings. Long term evaluation was made from the initial implantation of the device up to the termination of the trial with average of 19.2 months and was mentioned altogether.

Adult↗
PubMed1990

Multiple endocrine neoplasia type 1--presenting with impotence.

A 35-year old man presented with a 4-year history of impotence. His past history was significant for hypercalcaemia, bilateral pyelolithotomies for renal calculi and parathyroidectomy for hyperparathyroidism. He had an episode of haemetemesis and malaena a year before being seen here. Endocrine investigations revealed hyperprolactinemia, hypergastrinemia and increased basal acid output. Magnetic resonance imaging of the brain was indicative of a pituitary microadenoma. Computed tomographic scan of the abdomen revealed a bulky pancreas which was suggestive of a gastrin-secreting islet cell tumour. This case illustrates an unusual presentation of multiple endocrine neoplasia type 1 (MEN-1) with impotence and hyperprolactinemia. A short review of the literature was done.

Adenoma↗
PubMed1990

Evaluation of vasculogenic impotence using dynamic penile washout test.

Two control volunteers and 8 impotent patients entered this study for evaluation of arterial function and venous competence of the corpus cavernosum. The skin and corporeal xenon-133 (Xe-133) penile washout tests were conducted on each person before and 5 and 60 minutes after an intracavernous injection of prostaglandin E1. The half-time clearance (T 1/2) and blood flow (Q) were used for evaluation. The parameters of the skin washout test obtained from impotent patients changed from T 1/2 = 14.3 +/- 6.2 minutes, Q = 3.75 +/- 2.56 ml/100g tissue/minute preinjection to T 1/2 = 5.23 +/- 1.78, Q = 9.96 +/- 2.69 at 5 minutes post-injection and T 1/2 = 3.89 +/- 0.86, Q = 12.9 +/- 3.0 at 60 minutes post-injection, p less than 0.01; while the corporeal washout test changed from T 1/2 = 84.6 +/- 107.1 minutes, Q = 2.91 +/- 3.17 ml/100g tissue/minute to T 1/2 = 41.2 +/- 99.6, Q = 10.6 +/- 9.7 and T 1/2 = 13.9 +/- 16.2, Q = 7.78 +/- 6.35, p less than 0.05, respectively. The flow ratio (post-injection/pre-injection) was 1.01-6.04 at 5 minutes and 1.39-8.01 at 60 minutes later in the skin washout test, and 1.07-72.2 at 5 minutes and 0.60-45.7 at 60 minutes in the corporeal washout test. However, the individual variations were considerable. This study suggests that the Xe-133 penile washout test after an intracavernous injection may help in demonstrating the hemodynamics of the cavernosal arteries and dorsal arteries, and in evaluating the severity of penile vascular impairment. Moreover, the flow ratio may reflect vascular compliance; the higher the ratio, the better the compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Diagnostic and therapeutic technology assessment. Vasoactive intracavernous pharmacotherapy for impotence: intracavernous injection of prostaglandin E1.

The DATTA panelists consider PGE1 to be a useful addition to the family of vasoactive agents used to treat organic impotence. It is associated with fewer side effects than either papaverine or phentolamine. Although most patients can achieve an erection with PGE1, some will not, and the other vasoactive agents may be of benefit in these cases. Synergy has been demonstrated when papaverine and PGE1 are used together, and a combination of the two in reduced dosages may be effective in producing an erection with a reduction in side effects. Intracavernosal therapy should be prescribed and monitored by a urologist who is experienced in the treatment of impotence and who is able to treat any of the potential side effects. Whether long-term use of local injections will produce additional complications is yet to be determined.

Alprostadil↗
PubMed1991

[Is venous cavernous insufficiency the only cause of organic impotence?].

Organic causes for impotence are rarely detected because of the inadequate investigation of the patients. The assessment of impotence must include clinical examination (principally interview) and complementary investigations. The clinical history is strongly suggestive of an organic cause. Organic investigation must be proposed to these patients when they are motivated and occasionally in obviously "psychological" patients in order to reassure him that all of the organic factors "function correctly". The complementary investigations are as follows: hormonal survey (testosterone, prolactin), nocturnal penile plethysmography, penile arterial Doppler, EMG of the bulbocavernosus muscles and the papaverine test (30 mg or 60 mg). When the papaverine test is abnormal, cavernometry should be proposed. In conclusion, supportive sex therapy is often essential and a penile prosthesis should only be proposed as a last resort, when treatments adapted to the cause have failed.

Endocrine System Diseases↗
PubMed1990

[Diagnosis and surgical treatment of impotence caused by venous leakage].

Abnormal venous leaks are a causative factor of impotence and can be identified by perfusion cavernosography. The perfusion cavernosography was carried out in 47 impotent patients and the venous leakage was found in 21. Among 21 cases found the venous leakage, 20 cases underwent surgical treatment and the results showed that the patient's sexual life (erection) was not satisfactory after simple ligation of the deep dorsal vein and that ligation of the abnormal venous outlets at the level of the crura on penis was an effective way to restore potency. The authors consider that intra-cavernous papaverine injection induced penile erection is an effective means of screening for venous leakage.

Adult↗
PubMed1990

Diabetes-related impotence in the elderly.

