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PubMed1999

Perineal floor efficiency in sexually potent and impotent men.

Given the knowledge that the ischiocavernous and bulbocavernous muscles are involved in the erection of the penis, we studied the voluntary contractile activity of the perineal floor muscles in sexually potent and impotent men to investigate whether or not a different muscular efficiency can be found in these subjects. The activity of perineal floor muscles was studied in 76 sexually potent men and in 97 impotent men matched by age. A further group of 217 older impotent men was also studied to verify the impact of age on the efficiency of perineal floor contraction. The average myoelectrical activity of 24 maximized contractions of the perineum was measured in microV by anal plug electromyography. Perineal floor muscle contraction was significantly higher (P = 0.0007) in potent than in impotent men matched by age. In addition, in older impotent men the less perineal floor efficiency was also negatively correlated to age (r = -0.21, P = 0.002). Our results clearly demonstrated that a reduction of contractile activity of perineal muscles may be related to erectile dysfunction in younger men and an additional influence of age on perineal floor efficiency can be present in older impotent men.

Adolescent↗
PubMed1994

Cigarette smoking: an independent risk factor for impotence?

The authors sought to determine whether current cigarette smoking was associated with impotence among middle-aged men. This is a secondary analysis of a cross-sectional survey of 4,462 US Army Vietnam-era veterans aged 31-49 years who took part in the Vietnam Experience Study in 1985-1986. The main outcome measurement was the odds ratio for reported impotence, which was calculated by comparing current smokers with nonsmokers while controlling for multiple confounders. The study sample consisted of 1,162 never smokers, 1,292 former smokers, and 2,008 current smokers. The prevalence of impotence was 2.2% among never smokers, 2.0% among former smokers, and 3.7% among current smokers (p = 0.005). The unadjusted odds ratio (OR) of the association between smoking and reported impotence was 1.8 (95% confidence interval (CI) 1.2-2.6). The association held even after adjustments were made for confounders, including vascular disease, psychiatric disease, hormonal factors, substance abuse, marital status, race, and age (OR = 1.5, 95% CI 1.0-2.2). Neither years smoked nor cigarettes smoked daily were significant predictors of impotence in current smokers. The authors concluded that, among the men in this study, a higher percentage of cigarette smokers reported impotence than did nonsmokers. This observation could not be totally explained by comorbidity factors related to smoking.

Adult↗
PubMed1987

Pharmacologic erection program for the treatment of male impotence.

Recent advances in the understanding of the physiology of the erection process have led to exciting new diagnostic and therapeutic techniques in the management of impotence. Intracavernous injection of pharmacologic agents can be used to both diagnose and treat certain types of impotence. At the Nashville Impotence Center we use intracavernous injections of papaverine-phentolamine to diagnose vascular impotence and to treat certain patients with organic impotence as well as some patients with psychologic impotence. One hundred thirty-six patients are currently enrolled in our self-injection treatment program. Complications and side effects have been rare.

Drug Therapy, Combination↗
PubMed1993

Ultrastructural features of penile tissue in impotent men.

Penile erection is related to the integrity of penile tissue. In order to study the ultrastructural histopathological changes in penile erectile tissue in impotent men, biopsies were taken from 29 impotent and 5 normal patients during surgical treatment. Light microscopy revealed insignificant histological changes and various degrees of fibrotic change in the corpora cavernosa of impotent men, and electron microscopy revealed severe myopathic, fibrotic changes in the penile tissue. These non-specific changes could not be used to determine the aetiology of impotence, and the relationship between the ultrastructural appearances, the causes of impotence and the results of treatment was unclear. Further studies are required to establish the value of intracorporeal biopsy in selecting treatment for impotent patients.

Adult↗
PubMed1984

Cavernometry-cavernography: its role in organic impotence.

The intracavernous pressure necessary to produce a passive erection was recorded in 35 patients suffering from impotence. Among these patients, 5 presented psychogenic impotence. The intracavernous pressure was also recorded at rest during inflow and in the state of erection. The 5 psychogenically impotent patients had passive erections with a flow of 80-120 ml/min. 18 patients suffering from organic impotence developed passive erections at a flow of 80-120 ml/min, while the remaining 12 men needed a flow between 160 and 300 ml/min with visualization of a venous leak. The intracavernous pressure varied between 90 and 110 mm Hg in the state of erection. Artificial erection, induced in impotent men, allows to classify patients with vascular organic impotence into three categories: those with pure arterial insufficiency; those with pure venous leak, and patients with both.

