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PubMedDate not supplied

Fournier's syndrome in a ketoacidotic diabetic patient after intrascrotal insulin injections because of impotence.

Fournier's syndrome is a necrotizing fasciitis most commonly confined to the male genitalia with high morbidity and mortality rates. The salient features are (1) sudden explosive illness in the midst of apparent health; (2) rapid necrosis and sloughing of tissues of the scrotum and penis; (3) absence of an obvious cause; (4) a mixed bacteriologic picture; and (5) gangrene affecting the whole thickness of the scrotal skin, but not the underlying testes. With the propensity toward life-threatening infections in patients with diabetes, it is surprising that Fournier's syndrome is not more common in suboptimally treated diabetic patients. This report is to illustrate the recognition and treatment of Fournier's syndrome in a patient with diabetes. Also, it must be emphasized that the explosive course of the disease process begins with a benign-appearing, epididymitis-like picture. Prompt recognition followed by prompt surgical debridement and appropriate antibiotic therapy along with surgical wound closure is necessary to reduce morbidity and mortality. The present case is unusual for the following reasons: (1) necrosis of the testicles requiring orchiectomy; (2) extensive spread of gangrene beyond the genitalia; and (3) the route of infection, which appeared to be intrascrotal injections of insulin in a vain attempt to cure impotence.

Adult↗
PubMed1984

Penile implants in erectile impotence: outcome and prognostic indicators.

In a prospective, multi-disciplinary study thirteen men with protracted, organic erectile impotence were examined before and after penile implantation. Outcome after one year was judged as favourable in nine, doubtful in two, and unfavourable in two cases. Neurotic functioning was unexpectedly common in the group and the more neurotic subjects fared less well after surgery and reported less benefit from it. Findings in the preoperative psychiatric examination that correlated significantly with unsuccessful outcome were immature and neurotic, particularly hysterical traits, low sexual drive, low sexual activity, disavowal of ambivalence towards penile implantation and high "femininity" scores on a sex role inventory, the Gough Femininity Scale.

Adult↗
PubMed1987

The value of basic investigations in the diagnosis of impotence.

172 patients with impotence symptoms were investigated by SBBBV-test, orthostatic blood pressure, Doppler examination of the superficial and deep penile arteries, penile-brachial index, visual sexual stimulation, papaverin test, and measurement of bulbocavernous reflex latency time. Visual sexual stimulation and papaverin test correlated well with each other, and so did papaverin test and PBI in cases of arterial insufficiency. SBBBV was simple to perform and useful in detecting autonomic neuropathy. There were characteristic differences in the pattern of erectile failure between young and old patients. The differentiation to organic or psychogenic erectile failure was easier in the young age groups, whereas the old patients more often had a combination of vascular and psychogenic aetiology.

Adolescent↗
PubMed1989

Etiologic aspects of impotence in diabetes.

An investigation of 37 diabetics with impotence (15) or erectile difficulties (22) is presented. On average two significant abnormalities per patient were found. Ranked in order of incidence, the causes were as follows: 1) Combination of neuropathy and psychosocial factors, 2) combination of neuropathy and vascular disease, 3) peripheral neuropathy only, 4) combination of hormonal imbalance and psychosocial factors, 5) combination of three or more defects, and 6) penile vascular disease or psychosocial problems only, or hormonal imbalance combined with peripheral neuropathy.

Diabetic Angiopathies↗
PubMed1981

Male diabetic sexual impotence: effects of dopaminergic agents.

A double blind study was carried out with placebo and dopaminergic agents in 100 patients with male diabetic sexual impotence. In basal conditions, mean serum FSH, LH, PRL, and T levels did not significantly differ from those found in a normal control group. No significant variations with the exception of PRL reduction were observed after use of the dopaminergic agents. Sexual activity was improved in 50% of cases after 3-4 dihidroxifenilalanine and 10% of those of the placebo group. In patients with bromocriptine, 20% improved their sexual function without changes in those receiving placebo.

Adult↗
PubMed1993

[Postoperative results of ligation of crura penis for impotence with corporal veno-occlusive insufficiency].

We performed ligation of the crura penis for 34 impotents with corporal veno-occlusive insufficiency without arterial insufficiency and neural dysfunction from October 1987 to April 1991. Ages ranged from 24 to 72 (52.6 +/- 12.7) years old and follow up period was from 1 to 41 (17.7 +/- 12.6) months. For six patients ligation of the crura only was performed, for 22 ligation of the crura and deep dorsal vein (DDV) as well was performed at the same time, and for 6 crural ligation was performed after ligation of DDV. These operations required less than one hour and there were no severe complications. The postoperative results at 1 month were as follows: Excellent (sufficient spontaneous erection was recovered); 18, Improved (complete erection with intracavernous papaverine injection was achieved); 13, and Failure; 3. Erectile function was maintained only in 50% of the 18 pts. graded excellent. Ninety percent of the 31 patients graded either excellent or improved could maintain erectile function after 40 months with papaverine injection. Venous surgeries could not be a primary treatment for correcting the outflow abnormalities (of the veins). So it is conceivable that failure or recurrence could occur during a long follow up period. We concluded that crural ligation was acceptable as the first line treatment for erectile dysfunction due to corporal veno-occlusive insufficiency because of its relative non-invasiveness compared to other venous surgeries.

