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PubMed1979

Impotence in the bull: (1) Abnormal venous drainage of the corpus cavernosum penis.

Six young bulls (two Friesian, two Charolais, one polled Devon and one North Devon) that had never served successfully, showed good libido but lacked penile erection. In five of these bulls, the short flaccid organ was not protruded during attempted service. Radiography of the cavernous bodies and veins of the penis in the living animal demonstrated major venous drainage of the corpus cavernosum penis (ccp) by the dorsal venous system in all cases. This was not seen in normal bulls. Radiography and anatomical preparations of post mortem specimens showed that the ccp was drained by the dorsal venous system throughout the length of the organ. Proximally, the cavernous spaces of the ccp anastomosed with those of the corpus spongiosum penis (csp) and were drained by numerous small veins. Distally, a system of larger veins, not seen in normal bulls, drained into left and right sides of the dorsal venous system. No microscopical abnormalities of spermatozoa or of testes were found, but there was a marked lack of spermatozoa in the caudae epididymides. The evidence suggests that abnormal venous drainage of the ccp may have been the immediate cause of impotence in these bulls.

Animals↗
PubMed1985

Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis.

Vasculogenic impotence was evaluated by high-resolution sonography and quantitative Doppler spectrum analysis in 21 patients and two normal volunteers. Erection was induced by intracorporeal injection of papaverine, and B-scan imaging and Doppler analysis were performed with the penis flaccid and erect. The corpora cavernosa and its deep arteries, median septum, and corpus spongiosum were clearly displayed in every subject, with the dorsal vein and dorsal artery seen ventral to the corpora cavernosa. In the flaccid state, in all subjects, Doppler analysis demonstrated flow in the dorsal arteries but not in the deep arteries. During erection, the B-mode image showed varying degrees of enlargement of the corpora cavernosa, with increased tissue echogenicity, as well as a hypoechoic area in the peri-arterial region. The diameter of the penile arteries and flow within them also increased by varying degrees. Quantification of blood flow through all deep and dorsal arteries is feasible with this technique.

Adult↗
PubMed2001

Diabetic impotence treated by intracavernosal injections: high treatment compliance and increasing dosage of vaso-active drugs.

AIMS: To compare patient compliance with treatment and the dosages of vaso-active drugs used, for the management of impotence in diabetic and non-diabetic patients. METHODS: Eighteen diabetic and a control group of 22 non-diabetic men were followed up regularly for 7 years after they had begun self-injections for severe erectile dysfunction. Rigiscan was used for the objective determination of the initial dosage and then doses were regulated in order to introduce an erection suitable for penetration and maintenance of erection for 30 min. RESULTS: Sixteen of 18 diabetic men are still using self-injections successfully after 7 years while of the 22 non-diabetic men, only 7 still continue injections. Compliance of diabetic men with treatment is significantly higher compared to the control group (p = 0.001). Doses of prostaglandin E(1) (PGE(1)) or mixtures of PGE(1) and papaverine (PAP) had to be increased over time. Although self-injections were a safe kind of treatment and no major complications were observed in both groups, a decrease in the frequency of injections was observed, particularly in the diabetic group, but this was not statistically significant (p = 0.15). CONCLUSIONS: Diabetic patients with severe erectile dysfunction have much higher compliance with self-injections than the non-diabetic patients. They respond initially to reasonable doses of PGE(1) but over time need increasing doses of PGE(1) or mixtures of PGE(1) and PAP. Frequent follow-up visits and the adjustment of dosage to continue the success of therapy may prevent patient dissatisfaction and drop-out from treatment. Patients treated with self-injections decrease the frequency of injections over time. They are satisfied with less frequent but successful intercourse and have a low risk of side-effects.

Alprostadil↗
PubMed1975

Sexual impotence: a double-blind study of LHRH nasal spray versus placebo.

A double-blind study comparing application of 1.0 mg LHRH nasal spray per day against a placebo was performed in a group of 20 sexually impotent patients in whom no clinical endocrinological pathology was evident. After a 2-week placebo-spray period, LHRH was given for 4 weeks. A 2-week placebo-spray period followed. A better therapeutic effect was seen in the LHRH as opposed to the placebo group (p = 0.024) 4-6 weeks after cessation of LHRH medication. After 4 weeks of LHRH medication there were no changes in basal LH/FSH levels or in the LH response after administration of 25 mug LHRH. The FSH response was, however, significantly lower.

Administration, Intranasal↗
PubMed1992

Postoperative hyperemia of the glans penis with ulcers following revascularization surgery for vascular impotence.

