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PubMed1999

[The etiology of impotence in 327 diabetic male adults].

OBJECTIVE: To investigate the etiology of impotence in diabetic male adults. METHODS: 327 diabetic men aged 20 - 70 years were interviewed; 129 (39.6%) of them complained of impotence. All the 129 patients were initially evaluated by diabetologists and then underwent psychosexual assessment by psychiatrists. In addition, evaluation for retinopathy, neuropathy, vascular disease and sex hormone level was carried out. RESULTS: The 327 diabetic patients were divided into four age ranges 25 - 34, 35 - 44, 45 - 54, and 55 - 70. The frequency of diabetic impotence in these groups was 9.7%, 34.2%, 48.0%, 62.7% respectively. Neuropathy was found in 79 (61.2%), psychogenic factor contributed in 66 (51.2%), vascular factor was present in 31 (24.0%), leakage of penile venous cavernosa occurred in 5 (3.9%), and treatment with impotence- related medications was the contributing factor in 2 (1.6%). There are significant differences of glycosylated hemoglobin, peripheral neuropathy, autonomic neuropathy, and proliferative retinopathy between impotent and potent diabetic patients. The degree of psychological problem is more serious in the diabetic impotent patients than in potent patients according to Minnesota multiphasic personality inventory (MMPI) test. No significant difference was found in smoking, alcohol and plasma testosterone level. CONCLUSION: The etiology of diabetic impotence is multifactorial. Neuropathy is the main cause, but vascular and psychological factors also contribute to it significantly.

Adult↗
PubMed1992

[Impotence: introductory notes].

If we define erectile impotence as the inability to achieve and maintain a firm erection we can distinguish several pathogens of impotence: psychologic disorders, neurogenic sinusoidal disorders, arterial disorders, venous & sinusoidal disorders and systemic diseases and other disorders can cause erectile impotence. An etiologic screening of impotence must be carried out by Urologists in order to adopt the best surgical approach. Especially when surgery has to be planned, a complete, often invasive screening associated with a super-specialist diagnostic study is necessary at the beginning of any procedure. Different approaches to impotence can be adopted on the basis of patient's age, etiology and failure of other devices. The main methods of surgical correction of impotence may be divided as follows: a) percutaneous transluminal angioplasty (P.T.A.); b) revascularization; c) surgical treatment of "venous leakage", d) trans-luminal veno-occlusion (T.L.V.O.); e) correction of penile curvature; f) prostheses placement. The diagnosis of arteriogenic impotence depends upon the arteriographic demonstration of bilateral hemodynamically significant obstruction. In our experience the injection of papaverine during the test has provided a better visualization of cavernous arteries and helicine branches. Reduction of luminal diameter by more than 50% suggest a hemodynamically significant stenosis. Intracavernous injection of vasoactive agents has provided an attractive alternative to surgery. We have employed papaverine alone or with phentolamine or phenoxybenzamine. After short term treatment, some patients have achieved good erections without further injections. For P.T.A. of the distal internal pudendal arteries our approach has been via the ipsilateral or contralateral femoral arteries. Under local anesthesia a penile arteriographic catheter is placed in the internal pudendal artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMedDate not supplied

Autonomic neuropathy and sexual impotence in diabetic patients: analysis of cardiovascular reflexes.

Four cardiovascular tests exploring autonomic nervous function (Deep Breathing, 30:15 ratio, Lying to Standing, Hand Grip) have been performed in 38 diabetic patients with erectile failure (mean age 53.2 years, range 34.5-60.5) and in 35 diabetic subjects without sexual dysfunctions (mean age 52.8 years, range 45-60.5). In our study Deep Breathing test was abnormal in 21 patients with erectile failure (55.3%) and in 9 patients without sexual dysfunction (25.7%) (P less than 0.05). Seven patients with sexual impotence (18.4%) and 2 subjects without sexual dysfunction (5.7%) showed abnormal results of 30:15 ratio test. The Lying to Standing test was not abnormal both in impotent and in non impotent subjects, while the Hand Grip test was abnormal in 7 patients with impotence (18.4%) and in 8 patients without sexual dysfunction (22.9%). Results obtained from Deep Breathing test were significantly lower (P less than 0.01) in impotent (10.25 +/- 6.10 beats/min) than in non impotent patients (14.63 +/- 6.85 beats/min). Lower 30:15 ratios were also found in patients with erectile failure (1.09 +/- 0.10 vs 1.12 +/- 0.09). The tests exploring the sympathetic function did not show any difference between the two groups of patients. The present study confirms the major role of parasympathetic impairment in the pathogenesis of sexual dysfunctions in diabetic men. Cardiovascular tests can be a first-step diagnostic tool in the assessment of diabetic impotence.