Adult↗
PubMed2006

HMG CoA reductase inhibitors and impotence: two case series from the Spanish and French drug monitoring systems.

OBJECTIVE: HMG CoA Reductase inhibitors, more commonly called statins, are used in the pharmacological management of hyperlipidaemia. At present, the use of these drugs is increasing worldwide. They have been linked to certain adverse drug reactions, including impotence. The aim of the present study is to explore the basis of the association between statin use and impotence using data from spontaneous reports. METHOD: We analysed the cases of impotence associated with statins that were collected by the Spanish and French pharmacovigilance systems. We used cases of impotence as a numerator and consumption data as a denominator to estimate the cumulative reported incidence of impotence. RESULTS: Thirty-eight cases of impotence associated with statins have been identified in the database of the Spanish pharmacovigilance system; overall, there was a temporal sequence of events in all cases and the adverse reaction disappeared after drug withdrawal in 93% of the cases. Sixteen patients had also been treated with other drugs. In France, 37 cases were collected. In 85% of these cases recovery from the adverse reaction was observed after drug withdrawal; there was a positive rechallenge in five cases, and 15 patients were receiving other drugs at the same time. No significant differences among reported incidences with different statins were found. CONCLUSION: Considering the widespread use of this drug class and the under-reporting of this particular reaction it could affect a large number of patients. The reaction seems to be reversible in most of the cases after drug withdrawal. Doctors should be aware of this potential adverse reaction when prescribing statins to their patients.

Adult↗
PubMed1999

Outcome of managing impotence in clinical practice.

AIMS: Outside of controlled clinical trials, the outcome of treatment for unselected men with impotence is uncertain. This study aims to describe the clinical course of consecutive, unselected men referred to a specialist endocrinology private practice with a primary diagnosis of impotence. METHODS: Consecutive men referred with a primary diagnosis of impotence between June 1995 and December 1997 were studied. After initial evaluation and appropriate investigation, treatment with testosterone in hypogonadal men and instruction in the use of a vacuum device and intracavernosal alprostadil (Caverject) in all men was offered. All men were followed up by telephone and/or questionnaire about erection outcome three to twelve months later. RESULTS: Nineteen diabetic men, aged 53.1+/-8.2 years and forty non-diabetic men, aged 54.8+/-11.6 years were seen. Follow-up information beyond three months was complete in fifty-three (90%). Eighteen eugonadal men chose no further therapy and four of these men had spontaneous return of erections. Eight men were hypogonadal and potency returned in two of six men treated with replacement testosterone. Nine men used the vacuum device, which was effective in three of them. Forty-one men had a trial of Caverject injection, which was effective in twenty-eight. Only twelve of these men used Caverject for longer than six months. CONCLUSIONS: Return of erections with therapy beyond three months in unselected men with impotence is successful in only about one-third. Unexpected hypogonadism is relatively common in impotent men, but testosterone replacement therapy has a low rate of improving erections. New therapies for impotence need careful follow-up studies to assess their effectiveness in clinical practice.

Alprostadil↗
PubMed1975

[Sexual impotence: clinical and existential context].

A simple classification in global impotence and erective impotence appears closer to reality than more sophisticated but more arbitrary classification. In the majority of cases, impotence reflects a global psychological dysfunction. Psychogenic impotents are most of the time inferiorized subjects alledging organic or other non justified factors to their disorder. Generally, they are peaceful, obsessive, often hypothymic; they express disgust for the body, suffer various somatic dysfunctions due to the sexual stasis; they have difficulties in communicating with things and beings. As compared to erective impotents, it seems that the global impotents have a more rigid father, are among the younger sibblings and have more brothers and sisters. The author describes further some observations of partners and of couples, as well as etiological and prognostic factors.

Aggression↗
PubMed1992

[Recent diagnostic and therapeutic aspects in male sexual impotence].

