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At least 757 records · Page 42Linked to original sources
PubMed1996

Effect of intracavernosal sodium nitroprusside in impotence.

Recent studies have shown an important role for nitric oxide (NO) in cavernous smooth muscle relaxation. In this study the intracavernosal effects of the NO donor sodium nitroprusside (SNP) were investigated in 32 patients with erectile dysfunction. Erectile response and penile blood flow were investigated following intracavernosal administration of 360 micrograms SNP and 60 mg papaverine for diagnostic purposes. In all of 32 patients the erectile response to SNP was not better than that to papaverine. Haemodynamic evaluation of the deep penile arteries was carried out by colour duplex Doppler sonography after administration of SNP and papaverine. No differences in peak flow velocities were measured, but the increases in diameter and end-diastolic velocities were higher after SNP than after papaverine. Our data suggest that the NO donor SNP is not a new alternative agent for diagnosis and treatment of impotence.

Adult↗
PubMed1996

Judgment of color Doppler ultrasound with respect to cavernous artery occlusion pressure in dynamic infusion cavernosometry when evaluating arteriogenic impotence.

This prospective study was designed to compare the parameters obtained by color Doppler ultrasound to cavernous artery occlusion pressure measured by dynamic pharmacoinfusion cavernosometry in evaluating arterial components of erectile dysfunction. Four indexes were determined as parameters of sonography to indicate arterial competence. Indexes 1 and 2 reflected peak systolic velocities with respect to the cut-off values 25 and 30 cm/s after pharmacological stimulation with 60 mg papaverine hydrochloride respectively. Index 3 was the percentage of diameter changes in cavernosal arteries which was expected to be > 75%. The sum of the percents of increases in diameters of both cavernosal arteries which should be > 200, formed index 4. The sensitivity, specificity, positive predictive value and accuracy rates were 76, 100, 100 and 90% for index 2. These values were 50, 100, 100 and 71% for index 1. Very low statistical values were obtained for indexes 3 and 4. Although the gold standard in the diagnosis of arterial impotence is pharmacoangiography, color Doppler sonography using the parameter peak systolic flow rate > 30 cm/s may be a reliable, easily obtained, noninvasive technique for evaluating arterial components of erectile dysfunction.

Adult↗
PubMed1997

Is deep dorsal vein arterialization an alternative surgical approach to treat venogenic impotence?

OBJECTIVE: Several surgical techniques have been applied for the treatment of cavernosal venous leakage, sufficient enough to create erectile dysfunction. In light of the variable success rates, we report our experience with deep dorsal penile vein arterialization for the management of severe cavernosal venous leakage. PATIENTS AND METHODS: Twenty-four impotent patients with venous leakage were treated by the Virag-II type of end-to-end anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally. Diagnostic evaluation included color flow Doppler sonography before and after intracavernous 60 mg papaverine injection and dynamic cavernosometry/ cavernosography, which indicated veno-occlusive dysfunction in 28 patients. Revascularization was technically possible in 24 of the patients, although in 4 anastomosis could not be achieved due to the poor quality of the inferior epigastric artery. RESULTS: Five patients had early occlusion in the immediate postoperative period and 4 had late occlusion within 8 months. Potency was improved initially in 9 (38%) of the 24 patients in whom successful anastomosis had been achieved, with longer term improvement in 6 (25%) of 24 who realized restoration of erectile potency as defined by clinical investigations. The mean follow-up was 24 months (range 3-36 months). CONCLUSION: We believe that anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally in cases of venous leakage results in a low success rate due probably to a pancavernosal alteration in corporal tissue compliance.

Adult↗
PubMed1994

Penile vein ligation for venogenic impotence.