Adult↗
PubMed1989

Why aged men become impotent.

Despite frequent erectile impotence in aged men, etiologic data are scarce. We evaluated 121 impotent male veterans (mean age, 68 +/- 5.3 years) to obtain information on potential pathophysiologic mechanisms. Subjects related a complete medical history and underwent physical examination, metabolic assessment, nocturnal penile tumescence monitoring, and vascular and neurologic assessment. The most frequent cause of impotence was the coexistence of neurologic and vascular disorders (30.3%). Other subjects had single causes, including vascular disease (21.1%), diabetic neuropathy (17.1%), nondiabetic neuropathy (10.5%), and psychopathology (9.2%). Remaining patients suffered from adverse drug effects (3.9%), hypogonadism (2.6%), and Peyronie's disease (1.3%). Five patients were objectively impotent on the basis of nocturnal penile tumescence, but otherwise normal. We conclude that geriatric impotence is primarily related to vascular or neurologic dysfunction. However, 15.7% of aged impotent men may have reversible impotence (eg, psychogenic causes or hypogonadism), and an additional 31.5% may have a treatable disorder (eg, penile neuropathy).

Aged↗
PubMed1987

Diabetic impotence: risk factors in a clinic population.

Analysis of questionnaire replies from 292 diabetic men aged 20-59 revealed impotence in 23% (66), compared to 9% (7) of a sample of 81 non-diabetic outpatients. Further investigation of 45 impotent diabetic men and 45 matched non-impotent diabetic controls revealed greater psychological stress and poorer glycaemic control in the impotent group. There were no significant differences in the frequency of peripheral neuropathy, retinopathy, nephropathy or large vessel disease in the 2 groups. 20% (9) of the impotent diabetic group had definite autonomic neuropathy which was not present in any of the non-impotent group. The frequency of early autonomic damage was, however, similar in both groups. Impotence in diabetic men is associated with hyperglycaemia, stress and definite autonomic neuropathy. Our data suggest that men with early autonomic neuropathy are frequently potent.

Adult↗
PubMed1996

The bulbocavernosus reflex in the assessment of neurogenic impotence in diabetic and non-diabetic men.

The results of a 6-year review of bulbocavernosus reflex (BCR) latencies in 300 men are presented. The relationship of BCR latency to potency, diabetic status and age was examined. The mean BCR latency in 32 normal men aged 22 to 78 years (x = 44.9 +/- 14.4) was 40.6 +/- 8.9 ms. A significant trend towards increasing BCR latency with age was evident. BCR latency was not found to be significantly associated with potency, the mean measurable BCR latency in impotent men being 43.0 +/- 11.6 ms. Diabetic men were more likely to have a prolonged measurable BCR latency (x = 46.2 +/- 11.2) and impotence, but even in this subset no significant correlation between BCR latency and impotence was detectable. Our results suggest that detectable pudendal neuropathy is unrelated to impotence in non-diabetic and diabetic men and does not usefully distinguish between neurologic and non-neurologic causes of impotence. With the advent of newer objective techniques to assess organic impotence, the value of BCR latency in the routine assessment of impotent subjects is questionable.

Adult↗
PubMed1996

[Clinical studies for venogenic impotence with color Doppler ultrasonography--evaluation of resistance index of the cavernous artery].