A case of postoperative hyperemia of the glans penis following revascularization surgery for erectile impotence is described. This new surgical concept (Hauri) combines arterial revascularization with an arteriovenous shunt. The so-called 'postoperative hyperemia of the glans penis' is observed in 10-20% of the cases after arterialization of the dorsal penile vein, i.e. a pure arteriovenous shunt, and in 2-3% of the cases in arterioarterial anastomoses. The ulcers of the glans penis, which occurred 1 year after the operation, healed under careful local anti-inflammatory and antibiotic therapy.

Erectile Dysfunction↗
PubMed1975

Treatment of organic impotence by implantation of silicone penile prosthesis.

To help bolster penile tension mechanically, we have tried implantation of silicone penile prostheses varying in type. Our simple and apparently successful procedures for organic impotence with the implantation of intrapenile silicone prostheses may well deserve recommendation in view of spinal impairment therapeutically categorized irreparable.

Erectile Dysfunction↗
PubMed1989

Radical prostatectomy in cases of prostatic carcinoma: the problem concerning erectile impotence.

It has become fashionable to perform radical prostatovesiculectomy for carcinoma of the prostate using the nerve-sparing method. In cases with a not too large prostate and a locally limited tumor, it is possible to preserve erectile potency. Our anatomic and radiologic preparation proved that postoperative impotence is not only due to lesions of the nerves but, almost as frequently, the consequence of obliterations of the vessels or a combination of both. If the lesion is purely arterial, revascularization surgery guarantees normal erections.

Erectile Dysfunction↗
PubMed1989

Transcutaneous nitroglycerin therapy in the treatment of impotence.

In order to avoid the side effects and drawbacks of intravenous injection of vasoactive drugs, we evaluated the use of transcutaneous nitroglycerin, a powerful smooth muscle relaxant, in enhancing the quality of erection. In this study, 26 impotent patients were treated with (nitroglycerin or placebo) patches applied to the skin of the penile shaft. A positive response was reported by 21 patients and 17 men out of the 21 were able to distinguish a marked difference between the nitroglycerin and placebo patches. These results indicate that nitroglycerin patches have to be tried, especially in patients with moderate erection disturbances.

Administration, Cutaneous↗
PubMed1990

Intracavernous drug delivery system: an alternative to intracavernous injection in the treatment of impotence?

In 6 monkeys, the feasibility of chronic intracavernous drug application via a permanent intracavernous catheter was examined. In 4 monkeys, a combination of papaverine (15 mg/ml) and phentolamine (0.5 mg/ml) was injected via the drug delivery system; in 2 monkeys each, 30 or 100 injections were done. As a control, saline was injected in 2 monkeys. The dose of the papaverine-phentolamine mixture to induce full erection had to be increased by a mean of 240%, comparing the 1st to the 30th injection. The dose then remained stable. After 100 injections, penile histology showed a thin fibrotic layer around the implantation site of the catheter. Beside slight smooth muscle hypertrophy in the papaverine-phentolamine group, there were no abnormal findings in the proximal and medical part of the cavernous bodies. The distal part of the cavernous bodies showed extensive fibrosis due to mechanical irritation by the tip of the intracavernous catheter. Given appropriate selection and indication, implantation of an intracavernous drug delivery system may be an alternative to chronic intracavernous injection in the treatment of impotence.

Animals↗
PubMed1991

Angiodynography (color-coded duplex sonography) in the evaluation of vasculogenic impotence.

The penile arteries of 18 men with erectile dysfunction were examined by angiodynography (color-coded duplex sonography). Blood flow velocity was measured before and after intracavernous injection of papaverine/phentolamine. The angiodynographic findings were compared to arteriography. Normal values of peak flow velocity (after injection) were obtained from 6 men with normal arteriographic findings (deep artery greater than 25 cm/s, superficial artery greater than 30 cm/s). Angiodynography enables good imaging of the four penile arteries superior to duplex sonography. A strong correlation with the arteriographic findings could be found. Thus noninvasive angiodynography may replace penile arteriography for the routine evaluation of impotence.

Adult↗
PubMed1992

Venous surgery in erectile dysfunction. The role of dorsal-penile-vein ligation and spongiosolysis for impotence.

We report here on our surgical experience with venous leakage of the cavernous bodies. Out of 159 patients operated on, 134 were available for long-term follow-up. Depending on the cavernosographic findings, one of three different surgical procedures was carried out: ligation of the deep dorsal vein of the penis, spongiosolysis, or ligation of the crura. 18% of the patients undergoing ligation of the deep dorsal vein, postoperatively attained spontaneous erections, while 35% needed adjuvant corpus cavernosum autoinjection therapy. Spongiosolysis gave a more favourable result: spontaneous erections in 30% and vasoactive drug-dependent erections in 35%. Crural ligation did not prove successful. No serious complications were encountered postoperatively. Our data suggest that venous surgery should only be offered to a selected group of patients comprising young impotent men with venous leakage, maybe in combination with arterial disease, and patients suffering from distal venous leakage. Old age, neurogenic disorders causing erectile dysfunction, and diabetes mellitus should represent exclusion criteria for venous surgery.