We have performed penile vein ligation on 35 patients with venogenic impotence from July 1989 to December 1991. The criteria for surgery were (1) age less than 60 years; (2) negative vasoactive agent intracavernous injection but normal penile arterial function, and (3) abnormal venous leakage documented by dynamic infusion cavernosometry and cavernosography. The procedure in venous ligation is excision of the deep dorsal vein from coronary sulcus to pubic arch, and ligation of cavernous veins after identification. The average follow-up was 27.5 months (range 12-37 months) for 30 patients. The 2 patients who revealed no erection at all immediately after operation had dense adhesion of penile hilar region caused in one case by severe pelvic trauma and in the other by pubic bone fracture. Twenty-eight (93.3%) patients were found to sustain excellent erection within 3 months postoperatively. However, only 12 (40.0%) patients sustained spontaneous erection at long-term follow-up, while another 7 (23.3%) responded to intracavernous injection. It is worth mentioning that tortuous and marked dilation of the deep dorsal vein and/or cavernous veins were found intraoperatively in 6 patients who were observed to have excellent erections postoperatively. Inadequate elimination of the leakage veins, especially crural veins, is the most likely factor in those who had a recurrence of erectile dysfunction. However, the corpus cavernosum, particularly a myopathic condition or inadequate neurotransmitters, also plays an important role. Complications included shortness of penis (3 patients), penile deviation (3), numbness of glans penis (4) and wound infection (1).(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed1997

Laparoscopic mobilization of the inferior epigastric artery for penile revascularization in vasculogenic impotence.

A laparoscopic approach was used for penile revascularization in a patient with vasculogenic impotence to avoid the long abdominal incision which was traditionally required to harvest the inferior epigastric artery as a neoarterial source. Despite the time-consuming nature of laparoscopy, this procedure was as efficacious but less morbid and required less convalescence than open revascularization. Whether more patients may benefit from this procedure must be evaluated in further studies.

Epigastric Arteries↗
PubMed1995

Impotence associated with blunt pelvic and perineal trauma: penile revascularization as a treatment option.

Erectile dysfunction (impotence) is a well-known complication of blunt pelvic and perineal trauma. The mechanism of injury is usually related to the trauma itself, via shearing of the penile blood vessels in the pelvis, or via direct trauma to the blood vessels in the perineum. The diagnostic evaluation of these patients should include evaluation of the nervous supply of the penis, the penile arterial tree and the veno-occlusive mechanism. Penile revascularization is a reasonable treatment option for this group in that many injured patients are young and show arterial injury, with minimal or no veno-occlusive dysfunction. Proper patient selection and precise operative technique should allow for restoration of erectile dysfunction in these patients.

Humans↗
PubMed1994

Diagnosis and treatment of vasculogenic impotence.

In this review the authors discussed the diagnosis and treatment of vasculogenic impotence. They evaluate the different diagnostic methods and treatment possibilities for the everyday clinical practice. The surgical procedures need to be done by qualified specialists who are familiar with penile anatomy and trained in microvascular surgical techniques.

Humans↗
PubMed1995

[Efficacy of Doppler color echography in the diagnosis of caverno-venous leakage in the impotent patient].

Duplex sonography is now the gold standard for the non-invasive study of cavernous arteries. Many authors consider that this technique allows for the exploration of the veno-occlusive system and can detect venous leakage. The most common criteria is an end diastolic velocity > 5 cm/s, measured in the cavernous arteries. In a retrospective study, 34 impotent patients were reviewed. All of them were explored both by doppler sonography and pharmacocavernosometry to assess the efficacy of duplex sonography in detecting venous leakage. The data show that the doppler detects venous leakage in only 41%. The specificity and the sensitivity are both 50% which is clearly disappointing. Therefore, in our experience, duplex sonography is not a reliable technique to detect venous leakage. We consider that the best method is still pharmacocavernosometry.

Arteries↗
PubMed1995

[Penile prosthesis in case of impotence: 12 years of clinical experience].

Among 95 patients who have received a penile prosthesis between 1982 and 1993 (mean follow up of 46 months), 21 (22%) presented complications requiring one or more reintervention(s). Only for two patients the problem was mechanical, in the majority, they were non mechanical. Five of those subjects (5.5%) presented such complications that definitive explanation of the device was necessary. The problems presented by the 9 remaining patients were fully satisfactorily managed. Presently 94.5 per cent of the patients are using the device. Follow-up study of our interdisciplinary group demonstrates the efficacity of the prosthesis for revitalisation of the couples. The definitive parameters of implantation acceptance are essentially the partner influence and the treatment cost. This clinical study shows that the implantation of a penile prosthesis is an effective therapy in the treatment of impotence in a selected population. Presently, the mechanical reliability of different device has been good to date.

