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PubMed1993

Pharmacotesting with high dose prostaglandin E1 in impotence.

The diagnostic value of pharmacotesting in impotence is controversial. The results of high dose prostaglandin pharmacotesting were compared with those of colour duplex Doppler scanning and pharmacocavernometry in 82 impotent patients and 10 control subjects. Based on the results of 10 control subjects, the prostaglandin test was defined as positive if intracavernous pressure 200 minutes after injection of 40 micrograms prostaglandin E1 was > or = 42 mm Hg and negative if intracavernous pressure was < 42 mmHg. The test was repeated in 29 subjects and classified results were consistent in 24 subjects (86%, k = 0.65). The test was negative in 52 out of 56 patients (sensitivity 93%) with vasculogenic impotence (arteriogenic and/or cavernovenous factor involved) and the test was positive in 21 out of 26 patients (specificity 81%) with non-vasculogenic impotence (arteriogenic or cavernovenous factor not involved). The majority, 27 out of 31 patients (87%) with arteriogenic impotence showed simultaneous dysfunction of cavernovenous occlusion mechanism. In conclusion, pharmacotesting with high dose prostaglandin is a useful screening test of vasculogenic impotence.

Alprostadil↗
PubMed1994

Diagnostic value of radionuclide phallography with intravenous vasodilator stress in the evaluation of arteriogenic impotence.

Arteriogenic impotence is a major cause of organic erectile dysfunction. We evaluated the diagnostic value of quantitative radionuclide phallography with intravenous pharmacological stress in screening impotent patients for penile arterial inadequacy. Using technetium-99m labelled autologous erythrocytes, dynamic scintigraphy of the penile blood pool was performed. Penile haemodynamic changes following intravenous injection of the vasodilator isoxsuprine hydrochloride were assessed by quantitation of penile blood flow and volume. Forty-seven impotent patients (11 psychogenic, 24 arteriogenic, 10 venogenic, 2 endocrine) were studied. Arteriogenic impotent patients demonstrated a lesser degree of increase in penile blood flow and volume than impotent patients with uncompromised penile arterial inflow. Quantitation of penile blood flow and volume yielded a high diagnostic accuracy (> 90%). Radionuclide phallography with intravenous vasodilator stress forms a simple and accurate method for evaluating the functional integrity of penile arterial inflow.

Erectile Dysfunction↗
PubMed2001

Honeymoon impotence: psychogenic or organic in origin?

OBJECTIVES: Honeymoon impotence is the inability to perform successful sexual intercourse during the initial experience, especially during the first nights of marriage, and it is relatively frequent in Turkey. We investigated the underlying penile vascular abnormalities in patients presenting with honeymoon impotence and sought to differentiate between psychogenic and organic etiologies. METHODS: Between 1989 and 1999, 90 patients sought urologic help for honeymoon impotence. Patient age ranged from 18 to 39 years (mean 28.06 +/- 3.4). All patients were given an intracavernous injection of 60 mg papaverine combined with self-manual genital stimulation (CIS test) to assess the degree of tumescence. Patients with a positive response to the CIS test were later evaluated with nocturnal penile tumescence (NPT) monitoring. Patients with a negative response to the CIS test and/or NPT monitoring were evaluated further using penile color Doppler ultrasound. RESULTS: A psychogenic etiology was found in 61 patients (67.7%), 50 (55.5%) of whom achieved satisfactory sexual intercourse after intracavernous injection. Twenty-five patients (27.7%) exhibited penile vascular abnormalities by color Doppler ultrasound. Neurogenic erectile dysfunction was considered in the remaining 4 patients (4.4%) with a positive response to the CIS test, abnormal findings on NPT monitoring, and a normal vascular system with color Doppler ultrasound. CONCLUSIONS: The present study is the first to report penile vascular abnormalities in patients presenting with honeymoon impotence, which was previously believed to be exclusively psychogenic in origin. The evaluation of the penile vascular system in patients with honeymoon impotence may reveal underlying penile vascular abnormalities, allowing the choice of the appropriate therapeutic option.

Adult↗
PubMed1999

Autonomic nerve involvement and venous leakage in diabetic men with impotence.