Combined Modality Therapy↗
PubMed1992

High-flow priapism and glans hypervascularization following deep dorsal vein arterialization for vasculogenic impotence.

Microsurgical penile revascularization is becoming an increasingly applied technique in patients with arteriogenic or mixed arteriogenic and venogenic impotence. Deep dorsal vein arterialization has been used successfully in selected patients. Aside from failure of the procedure and the occasional problems associated with vascular surgery, priapism and glans hypervascularization are specific complications of deep dorsal vein arterialization. Priapism in these cases is 'high-flow'; the functional arterial-cavernous fistula can overcome the maintenance of the flaccid state and cause persistent erection. Glans hypervascularization, a syndrome of glans enlargement, skin changes and pain secondary to excessive retrograde filling of the glans penis and corpus spongiosum, can result in urethral compression and glans ulceration. Along with the presentation of the case of a man who suffered both complications, we discuss their pathophysiology, prevention, and treatment.

Adult↗
PubMed1987

On desire, excitement, and impotence in modern sex therapy.

The widely accepted DSM-III classification of sexual dysfunctions has reinforced the idea that it concerns easily distinguishable deficiencies in the 'normal' phases of the sex response cycle: desire, excitement, and orgasm. For each of these deficiencies sex therapists offer a standard treatment package by which clients can learn to restore the 'natural' response pattern. As such, treatment has become a matter of techniques and so has sexuality itself. Acting as psychotechnologists, many sex therapists show an almost insatiable 'desire' to improve their clients' sexual performance and they experience the 'excitement' of their therapeutic work in counting the number of orgasms their clients are able to reach. But facing the problem of inhibited sexual desire, a lot of sex therapists must admist their 'impotence' in this matter. What they do not seem to realize is that their performance-oriented approach enhances a sociocultural climate in which people lose interest in preprogrammed sex, because sexual lust has turned from a taboo into a 'must'.

Arousal↗
PubMed1989

New treatment of increased venous drainage in organic impotence: ligation of internal iliac veins.

The internal iliac vein is the main confluent of the periprostatic and pudendal plexus. Therefore, it seems logical to ligate both internal iliac veins in impotent patients with increased venous drainage. The procedure was performed on 52 men and combined with ligation of collaterals to the saphenous and femoral veins in 32 of them. Erectile capacity improved in 36 patients (70%). Occasional papaverin injections and local nitroglycerin application were of help in 10 patients. Failures in 16 of 52 cases were mainly due to neurovascular lesions in diabetics.

Collateral Circulation↗
PubMed1989

Severe arterial insufficiency in impotence confirmed with an improved angiographic technique: the impact of smoking and some other etiologic factors.

Arteriography of the penile arteries in patients with pharmacologic erection has been performed by our group since 1983. Pathological Doppler findings and weak response to locally administered papaverine or alpha-blocking agents in these impotent men led to pharmacoangiography in 17 of 372 patients with erectile dysfunction; of these 372 patients 130 (35%) had subnormal penile blood flow according to Doppler ultrasonography. Only one had a proximal lesion (occlusion of the right common iliac artery) while the rest had distal lesions. Three patients were nonsmokers and the remaining 14 patients (82%) were smokers or had smoked previously. Only 2 of the 14 had other predisposing diseases.

Aged↗
PubMed1979

Impotence secondary to postpuberal hypogonadism.

We studied 4 patients who were under consultation for secondary 'impotence coeundi' and who had had normal puberal development (degree V in the Tanner's scale). 2 of them had children. In the diverse diagnostic attempts, basal deficits of FSH, LH and testosterone were repeatedly confirmed. Stimulation with HCG was positive. Stimulation with Gn-RH did not modify the basal deficient values. Stimulation with clomiphene in 1 case was also negative. The determinations of ACTH, TSH, metopirone test and PBI were normal. In the spermiograms there was oligoasthenozoospermia. We have not found antecedents that justify the hormonal insufficiency, thus we consider that it is a selective deficit of FSH and LH and of hypothalamic or pituitary postpuberal idiopathic genesis. Sexual potency was quickly regained when the patients were treated with HCG. In every case the dose was adjusted to allow therapeutics.

Adult↗