SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A case of priapism is described which complicated treatment of impotence with local injections of papaverine. A review is presented of the pertinent literature on the principles and complications of local pharmacotherapy of erection disturbances.
We report our study of surgical treatment of vasculogenic impotence using the technique of arterialization of the deep dorsal vein. The results of the operation performed in 13 selected cases are good although the follow-up is still short. The reasons why we consider this technique preferable to the others available for penile revascularization are discussed.
Intracavernous injection of various vasoactive drugs was performed in six erectile failure patients. The effects of each drug were evaluated in four grades: complete functional erection, incomplete functional erection, nonfunctional expansion and no effect. When papaverine hydrochloride (40 mg/ml) was administered, 4 of the 6 patients had nonfunctional expansion. By administering a mixture of 80 mg/ml papaverine hydrochloride with 1.0 mg/ml phentolamine mesylate, nonfunctional expansion was seen in four patients and incomplete functional erection in two patients. As for the effects of prostaglandin E1, incomplete functional erections were seen in all patients, while complete functional erection was seen in two patients. These findings indicated that the patients reacted differently to the same vasoactive drug, and that the papaverine and phentolamine mixture had a stronger effect than papaverine alone, while prostaglandin E1 had the strongest effect on erection. Intracavernous injection of the these drugs is useful for the treatment and differential diagnosis of impotence.
Attention is called to the clinical problem of masked depressions and depressive equivalents. In certain situations, the "impotence" symptom can be classified sonographically among cyclothymic disturbances. The Rorschach test has been used to study some typical cases and it is stressed that a psychodiagnostic investigation may be useful in the differential diagnosis of the clinical syndrome.
Impotence is a distressing problem with a number of causes. In the absence of serious pathology, a careful study of the doctor-patient relation may provide insight into the underlying aetiology.
Intracavernous injection of papaverine and phentolamine (Regitine) was performed in 223 impotent men. These patients had been previously evaluated at another department. Patient failure to obtain spontaneous erection during sleep or on waking was a prerequisite for inclusion in the study. Following evaluation of the penile brachial pressure index (PBI), patients under 50 years received an intracavernous injection of 0.5 mg. Regitine and papaverine 30 mg; patients over 50 years received 1 mg. Regitine and 30 mg. papaverine. Patients were observed for a minimum of 30 minutes. Fifty-eight attained erection and the remaining patients achieved varying degrees of penile tumescence. Patients were advised to have sexual intercourse within two hours following injection. Fifty-eight patients attained erection immediately and 132 achieved erection following immediate sexual stimulation. Of these 132 patients, 72 (54.5%) had successful sexual intercourse, 60 (45.5%) failed to obtain erection sufficient for coitus. We are unaware of the result in the remaining 33 patients who had none or late sexual stimulation. Of the 58 patients who achieved erection, the PBI could be quantified in 53 (mean 0.84). Likewise, the PBI could be determined in the 141 patients who had failed to achieve erection immediately (mean 0.77). Priapism was the only serious complication observed. Seven (3.1%) patients who presented with this condition were treated with the intracavernous injection of dopamine.
In 14 out of 94 patients with erectile dysfunction a venous insufficiency was suspected. Localization and securing of the venous leak were done by dynamic cavernosography. An insufficient penile blood supply could excluded by Doppler ultrasonography and measurement of the penile-brachial artery-pressure index. In 7 out of 13 patients treated by ligation of penile veins the erectile function was normalized after operation, in 4 cases an additional intracavernous injection therapy was necessary and in 2 patients the operation was unsuccessful. If impotence occurs once more due to venous collaterals the implantation of a penile prosthesis should considered.
It is reported on the diagnosis and treatment of vasculogeneic impotence. With the use of dynamic cavernosography in 6 patients changes in the venous system were detected and therefore the profound dorsal penile vein was ligated. In 4 patients the sexual function could be improved. The results are encouraging in the case of safe diagnosis and adequate operative treatment.
The increased use of intracorporeal drugs in the treatment of impotence has advanced our understanding of erectile physiology. Radionuclide imaging of the penis (nuclear penogram) has provided clinicians with a noninvasive, objective measure of blood flow and blood pool changes during erection and with assistance in the quantitative documentation of therapeutic effect.
The AMS 700TM & 700 CXTM penile prosthesis was implanted in 34 organic and mixed-type impotent patients between November, 1984 and July, 1988. The patients' ages ranged between 32 and 70, with an average age of 57.2. Twelve weeks after implantation, the prosthesis was evaluated in terms of patient satisfaction with sexual intercourse and postoperative complications. Twenty three patients (67.7%) were highly satisfied, 7 (20.3%) satisfied, 3 (8.8%) dissatisfied and 1 patient worsened (2.9%). Severe complication was found in two cases, both of them being complicated by infection; as a result the prosthesis was removed. Utility of the prosthesis, e.g. effectiveness and safety was; high utility in 26 cases (76.5%), moderate utility in 7 cases (20.6%), and no favorable in one case (2.9%). Thus, overall effectiveness and safety of the AMS 700 penile prosthesis, with its excellent cosmetic appearance upon implantation, were demonstrated by the above findings.
