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PubMed1995

Management of impotence in a developing country.

Three hundred and seventy five impotent men attended our Andrology clinic between July 1988 and June 1993. Their ages ranged from 20-89 years. Associated factors were diabetes mellitus, testicular failure, trauma, venous leak and hyperprolactinaemia. We categorised them into subgroups of highly educated men with manual dexterity and financial ability but impairment of manual dexterity, financially able but illiterate men, and illiterate poor with or without manual dexterity. Penile prostheses were implanted in 15; 48 were treated with vasoactive substances; 4 with vacuum devices and two had ligation of venous leaks. However, 297 (79%) men did not get the treatment best suited for their problems and received only supplementary hormones and/or psychological reassurance. In the developing countries, the selection of the appropriate treatment modality for impotence is compounded by considerations of economic, social and educational factors.

Adult↗
PubMed1994

[Clinical evaluation of intracavernous self-injection of vasoactive drugs for impotence: a long-term follow-up observation].

From December 1989 to September 1992, nine patients with impotence were instructed to perform intracavernous self-injection of vasoactive drugs. At first 40 mg of papaverine hydrochloride was used in all patients and the response on erection was evaluated. If the response did not show sufficiently functional erection, a mixture of 40 mg of papaverine hydrochloride and 1 mg of phentolamine mesylate or 20 mg of prostaglandin E1 was reinjected. Eight patients had achieved full erections and vaginal penetrations without noteworthy complications during the follow-up period. Out of eight patients, three patients were able to ejaculate and one patient showed recovery of erection. No major side effects were seen. In conclusion, intracavernous self-injection is a useful modality for impotence.

Adult↗
PubMed1995

[Analysis of the results with Rigiscan in 93 impotent patients].

OBJECTIVE: This study was undertaken to evaluate the performance of the Rigiscan in the diagnosis of sexual impotence. METHODS: Erectile nocturnal activity was evaluated by Rigiscan in 93 patients consulting for impotence; mean age 56.8 years. Diagnosis and treatment were performed between October, 1990 and May, 1992. Follow up is currently ongoing. RESULTS: 95.1% of the patients with normal recordings had no organic pathology, and 80% of these recordings were observed on the first night of the study. In ruling out organic pathology, the Rigiscan did not have a higher specificity than the report of early morning erection (EME) by the patients (p > 0.05). Seventy three percent of the pathological results on the Rigiscan studies were associated to organic pathology. This test showed a higher sensitivity than the absence of EME (p < 0.01). Although no pathognomonic diagnostic pattern was found, a flat pattern and uncoupling were highly suggestive of organic disorders. CONCLUSIONS: The Rigiscan is a useful diagnostic tool, especially in patients reporting no EME. Furthermore, the Rigiscan was able to detect almost all the patients with organic pathology.

Equipment Design↗
PubMed1994

[Penile prosthetic implant in the treatment of impotence: our experience].

The aim of this study was to review the current situation of penile prostheses in the treatment of erectile dysfunction and to analyze the indications, degree of acceptability and complications in our experience. From 1987 to 1993, 35 implants were inserted in men suffering from impotence due to different etiologies. The mean age was 54 years and the mean duration of erectile dysfunction was 37 months. Diabetes, vascular disease and pelvic surgery were the most common pathologies recorded. We utilized the penoscrotal approach in 97.14% of the cases and implanted the following prostheses: 12 Hydroflex, 7 Uniflate 1000, 6 Acuform, 4 Mark II, 3 Dynaflex and 3 Alpha 1. The mean follow-up was 38 months. Infection of the prosthesis by Staph. epidermidis was observed in 5.71% of the cases. This infectious complication required removal of the prosthesis. Two patients with a Uniflate prosthesis complained of mechanical failure. Eighty percent of the patients and 74.28% of their partners were satisfied with the results. When asked if they would undergo another operation again if it were necessary, 71.42% answered "yes". Penile prostheses have withstood the test of time and continue to be an effective and valid therapeutic alternative in impotent men. Although the complication rate is low, adequate information must be provided to the patient and partner in order to enhance the results.

Adult↗
PubMed1995

Objective quantification of cavernous endothelium in potent and impotent men.

