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PubMed1995

Clinical evaluation of impotence.

With better understanding of the pathophysiology of erectile dysfunction, various causes of impotence can be identified accurately with the help of different investigation modalities. However, it is controversial as to what extent investigations are considered as adequate because most of the time they do not influence patient management. The clinical evaluation of erectile dysfunction should include a thorough sexual and medical history and physical examination. Further special investigations such as nocturnal penile tumescence studies, duplex ultrasonography, dynamic infusion cavernosometry and cavernosography, and arteriography should only be ordered logically after careful consideration of whether they will affect patient outcome. Therefore in this review, we aim to evaluate critically these different special investigations with regards to their indications and pitfalls so that a logical approach to the evaluation of impotence can be obtained.

Erectile Dysfunction↗
PubMed1995

[Impotence: non-hormonal drug therapy. Old and new drugs].

The treatment for male impotence has undergone a radical change during these last years. This change is due mainly to the use of vasoactive drugs and more and more sophisticated prosthesis. The Authors discuss old and new drugs used, considering that often pharmacotherapy for impotence doesn't require the giving of a drug, but its suspension. The Authors mention, among the most active drugs, trazodone, yohimbine, pentoxifylline and L-arginine hydrochloride. However these pharmacological agents found only application to well defined and unfortunately limited cases. To day the ideal therapeutic agent is still not available. There is a need for continued research in this field; the initial results, like the ones on the erective mechanisms NO-dependents, give hope for the future.

Erectile Dysfunction↗
PubMed1996

Impotence and incontinence after immediate realignment of posterior urethral trauma: result of injury or management?

PURPOSE: We examined further whether the injury or method of management is responsible for impotence and incontinence after immediate realignment of prostato-membranous urethral disruptions. MATERIALS AND METHODS: A total of 20 patients with complete urethral disruptions treated with immediate realignment (group 1) was compared to 12 with partial or complete injuries treated with retrograde catheterization alone (group 2). Followup status was obtained by patient questionnaire or telephone interview. RESULTS: Of the patients 83% in group 1 and 80% in group 2 are continent, and 76% and 70%, respectively, regained erections suitable for sexual intercourse. CONCLUSIONS: The results suggest that impotence and incontinence in this setting are the result of the injury and not of attempts at immediate surgical management.

Erectile Dysfunction↗
PubMed1977

The hypnotherapeutic treatment of impotence.

Fifty cases of primary and secondary impotency are presented. A breakdown of the patients as to age shows that the problem is wide-spread from youth to middle-age; in this study there was a mean age of 29.40 years. All patients who remained in therapy were able to perform sexually at the time of their discharge. In followup of 66% of the patients, all stated they were doing well except for two. Hypnosis used as an uncovering modality is shown to be markedly effective. This, incorporated with ego-strengthening and new self-image suggestions, seems to be the treatment of choice for psychogenic impotence.

Adolescent↗
PubMedDate not supplied

Difference in glycohistochemical lectin staining of collagen fibers in the corpora cavernosa of normal and impotent men.

The objectives of this study were to investigate the value of glycohistochemical staining with three lectin types specific to a particular glycan structure (Arachis hypogaea [PNA], Triticum vulgare [WGA], and concanavalin A [Con A]) as a method of defining possible changes in the collagen structure in the corpora cavernosa in potent and impotent men. The study group consisted of 4 normal potent men and 22 men with various etiologies of impotence. The quantitative histochemical measurements were performed by means of a cell image processor. Two variables for each of the three types of lectins were studied. These were the mean optical density (MOD), which relates to glycohistochemical staining intensity, and the labeling index (LI), which is positively related to the percentage of immunostaining. Only WGA staining made it possible to discriminate significantly between the normal and pathological groups under study. The two parameters (LI, MOD) were significantly higher in the case of WGA staining in the normal group (P = 0.004 and 0.013, respectively). In contrast, only the mean LI value, in the case of the psychogenic and venogenic patients, reached a level of statistical significance (P = 0.005 and 0.001, respectively), when it increased from PNA through WGA to Con A histochemical staining. The two variables (LI, MOD) changed markedly from PNA through WGA to Con A in the arteriogenic patients (P = 0.003 and P < 0.001, respectively). WGA is of diagnostic value in distinguishing between normal and abnormal collagen in the corpora cavernosa. The difference in the lectin staining of the other groups, particularly the arteriogenic group, may be attributed to alterations in the glycosylation of the procollagen that are probably due to changes in the partial pressure of oxygen (PO2) level, an important cofactor in normal glycosylation. WGA staining may therefore be used as a marker to distinguish true psychogenic patients from those with organic diseases. Moreover, it may be used as an additional parameter in selecting the best candidates for penile revascularization.