OBJECTIVE: To determine the neurophysiological and vascular factors in diabetic impotence, particularly the role of autonomic neuropathy on venous leakage and erectile impotence. PATIENTS AND METHODS: Thirty-four diabetic men with impotence were investigated using various neurophysiological and radiological methods. The results were compared with those from patients with idiopathic penile venous leakage for autonomic neuropathy, especially for spontaneous cavernosal activity (SCA). RESULTS: Of the neurophysiological tests, the SCA was most frequently abnormal, with the loss of normal periodic oscillations. Penile venous leakage, either alone or with arterial insufficiency, was the most frequent vascular problem (67%) in patients with diabetic impotence, in whom the SCA was absent in most (83%). Conversely, the SCA was normal in all impotent patients with idiopathic venous leakage. CONCLUSION: Venous leakage in diabetic patients is probably produced by autonomic dysfunction of the penile vascular innervation or degeneration of penile smooth muscles, because the SCA was absent more often in these patients.

Adult↗
PubMed2003

The place of surgery for vascular impotence in the third millennium.

PURPOSE: With the arrival of new oral therapies the question arises about the role of surgery in patients with vascular impotence. We compared the sexual satisfaction rate in patients with arterial and/or venous impotence treated with 4 surgical techniques with long-term followup. MATERIALS AND METHODS: Surgery was performed in 130 patients with vascular erectile dysfunction by 1 surgeon. Two young patients (2%) with traumatic arterial lesions underwent penile revascularization (group 1), while 128 with arterial and/or venous impotence were also treated with surgery, including 11 of 130 (8%) with deep dorsal penile vein resection (group 2), 39 (30%) with arterialization of the deep dorsal penile vein (group 3) and 78 (60%) with penile implants (group 4). Sexual satisfaction, defined as the possibility of satisfactory sexual intercourse without any additional treatment or pain, was evaluated by patient interview. RESULTS: Of the 130 patients 111 (85%) participated in the sexual life events interview, including 2 of 2 (100%) in group 1, 7 of 11 (63.6%) in group 2, 33 of 39 (85%) in group 3 and 69 of 78 (88%) in group 4. Mean followup was 50, 48, 46 and 54 months for groups 1 to 4, respectively. The sexual satisfaction rate was 2 of 2 (100%) for penile revascularization, 1 of 7 (14%) for venous resection, 4 of 33 (12%) for arterialization and 64 of 69 (93%) for penile implantation. Complications occurred in 9.5%, 12.5% and 20.5% of the patients in groups 2 to 4, respectively. CONCLUSIONS: Except for young patients with traumatic arterial lesions this study demonstrated the poor sexual satisfaction rate in impotent patients treated with the vasculogenic approach and the high rate of satisfaction in those treated with penile implants. Better selection criteria must be applied for vascular surgical treatment for impotence.

Adult↗
PubMed1998

The relationship between diabetes mellitus, impotence and veno-occlusive dysfunction in Peyronie's disease patients.

Peyronie's disease is an ill-defined condition that often leads to severe penile deformity and sometimes erectile dysfunction. Penile Doppler studies indicate veno-occlusive dysfunction as the principal cause of poor rigidity in Peyronie's disease patients. Diabetes mellitus is also a known cause of impotence and its prevalence tended to be higher in patients with Peyronie's disease. We evaluated 143 patients with Peyronie's disease, also 92 impotent men (37 diabetic, 55 nondiabetic) as control group. Penile vascular studies were performed on each group. Diabetes mellitus was also investigated in patients with Peyronie's disease. Veno-occlusive dysfunction was found as the main cause of impotence in both groups (81.1% in diabetic, 89% in nondiabetic control group and 88.8% in Peyronie's disease patients). In our study group the prevalence of diabetes mellitus tended to be higher than in the control population but it did not alter the ratio of veno-occlusive dysfunction and impotence in Peyronie's disease patients. We believe there is a close relationship between diabetes mellitus and Peyronie's disease, considering our high incidence. We also conclude that diabetes mellitus is not the main cause of impotence in patients with Peyronie's disease.

Adult↗
PubMed1995

Value of color Doppler sonography in the diagnosis of venous impotence.

