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PubMed1985

Auto-injection of the corpus cavernosum with a vasoactive drug combination for vasculogenic impotence.

Intracavernous injection of papaverine hydrochloride with phentolamine mesylate rapidly produces transitory penile tumescence, which can be followed by erection and coitus provided there is sexual stimulation. Coital penetration was possible in 59 of 62 patients with impotence of divers etiologies (vascular, diabetic, iatrogenic and Peyronie's disease) who underwent injection and were sent home to attempt coitus. One patient had a prolonged erection that was treated successfully with aspiration of a corpus. When coitus was successful the patient was offered training in self-injection. With self-injection 18 patients have had satisfactory coitus without a noteworthy complication; 5 for more than 12 months. The long-term effects of intracavernous injections remain unknown. Intracavernous injection of vasoactive substances (chemical prosthesis) may become a useful alternative treatment. Administration should be restricted to urologists able to manage the possible complication of priapism.

Aged↗
PubMed1984

Impotence associated with pudendal arteriovenous malformation.

Three young men with impotence due to a pudendal arteriovenous malformation had a common selective pudendal arteriographic finding of early passage of contrast medium from the bulbar artery region into the venous drainage of the pelvis. Perineal exploration revealed the malformation and correction resulted in significant restoration of erectile capacity. This entity may be a frequent occurrence in young men that may become apparent only when trauma or disease affects the contralateral pudendal artery or its branches.

Adult↗
PubMed1982

Lack of correlations between penile thermography and pelvic arteriography in 29 cases of erectile impotence.

We studied 29 cases of penile impotence to determine whether thermography could be used to screen for cases of vascular origin and, therefore, candidates for arteriography. Sixteen thermographic parameters were used to compare 3 groups of patients having normal, mildly altered and severely stenotic arteries on arteriography of the aortic bifurcation and selective catheterization of the hypogastric arteries. The averages of these parameters were computed for each of the 3 groups, and 104 comparisons then were made using student's t test. A significant difference was found between 2 groups in only 2 of the comparisons (p less than 0.05) and no threshold for significant differences was found. Penile thermography did not correlate with pelvic arteriography and does not appear useful in the selection of candidates for arteriography.

Adult↗
PubMed1982

Complications of penile prosthesis surgery for impotence.

Complications and their management in 1,207 cases of semirigid rod prosthesis for erectile failure are presented. Major complications occurred in 7.8 per cent of the cases. Complications and management of 84 cases of impotence treated with inflatable penile prostheses also are discussed. Mechanical problems occurred in 44 per cent of the cases and medical complications occurred in 10 per cent.

Erectile Dysfunction↗
PubMed1982

Perineal trauma and vasculogenic impotence.

Twenty men were subjected to a brief period of perineal compression. Measurement of brachial, ankle and penile blood pressures revealed a reversible decrease in pressure. Penile pressure can be measured accurately. It represents an objective method of measuring vasculogenic impotence.

Adult↗
PubMed1982

Analysis of 122 unselected impotent men subjected to multidisciplinary evaluation.

Erectile impotence is not a simple problem and it is important to recognize that the presence of a possible organic cause does not rule out emotional difficulties or sexual maladjustment. Behavioral therapy and surgery have an important role in treating this symptom. By careful pre-treatment evaluation the most appropriate therapy can be selected. It has been our general rule that when neither clear organic nor psychogenic problems lie at the root of the difficulty, a trial of behavioral therapy is the most appropriate procedure. If no success is achieved after an adequate trial of therapy re-evaluation and recommendation for a prosthetic implant can be made.

Behavior Therapy↗
PubMed1982

The diagnosis and surgical management of vasculogenic impotence.

Thirty-two patients have been treated for organic impotence at our institution during a 16-month period. Of these patients 5 were found to have penile vascular insufficiency and underwent a femorocavernosal bypass with an autogenous saphenous vein graft. Initial results were excellent but late failures occurred. At 28 months all shunts were occluded. Microscopic examination of the cavernous tissue revealed fibrous thickening of the septa and loss of cavernous spaces. These findings suggested that late failure in direct revascularization may be associated with fibrotic changes that occur under high pressure inflow to the corpora cavernosa.

Erectile Dysfunction↗
PubMed1980

Diagnosis and therapy of vasculogenic impotence.

Penile blood pressure studies and pudendal artery angiograms indicate that vascular disease may be a frequent cause of erectile failure in men. Attempts to correct this form of impotence with revascularization of the corpus cavernosum have been satisfactory in a minority of patients.

Adult↗
PubMed1980

Comparison of the inflatable penile and the Small-Carrion prostheses in the surgical treatment of erectile impotence.

In 1974 a combined 3-hospital assessment was undertaken to evaluate the surgical treatment of erectile impotence. A comparison study on the inflatable penile and the rigid rod (Small-Carrion) prostheses was established. The inflatable penile prosthesis was implanted in 105 patients, while 45 men received the Small-Carrion prosthesis. A long-term success rate was achieved in 98 patients (93 per cent) who received the inflatable prosthesis. This prosthesis was removed in 7 cases because of infection, pain or inability to operate it. Functional success was achieved in 39 patients (88 per cent) with the Samll-Carrion prosthesis. This prosthesis was removed in 6 cases, mainly because of infection and erosion of the rods into the urethra or glans penis. A guide line to proper prosthetic selection is presented for various patient populations.