Male sexual impotence is the symptom of an alteration of central and peripheral mechanism neuropsychoendocrine, vascular and neurological. Nowadays it affects 8-10% of sexually active population. In some diseases, like diabetes and uremia, it can reach very high percentages of incidence. At our Andrology Center 35% of referrals are represented by sexual complaints. In the last years the diagnostic accuracy has increased, narrowing the percentage of unknown causes. Vasculopathy represents the most relevant pathological condition associated with impotence: it can affect both arterial and venous vessels. The new medical technologies and procedures permit an increase of the life span but often affecting the quality of life. Therefore, the iatrogenic causes of impotence, both pharmacological and surgical, are growing. A modern diagnostic approach starts with an accurate clinical history and physical examination, followed by an NPT (nocturnal penile tumescence) test and/or ICI (intracavernosal injection) with a standard dose of PGE1 and Doppler flowmetry of penile arteries. An endocrine evaluation (LH, testosterone and prolactin) is also performed. Further investigation of a vascular dysfunction is represented by more invasive procedures, like arteriography, cavernosography and cavernosometry. A suspect of neurological disease is confirmed by sacral evoked potentials. According to the findings of these examinations, a correct therapeutical approach can be applied in 100% of cases. An endocrine treatment is adequate only when a clear reduction of T plasma level or hyperprolactinemia are present. The treatment of other central disorders causing psychoneuroendocrine impotence is promising, but still under investigation. The intracavernosal injection of vasoactive drugs, apart from having revolutionized the diagnostic approach to the impotent patient, represents a clear standpoint in medical management of impotence, particularly in vascular and neurological diseases. The great advancement in the technology of penile prostheses has allowed the development of valuable and reliable tools to be used in selected cases.

Adult↗
PubMedDate not supplied

Impotence in the XVIII-XIX century as described by Gian Pietro Fusanacci and Tommaso Eduardo Beatty.

In 1992, the definition of erectile dysfunction (ED) replaced the old term of impotence that had been used for many centuries, in order to avoid the general confusion existing until today in this field. In the past, the origin of impotence had been attributed to different causes such as psychological diseases, or witches and demons. In 1764, Fusanacci described impotence that can occur in the male as well as in the female, as a defect in reproduc-tion. The main causes responsible for impotence were identified as inability to achieve erection, a very fluid seminal ejaculation, a defective organ, dryness of testicles, and lack of copulative power after many sexual intercourses with healthy women. Some decades later in 1847, Beatty affirmed that one of the most remarkable changes that can be observed in the passage from childhood to maturity is the development of the sexual organs, followed by the appearance of new sensations. He distinguished impotence that occurs only in men from sterility that for him affects women, and divided the causes of impotence into 3 classes: organic, functional and moral (today defined as psychological). For Beatty, the progress of knowledge had taken away magic and sorcery from the human mind and now it was widespread only among the lowest and most ignorant classes of humble people. In this way, he shows the evolution of medical science in XIX century in accepting only the rational explanation of the human diseases.

Erectile Dysfunction↗
PubMed1991

[Non-surgical treatment of impotence].

Non-surgical treatment of impotence comprises psychotherapy, drug oral administration and injection, drug intracavernous injection and penile vacuum extraction. Concerning psychotherapy, functional impotence is indicated, but urologists find difficulty in treating patients by themselves, thus requiring the co-operation of a psychiatrist, psychosomatic physician, psychologist and others. Concerning drug therapy, functional impotence is the main target, but is practically unbenefit with the reserve of endocrinally effective hormone. For drug intracavernous injection, papaverine hydrochloride and prostaglandin E1 are mainly used. At our Department, 51 patients have so far had successful self-injections according to this method. However, the self-injection requires strict control of drugs, syringes, etc. and proper selection of indicated cases and that includes an incidence of priapism of ca. 10%, making it necessary to take quick countermeasures. This method is targeted mainly for organic impotence, but is also indicated partially dysfunctional impotence. Penile vacuum extraction is indicated for all kinds of impotence and has no side effect, but is actually too expensive (ca. 130,000 yen) though noteworthy.

Adult↗
PubMed1990

[Ligation of the crura penis: surgical treatment for venous impotence].

Recently it has become clear that venous impotents account for a high percentage of all impotents. In venous impotents a decrease in outflow resistance is seen. We have aggressively performed operations on venous impotents to produce artificial outflow resistance. In this study, we performed ligations of the crura penis in 6 venous impotents. Five patients recovered from erectile dysfunction and 1 patient showed papaverine-induced full erection. There were few severe complications and the duration of operation was very short. This operation is thought to be a simple and effective treatment for venous impotence.

Adult↗
PubMed1989

[Impotence due to venous incompetence. Research on reliable diagnostic criteria].