The gold standard in the diagnosis of venous impotence is cavernosometry. But a less invasive and time-consuming screening test for patients with a high probability of venous impotence is required. Therefore we evaluated 82 men with erectile dysfunction by color Doppler sonography after intracavernosal injection of 60 mg papaverine. 28 of them who had a poor erectile response but sufficient arterial inflow were included in this study. 6 patients who were previously found to have psychogenic impotence formed the control group. After pharmacological stimulation by papaverine, all patients were examined for 20 min by color Doppler sonography in order to detect diastolic flow velocities in the cavernosal arteries and erectile responses. Both groups of patients underwent pharmaco-cavernosometry in a blind fashion afterwards. The diagnosis of venous impotence with color Doppler sonography was confirmed by dynamic pharmaco-cavernosometry in 25 of 28 (89%) and 6 of 6 (100%) subjects of the study and control groups, respectively. Statistically, in the diagnosis of venous dysfunction, color Doppler sonography had a sensitivity of 100%, specificity of 66.6%, accuracy rate of 91% and a positive predictive value of 0.892. The gold standard in the diagnosis of venous impotence is still cavernosometry, but it seems that color Doppler sonography may provide a sensitive assessment of penile venous competence.

Adult↗
PubMed1994

The contribution of cavernous body biopsy in the diagnosis and treatment of male impotence.

This study concerns the results of penile biopsies in 50 patients aged 27 to 80, with secondary impotence removed with a biopty gun or during penile surgery. The biopty gun specimens were equally representative as the open biopsy ones. The cause and the degree of erectile dysfunction were determined by clinical and laboratorial investigation. The histological study of the cavernous bodies in the patients with psychogenic impotence revealed normal erectile tissue. In patients with organic impotence, histological lesions were graded as mild, moderate or severe. The most severe lesions were observed in the erectile tissue and in particular in the smooth muscle of the trabeculae and the helicine arteries, which had been reduced and replaced by connective tissue. Histological lesions were found not only in the arterial but also in the venous leak cases. There was a correlation between their severity and the degree of impotence, although of no statistical significance. The penile biopsy determines the condition (state) of the functional cavernous smooth muscle tissue, the integrity of which is essential for the erectile mechanism as well as for the action of the vasoactive drugs and the results of vascular surgery. Its important role is evident as it contributes not only to the diagnosis of the cause, but also to the choice of treatment of male impotence.

Adult↗
PubMed1996

Polyneuropathy in impotence.

Three hundred and forty-one consecutive impotent patients were evaluated for the presence of polyneuropathy (PNP) by neurophysiological and psychophysical tools, including nerve conduction and quantitative sensory tests (thermal and vibratory). PNP was present in 38% of diabetics, and 10% of non diabetics. Overall, PNP was found in 19% of impotent patients. PNP is relatively common among impotent patients, and might play a causative role. Patients judged 'neurogenic' and those judged 'vasculogenic', based on nocturnal tumescence test (NPT) and vasoactive drug injection tests, had very similar rates of PNP (21 and 23%, respectively). Thus it is suggested that the vasoactive drug injection test does not serve in discriminating neurogenic from non-neurogenic impotence. NPT, however, faithfully discriminates psychogenic from organic impotence, as far as PNP is involved, since a very low percentage of patients with normal NPT had PNP.

Adolescent↗
PubMed1997

Penile revascularisation for vascular impotence.

OBJECTIVE: Many methods of microscopic penile revascularisation procedures have been employed over the past 2 decades for the treatment of vasculogenic impotence, with varying success rates. The aim of our study was to evaluate the effectiveness and complications of deep dorsal vein arterialisation in the treatment of selected patients with arteriogenic and mixed arteriogenic/venogenic impotence. METHODS: This involved a retrospective analysis of 6 patients with vasculogenic impotence who presented to Toa Payoh Hospital from December 1991 to November 1994 and had penile revascularisation surgery performed. All patients underwent an extensive preoperative assessment, including dynamic infusion cavernosometry and cavernosography and selective pudendal arteriography. RESULTS: The 6 patients were aged between 27 and 51 years (mean 44 years). 2 (33%) patients had pure arteriogenic impotence, while 4 (66%) had mixed arteriogenic and venogenic impotence. Two patients (33%) had excellent surgical outcomes and 2 patients (33%) were considered improved. The mean follow-up period was 19.8 months (range 8 to 37). Complications were minimal. CONCLUSIONS: We conclude that although the results of penile revascularisation are promising in carefully selected patients, further studies with longer follow-up and more objective postoperative tests of hemodynamic and erectile function are needed to assess the true value of this mode of treatment.