Adult↗
PubMed1997

Safety and efficacy outcome of mentor alpha-1 inflatable penile prosthesis implantation for impotence treatment.

PURPOSE: We investigated safety and efficacy outcome pertaining to the Mentor Alpha-1, 3-piece inflatable penile prosthesis for impotence treatment. MATERIALS AND METHODS: A 2-phase, multi-institutional, large scale retrospective study, with independently analyzed medical record (phase I) and questionnaire (phase II) data from consecutive eligible patients of 7 physician investigators was performed from March to October 1993. RESULTS: In phase I there were no morbidities of any type in 394 of the 434 patients (90.8%) (mean age 61 years, range 24 to 88) who underwent Alpha-1 implantation (mean followup 22.2 months, range 0.67 to 44.5). The risk of prosthesis malfunction (fluid leak and auto-inflation) was 2.5%. No cylinder aneurysms were reported. A total of 93.1% of Alpha-1 devices was free from explantation (4.4%) or revision surgery (2.5%) for approximately 2 years from the original implant date. Kaplan-Meier actuarial analyses revealed that cumulative survival of the Alpha-1 prostheses at 12, 24 and 36 months was 98 +/- 1%, 93 +/- 2% and 85 +/- 7% until device malfunction, and 91 +/- 2% 83 +/- 4% and 75 +/- 7% until surgical intervention (revision or explantation). In phase II 89% of the men claimed fulfilled expectations with the Alpha-1 prosthesis as impotence treatment. Satisfaction responses 80% or greater were noted with regard to intercourse ability and confidence, and device rigidity and function. Implantation did not result in greater than 80% satisfaction in partner relationships or feelings (as judged by the patient), social or work confidence, or intercourse frequency. Factors adversely affecting satisfaction included partner feelings of dissatisfaction (as judged by the patient), specific physician investigators and need for explantation/revision surgery. CONCLUSIONS: In 1 of the largest multi-institutional implant outcome studies thus far performed, safety and efficacy data concerning the Alpha-1 contemporary inflatable device were found markedly improved over earlier inflatable prostheses and now compare favorably with historical data from noninflatable rod type devices.

Actuarial Analysis↗
PubMed1997

Impotence and its non-surgical management.

Impotence is a common symptom which can cause considerable distress to both the sufferer and his partner. The use of pharmacotherapy to improve erectile function will continue to increase as safe and effective drugs are developed. However, restoring erectile function should not be the only treatment objective. It is also essential to address personal and emotional factors in the sufferer, conflicts in his relationship with his partner, and sexual problems in his partner, all of which may be instrumental in causing or maintaining the presenting impotence. We advocate a combined approach with appropriate medical treatment and sex and couple therapy.

Adult↗
PubMedDate not supplied

Use of the AMS inflatable penile prosthesis in the management of erectile impotence.

Penile prostheses have become widely accepted in the management of erectile impotence. We report on 21 patients, aged from 22 and 65 years, who were implanted with AMS inflatable prostheses. Diabetes Mellitus, peripheral vascular disease, radical pelvic surgery and Peyronie's disease were among the most common aetiological factors in our patients. Psychogenic impotence was the indication for implantation in one patient. Two patients developed complications that required explantation of their devices. One additional patient who has a functioning device considers this form of assisted erection too artificial and has declined to use it for aesthetic reasons The AMS inflatable prosthesis effectively restores erectile function when initial conservative therapies have failed.

Adult↗
PubMed1997

Clinically occult Leydig cell tumor in a cryptorchid man. Report of a case presenting with unilateral gynecomastia and impotence.

Left painful breast enlargement and impotence were the main complaints of a right cryptorchid young man. On ultrasonography a hypoechoic mass was found in the right testis. Postoperatively the increased level of estrogens and the decreased levels of testosterone were normalized 6 months following the orchiectomy, gynecomastia subsided considerably and the impotence improved quite satisfactorily.

Adult↗
PubMed1997

[Drug induced impotence].