Penile corporeal lacunar endothelium is active in the local neural control of corporeal smooth muscle relaxation by producing nitric oxide, a potent vasodilator neurotransmitter. Via computerized image analysis we quantified objectively the percentage of endothelial cells in corpus cavernosum tissues of potent and impotent men. Immunohistochemical staining factor VIII was used to identify the endothelial cells. Five normal potent men had a mean of 2.8% cavernous endothelial cells, compared to 2.4% in 12 patients with venous leakage and 2.8% in 10 with arterial disease. Objective quantification showed no difference in the numbers of cavernous endothelial cells between potent and impotent men.

Adult↗
PubMed1995

Systemic sclerosis and impotence: a clinicopathological correlation.

A hypothesis of the mechanism of systemic sclerosis associated impotence was developed by making a clinicopathological correlation between the results of preoperative erectile function testing and those of pathological examination of excised erectile tissue in an impotent man with systemic sclerosis. Preoperative examination revealed firm corporeal tissue with diminished penile stretch capability. Pharmacocavernosometry/pharmacocavernosography under conditions consistent with trabecular smooth muscle relaxation revealed severe diffuse corporeal veno-occlusive dysfunction. During penile implantation surgery the compact erectile tissue was unable to be dilated and required sharp corporeal tissue excision under direct vision to achieve cylinder insertion. Histological investigation of the excised corporeal tissue demonstrated severe corporeal fibrosis. Computer assisted color histomorphometry revealed that the mean percentage of trabecular smooth muscle area to total erectile tissue area was 18.2 +/- 13.9% (normal 40 to 52). Immunohistochemical staining with desmin, a protein found in smooth muscle, verified prolific corporeal fibrosis. In situ hybridization of the corporeal tissue demonstrated messenger ribonucleic acid collagen and fibronectin messenger ribonucleic acid expression. Strong hybridization signals were found in mesenchymal cell types, including trabecular smooth muscle cells. In summary, clinicopathological correlation revealed that veno-occlusive dysfunction and loss of penile length were secondary to the excessive accumulation of extracellular matrix, partially due to trabecular smooth muscle cells undergoing synthetic as opposed to contractile phenotypic activity.

Adult↗
PubMed1994

[Role of color-Doppler in the assessment of erectile impotence: personal experience].

We present our experience with colour duplex sonography in the assessment of 38 impotent men, whose ten underwent radical prostatectomy, following intracavernous pharmacological stimulation with PGE1. All patients with a clinical good response following PGE1 injection had peak cavernosal artery velocities > 30 cm/sec. The remaining suboptimal responders who presented an elevated end-diastolic velocity (> 5 cm/sec) showed a venous leakage demonstrated with cavernosography. Colour duplex sonography is a valuable and non-invasive tool in the assessment of impotence and can provide valuable information in the diagnosis of vasculogenic erectile dysfunction.

Aged↗
PubMed1994

[Psychotherapy combined with use of the vacuum constrictive device for erectile impotence].

Psychotherapy and the vacuum constriction device were used to treat 125 men with different types of erectile impotence. 58 came with their wives (Group 1), the wives of 49 did not agree to come (Group 2), and 18 men did not want to inform their wives of their condition (Group 3). Age ranges and means for the 3 groups were, respectively: 26-82 (56.2 +/- 2.8); 24-80 (53.1 +/- 2.2); and 25-76 (59.3 +/- 2.7). All groups received 6-10 combined treatments, and in all 3 groups there was improvement in the objective parameters of sexual function (nocturnal penile tumescence, penile brachial index, maximal penile rigidity). But only in Group I was there improvement in subjective parameters (spontaneous erection, adequate coitus without the vacuum device). After treatment, successful coitus, with or without use of the device, was achieved in 91.3% of Group I, 69.3% of Group II and 50.0% of Group III. These results indicate that regardless of type of erectile impotence, the greatest degree of success is achieved when the patient comes for treatment together with his wife.

Adult↗
PubMed1993

[Treatment of impotence with intracavernous auto-injections: moxisylyte diminishes the risks compared to papaverine].