"Venous incompetence" is thought to be an organic cause of impotence. Its diagnosis is usually based upon Artificial Erection Test (AET); now, the reliability of this procedure is contested. We tested it in 9 controls, 13 psychogenic impotent patients and 65 impotent patients presenting "venous incompetence" according AET (maintenance flow rate needed for erection--MFR greater than 75 ml/min). Organicity of impotence was evaluated by Nocturnal Penile Tumescence monitoring and by the results of a sex-therapy. AET reproducibility was tested in 24 cases. The interest to perform an intracavernous injection of 80 mg papaverine before AET was tested in 18 impotent patients. Our results confirm that MFR is the most reliable criterion for interpreting AET. But 15% of the impotent patients with a MFR greater than 120 ml/min, 32% of those with a MFR greater than or equal to 80 ml/min and 66% of those with a MFR between 80 and 120 ml/min were in fact psychogenic patients. Moreover, we found "excessive" MFR in 3 of the 13 psychogenic patients and one of the normal controls (160 ml/min). In 50% of our patients, AET results were not reproducible. Injecting papaverine before AET significantly reduces MFR, but false positive results do still exist. Some recent physiopathologic data suggest that AET performed after papaverine injection might logically be disturbed by stress. These data should incite to be cautious when interpreting AET results, and results of "venous incompetence" surgery.

Adult↗
PubMed1986

[Intracavernous injections of vasoactive drugs. Evaluation of their diagnostic and therapeutic value in 65 cases of erectile impotence].

Intracavernous injection (IC) of vasoactive drugs (papaverine (ICP) in 115 cases and different alpha-blockers in 65 cases) were administered to 65 patients with erectile impotence to evaluate diagnostic and therapeutic interest of this procedure. Immediate (induction of erection) and medium term (lasting improvement in impotence) results were correlated with those of investigations of multidisciplinary etiologies. Comparison of results of ICP with those of plethysmography of nocturnal erections (PEN, 52 cases) gave negative results for the papaverine test (lack of erection or one without rigidity) in 67% of cases of impotence of organic origin (PEN abnormal). However, the test was positive (totally rigid erection) in 17% of cases of organic etiology and only 40% of psychogenic cases (PEN abnormal). Comparison of results with those of selective hypogastric arteriography and of the artificial erection test with dynamic cavernography (43 cases) showed that the papaverine test was never positive in patients with severe arterial occlusion or obvious venous leaks. However, an elevated proportion of cases with a negative test failed to show signs of marked vascular anomalies. Integration of results of total multidisciplinary explorations showed that most patients with organic or mixed impotence producing a positive or intermediary type papaverine test were cases of neuropathic impotence or had major neuropathic elements. Repeated IC of different vasoactive drugs (excluding the use of autoinjection techniques) failed to provide lasting improvement except for psychogenic impotence (5 of 9 cases). But it is in this group that IC is the most dangerous (2 cases of priapism and 8 cases of rigid erection prolonged over more than 4 hours).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1986

Arteriogenic erectile impotence.

Organic causes of erectile impotence, including penile arterial insufficiency, is far more frequent than previously assumed. The aim of this review (based on the literature and previous works of the author) is to define arteriogenic erectile impotence, and to describe its pathophysiological and clinical features, the diagnostic approach, differential diagnostic aspects and possible treatment of this type of impotence. Erectile impotence is inability to react to relevant sexual stimulation, with a change in pelvic and penile hemodynamics that will increase the pressure in the cavernous bodies thus enabling vaginal intromission without special precautions; as well as inability to maintain this pressure ordinarily until ejaculation occurs. Arteriogenic erectile impotence is erectile impotence caused by insufficient arterial blood supply to the cavernous bodies regardless of the arterial disease or abnormality responsible for the insufficiency. The normal mechanism of erection is not fully understood. Accumulation of blood under pressure in the cavernous body is brought about by dilation of the arteries to the cavernous spaces and closure of the drainage from the cavernous body. The drainage blockade is active and located just inside the tunica albuginea at the origin of the emissary veins. The mechanism is probably related to the smooth muscles of the cavernous body which become relaxed at the start of erection. Furthermore, passive out-flow restriction probably supporting the active closure when the cavernous body is distended. The autonomic nerves regulating the erection come from Th10-L2 and S2-S4 and pass the pelvic plexus. The target organ neurotransmitters are probably vasoactive intestinal polypeptide and catecholamines. Penile arterial insufficiency can be demonstrated by penile blood pressure measurement either as a simple measurement, or, better, as pelvic steal test and hyperemic stress test. Ultrasonic Doppler pulse curve analysis is another way of demonstrating penile arterial insufficiency. Visualization of the arterial disease causing penile arterial insufficiency requires bilateral selective internal iliac arteriography.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1987

A screening sequence for vasculogenic impotence.