Adult↗
PubMed1979

Vascular-induced erectile impotence in renal transplant recipients.

The incidence and pathogenesis of sexual dysfunction were studied in 16 male renal allograft recipients. In 9 patients with bilateral renal transplants in whom both internal iliac arteries were occluded nocturnal erections were absent and a penile arterial pulse could not be palpated. Of 7 patients with 1 renal allograft 4 demonstrated penile nocturnal tumescence and the penile pulse could be palpated in 5. Since interruption of pelvic arterial blood supply appears to contribute to impotence in renal transplant recipients consideration should be given to the use of the external iliac artery for arterial anastomosis. Two patients were treated successfully with an inflatable penile prosthesis.

Adult↗
PubMed1978

The current status of the inflatable penile prosthesis in the management of impotence: Mayo Clinic experience updated.

During the last 2 years the inflatable penile prosthesis has been implanted at the Mayo Clinic in 63 organically impotent male subjects. Over-all functional success is between 90 and 95 per cent. Experience indicates that 25 per cent of the patients require a second surgical procedure to correct a mechanical problem. Further experience with the technique and improvement in the product design have significantly decreased the number of mechanical problems encountered. Patient partner acceptance of this device continues to be excellent.

Erectile Dysfunction↗
PubMed1977

Surgical treatment of erectile impotence with inflatable penile prosthesis.

Thirty-nine men with erectile impotence were treated with surgical implantation of an inflatable penile prosthesis. The patients were followed for 6 months to 2 years. Thirty-five patients (90 per cent) have expressed long-term satisfaction with the appearance and performance of the prosthesis. Major complications developed in 9 patients (23 per cent), requiring 12 subsequent operative procedures.

Erectile Dysfunction↗
PubMed1976

Experience with implantation of the Small-Carrion penile implant for organic impotence.

The 13 patients described herein have had successful placement of a Small-Carrion penile prosthesis through a penile incision. Because of surgical control and possible decreased chance of infection this approach is advocated over the perineal incision except in cases of post-priapism impotence or simultaneous placement of a Kaufman anti-incontinence device.

Doxycycline↗
PubMed1976

Psychological screening of impotent men.

Rapid advances in methods of treating sexual impotence have produced concomitant demands for more specific diagnosis and determination of prognosis. Herein are presented guide lines for a rapid screening procedure that has diagnostic and prognostic utility. Use of 2 decisional rules for the Minnesota Multiphasic Personality Inventory, an easily administered and scored psychological test, can provide assistance to the urologic surgeon in determining the suitability of a candidate for a corrective operation. Case histories illustrate the value of this test in making treatment recommendations and assessing prognosis.

Adult↗
PubMed1975

Diagnostic value of the penile pulse and blood pressure: a Doppler study of impotence in diabetics.

Penile pulses were palpated and brachial, penile and popliteal pressures were measured with the Doppler technique in 29 normal subjects and in 15 impotent diabetics. The pulses were palpable in all normal subjects but not in 6 diabetics. The penile blood pressure was obtainable in all the normal subjects but not in 2 diabetics. Using the penile pulse data and a comparison of the penile with the brachial systolic pressures, 2 or possibly 3 grades of penile ischemia are definable, providing a measure of pelvic vascular insufficiency.

Adult↗
PubMed1982

Impotence: the surgical approach.

Techniques are now available to restore erectile potency. Several prosthetic devices have been developed that afford a high degree of reliability. The inflatable prosthesis is cosmetically superior, but it is associated with the highest mechanical complication rate. Penile revascularization is a technique with great potential, but the methodology at this point requires further development. Surgeons involved with the treatment of impotency must acquire both the surgical skills required by the operative techniques as well as a philosophical approach to the psychological aspects involved in such therapy. Restoration of penile rigidity can, for some men, mean a new lease on life, but in the improperly selected patient a surgical success may be associated with utter patient dissatisfaction.

Counseling↗
PubMed2001

Dose of radiation received by the bulb of the penis correlates with risk of impotence after three-dimensional conformal radiotherapy for prostate cancer.

OBJECTIVES: To evaluate the effect of the dose to the bulb of the penis on postradiation potency. METHODS: Twenty-one patients reporting potency before three-dimensional conformal radiotherapy had the dose delivered to the bulb of the penis evaluated. This was then compared with the patient assessments of post-treatment sexual function to determine whether a dose-volume relationship exists. RESULTS: Among the patients analyzed to date, a strong dose-volume relationship and the likelihood of remaining potent after treatment seems to exist. Patients receiving a dose of less than 40 Gy to 70% of the bulb of the penis appear to have a much greater likelihood of maintaining potency. Patients receiving 70 Gy or more to 70% of the bulb of the penis appear to be at very high risk of experiencing radiation-induced impotence (P = 0.03). CONCLUSIONS: More studies are needed to confirm these observations. If confirmed, these data suggest that by using three-dimensional-based treatment planning and carefully designed treatment fields, the potency of men treated with radiotherapy might be substantially improved.

Aged↗