Medication induced impotence has been reported in the some papers. However, it is unusual to talk about the sexual history in a general clinical interview and there are few reports to show the possible mechanisms of induced sexual dysfunction in Japan. Recently, the average life span of the Japanese population has gradually increased, so now we have a chance to evaluate the sexual history from older people. Some drugs, such as diuretics, antiarrtythmic and antihypertensive drugs, were reported to induce impotence, however, there was not a detailed study in Japan. We studied the effect of cardiovascular medicine to sexual dysfunction in 1,000 patients. Almost all medication did not always reduce sexual activities, however, sexual activities in old people might decrease because of medications or sickness. It is important for the general physician to ask the patients about general conditions including sexual history while on medications.

Adult↗
PubMed1998

Factors in predicting initial in-office therapeutic dosages of alprostadil for the treatment of organic impotence.

The use of intracavernous penile injections of alprostadil for treating organic impotence is well-established. Using blood pressure measurements, especially systolic BP and MABP as measured in a flat supine position, the dosage of alprostadil required to achieve satisfactory erections in men with organic impotence can be predicted. This guidance can significantly influence the outcome of therapy by reducing the number of titrated diagnostic injections and the time required for the patient to achieve satisfactory results.

Adult↗
PubMed1998

Impotence and perceived partner support.

Because impotence has both physiologic and psychologic components, it seems that impotent patients might benefit from a holistic approach to treatment that includes a medical regimen for physiologic factors as well as treatment for social and psychologic factors. The spousal relationship is one social and/or psychological factor. Often, a male experiences his sexual dysfunction as profoundly stressful while the partner finds it annoying or disturbing, but not threatening to the overall bond between them (Rust, Golombok, & Collier, 1988). This study was conducted to explore patient perception of the spousal (partner) relationship during admission to an erectile dysfunction clinic.

Adult↗
PubMed1996

Ultrasound evaluation of the penis for assessment of impotence.

Image directed Doppler ultrasonography of the cavernous arteries provides functional, quantifiable assessment of penile arterial flow during a pharmacological erection. In this respect, this modality is superior to arteriography as a means of evaluating arteriogenic impotence. Peak flow velocity, arterial dilatation, and vessel pulsation are the most reliable ultrasonic indicators of arterial health. Aberrant arterial anatomy should be noted as this may contribute significantly to total penile blood flow. A thorough understanding of erectile physiology and anatomy is necessary to properly perform and interpret Doppler ultrasound results.

Humans↗
PubMed1997

Laparoscopically assisted penile revascularization for vasculogenic impotence: 2 additional cases.

PURPOSE: Microsurgical revascularization of the penis in vasculogenic impotence is an accepted surgical procedure in young men with a history of blunt pelvic or perineal trauma. Most penile revascularization techniques use the inferior epigastric artery in direct artery-to-artery revascularization or dorsal vein arterialization procedures. To obviate the wide pararectal incision laparoscopic mobilization of the inferior epigastric vessels has been recently proposed. We present 2 cases of successful laparoscopically assisted penile revascularization. MATERIALS AND METHODS: With the patient under general anesthesia the first trocar was inserted in the umbilical region and pneumoperitoneum was induced. Two other trocars were positioned laterally. As soon as the inferior epigastric vessels were accessed, dissection was initiated below the level of the arcuate line. The vessels were dissected cephalad en bloc to a point of bifurcation of the inferior epigastric artery above the umbilical level. The inferior epigastric pedicle was ligated with clips and transected at the cephalad edge of the dissection. It was then mobilized and tunneled through an infrapubic incision at the base of the penis for subsequent microvascular anastomosis with the penile vessels. RESULTS: The anastomosis was patent and hemostasis was satisfactory. Operative time in the 2 cases was 4.3 and 5.2 hours, respectively. At 3 months both patients reported complete erections. CONCLUSIONS: Our experience confirms the extremely practical use of laparoscopy which, due to its magnification power, makes it possible to perform fast, accurate excision of the epigastric bundle. Moreover, a wide pararectal incision, which is a frequent cause of postoperative complications, is avoided.

Humans↗
PubMed2001

Therapeutic effects of high-dose isoxsuprine in the management of mixed-type impotence.