Adult↗
PubMed1994

Early history of venogenic impotence.

As early as 1860, innovative research defined the neural and vascular phenomena which generate male sexual tumescence. Sophisticated animal experiments provided important data about enhanced arterial inflow and occlusion of venous outflow which cause and maintain erection of the penis. On the basis of these observations, various treatment strategies for impotence, like sclerotherapy or surgical ligation to improve penile venous occlusion, have been attempted since 1873. In this historical review, I assert that contemporary theories of the role of penile venous occlusion during tumescence reiterate ideas proposed more than a century ago.

History, 19th Century↗
PubMed1994

Adenosine: a new agent in the diagnosis of impotence.

The haemodynamic effects of different dosages of adenosine were studied using colour flow Doppler sonography (CFDS) in 33 men, whose penile vascular bed responded well to papaverine. In six cases, we injected 25, 50, 100, 250 micrograms dosages of adenosine intracavernously at 15 min intervals and no erection occurred. However, 500 and 1000 micrograms doses of adenosine increased the arterial blood velocities for a few seconds in five cases. Later on, in eight cases, we infused 80 and 120 micrograms/kg/min adenosine for 3 min and only with 120 micrograms/kg/min dosage, did we observe clinical response and significant changes in CFDS parameters. Finally, 120 micrograms/kg/min adenosine dosage was infused for 10 min in 14 men and eight showed full erection while six had only tumescence. As adenosine was rapidly metabolized by adenosine deaminase, the erection lasted for only 5 to 13 min. No prolonged erection and no other side-effect was observed. In addition no fibrosis and curvature was detected 6 months after the injections. We found that, in men, 10 min infusion of 120 micrograms/kg/min adenosine increased the arterial flow and to some extent venous resistance, resulting in full erection or tumescence. Therefore, adenosine may be used as an agent for the diagnosis of vasculogenic impotence, but further studies for determining the standard dosage of adenosine are needed.

Adenosine↗
PubMed1995

Deep dorsal vein arterialization in arteriogenic impotence: use of the dorsal artery as a neoarterial source.

Deep dorsal vein (DDV) arterialization has developed as a treatment option for patients with arteriogenic impotence, especially in situations where artery-to-artery bypass is not feasible. The inferior epigastric artery (IEA), harvested through a lower abdominal incision, has usually served as the neoarterial source. Using dynamic infusion cavernosometry and cavernosography (DICC) to evaluate arterial and venous erection factors and pudendal arteriography to define arterial anatomy, we have identified 16 patients with cavernosal artery (CA) obstruction and a normal dorsal artery (DA) to serve as the neoarterial source. All patients were less than 50 years old (mean 34.8 +/- 8.6 years). During DICC, the gradient between systemic and CA systolic occlusion pressures averaged 38.7 mmHg. Two patients showed moderate and two minimal corporal veno-occlusive dysfunction (CVOD). From 1991-94, all 16 underwent microscopic DA-DDV arterialization. Four of these patients also underwent venous ligation procedures and three had IEA bypass to the other DA. With adequate follow-up in 15 men, the results for six are considered excellent or normal (40%); eight improved (53.3%) and one was unchanged. In the improved group are three men who did not respond adequately to maximum penile injection therapy before surgery but used small doses afterward with success. Of the three smokers in the series, two were improved and one unchanged. Excellent results were found in four of five men (80%) under age 30 but only one of five (20%) over age 40. Complications included two instances of penile shortening and one of glans hyperemia requiring reoperation. By avoiding an abdominal approach, operative times, morbidity and recovery were substantially shortened. This operative approach can provide an excellent treatment for nonsmokers with CA obstruction and a normal DA.

Adult↗
PubMed1996

[Epidemiology and treatment of long-term male impotence].