Adult↗
PubMed1986

Plasma prolactin and estradiol during sleep in impotent men and normal controls.

There are no investigations of sleep-related changes in circulating prolactin and estradiol in impotent men without known organic pathology. This study compares plasma levels of both hormones during sleep in 17 physically healthy patients with erectile impotence and 11 normal controls. Five men had never been able to achieve intercourse (primary impotent group) and 12 suffered from a lifelong history of intermittent erectile failure (secondary impotent group). The subjects, aged 23 to 36, were studied in a sleep laboratory from 3 to 6 nights with the last two devoted to sequential blood sampling every 20 min. Samples were pooled during consecutive 2-hr periods from 11 PM to 7 AM for hormonal assessment. There were no statistical differences in sleep measures among groups. Mean prolactin and estradiol values for all subjects were within the normal range. Both impotent groups showed a significant nocturnal increase in prolactin concentration and no time-related changes in plasma estradiol. There were no statistical differences in the plasma concentration of both hormones among groups or between study nights. The results suggest that severe and long-lasting erectile failure may occur in physically healthy individuals without associated abnormalities in circulating prolactin and estradiol.

Adult↗
PubMed1988

Impotence in diabetic men.

Studies relating to pathogenetic mechanisms resulting in impotence in diabetic subjects have been reviewed. Erectile dysfunction was reported to occur in 50 to 75 percent of diabetic patients and the prevalence appeared to increase with age. Contributions of vascular, endocrine, and neurologic system alterations result in this disturbing condition, but a detailed analysis of all the parameters was not found in any individual study. In our review of 301 veterans presenting to a sexual dysfunction clinic, the clinical and hormonal alterations in the diabetic patients closely resemble those seen in nondiabetic impotent subjects. Atherosclerotic vascular changes play an important predisposing role in the development of impotence. A difference exists between the prevalences of associated medical conditions in diabetic patients taking insulin, compared with those receiving oral agents or receiving dietary management. The high prevalence of impotence in diabetic patients seems to be due to the high prevalence of its vascular complications. Considering the availability of useful therapeutic approaches, it is mandatory to evaluate all diabetic men for the presence of impotence.

Diabetes Complications↗
PubMed1988

Short REM latency in impotence without depression.

In a retrospective study, the presence of depression was studied in a group of 14 impotent patients who were selected on the basis of the similarity between their electroencephalographic (EEG) sleep patterns and those of patients with endogenous depression. Specifically, the value of rapid eye movement (REM) latency plus age less than 100 was used as a selection criterion. Sleep continuity disturbances, increased REM time, and increased REM% were noted in the short REM latency impotent group. On the basis of MMPI and psychiatric history and interview, only one of these impotent patients showed major depression. The authors conclude that impotent patients with a short REM latency are not, as a group, depressed and that the incidence of depression in impotent men should be determined irrespective of EEG sleep findings.

Depressive Disorder↗
PubMed1980

Sexual impotency: current knowledge and treatment I. Urology/sexuality clinic.

Investigative and therapeutic measures for evaluating sexual impotency are rather recent. Psychogenic and organic problems may overlap. Thorough clinical appraisal and objective tests are currently affording better differentiation of etiology and, consequently, appropriate treatment. Causes of and tests for sexual impotency guide the choice of treatment. Surgical intervention can be offered for irreversible organic impotency. However, most instances of acquired impotence are psychogenic. Any nonjudgmental, competent practitioner can aid victims of psychogenic impotence by a "listening and encouragement" method. Urologists, in particular, are commonly confronted with genital/sexual problems and may be best suited as primary therapists by developing interest in urologic counseling. A newly formed Urology/Sexuality Clinic at the University of California in San Francisco provides therapy for patients and offers training for resident physicians.