The alpha-blocking agent Moxisylyte was tested in auto-intracavernous injections (auto-ICI) in 72 impotent patients. The side-effects were compared to those observed in a group of 34 impotent patients treated with auto-ICI of Papaverine during the same period of time. The Moxisylyte auto-ICI improved 83% of the patients including 68% reporting a complete and durable success. Moxisylyte proved to be safer due to a reduced rate of prolonged erections (1.3% of the patients versus 8.8% with Papaverine) and corporeal fibrosis (1.3% versus 32% with Papaverine). Though less potent than Papaverine, and often seeming insufficient when tested in the office, this type of alpha-blocking agent could be tried in a first time in most candidates to auto-ICI before resorting to Papaverine or Prostaglandin E1 if it fails.

Adult↗
PubMed1994

[Our experience with impotence following radical pelvic surgery].

The etiology of impotence after radical prostatectomy and radical cystoprostatectomy is unclear, although a variety of potential factors have been cited: neurogenic, psychogenic and vascular. Injury to the pelvic nerve plexus and the branches that innervate the corpora cavernosa (cavernous nerves), seems to be the most important iatrogenic factor. The Authors selected 14 patients candidate to radical prostatectomy or radical cystoprostatectomy and studied their potency pre and post operatively by anamnesis and/or Rigiscan test. The sacral-evoked potential was determined in all these patients in order to detect a neurological etiologies. The average latency of the bulbo cavernous reflex was similar in the patients that lost their potency after surgery and in the patients that didn't lose their potency after surgery. The sacral-evoked response seems not to be a diagnostic test in the study of the impotence after pelvic radical surgery.

Arteries↗
PubMed1994

[Male impotence in old age].

Normal aging does not induce impotence, but only modifies the physiology of the erection which, however, allows good sexual intercourse. Impotence, found in 55.0% of the over 75 men, is due to organic or psychogenic causes: above all, penile arterial insufficiency and the collateral effects of drugs for the diseases which often affect the elderly, are the main factors.

Aged↗
PubMed1994

[Diagnostic and therapeutic approach in organic impotence].

The incidence of impotence increases with age. Its etiology is always complex and often multifactorial. The hidden organic causes of impotence are as follows in decreasing order of frequency: arterial, venous, neurological and endocrine. Paraclinical investigation of erection dysfunction plays an important role: hormone levels, arterial Doppler, digitalised rigidimetry, the intracavernous test, cavernometry-cavernography and internal iliac angiography, are used to define the diagnosis and determine appropriate management. It is stressed that supportive sex therapy is often indispensable and that penile prostheses are the final recourse, when treatment based upon etiology has failed.

Endocrine System Diseases↗
PubMedDate not supplied

[Role of arteriography and percutaneous transluminal angioplasty in the diagnosis and treatment of arterial vasculogenic impotence].

High quality arteriographic studies of the iliopudendal vascular tree are mandatory for the correct examination of arteriogenic impotence patients before revascularization procedures. Twenty-three patients with chronic erectile dysfunctions due to stenosis or occlusive arteries diseases of the iliac arteries were treated with percutaneous transluminal angioplasty (PTA) in our Department. A positive clinical result was obtained in 15 of 23 cases (65.2%). The maneuver was successful in 8 of 14 patients with vascular lesions of the common and/or external iliac artery (57%). The erectile dysfunction was resolved in 4 of 6 patients with stenosis of the external iliac artery associated with a stenosis of the hypogastric artery (66.6%). The erectile dysfunction was also resolved in 3 patients with a single vascular lesion in the hypogastric artery. No major post-angioplasty complications were observed. PTA is a repeatable and not very invasive method with a low complication rate and could represent a valuable alternative to surgical revascularization in the patients with associated impotence and claudication of leg and hip. Moreover, it makes the treatment of choice in the patients with erectile dysfunctions due to isolated lesions of the hypogastric arteries.

Aged↗
PubMed1994

The role of nocturnal penile tumescence and rigidity monitoring in the evaluation of impotence.

