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PubMed1989

[Cavernovenous leakage, a surgically treatable cause of erectile impotence].

In 17 of 33 patients with proven organic erectile impotence, caverno-venous leakage was determined by dynamic cavernosography in conjunction with high flow rates to induce and maintain artificial erection. The normal values of dynamic cavernosography in 12 healthy males are presented as well. Of these 17 patients 12 (aged 26-51 yr) underwent surgical ligation or resection of the deep dorsal vein of the penis and ligation of ectopic veins if present. Potency was restored immediately postoperatively in 8 of these 12 patients. In 2 of the other 4 operated patients cohabitation was possible again only with auto-injections of papaverine. The short-term results are presented.

Adult↗
PubMed1989

[Stimulation of experimental conditioned reflex impotence and a new method of detecting an aphrodisic effect].

Ten original apparatuses were constructed to examine aphrodisiac effect. For the purpose conditioned reflex impotence was induced in white male mice in advance. Using the new method for establishment of the aphrodisiac effect the values of ED50 of the preparations Yohimbin, Testosteronum dipropionicum, Tribestan, Captogon, Coffeinum n. benzoicum and Imipramin were estimated. The new method allows to differentiate aphrodisiac effect from psychostimulating and antidepressive action. The advantages of the new method are: objectivity, adequacy to human pathology and does not require constant observation of the experiment.

Animals↗
PubMed1989

[Hypervascularization syndrome of the penis following arterialization of the dorsal penile vein for erectile impotence].

A hypervascularization syndrome following arterialization of the deep dorsal vein of the penis to amend venous erectile impotence is a rare cause of penile ulcers that has not previously been described in the dermatological literature. Arterialization is performed by installing a shunt from the inferior epigastric artery or a venous bypass from the femoral artery to the deep dorsal vein of the penis, resulting in a blockage of venous outflow and in retrograde inflow into the corpora cavernosa. Complications arise as a result of persistently elevated blood pressure in the deep venous system and the erectile tissue in 10-20% of cases and are most often linked to dilatation of the shunt: the consequences are enlargement and induration of the glans, hazard of phimosis and paraphimosis, pulsation of the penis, micturation difficulties and, ultimately, ulceration of the glans. Surgical reduction of the arterial inflow ("banding" of the shunt) is the only therapeutic procedure that reduces hypervascularization without compromising the newly gained erectile function.

Arteriovenous Shunt, Surgical↗
PubMed1988

[Radionuclide diagnosis of vasculogenic impotence].

Pathogenesis of vasculogenic impotence is most adequately revealed by modern methods of the investigation of the hemodynamic mechanisms of erection with the enhancement of arterial perfusion of corpora cavernosa by artificial sexual stimulation. Radionuclide diagnostic methods effectively differ from the methods of radiocontrast phalloangiography by the simplicity of investigation and the absence of traumatism for a patient. The authors have proposed a mathematical model of a process of filling in the functioning volume of the penile vascular bed with a radiopharmaceutical preparation against the background of erection induced by intracavernous administration of papaverine hydrochloride solution. Parameters of the model determine the ratio of blood flow volumetric rates in the penis at rest and when erect.

Erectile Dysfunction↗
PubMed1987

Pharmacologic treatment of impotence.

A discussion of the anatomy, neurophysiology, endocrinology, and organ pharmacology pertinent to erectile function is presented, highlighting recent innovations in the pharmacologic treatment of impotence. Both oral and intracorporal pharmacologic agents that affect erectile dysfunction are discussed.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

[Impotence caused by venous leakage. Placement of a prosthetic venous bandage].

A new treatment of impotence by venous leakage is reported. It consists of tying the dorsal and lateral aspects of the cavernous body with a bandage of synthetic material. The bandage, inserted on the bulbo-cavernous muscles, restores a "carter effect" and prevents venous leakage during erection. This technique has been used in 20 patients, with satisfactory results in 10 who were followed up for more than 4 months.

Blood Vessel Prosthesis↗
PubMed1988

[Selective microsurgical therapy in vascular-induced erectile impotence].

Patients with erectile dysfunction should be subjected to a complex and complete diagnostic procedure, including selective pharmaco-phalloangiography and dynamic pharmacocavernosonography only when SKAT has failed and after the exclusion of neurological disorders. Patients being offered these invasive procedures should be highly motivated and willing to undergo surgical correction of the vascular origin of their erectile impotence. If peripheral vascular occlusive disease is found affecting the pelvic arteries, the best operative technique must be selected. In our opinion, this decision should be made intraoperatively after visualization of the dissected dorsal penile vessels. Use of the Doppler probe can be extremely helpful during the operation. Intraoperative findings on the degree of arteriosclerosis and arterial flow can differ from those allowed by preoperative diagnostic procedures. Penile erectile function was restored in seven of nine patients after penile revascularization performed under microsurgical conditions. We used the operative methods described by Virag and Hauri, applying our own modification of the Hauri procedure in two patients. With careful selection of patients and methods it should be possible to resolve individual patients' problems with peripheral occlusion, even though the exact hemodynamic pathology remains obscure.

Adult↗
PubMed1988

Radiological investigation of impotence.

Recent advances in the understanding of the causes of impotence have led to the recognition of various treatable physical causes. Some of these causes are related to vascular abnormalities which have necessitated the development of new imaging techniques. These now allow more precise diagnosis and the development of more appropriate surgical and radiological treatment.