Adult↗
PubMed1980

An inflatable penile prosthesis for treatment of diabetic impotence.

Surgical results have improved considerably since the first implantation of the inflatable penile prosthesis in 1973. The incidence of infection appears to be less than 2% and the overall success rate greater than 95%. With strict attention to details of preoperative preparation and to asepsis, the incidence of infection is probably no greater in the diabetic patient. Although there will always be mechanical problems with this more sophisticated device, the ease with which these problems can be corrected and the advantages of having natural erections, as well as flaccidity, makes the inflatable prosthesis the most desirable treatment for organic impotence.

Adult↗
PubMedDate not supplied

[The treatment of organic impotence by implantation of plastic prosthesis. Reflections on 50 cases (author's transl)].

The treatment of impotence by implantation of a semi-rigid silastic prosthesis is suitable only for the patient with persistent libido and who has a short or weak erection. Patients in whom libido is absent; or in whom there is absolutely no erection are not improved by operation. Use of a semi-rigid silastic prosthesis which may be introduced unto a canal formed between the tunica albuginea and the corpora cavernosa is, in our experience, the simplest and most rapid method, as well as being associated with the least complications. The semi-rigidity of the penis did not pose any problems in any of our patients and none reported any complaints by the partner.

Adult↗
PubMed1998

A VR based therapy for the treatment of impotence and premature ejaculation.

The use of psycho-dynamic psychotherapy integrating virtual reality (VR) dealt with in this study on the treatment of erection dysfunctions and premature ejaculation started several years ago, after having seen the scarce results we obtained using exclusively a psycho-dynamic approach (accompanied by pre-recorded sound and music). Considering the particular way that full-immersion VR involves the subject who experiences it, we hypothesized that better results could be obtained during therapy for these sexual disorders and in particular regarding the nature of erection dysfunction, commonly referred to as impotence "a persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection." The plan for therapy consisted of 12 hour-long sessions over a 25-week period, and the methods involved the use of a VR helmet, joystick and miniature television screens that projected specially-designed CD-ROM programs on psychological development.

Adult↗
PubMedDate not supplied

[Physical factors in the treatment and rehabilitation of patients with chronic prostatitis complicated by impotence].

103 patients with chronic prostatitis complicated by erectile impotence were given combined treatment including shock-wave massage, mud applications, local vacuum magnetotherapy. This combination was found to stimulate copulative function, urodynamics of the lower urinary tracts, to produce an antiinflammatory effect. These benefits allow to recommend the above physical factors for management of chronic prostatitis patients with copulative dysfunction.

Adult↗
PubMed1999

A parallel study on the effects in treatment of impotence by tonifying the kidney with and that without improving blood circulation.

141 cases of functional impotence of the kidney-deficiency type were treated by tonifying the kidney. On them, 103 cases at the same time were treated by improving blood circulation and the other 38 cases by the former only. As a result the total effective rate and the markedly effective rate in the former were 84.46% and 46.60% respectively; but in the latter, 60.55% and 13.15%. A significant difference was found in Ridit analysis (P < 0.05), indicating that method of tonifying the kidney with improving blood circulation is much better than by simply tonifying the kidney alone.

Adult↗
PubMed1998

[Viagra--the first oral treatment for impotence that is not lacking in fatal effects].

Impotence, a common problem especially among older men, can now be treated with Viagra, This oral pill, unlike previous approved treatments mostly involving local injections, does not directly cause penile erection, but increases response to sexual stimulation. It acts by enhancing the relaxant effects of nitric acid on smooth muscle, and thus increases blood flow to certain areas of the penis, leading to erection. It has been evaluated in many randomized trials and in all was more successful in inducing erection than placebos. The most common side-effects include headache, flushing and indigestion, but there have also been reports of fatalities. We describe a 75-year-old man who had an acute myocardial infraction in the past and who had maturity-onset diabetes and hypertension. In the week prior to admission he had a cardiac scan following a few weeks of exacerbation of anginal pain for which he had been taking nitrites. He took a Viagra pill without prescription or medical advice and 2 hours later, during intercourse with his wife, developed audible respiratory distress and lost consciousness. His wife started cardiac massage but not mouth-to-mouth breathing. The emergency team found ventricular fibrillation and gave 5 electrical shocks and amines and atropine. He remained unconscious, but his pulse returned and he was hospitalized. He then had several generalized convulsions treated with i.v. valium. 20 minutes after admission there was asystole and all attempts at resuscitation failed. Cardiovascular status must be considered prior to prescribing Viagra, and the associated risk evaluated.