Male impotence has assumed increasing clinical importance and the perfection of diagnostic and therapeutic methods has opened new horizons for medical treatment. The aim of this paper is to provide a review of the epidemiology of this disorder with the relative diagnostic and therapeutic correlations. The authors report a series of 161 patients who were treated for one year at most with prostaglandin E1 (Alprostadil alpha-cyclodextrin).

Adult↗
PubMed1984

Radiation-associated impotence. A clinical study of its mechanism.

External beam pelvic irradiation in men is frequently complicated by erectile dysfunction. We tested the erectile function in 23 patients (mean age, 65 years) who received radiation therapy for prostate cancer. Fifteen patients experienced changes in erectile potency following radiotherapy. Neurological, endocrine, and vascular testing revealed abnormalities in 0, 5, and 15 of these patients, respectively. In two, arteriography revealed bilateral occlusive disease in the distal internal pudendal and penile arteries overlying the pelvic radiation field. A significant difference with cigarette smoking was found among the 15 patients whose erectile capacity decreased and the four patients whose capacity remained unchanged. Vasculogenic impotence is the most consistent organic erectile abnormality in RAI.

Aged↗
PubMed1995

Erectile impotence in multiple sclerosis: a neurophysiological study.

Pudendal evoked potentials, motor evoked potentials of the bulbocavernosus muscle to magnetic stimulation and bulbocavernosus reflex were recorded in 34 patients with multiple sclerosis (MS). Responses were delayed in 26, 20 and 3 cases respectively. No relationship was found between neurophysiological abnormalities and the presence or severity of erectile dysfunction, showing that these tests have little diagnostic usefulness in MS patients with impotence. Nocturnal penile tumescence was assessed in 14 cases: the test result was normal in 10 patients, including 3 severely paraplegic subjects.

Adult↗
PubMed1984

[Sexual function after vascular surgical interventions in the aortoiliac area--causes and the avoidance of impotence].

Neurogenic and vasculogenic impotence after aortoiliac reconstruction is an unpleasant problem in vascular surgery. The importance of maintaining or restoring intraoperatively a sufficient hypogastric artery blood flow is emphasized. Postoperative neurogenic sexual disabilities are irreversible and are due to interruption of sympathetic nerve fibers supplying the genital system. Dissecting the terminal aorta and the iliac arteries the hypogastric sympathetic plexus--which descends across the bifurcation--can be easily damaged. This is the cause of the high incidence of failure of ejaculation after aortoiliac surgery. In order to avoid this neurogenic sexual dysfunction a retromesenteric approach to the aortoiliac region is anatomically suggested by A. v. Hochstetter. It enables the exposure of the abdominal aorta and the iliac arteries without disrupting the superior hypogastric plexus and its variants. Respecting the integrity of the sympathetic plexus and a sufficient flow in the internal iliac artery the frequency of postoperative disturbances of erection was reduced from 17% (1199 patients) to 12.3% (570 patients). The incidence of postoperative loss of ejaculation in the same groups of patients decreased from 81% to 20%.

Aorta, Abdominal↗
PubMed1979

Treatments of premature ejaculation and psychogenic impotence: a critical review of the literature.

Research on the treatments of premature ejaculation and psychogenic impotence is reviewed. Problems with the existing definitions of these disorders are discussed. The studies are reviewed under seven major headings: depth therapies, behavior therapies, hypnosis, drug therapy, mechanotherapy, reeducative and supportive therapies, and extensive retraining programs. Most of the studies were case reports. Considerable methodological weaknesses were found, most notably the failure to specify subject and treatment variables, the confounding of treatment methods, inadequate or nonexistent control groups, limited, if any, follow-up assessments of treatment effects, and a failure to obtain partner validation of subjects' progress. The studies which used systematic desensitization and the studies which assessed the extensive retraining programs reported the most consistently positive results, although better-controlled replications are needed. Among other issues, it was suggested that future investigators examine the impact of treatment of homogeneous samples and conduct controlled comparisons of different treatment methods.

Artificial Organs↗