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PubMed1987

Use of sexual history to differentiate organic from psychogenic impotence.

The use of sexual symptomatology to differentiate psychogenic from organogenic impotence was studied. All patients were independently classified based on the evaluation of a minimum of one night of nocturnal penile tumescence recording, a sleep lab technician's rating of penile turgidity of erections, Doppler determination of penile blood flow, determination of serum prolactin and testosterone levels. Three aspects of symptomatology significantly discriminated the criterion groups. The single best predictor was the presence or absence of early morning erections as reported by the patient.

Diagnosis, Differential↗
PubMed1982

Referral of impotent patients to a sexual dysfunction clinic.

The referral pattern of impotent men from a urology clinic to a sexual dysfunction clinic was investigated. Only 62% of referred patients made such recommended appointments. Of the patients for whom sex therapy was recommended, only 32% accepted this recommendation. Of those accepting a recommendation for treatment, 57% prematurely terminated treatment against medical advice. The implications of this for referring physicians and alternative treatment approaches are discussed.

Erectile Dysfunction↗
PubMed1989

Surgical treatment of impotence due to venous outflow.

Coital impotence was studied in 94 patients. In 14 of them the history, as well as the papaverine-induced erection, penile Doppler test and dynamic cavernosography suggested venous outflow as a basic process. In 13 who underwent surgery, the draining vein visualized by dynamic cavernosography was tied down. Seven patients now have spontaneous erection, four present it upon intravenous papaverine injection. Two operations failed: one for an existent spongiocavernous fistula, the other for the development of collateral circulation in the early phase.

Adult↗
PubMed1995

Treatment of penile incarceration in an impotent patient.

We report a case of penile incarceration in a 53-year-old impotent man. The base of the penis was encircled by a metal ring in order to achieve better erection. There was marked oedema of the entire penis distal to the constricting ring. The metal ring was removed successfully by cutting it with a steel saw.

Constriction↗
PubMed1988

Transluminal penile venoablation for impotence: a progress report.

Based on theoretical advantages and successful pilot experiments in dogs, therapeutic transluminal penile venoablation underwent clinical trials in 13 impotent men. Catheter access to the penile venous structures was gained via (1) direct percutaneous puncture of the deep dorsal penile vein, (2) cut-down over the dorsal vein of the penis, or (3) retrograde catheterization of internal or external pudendal veins from a femoral vein. Alternatively, needle access only was gained into (4) the preprostatic plexus or the pudendal vein, (5) the superficial penile vein, or (6) the crura. Once venous access had been gained, selective venography was performed to clarify the relevant anatomy in each case. After catheterization, venoocclusion was produced by embolization with combinations of coils and Gelfoam, followed by sclerosant. Results to date indicate high feasibility of access by a variety of methods, and the safety of transluminal venoablation. Clinical efficacy to date seems only moderate. Eight of 13 patients report subjective improvement in the quality of erections after a mean follow-up period of 5.2 +/- 2.4 months. With regard to sexual activity, 2 patients are considered cured, 2 improved sufficiently for sexual intercourse, and 9 were insufficiently improved for intercourse. Of the nine failures, two were considered cures for 3 weeks, but then relapsed for unknown reasons. Two of the 4 patients that regained potency had concomittant unilateral or bilateral pudendal arterial occlusions. Technical modifications for improving results are under continuing investigation.

Adult↗
PubMed1997

Gadolinium-enhanced magnetic resonance angiography of the pelvis in patients with erectile impotence.