Because many elderly men with chronic illnesses such as diabetes have multiple causes contributing to their impotence and may still retain an interest in sexual activity, those who still are unable to adequately perform sexually after treatment of their medical problems should be informed of the alternative methods of treatment of their impotence or alternative methods of sexual fulfillment and gratification and, when necessary, should be offered supportive counseling and psychotherapy.

Age Factors↗
PubMedDate not supplied

[Impotence].

"Impotence" is a vague term for a variety of sexual dysfunctions in the male, such as libido disturbance, erectile impotence, dyspareunia and a number of ejaculatory problems. They are very rarely caused and maintained by any single factor. Usually a combination of organic and psychic factors is involved; the symptoms may give some indication as to what factors are dominant. Organic and surgical treatment should be considered cautiously and should have a clear indication. Frequent psychic causes are partnership or personality problems and the so-called vicious circle of performance anxiety. Sexual counselling is often all the therapy needed, especially when sexual knowledge is inadequate or when relative trivial partnership problems are involved. The kind of psychotherapy offered depends on the main problem: partner therapy, therapy directed at the control of personality problems, or therapy based on the Masters and Johnson method may be indicated.

Counseling↗
PubMed1990

[Diagnosis and microsurgical correction of impotence of vascular origin].

The authors worked out an original complex of instrumental methods for the diagnosis of impotence of vascular origin, which includes ultrasonic Dopplerography of the genital arteries, radionuclide examination of hemodynamics of the penis, and radiocontrast phalloarteriography with the use of intracavernous pharmacological load. The results of the study make it possible to increase essentially the efficacy of microsurgical correction of impotence of vascular origin through objective indications for operative treatment on the basis of the suggested diagnostic methods, improvement of the techniques of revascularization of the cavernous bodies, and pathogenetically substantiated tactics of postoperative rehabilitation of patients.

Adult↗
PubMed1989

History of the prosthetic treatment of impotence.

Early records of observations of the os penis or baculum in mammals go back to Aristotle. These heritable cartilaginous supports were noted to help the penis during copulation. Prosthetic surgery for treatment of impotence was born from the initial experience with the use of the "artificial os penis" (rib cartilage) in post-traumatic reconstruction in 1936. Slow progress was made with the use of extracavernosal acrylic stents, followed by intracavernosal polypropylene rods, and finally the silicone prosthesis over the next 20 years. The introduction in 1973 of the inert silicone semirigid prosthesis and inflatable prosthesis met with great successes. Most recently (1985), there has been development of self-contained prostheses that are technically more simple to insert. Today, much more is known about specific organic causes of impotence that are amenable to many successful nonprosthetic alternative therapies, adding more stimuli to continued innovations in prosthetic surgery for erectile dysfunction.

Erectile Dysfunction↗
PubMed1989

[Surgical treatment of impotence caused by venous dysfunction].

The authors examined 94 patients suffering from sexual impotence. On the basis of the history, erection induced with papaverine and the results of Doppler's operation as well as dynamic cavernosography of the penis venous excape was found in the background of impotence of 14 patients. Operation was performed with 13 patients in the course of which the draining vein depicted by cavernosography was ligated. 7 patients have erection spontaneously and 4 on papaverine given intracavernously. The operation was unsuccessful with 2 patients which was due in one case to the existing spongiocavernous fistula and in the other to the development of early collateral circulation.

Erectile Dysfunction↗
PubMed1989

Impotence: its evaluation and treatment.

More men are seeking treatment for impotence today. Recent advances have resulted in a better understanding of the problem, and a wider array of treatment options. The authors review the pathophysiology of the condition and provide an algorithm for evaluating patients with impotence.

Attitude to Health↗
PubMed1989

[Neurogenic impotence].

Until recently, the management of impotence was mainly concerned with the distinction of psychogenic from organic causes of erectile failure. Patients with the former were offered psychosexual counselling, while surgery, principally in the form of prosthesis implantation, was reserved for those with organic impotence. With the identification of pharmacologic regimes that can successfully induce erection, it has become necessary to distinguish between vascular and neurogenic causes of erectile failure, since it is mainly the latter patient group that can profit from an intracavernosal injection therapy with papaverine and phentolamine. Neurogenic erectile failure is further classified according to lesion localization and underlying disease.

Erectile Dysfunction↗
PubMed1989

Experience in diagnosis and treatment of impotence caused by cavernosal leak syndrome.

To delineate neural, arterial, and venous components contributing to impotence, we used a previously described noninvasive screening sequence combined with stimulation of artificial erection with papaverine injection, selective pudendal arteriography (SPA), and dynamic cavernosography (DC). Among 572 men with impotence, age range 17 to 78 years (average age 54.8 years), 26 men with potential cavernosal leaks in absence of other factors were identified; 16 underwent DC; among these five had normal cavernous venous drainage. Eight men with abnormal cavernosal venous drainage required cavernous infusion flow rates higher than 120 ml/min to obtain erection and higher than 40 ml/min to maintain erection. Radiographic studies showed cavernosal leakage in all eight patients. Eight men, ages 39 to 61 years, underwent surgical ablation of abnormal cavernosal venous drainage. Among these, five men have had excellent results for up to 3 years. One failure was related to unrecognized penile arterial disease later shown by SPA. In two men small doses of papaverine now induce erection. We now recommend SPA before DC to rule out an arterial abnormality. Accurate identification of factors contributing to erectile failure is critical for successful treatment; in this experience candidates for correction of cavernosal leak syndrome were uncommon.

Adolescent↗