BACKGROUND: Pharmaco-dynamic infusion cavernosometry and cavernosography (pharmaco-DICC) is essential for diagnosis of venogenic impotence, however it is so invasive. On the other hand, color Doppler ultrasonography is non-invasive and has become one of the useful diagnostic methods for arteriogenic impotence. And there are some reports evaluating whether venogenic impotence can be diagnosed using color Doppler ultrasonography. In this study, we investigated whether the resistance index (RI) could be useful for screening for venogenic impotence. METHODS: We performed color Doppler ultrasonography in 49 patients who had shown negative responses to an intracavernous injection of 20 mcg of prostaglandin E1 (PGE1). They previously underwent pharmaco-DICC and were diagnosed venogenic impotent when the maintenance flow rate was equal to or more than 20 ml/min. In 49 patients, 17 patients had DICC normality, while 32 patients had corporal leakages. After an intracavernous injection of 20 mcg of PGE1, we performed color Doppler ultrasonography, and measured peak systolic velocity (PSV) and end diastolic velocity (EDV) in the cavernous artery. RI was calculated as follows. RI = (PSV-EDV)/PSV We adopted the RI value near to 1 as the case's RI from two RI values of bilateral cavernous arteries, and compared RI values with the results of pharmaco-DICC. RESULTS: RI range in patients with normal DICC results was 0.895 +/- 0.092 (0.70-1.00), while RI range in patients with corporal leakages was 0.742 +/- 0.095 (0.55-0.97). RI values in patients with corporal leakages were significantly lower than those in patients with normal DICC results although there was some overlap in each group. From receiver-operating-characteristic curve (ROC curve) of the correlation between sensitivity and specificity at various RI values compared with DICC results, the RI cut off values were set up at 0.75 and 0.90, and classified the patients into 3 group according to their RI cut off values. In 10 patients with 0.9 < RI, 9 patients (90%) had DICC normality. In 17 patients with 0.75 < RI < or = 0.9, 7 patients had DICC normality while 10 patients had corporal leakages. In 22 patients with RI < or = 0.75, 21 patients (95.5%) had corporal leakages. CONCLUSION: We consider without carrying out pharmaco-DICC that patients with 0.9 < RI were not venogenic impotent, while patients with RI < or = 0.75 had corporal leakages. Pharmaco-DICC will remain essential only in patients with 0.75 < RI < or = 0.9.

Adult↗
PubMed1984

Impotence in diabetics: organic versus psychogenic factors.

Four types of impotence were diagnosed in 75 consecutive impotent diabetic patients: chronic persistent organic type due to vascular and/or neurologic factors (44%), temporary organic types due to medical illness other than diabetes (10.6%) or uncontrolled metabolic state (6.6%), and psychogenic impotence (38.6%). Despite higher incidence of organic etiology (61.3%) the incidence of psychogenic impotence was significant. None of the methods used to diagnose the type of impotence in the present study proved 100 per cent accurate, and we advise a combination of history-taking including the wife's history, physical examination including vascular and neurologic tests, nocturnal penile tumescence studies, and therapeutic trials with sex therapy to differentiate between true organic, temporary organic, and psychogenic types of impotence in diabetic patients. This differentiation is mandatory since the latter two types may have a better prognosis.

Adult↗
PubMed1986

Cost-effective evaluation of impotence.

Two hundred consecutive men presenting with a chief complaint of impotence have been evaluated with a protocol involving one or two outpatient visits. The initial evaluation for all patients consisted of a history taken in a conventional manner and supplemented by a patient-completed sexual function questionnaire, physical examination, serum testosterone and prolactin, and two-night nocturnal penile tumescence studies. Following the initial evaluation the patients were placed in one of three categories: (1) organic impotence, (2) functional impotence, (3) ambiguous impotence (mixed functional and organic impotence or organic impotence of undetermined etiology). Patients in the latter group underwent additional testing including penile vascular studies, two-hour oral glucose tolerance test, and psychiatric consultation. With this protocol, patients can be efficiently and effectively evaluated as outpatients with costs ranging from +250 to +450.

Cost-Benefit Analysis↗
PubMed2004

Constructions of masculinity following prostatectomy-induced impotence.

Large numbers of Australian men are diagnosed and treated for prostate cancer each year. The incidence is exceeding mortality, and men are living longer with prostate cancer and the common treatment[s] side effect of impotence. Despite these epidemiological trends there is little research about men's experiences of impotence following treatment. An ethnographic study of Anglo-Australian men with localized prostate cancer explored participants' experiences of impotence following prostatectomy. In-depth semi-structured interviews with 15 men were analyzed using a social constructionist gendered framework. In particular, the effect of impotence on participants' masculinity, sexuality and intimate relationships was explored. The findings show that participants rationalized forgoing potency prior to surgery as a way of living longer. However, diverse complex reactions accompanied impotence. Whilst most participants redefined masculine ideals of phallocentric sex, the way in which this occurred varied greatly. The findings disrupt essentialist constructions of male sexuality and impotence, and provide valuable insight for clinical practice.

Aged↗
PubMed1992

The change of urinary 11-dehydro-thromboxane B2 and 2,3-dinor-6-keto-prostaglandin F1 alpha in arteriogenic impotence.