This study evaluated the potential of contrast-enhanced digital-subtraction magnetic resonance angiography (CE-DS-MRA) for noninvasive angiographic delineation of the arterial supply of the penis in patients with erectile dysfunction. After induction of an erection with prostaglandin E, a three-dimensional fast imaging with steady-state precision (FISP) sequence with TE of 1.8-2 milliseconds, TR of 4.4-5 milliseconds, and flip angle of 40 degrees-60 degrees was used to obtain high-resolution angiograms of the pelvis and penis during the injection of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) 0.3 mmol/kg body weight, within 30-50 seconds. DS maximum intensity projections (MIPs) and multiplanar reconstructions (MPRs) were compared with clinical work-up and directional Doppler ultrasound in 11 patients. In all 11 patients (100%), the arterial supply of the penis could be delineated from the aortic bifurcation via the iliac and internal pudendal arteries to the dorsal and deep penile arteries. Of the 22 internal pudendal arteries, 6 (27%) were occluded on CE-DS-MRA and 5 (23%) had stenoses, of which 4 (18%) were greater than 50%. In 7 patients (64%) good correlation between CE-DS-MRA and clinical findings and/or Doppler ultrasound was found; in 2 patients (18%), the correlation was moderate, and in 2 patients (18%) results were discrepant. In 6 patients (55%), MRA provided additional information to the clinical and Doppler ultrasound work-up. CE-DS-MRA can delineate small vessels such as the internal pudendal and penile arteries and thus has the potential to become a noninvasive angiography method in the work-up of erectile impotence.

Arteries↗
PubMedDate not supplied

Percutaneous penile venoablation for treatment of impotence.

Percutaneous penile venoablation with sclerosing agents and coils was performed in 58 patients. Of 104 ablations attempted, 44 of 51 (86%) transpenile, and 46 of 53 (86.7%) retrograde interventions were technically successful. In 40 patients (69%) erectile function improved (intercourse was possible in 21 without additional measures). Initially improved erectile function deteriorated in 24 patients during follow-up (in an average of 6 months); in 15 of these, intercourse was still possible with injection of vasoactive drugs. In 7 patients, repeat venoablation improved erectile function again. Hot contrast medium was slightly superior to sodium morrhuate as a sclerosing agent. In successfully treated patients, the average decrease in venous leakage was 30 ml/min vs 13 ml/min in treatment failures, with considerable overlap between both groups. Only minor complications were observed. We conclude that percutaneous penile venoablation is technically feasible, and safe. Whether the procedure will have a definite role in the treatment of venogenic impotence, however, still has to be determined.

Embolization, Therapeutic↗
PubMed1984

Investigation of the venous system in impotence of vascular origin.

Vascular pathology is responsible for about 25% of cases of male impotence. Pudendal arteriography has been the object of numerous publications. Venous conditions explain the majority of erectile dysfunctions in patients with normal arterial anatomy. We have performed cavernography in 30 patients, with monitoring of intracavernous pressure and flow measurement. Cavernograms allowed study of the corpora cavernosa and the venous drainage. Cavernography not only helps in understanding the mechanism of erection but also is essential to the successful treatment of pathologic venous drainage.

Adult↗
PubMed1982

Arteriography of the penis in secondary impotence.

Twenty-four men aged 20-67 years (mean 42 years) were examined by selective arteriography for secondary impotence. The angiographic technique used as well as the normal anatomy and its variations are described. Arterial occlusive disease of vessels leading to the penis and the corpora cavernosa was found in 71% of the patients examined. This high incidence of arterial occlusive disease corresponds with the findings of other authors. The significance of these findings is discussed. In our limited experience of 3 patients, arterial anastomosis from the inferior epigastric artery to the corpora cavernosa has not been successful.

Adult↗
PubMed1988

Arteriography and radiology of impotence.

Both arterial and venous dysfunction are now recognized as significant causes of organic impotence. Numerous therapeutic modalities are currently available, including surgical bypass, venous ligation, transluminal angioplasty, and transcatheter vessel occlusion. The specific nature of this patient population requires correlation of angiographic findings with the patient's history and physical examination to determine the appropriate intervention and obtain a satisfactory outcome.

Angiography↗
PubMed2003

New achievements and pharmacotherapeutic approaches to impotence in the elderly.