OBJECTIVES: To determine the effectiveness and safety of high-dose isoxsuprine for the treatment of mixed-type erectile dysfunction. METHODS: Forty-four patients who had vasculogenic impotence diagnosed on the basis of their sexual history, physical examination, laboratory analysis, polysomnographic recording of nocturnal erections, and dynamic color Doppler sonography of the cavernosal arteries were entered into a randomized, double-blind, placebo-controlled, crossover comparison of a placebo with high-dose isoxsuprine hydrochloride (60 mg/day orally). The treatment consisted of two 30-day courses. After a 14-day washout period, the patients who initially received the placebo for 30 days switched to isoxsuprine hydrochloride for 30 days and vice versa. Erectile function, ejaculation, interest in sex, and physical examination findings were investigated before treatment and at the end of each drug period. RESULTS: Thirty-six patients (82%) completed the entire treatment schedule. Positive clinical results (complete and partial responses) were obtained in 6 men (16.6%) at the end of the isoxsuprine phase and in 7 men (19.4%) after the placebo period. The statistical analysis disclosed no significant difference when isoxsuprine was compared with placebo (P >0.05). Significant drug-related adverse effects occurred in the isoxsuprine group and treatment was discontinued in 2 patients. CONCLUSIONS: Isoxsuprine is no better than placebo as a first-line treatment for mixed-type erectile dysfunction.

Adult↗
PubMed2003

[Veno-occlusive dysfunction as a cause of erectile impotence: therapy of venous leak with retrograde embolization of the internal pudendal vein].

"Venous leak impotence" remains a therapeutic challenge as long term success rates with all interventions are only 50%. Surgical venous ligation is a well established procedure, yet not all pathological venous groups can always be occluded. Retrograde embolisation of angiographically identified pathological venous groups represent a promising alternative to surgical isolation and antegrad embolisation of deep dorsal penile veins. Four young men (19-42 years) presented with complete loss of erection. Vaginal intercourse was impossible. Pharmaco-duplex sonography with Prostaglandin E, 10-20 micrograms demonstrated normal arterial flow in all 4 penile arteries but even after intra-cavernosoal injection of Prostaglandin E, 20 micrograms no complete erection was achieved. Dynamic infusion cavernosometry showed increased maintenance flow. Cavernosography showed a venous leak involving the deep dorsal penile vein in all four cases. Embolisation was carried out via the femoral vein by coaxial technique using Histoacryl-Lipiodol solution in order to embolise all angiographically identified insufficient veins. At one year follow up all 4 patients still achieved spontaneous erections without any additional medical treatment.

Adult↗
PubMed1997

Vascular surgery for impotence: a review.

Progress in treatment of impotence in the past two decades has resulted in impressive advances. While most men respond to medical therapy including prostaglandin E1 injection or the more recent use of urethral alprostadil, 6-7% of men fail to respond to these treatments or vacuum devices. This review considers current and past results of vascular surgery in this group of men. Guidelines for case selection for vascular interventions as well as reporting criteria are suggested. Vascular surgery as a logical first step in selected patients may offer an advantage in men failing conservative therapy and for those not desiring prosthetic implantation.

Humans↗
PubMed1996

Vasoactive intestinal peptide and impotence in experimental diabetes mellitus.

OBJECTIVE: To determine whether a defect in vasoactive intestinal peptide (VIP)-mediated vasodilatation underlies diabetic impotence. MATERIALS AND METHODS: Rats treated with streptozotocin for 8 weeks developed diabetes, as shown by hyperglycaemia and glycosuria, and had significant impairment of sexual function, as determined by tests of sexual behavior. The VIP content of the penis and major pelvic ganglion, the VIP release by the penis in vitro and the responsiveness of the vasculature of the penis in vivo to intracavernous VIP injection were determined. RESULTS: In diabetic rats, the VIP content of the major pelvic ganglion and penis was markedly increased, while the acetylcholine content of the penis was normal. The amount of VIP released in vitro by high potassium concentration or veratridine was similar for penile tissue slices of normal and diabetic rats. Intracavernous injection of VIP induced erection in the control rats but not in diabetic rats, whereas intracavernous injection of the adenylate-cyclase activator forskolin produced erection in both control and diabetic rats. CONCLUSION: Because VIP induces vasodilatation by activating adenylate cyclase, and forskolin produced erection in the diabetic rats, the failure of VIP to produce erection in these rats is unlikely to be due to a defect in the second-messenger mechanism or in the properties of vascular smooth muscle. Thus, a defect at the level of the VIP receptor or of the associated G-protein possibly explains the failure of intracavernous VIP to produce erection in the diabetic rats. Hence, an abnormality in VIP is a component of sexual dysfunction in the diabetic rat and the defect is at the level of the VIP receptor or associated G-protein.

Acetylcholine↗