Delineation of neural, arterial, and venous components contributing to penile erectile failure is critical to proper patient selection for surgical interventions, particularly for a subset of men with impotence as the sole manifestation of pelvic arterial disease. In addition to obtaining a history and physical examination specific for disordered erectile function and vascular risk factors, we developed a sequence of testing to include noninvasive estimates of penile perfusion, pulse volume recording (PVR), and penile/brachial blood pressure indices (PBPI); somatosensory evoked potentials from dorsal penile (PEP) and posterior tibial nerve stimulation (SEP) and bulbocavernosus reflex time (BCR); stimulation of artificial erection with injection of papaverine (AE); and selective hypogastric-pudendal arteriography with patients under epidural anesthesia, and corpus cavernosography with AE. Three hundred fifty-three men complaining of impotence were screened by PVR and PBPI; among these 42 impotent men and 20 additional concurrent potent control subjects had evoked potentials and BCR measurements, and 55 men received one or more AE injections. On the basis of these results, angiographic investigation was recommended. Age and risk factors were similar in the two groups. Abnormal penile blood perfusion was associated significantly only with cigarette smoking (p less than 0.0001) or overt large vessel disease. Impotent men with (138) or without perfusion abnormalities (215) averaged 54 and 56 years of age, respectively; impotent men with normal flow patterns most commonly had treated hypertension or diabetes (79 of 215 men). Covert neurologic abnormalities were detected in 28 of 42 impotent men. Abnormal penile perfusion plus failure of AE predicted isolated ischiopudendal trunk or pudendal artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Impotence: evaluation and treatment.

Impotence is a multifaceted problem. Complex neurologic pathways intermingle to control specific vascular changes in a tightly controlled hormonal milieu. Although great progress has been made in understanding the mechanism of erection, further studies are needed. Careful history and physical examination along with appropriate laboratory tests and noninvasive penile vascular studies are important in differentiating organic from psychogenic impotence. Understanding the etiology of impotence permits a more logical and effective treatment plan. The advent of the semirigid and inflatable penile prostheses has provided a simple and effective treatment for patients with organic impotence for whom there were no treatment options available in the past. The continued improvement in the design of the prostheses and the simplicity with which they can be implanted have revolutionized the treatment of impotence. With newer prosthetic devices being developed, the penile prosthesis will continue to improve the quality of life for impotent patients.

Angiography↗
PubMedDate not supplied

Age-related alteration of the hypothalamic-pituitary-gonadal axis in sexually impotent males.

On 7 healthy normal men and 32 sexual impotent males aging between 45 and 75 years, total testosterone (T), oestradiol, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin were measured. Additionally LH and FSH was measured after injection of 25 and 100 micrograms LHRH. The main criteria for inclusion in the study were a reduced or nonexistent capacity to have an erection during intercourse and no clinical signs of endocrine disease. The group was divided in young impotent males (group I, less than 60 years) and old impotent males (group II, at least 60 years). The healthy males served as controls (group III). None of the intergroup differences for the basal hormones were statistically significant. But 7 of the man in group I and II showed pathological low T levels (less than or equal to 300 micrograms/100 mg). The high incidence of pathological low T levels in these patients suggests that measurement of plasma T levels is recommendable in the routine diagnostic examination of all sexual impotent males. Plasma levels of LH and FSH increased significantly in all groups following injection of LHRH. At delta 25 min LH was increased significantly in group II following 100 micrograms LHRH compared to group I and III; following 25 micrograms LH and FSH was increased significantly in group II compared to group I. The present findings suggest that, while pituitary function is normal in young and old sexual impotent males, T production may be inadequate in some older patients. Since the present patients failed to show clinical signs of endocrine disease, the abnormal response to LHRH in some of the older sexual impotent males indicates that these patients had a subclinical endocrine disorder.U

Age Factors↗