Erectile dysfunction (ED) has a negative impact on the quality of life of elderly men, but impotence is not an absolute concomitant of aging. Aging changes influencing sexual function in men consist of a decreased capacity to reach arousal by imagination or view, fragility of erection, and an increase in the refractory period. These events may be part of the andropause syndrome, which includes a decrease in intellectual activity, fatigue, depression, decreases in body hair, lean body mass and bone mineral density, accompanied by an increase in weight. As a consequence, the overlap of aging processes, concurrent diseases and social situations to which elderly men are subject, results in the great variability reported in epidemiological studies. In the same way, the complex physiology of erection depends on the social, environmental, or physical context in which it occurs. New achievements in research on intracellular mechanisms of erection and on the neuroendocrinology of aging contribute to better understanding the pathophysiology of ED in the elderly. For example, testosterone declines with age with great interindividual variability, since other hormonal changes are also involved. What currently can be easily identified is the alteration of LH-testosterone feedback alterations, although hormone levels fall in the normal range. Nevertheless, the extent to which age-dependent decline in hormones leads to health problems that may affect the quality of life remains to be clarified. Several concepts on aging-related processes have been challenged, and conditions that were once accepted as physiologically age-related are now thought to lead to medical problems, but until now erectile dysfunction remains underreported, underdiagnosed, and undertreated, especially in the elderly. Nowadays, we are witnessing a rapid growth in available pharmacotherapies, from intracavernous injections of vasoactive drugs, to powerful new oral agents, with differing pharmacological dynamic and kinetic properties. New options for treatment are therefore possible, taking into account both the possibility of changing ineffective drugs and augmenting efficacy by means of synergistic associations. This rich generation of progress is certainly contributing to a better medical approach to sexuality in aging people.

Age Distribution↗
PubMed1983

Paradoxical release of LH under TRH dynamic test in patients suffering from "psychogenic" erective sexual impotency: lack of neuroradiological signs for hypophyseal lesions.

More than two thirds of the patients suffering from "psychogenic" erective sexual impotency display a paradoxical LH response to the injection of 200 micrograms of TRH. As it is known that similar responses exist in patients with gonadotropic cell adenomas, we undertook a tomographic examination of the sella turcica in 8 such patients. In none of the patients did the results favour the existence of a microadenoma. Though the hypothesis of an infra-radiological microadenoma cannot be excluded, it is highly plausible that the origin of the paradoxical response observed is a functional impairment of the hypothalamo-hypophyso-gonadal regulation.

Adenoma↗
PubMed1975

Use of implantable prostheses for the treatment of urinary incontinence and impotence.

Silicone-Silastic implants to restore continence and potency have been used in one hundred twenty and twenty-five patients, respectively, and in eight patients a combined anti-impotence and anti-incontinence operation has been performed. The results have been gratifying, the complication rate has been minimal with fewer than five patients in our series having infection and a draining perineal sinus after the incontinence implant, and in no patient have delayed problems with the penile implants developed. Because of the design of the penile implants, fracture is extremely unlikely to occur, and the rods can be replaced if necessary because of inadequate length or asymmetry.

Erectile Dysfunction↗
PubMed1976

Impotence therapy and cancer of the prostate.

Prostate cancer developed in two male patients being treated with fluoxymesterone for erectile impotence. It is suggested that the current increased interest in and therapy for sexual dysfunction be accompanied by an awareness of a possible causal relationship between exogenous androgens and prostrate cancer.

Adenocarcinoma↗
PubMed1976

Surgical management of impotence: progress report.

Our experience utilizing a new design Lash-Maser silicone implant in the surgical management of impotence has been detailed. The present series includes twenty-five patients, twenty-three of whom achieved satisfactory intercourse without problems or complications. The implant's simplicity of design, function, and surgical implantation is appealing.

Erectile Dysfunction↗
PubMed1975

Implantable penile prostheses in impotent males.

Surgical experience with thirty-one implantable Silastic penile prostheses in 28 patients is reviewed, with success in all but 2 patients. Surgical technique, indications for the procedure, postoperative complications, and results are reviewed. It is suggested that consideration be made for use of an implantable penile prosthesis in patients with organic or psychogenic impotence unresponsive to other therapeutic techniques.

Adult↗
PubMed1975

Small-Carrion penile prosthesis. New implant for management of impotence.

The etiology of impotence and a review of various techniques in treatment are discussed. A perineal surgical approach with a new type of paired sponge-filled silicone prostheses is described. The prostheses are inserted into previously dilated corpora cavernosa. Of the initial 31 patients, excellent results were obtained 27, and a good result in 1. Of the 3 patients with initial serious complications, adequate functional results were attained in 2. The distinct advantages and potential complications using the Small-Carrion penile prosthesis and surgical technique are discussed.

Adult↗