Aged↗
PubMed2001

['Leiden Impotence Screening Test'(LIST) in men with erectile dysfunction as a pre-selective method prior to psychophysiological diagnostic tests].

OBJECTIVE: To compare, in men with erectile dysfunction, the diagnosis obtained with the 'Leiden impotence questionnaire' (LIQ)--which differentiates between psychogenic and organic erectile dysfunction--with the clinical diagnosis based on psychophysiological diagnostic screening (PDS). DESIGN: Exploratory, comparative, and prospective. METHOD: The LIQ-questionnaire was administered to 320 consecutive patients with erectile dysfunction who underwent PDS (i.e. visual sexual stimulation and penile vibration) in the Department of Endocrinology and Reproduction, Erasmus University Medical Centre, Rotterdam, the Netherlands. The clinical diagnosis was based on PDS and later, retrospectively, compared to the LIQ-based diagnosis (only the first six of the 11 LIQ-questions were answered by all patients). RESULTS: The clinical diagnosis, psychogenic or somatic, corresponded well with the LIQ-diagnosis. Following PDS an organic aetiology was assumed in 30% of the patients; compared to 33% according to the LIQ. For a psychogenic aetiology the figures were 70% and 67% respectively. Overall there was a 74% correspondence between PDS-diagnosis and the LIQ-diagnosis. Age was a significant factor: younger men (< 40 years) had the highest LIQ-score (compared to men aged 40-60 and > 60 years) and the strongest penile responses. This is indicative of a more frequent psychogenic aetiology of the erectile dysfunction in younger men. CONCLUSION: Elaborate psychophysiological diagnostic screening is not necessarily the first diagnostic choice in men with erectile dysfunction; one may start by applying the LIQ. A high LIQ-score (5-7) virtually excludes a somatic aetiology. A low LIQ-score (0-2) necessitates further psychosomatic diagnostic screening, preferably with PDS.

Adult↗
PubMed2001

Effect of glycemia status on endocrinological parameters of impotent and infertile patients.

OBJECTIVE: To identify the effects of glycemia status on hormone levels, we evaluated the effects of hypo and hyperglycemia on endocrinological parameters of patients with erectile dysfunction, infertility, varicocele and compared the results with control subjects. MATERIALS AND METHODS: Twenty patients with erectile dysfunction, 20 infertile patients with oligo-azoospermia, 20 patients with normozoospermic left varicocele and 15 healthy control subjects constitute our study population. Plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and prolactin (PRL) levels were measured both in patients in hypoglycemia and hyperglycemia status. Statistical analysis were done by Wilcoxon test. RESULTS: All endocrinological parameters did not show any statistically significant difference between the hypoglycemia and hyperglycemia status. Also, no abnormalities in the endocrinological parameters were observed. CONCLUSION: We showed that the glycemia status of the patient (either hypo or hyperglycemia) did not effect the results of endocrine profile. Also, endocrine evaluation is unnecessary in impotence and infertility.

Adult↗
PubMed1976

[Impotence and male sterility].

The causes of sexual impotence, including disturbances of ejaculation, and the methods of treatment are described. In the vast majority of cases male sterility results from a disorder of spermatogenesis. The main factors responsible for infertile semen are discussed: in most cases the causes are unknown. It is to be hoped that progress in research into human reproduction and recent diagnostic advances will provide the groundwork for more successful therapy of male sterility.

Chromosome Aberrations↗
PubMed2002

Gynecomastia and sexual impotence associated with methotrexate treatment.

Methotrexate (MTX) is the disease modifying antirheumatic drug most frequently used for rheumatoid and psoriatic arthritis (PsA). Several reports associate sexual dysfunction to MTX use. We describe 2 cases of sexual impotence and gynecomastia in patients with PsA treated with MTX. Although the mechanism underlying MTX induced sexual dysfunction is unknown, the potential consequences should be taken in account in view of the steady increase in the number of patients.

Adult↗
PubMed2001

[In venerem ignavus: medicine, impotence and law in modern age].

Surgical and forensic medical texts of modern age classifies male impotence according to two different patterns. If both psychological and functional causes can be admitted as responsible of male disfunctions, physical deficiencies only can be regarded as legal reason to obtain divorce.

Erectile Dysfunction↗