Counseling↗
PubMed1984

Penile xenon (133Xe) washout: a rapid method of screening for vasculogenic impotence.

The radioactive inert gas xenon (133Xe) is a well-established isotopic indicator used to assess vascular status in many organ systems. We employed xenon-133 to evaluate male impotence. Xenon-133 was injected subcutaneously at the level of the coronal sulcus in the detumescent state. Using the gamma camera, sequential images were obtained and computer-generated curves calculated. The clearance time for 50 per cent washout of the injected 133Xe (T1/2) was then calculated for each patient, as well as a control group. Preliminary findings indicate a correlation with such established techniques of evaluating erectile impotence as history, physical examination, penile pulse Doppler tracings, and brachial-penile blood pressure index. The xenon-133 washout study was a rapid, minimally invasive, reproducible, and cost-effective method of screening those impotent patients for vasculogenic etiology of their erectile impotence. We recommend the addition of this method to the surgeon engaged in the care of impotent males.

Adult↗
PubMed1986

Prevalence and significance of tobacco smoking in impotence.

We investigated the incidence of cigarette smoking in a sample of patients and compared these figures with estimates of smoking among males in the general population. Among 178 impotent patients the number of current smokers (58.4%) and current ex-smokers combined (81%) was significantly higher than would be expected among males in the general population. In each age group, and at all levels of tobacco use, impotent patients smoked more than would be expected from population estimates. Smoking and nonsmoking impotent patients did not differ in terms of their hormonal profile; however, mean penile blood pressure (PBI) was lower among patients who smoked than among those who did not. A significantly higher proportion (20.9%) of impotent patients with a history of smoking showed abnormally low PBI compared with nonsmoking patients (8.8%). This study adds to preliminary evidence that smoking may be a significant risk factor in impotence, and its effects are evident in the small vasculature.

Blood Pressure↗
PubMed1991

Double-blind, cross-over study comparing prostaglandin E1 and papaverine in patients with vasculogenic impotence.

Intracorporeal injection of vasoactive agents is the treatment of choice for many patients with organic impotence. However, some patients with vasculogenic impotence respond poorly to injections of papaverine or papaverine/phentolamine. This study was conducted to determine if patients with vasculogenic impotence who failed to respond to papaverine might respond to prostaglandin E1 and thus be salvaged from possible prosthetic surgery. A total of 54 patients with vasculogenic impotence were administered intracorporeal prostaglandin E1 (20 micrograms) and intracorporeal papaverine (60 mg) randomized in a double-blind fashion and crossed over one week later. Forty-six percent of patients receiving prostaglandin E1 produced a satisfactory erection compared with 14 percent of patients with a similar response to papaverine. The difference between these results was highly significantly by the McNemar test. The number of side effects were similar for both drugs. Prostaglandin E1 might be considered the intracorporeal agent of choice for patients with significant vasculogenic impotence.

Alprostadil↗
PubMed2004

Penile bulb dose and impotence after three-dimensional conformal radiotherapy for prostate cancer on RTOG 9406: findings from a prospective, multi-institutional, phase I/II dose-escalation study.

PURPOSE: To assess the relationship between the dose to the bulb of the penis and the risk of impotence in men treated on Radiation Therapy Oncology Group (RTOG) 9406. METHODS AND MATERIALS: Men enrolled on a Phase I/II dose-escalation study, RTOG 9406, who were reported to be potent at entry and evaluable (n = 158) were selected for inclusion. Follow-up evaluations were scheduled every 3, 4, and 6 months for the first, second, and the third through fifth years, then annually. At each follow-up visit an assessment of potency status was made. Penile structures were defined by a single observer blinded to the potency status, using Web-based, on-line software. The dosimetry for penile structures was calculated at the Quality Assurance Center at Washington University and provided to RTOG Statistical Headquarters to determine whether there was a relationship between dose and impotence. RESULTS: Patients whose median penile dose was > or = 52.5 Gy had a greater risk of impotence compared with those receiving <52.5 Gy (p = 0.039). In a multivariate analysis neither age, the dose to the prostate, nor the use of hormonal therapy correlated with the risk of impotence. CONCLUSIONS: Dose to the bulb of the penis seems to be associated with the risk of radiation-induced impotence.

Adult↗