Angiography↗
PubMed1985

[Technic for the indirect revascularization of corpus cavernosum in sexual impotence from distal arterial origin by double epigastro-veno-cavernous fistula].

A new technique of indirect revascularization of the corpora cavernosa in patients with sexual impotence of distal arterial origin is described. It consists of a termino-lateral anastomosis between the epigastric artery and the deep dorsal vein of the penis, followed by a latero-lateral anastomosis between that vein and one of the corpora cavernosa. This double epigastro-venous and veno-cavernous fistula has proved effective and has given satisfactory functional results in 5 patients followed up for a mean period of 12 months.

Arteries↗
PubMed1988

Can an intracavernous papaverine injection be used to diagnose arteriogenic impotence?

We injected papaverine into the corpus cavernosum of 93 patients with impotence, and compared the results with findings from nocturnal penile tumescence monitoring, psychogenic erection monitoring after sexual stimulation, penile-brachial indexes, and dynamic cavernosography. There was a significant correlation between the findings from papaverine injection and dynamic cavernosography, but there was no correlation between the papaverine findings and other tests including the penile-brachial index. We conclude that we can disregard the possibility of venous abnormality in those who respond to papaverine injection, but we cannot disregard the possibility of arteriogenic abnormality. We proved that papaverine injection cannot diagnose arteriogenic abnormality.

Adult↗
PubMed1988

[Surgical therapy of vascular impotence].

Improved diagnostic methods have increased the importance of surgery in the treatment of vascular impotence. The various surgical techniques and their limitations are reviewed. It is concluded that 50% of patients undergoing surgery regain their potency.

Arterial Occlusive Diseases↗
PubMed1988

Venous arterialization for erectile impotence.

Revascularization of the corporal bodies in arteriogenic impotence can be accomplished by means of a venous arterialization procedure as described by Ronald Virag. This surgical approach and early results are detailed in this article.

Erectile Dysfunction↗
PubMed1988

Evaluation of vasculogenic impotence.

Penodynamics, the functional evaluation of erection after intracavernous injection of vasoactive drugs, is a simple screening test that excludes significant vascular problems if full erection occurs within a reasonable period of time. Although it is more invasive than the penile brachial index (PBI), it is well tolerated and easy to perform. There is good evidence that studies on the flaccid penis are less accurate and do not correlate well with the results of functional papaverine testing. To evaluate arteriogenic impotence, sonography and pulsed Doppler analysis combined with papaverine injections provide objective and reproducible measurements of diameter increase and blood flow of each penile artery and have the advantage of being a functional study. Although this equipment is expensive, it is available in many centers where noninvasive vascular flow studies are performed. With training, the technique can be mastered by anyone. The arterial response to papaverine and the resulting erection allow indirect judgment about the venous system. Therefore, the whole penile vasculature can be evaluated with this technique. Currently, many drugs or drug combinations are used to induce artificial erection, not only for diagnosis but also as a therapeutic alternative to penile prostheses. The only physiologic agent is prostaglandin E1, a substance that seems to be as effective as papaverine but can be metabolized within the cavernous tissue and reportedly results in fewer incidences of prolonged erection and priapism. The use of vasoactive drugs is also very helpful for angiographic studies by improving flow and diameter of the penile vessels, which will result in better images of the arterial lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1988

Diagnostic and therapeutic technology assessment. Penile implants for erectile impotence.

Three semirigid penile prostheses (Small-Carrion, Finney Flexirod, and Jonas Silicone-Silver) and a multicomponent inflatable penile prosthesis (Scott) were considered safe and effective treatment for impotence unresponsive to medical management. Each of these prostheses has its own advantages and disadvantages. The entire semirigid prosthesis group is surgically easier to implant than the inflatable models and, except for fracturing of the silver wires in the Jonas model, has a low incidence of mechanical failure. However, the semirigid models are not as aesthetically pleasing or as sexually satisfying to both partners as are inflatable devices. Multicomponent inflatable penile prostheses have had a history of mechanical failure; however, improved design and materials have reduced this problem. Several new concepts in penile prostheses have recently been developed: the self-contained inflatable prosthesis and an articulating prosthesis made of a spring-loaded cable that runs through a series of plastic segments. The self-contained inflatable prosthesis contains a fluid reservoir within the device itself. This eliminates the need for a separate reservoir, pump, and connective tubing (AMS Hydroflex, Flexiflate). There are not yet enough long-term data available to evaluate these new single-component devices.

American Medical Association↗
PubMedDate not supplied

[Male impotence. Radiologic venous examinations].

A vascular pathology is the most common etiology of male impotence of organic origin and among these vascular problems, the most frequent are represented by the anomalies of the venous drainage. Based on a personal experience of more than 450 radiological examinations, we will describe the techniques of cavernography and cavernometry as well as the effects of intra-cavernous injections of papaverin and we will present the results from the literature.

Erectile Dysfunction↗
PubMed1988

[Surgical therapy of erectile impotence of vascular venous origin].

We report about 32 men, who suffered from erectile impotence due to venous leakage. Three methods of penile surgery are described, the ligature of plexus santorini, the ligature of deep dorsal vein and the ligature of ectopic veins of the penis. By these operations 72% of the patients achieved potency again.

Adult↗