The inability to achieve or maintain an erection of sufficient rigidity to perform sexual intercourse is a problem that affects between 10% and 20% of men at some time during their lives. Historically, the evaluation of impotence has been limited to history and psychological assessment. Nocturnal penile tumescence (NPT) monitoring is a procedure that can be used in the evaluation of impotence. Performed with appropriate measurement techniques and knowledge of the recording conditions and combined with a complete and accurate sexual history, NPT monitoring is the most effective noninvasive method of determining whether the underlying cause is organic or psychogenic.

Erectile Dysfunction↗
PubMed1993

[Color-Doppler in the study of male sexual impotence].

The authors report their experience with color-Doppler US in the study of 54 male patients with sexual impotence. The examination includes two distinct phases; in between, the erection-inducing drugs is injected directly in the cavernous bodies. During the basal phase, B-mode information relative to both morphology and structure of cavernous bodies is collected. After injecting the drug, systolic and end-diastolic velocities are evaluated as flowmetric indices, together with the resistive index; these variables are derived from cavernous arteries, at scheduled time--i.e., 5, 10 and 20 minutes after the injection. Moreover, the examined patients were divided into 4 groups according to their clinical response to the pharmacologic test. Color-Doppler US proved to be quite sensitive in the identification of the patients with a vascular alteration, both venous and arterial, underlying their erectile dysfunction; as a matter of fact, venous flights are easily depicted with the use of colors. The authors believe that color-Doppler could eventually become a major exam in the diagnosis of sexually impotent patients, thus allowing the marked reduction of such invasive diagnostic techniques as selective angiography of internal pudendum arteries and dynamic cavernosography, which are poorly tolerated by the patients.

Adolescent↗
PubMed1993

[Neurologic and neurophysiologic studies of impotent patients].

A multispeciality approach of impotent patients are necessary to establish the cause of impotence. Neurological history and examination are very important and must be completed by neurophysiological investigations. Bulbo-cavernosus reflex, conduction velocity of the dorsal nerve of penis and pudendal evoked potentials seems the most interesting tests. Urodynamics, perineal EMG, penile vibratory sensibility test can help determination of some peripheral neuropathies. Single potential analysis of cavernous electric activity may be useful in diagnosis of pudendal autonomic dysfunction.

Erectile Dysfunction↗
PubMed1993

[Intracavernous injection of lipo prostaglandin E1 for the diagnosis of impotence: a comparative study with prostaglandin E1-CD].

Intracavernous injection of 20 micrograms prostaglandin E1-CD (PGE1-CD, 8 cases), 5 micrograms lipo prostaglandin E1 (Lipo PG-E1, 8 cases) or 10 micrograms Lipo PGE1 (9 cases) was performed in patients with functional impotence in order to comparatively analyze the diagnostic efficacy of these drugs. Full erection was observed in all patients who received intracavernous injection of 20 micrograms PGE1-CD or 10 micrograms Lipo PGE1. However, full erection was observed in 4 out of 8 patients administered 5 micrograms Lipo PGE1. RigiScan was used on all patients, and latency until erection (achievement of maximum rigidity of the base) after injection, maximum rigidity of the penile tip and base and circumferential expansion rate of the penile tip and base were measured. With regard to these RigiScan data and duration of erection, there were no significant differences among the 3 groups. There were no severe side effects in any of the patients. These findings indicate that 10 micrograms Lipo PGE1 and 20 micrograms PGE1-CD have similar effects and that Lipo PGE1 may be an effective drug for the diagnosis and treatment of impotence.

Adult↗
PubMed1995

Patient satisfaction with current impotence therapy.

One hundred ninety-eight impotent men were evaluated between July 1993 and June 1994. A "patient goal-directed" approach was used in all cases. Treatment options presented to patients included: oral yohimbine, vacuum constriction devices, penile self-injection therapy, penile prostheses, and testosterone supplementation when clinically indicated. Thirty-two percent of patients declined treatment, and 67% chose nonsurgical therapy. Only two patients (1%) chose penile prostheses. In August 1994, a survey addressing satisfaction with therapy was mailed to all patients, and 99 men (50%) responded. Of the treated respondents, 80% stated that their therapy was "easy to use," and 70% reported that they were "able to have intercourse." Patients prefer nonsurgical impotence therapy, which restores satisfactory sexual function in most men.

Adult↗