From February 1989 to June 1989, 49 patients consulted our OPD for the complaint of impotence. The average age was 46.9 +/- 11.2 y/0. We applied intracorporeal injection of papaverine (60 mg) by color duplex sonography (Acuson 128) for evaluation. The results of the papaverine test were: good response in 6 (12%), imperfect response in 21 (43%) and impaired response in 22 (45%). So the total positive response rate was 55%; and the total negative response rate was 45%; two patients (4%) experienced priapism. Spontaneous detumescence occurred after aspiration of the corpus cavernosum and no complications ensued. We utilized duplex sonography for evaluating penile blood flow before and after papaverine injection. Diameters of the deep artery was: right artery increased from 0.42 +/- 0.13 mm to 0.76 +/- 0.26 mm, while the left artery increased from 0.43 +/- 0.19 mm to 0.64 +/- 0.31 mm. Following injection, the peak velocity and the increased change of peak velocity were higher in patients in the positive response group than in the negative response group. There was no correlation for the percent of increase in diameter of the deep arteries. This technique provides a safe method with few complications for the objective assessment of response to intracorporeal papaverine injection and the anatomic structure of the penis. Use of this technique can also avoid unnecessary examinations and influence the strategy of treatment. After normal values and parameters are established, this method should be a useful diagnostic tool.
Regional hemodynamics of the penis is an essential part in the complex investigation of patients with erectile impotence. It is an actual problem to find diagnostically valuable noninvasive techniques allowing one to make a reliable assessment of penile erection mechanisms in various groups of the patients. In this line the authors faced the problem to find out the diagnostic value of dopplerography in measuring the linear rate of the blood flow (LRBF) in the penile arteries during the complex study of penile hemodynamics with regard to various groups of patients. The authors employed the following techniques: measurement of penile systolic pressure; determination of the penile-brachial index; rheophallography and determination of rheographic index; dopplerography and LRBF measurements. A total of 60 males were under study: group I--controls (20 males); group II--sexologically compromised patients without any disease of major vessels; group III--patients with Leriche's syndrome. The findings were analysed in variance. The coefficient of paired correlation was derived. Comparing each parameter between the groups showed a significant difference in each method between groups 2 and 3, as for parameters, only LRBF varied greatly in these groups.
The authors develop the key position of the wife in male impotence, even if organic. This influence may be positive or negative and plays an important role in the prognosis.
Sixty-nine patients who underwent major pelvic surgery for bladder cancer were evaluated for sexual consequences. Impotence was observed in 85% of the patients after 48 radical cysto-prostatectomies. Among them, one third developed a parallel sexuality without erection but with orgasm: they are candidates for penile implants. In a small number (15%) of the patients, erections were preserved: this was observed in 5 out of 12 patients (41%) who were operated with the new technique sparing the cavernous nerves. An optimistic note emerges from surgical solutions, whether prophylactic or palliative, but one must insist on the necessity of a psychological support before and after the operation.
Forty milligrams papaverine HCl was intracavernously injected to 28 patients with erectile dysfunction for diagnosis and treatment in 14 cases in which it was injected a few times. We designed a brief manual method for measurement of penile hardness by artificial erection. Twenty of the patients corresponding to 71.4%, reacted, but only 16 (57.1%) had efficient erection for possibility of coitus. It was useful for the diagnosis of vascular dysfunction with dorsal penile arterial pulse sound examination in impotence. It was useful for the cases of small vascular impediment with preservation of nerve supply after the operation of intrapelvic malignancies, and self injection might be possible, but on the other hand, it had no effect for the patients of advanced age with vascular impediment and diabetes mellitus neuropathy, and with arteriosclerosis.
Examination of 50 patients suffering from impotence of vascular genesis included selective angiography of the penis conducted against the background of artificially induced erection, Doppler sonography of the penis and angiography and measurement of the corpora cavernosa. The following causes of impairment of erection were revealed: abnormal venous drainage of corpora cavernosa, derangement of arterial inflow due to occlusion of the aorta, iliac arteries, internal iliac artery, internal pudendal and penile arteries. Surgical correction was aimed at elimination of abnormal venous drainage, inclusion in the major blood flow of the internal iliac arteries and shunting of the penile arteries. Direct favourable results were obtained in 37 (74 per cent) of the patients operated on.
A case series of 226 male patients, aged between 19 and 65 years, in whom a "venous-leakage" was probably the cause of impotence is reported. The Authors describe the complex diagnostic iter, the principles of medical and surgical treatments and the results. Finally the clinical conditions considered essentially proposing a surgical treatment are announced.
In a recent experience we have studied 297 patients for impotence. 102 were considered psychogenic and 195 organic; 105 of the latter had isolated or associated arterial or venous lesions. The remaining 81 patients had preponderant organic pathology: Peyronie's disease, neurological disease, diabetes and pelvic trauma. All patients were explored by NPT (nocturnal penile tumescence), Doppler examination, intra-cavernous papaverine test, angiography and erectile flow associated with cavernography. We report our microvascular surgery results from the last seven years. 80 reconstructive vascular procedures were performed on a population of patients who averaged 50 years of age. 50 epigastric-cavernous by-passes were performed. Complete recovery has been observed in 14% with an average of 42 months follow-up. Erection improvement with possibility of vaginal intromission in 58%. Immediate or secondary thrombosis and priapism in 28%. 21 arterial epigastric-dorsal unilateral by-passes were performed with an average follow-up of 20 months. In 11 cases the arterial micro-revascularization was associated with deep dorsal vein ligature. Results are as follows: 10 excellent, 4 significant improvement, 3 failures and too short follow-up in three. 9 isolated venous ligature with a mean follow-up of 15 months. Complete recovery was observed in 3 patients, improvement in 3 and failure in 2. The author emphasizes the interest of a better selection of surgical indications, improvement of microsurgical techniques with epigastric-dorsal anastomosis associated with postoperative anticoagulant therapy whenever possible.