Thromboxane A2 is a potent vasoconstrictor and a stimulus of platelet aggregation, which may contribute to hypercoagulability. The prostacyclin, prostaglandin I2, has exactly the opposite effect. Measurement of the major urinary metabolites, 11-dehydro-thromboxane B2 and 2,3-dinor-6-keto-prostaglandin F1 alpha (prostaglandin F1 alpha) by radioimmunoassay can accurately reflect in vivo the biosynthesis of thromboxane A2 and prostaglandin I2, respectively. Group 1 consisted of 60 patients less than 50 years old. The mean urinary 11-dehydro-thromboxane B2 level of 3 patients with arteriogenic impotence was significantly greater than that of the 57 control volunteers: 2.66 +/- 0.65 versus 1.74 +/- 0.56 (plus or minus standard deviation) ng./mg. creatinine (p = 0.008). The prostaglandin F1 alpha levels for the patients and controls were 32.74 +/- 8.45 and 37.58 +/- 16.55 ng./mg. creatinine, respectively, which was not significantly different (p greater than 0.05). Group 2 consisted of 96 patients 50 years old or older. The 11-dehydro-thromboxane B2 concentration in the urine was 1.83 +/- 0.58, 2.54 +/- 1.12 and 1.91 +/- 0.73 ng./mg. creatinine in the 47 normal control volunteers, 20 patients with arteriogenic impotence and 29 with arteriogenic impotence plus intracavernous injection of 20 micrograms prostaglandin E1, respectively. The arteriogenic impotence group showed the significantly highest level among the 3 groups (p = 0.0025). Also, the urinary prostaglandin F1 alpha levels in these patients were 45.71 +/- 36.3, 57.71 +/- 35.53 and 59.30 +/- 45.08 ng./mg. creatinine, respectively, which was not significantly different (p greater than 0.05). For the 13 patients with arteriogenic impotence (group 3) we compared the urinary 11-dehydro-thromboxane B2 and prostaglandin F1 alpha levels before and after intracavernous injection of prostaglandin E1 by using a paired t test. The results showed that the change in 11-dehydro-thromboxane B2 levels was 2.78 +/- 1.09 versus 1.99 +/- 0.75 ng./mg. creatinine, which was significantly different (p = 0.005), whereas that for prostaglandin F1 alpha was 62.30 +/- 40.41 versus 58.86 +/- 44.26 ng./mg. creatinine, with no significant difference (p greater than 0.05). Our findings suggest that urinary 11-dehydro-thromboxane B2 may have an important role in the diagnosis and treatment of arteriogenic impotence.

6-Ketoprostaglandin F1 alpha↗
PubMed1991

Controlled trial of infusion cavernosometry in impotent and potent men.

Infusion cavernosometry often is performed to diagnose venous leak impotence. However, normal values have seldom been established in proved potent men. We performed a prospective study of infusion cavernosometry on nocturnal penile tumescence confirmed potent male volunteers and impotent men. Of 20 potent male controls 19 had resistance values of greater than 5 (mm. Hg.minute)/ml. Of 38 impotent men 20 (53%) had resistance values of less than 5 (mm.Hg. minute)/ml. There was considerable overlap between resistance values and infusion rates in potent and impotent men. Impotent men with resistances of greater than 5 (mm.Hg.minute)/ml. more often had normal nocturnal penile tumescence results than men with lower resistance values. Venous leakage is a significant cause of impotence.

Blood Pressure↗
PubMed1989

Anatomy of penile venous drainage in potent and impotent men during cavernosography.

Recent data suggest that approximately 80 per cent of the men with vasculogenic impotence have evidence of failure to store blood (venous leakage) within the corpora cavernosa. To identify the venous channels into which corporeal blood drains in impotent men, we performed cavernosograms after intracorporeal injection of papaverine in 44 consecutive men presenting with erectile dysfunction and these were compared to studies in 10 potent men. The cavernosograms were examined for evidence of venous drainage from the penis and the site of leakage was identified. It was determined that among the impotent population with vasculogenic impotence 37 of 40 evaluable men (92.5 per cent) demonstrated contrast medium in the venous system draining the penis: the deep dorsal vein was visualized in 55 per cent, proximal cavernosal and crural veins in 55 per cent, deep dorsal and proximal veins in 22.5 per cent and corpus spongiosum in 25 per cent. Only 2 of the 10 potent men demonstrated contrast medium in the venous channels draining the penis. From these observations we conclude that in men suspected of having venogenic impotence identification of the drainage vessels by cavernosography appears to be important in planning any surgical approach to occlude these veins. However, the finding of a venous leak by cavernosography must not be considered a sine qua non diagnosis of venogenic impotence, since a certain percentage of potent men will demonstrate this radiographic finding.

Adult↗
PubMed1985

Comparative investigations in 26 impotent and 26 nonimpotent diabetic patients.

To determine the causes of diabetic impotence the same investigations were performed in 26 impotent and 26 nonimpotent diabetics. The rates of abnormalities found were almost identical in the 2 groups in regard to Doppler examination of the penile arteries, conduction velocities of the median nerves, latency times of the bulbocavernosus reflex and cystometrograms. Conversely, urine flow rates (24 of 25 versus 2 of 26 patients) and Minnesota Multiphasic Personality Inventory (14 of 23 versus 0 of 14 patients) were almost exclusively abnormal in the impotent diabetics. In addition, inadequate sex-specific attitudes were found in 60 per cent of the impotent diabetic men, which was the proportion found in a carefully selected sample of psychogenically impotent nondiabetic men. The distribution of the abnormalities found suggests that in most diabetic patients impotence results from the addition of a subtle abnormality of the autonomic nervous system in almost every case or psychological and arterial factors.

Adult↗
PubMed1983

Impotence: are the newer diagnostic methods a necessity?

Until recently our evaluation of impotent men included a psychiatric evaluation, and history and physical examination by a urologist to determine whether the impotence was organic or psychogenic. After the introduction of specific laboratory methods, such as nocturnal penile tumescence monitoring and penile blood pressure studies, clinicians relied heavily on these tools. We evaluated 33 impotent patients and compared the results of the laboratory methods to the initial diagnoses of the psychiatrist and the urologist to determine if the new methods would confirm our initial impressions or uncover different diagnoses. Thirteen patients were considered to have psychogenic impotence by the clinicians and only 1 patient in this group had evidence of organicity when the laboratory tests were used. Twelve patients were considered to have organic impotence by the clinicians and this was confirmed in 75 per cent of the cases by laboratory testing. Thus, clinical evaluation predicted the outcome of laboratory methods in 92 per cent of the psychogenic group and 75 per cent of the organic group. In addition, postage stamps were used during nocturnal penile tumescence monitoring and in predicting the outcome of nocturnal tumescence monitoring the stamp test had a sensitivity and a specificity of 91 per cent. Many patients presenting with erectile impotence can be evaluated adequately by a psychiatrist and a urologist without the support of expensive laboratory tests. The postage stamp test is useful when nocturnal penile tumescence monitors are not available. Finally, the Minnesota Multiphasic Personality Inventory is of limited value as a screening device.

Blood Pressure↗
PubMed1980

Importance of penile arterial pulse sound examination in impotence.

Experience with the Doppler ultrasound examination of penile arteries in 93 impotent men is presented. The technique for this examination is a simple, reliable, inexpensive office procedure for the detection of penile arterial obstruction in patients with impotence. With this test 44 per cent of impotent men were found to have obstructive blood flow in the penis as the cause of impotence. A 95 per cent accuracy rate with this technique was confirmed by penile angiography in 22 patients. Since impotence is a common problem facing the clinicians it is important to detect penile arterial disease--a main causal agent of many impotent men.

Adult↗
PubMed1980

Serum prolactin in organic and psychogenic impotence.

Elevated levels of serum prolactin in patients with pituitary tumors have been associated with hypogonadism, frequently manifested in men as impotence and/or loss of libido. The purpose of our study was to test the hypothesis that psychogenic and/or organic impotence may be a manifestation of a relative hyperprolactinemic state. We studied 30 men with the known diagnosis of impotence: 17 organic and 13 psychogenic. There were 11 normal, sexually active men used as controls. Serum prolactins were determined with the radioimmunoassay technique. There was no significant differences in serum prolactin levels among control, organic impotent and psychogenic impotent groups. Impotence does not seem to be related to hyperprolactinemia in men in the absence of pituitary disease.

Adult↗
PubMed1995

Assessment and treatment of impotence.

Impotence is a common problem. History is primarily relied on to diagnose psychogenic impotence. Sex therapy is an effective treatment. Antihypertensive and psychiatric medicines often cause impotence, but most medicines should be considered a cause if this is supported by the history. Hormonal causes should be suspected in a patient with decreased libido or decreased testicular size, and testosterone should be measured in these cases. Hormone replacement may restore sexual function in hypogonadal men. Doppler sonogram or arteriography should be used to diagnose vascular impotence for men who would be good surgical candidates. Only young men without other illness are considered. There is little need to test neurologic function because there is no specific treatment for neurogenic impotence. These patients and patients who do not respond to the aforementioned treatments should be offered the vacuum erection device, penile self-injection therapy, or penile prosthesis. Choice depends on comorbid illness as well as patient preference. A basic algorithm for the evaluation and treatment of impotence is given in Figure 2.

Algorithms↗