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PubMed1992

Comparative value of prostaglandin E1 and papaverine in treatment of erectile failure: double-blind crossover study among Egyptian patients.

In a double-blind, crossover designation penile intracavernous prostaglandin E1 and papaverine hydrochloride were compared in regard to effectiveness and safety in 52 patients investigated and treated for sexual erectile dysfunction. In evidence of the reliable effectiveness, prostaglandin E1 (20 micrograms/ml.) induced significant positive erectile response in 42 of 52 patients (81%). This rate reached 100% with neurogenic, hyperprolactinemic and/or psychogenic impotence. However, with papaverine hydrochloride (30 mg./ml.) and exclusively in cases of vasculogenic (most probably arteriogenic) impotence, negative erectile response was revealed as absent erection in 6 of 52 patients (11.5%) and nonrigid tumescence in 13 (25%) versus 2 (3.8%) and 8 (15.4%), respectively, with prostaglandin E1. Moreover, with prostaglandin E1 the regional pain was tolerable and transient, and the positive erectile response was not attended by priapism even in patients who formerly had priapism with papaverine hydrochloride. However, presently with prostaglandin E1 the relatively higher cost and shorter expiration period would probably limit its diagnostic and therapeutic use in Egypt, and probably in other developing countries.

Alprostadil↗
PubMed1989

Prostaglandin E1 versus phentolamine/papaverine for the treatment of erectile impotence: a double-blind comparison.

The use of intracavernous prostaglandin E1 was studied in 48 organically impotent men. Eight men with previous chemical priapism did not have chemically induced priapism at up to 4 times the minimum effective dose of prostaglandin E1. Of 15 men with arteriogenic impotence who had failed prior intracavernous phentolamine and papaverine therapy 10 had adequate erections with prostaglandin E1. A total of 25 men received intracavernous prostaglandin E1 and phentolamine plus papaverine in a double-blind fashion. Erections with prostaglandin E1 were equal or superior to those with phentolamine plus papaverine in each case.

Alprostadil↗
PubMed1982

Diagnostic cardiac premonitory signs and symptoms of red scorpion sting.

The symptoms and signs of 51 patients with a history of scorpion sting were studied. Acute pulmonary oedema with peripheral circulatory failure due to myocarditis developed in 10. Pulmonary oedema appeared within thirty minutes to ten hours after the sting. 5 out of 7 male patients in whom pulmonary oedema subsequently developed presented with priapism. Profuse sweating, mydriasis, vomiting, and peripheral circulatory failure were also seen, and, in 1 patient, the clinical picture was suggestive on pancreatitis. The remaining 40 patients has severe local pain only and no subsequent cardiac manifestations. There appears to be a positive correlation between occurrence of priapism in a male and the later development of cardiac manifestations after a scorpion sting.

Acute Disease↗
PubMed2001

Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares.

BACKGROUND: Trazodone is commonly used in the treatment of insonmia and nightmares in patients with PTSD. There is little evidence in the literature for this practice. METHOD: Seventy-four patients from the Palo Alto Veterans Affairs Health Care System in California who were admitted to a specialized 8 week inpatient treatment program for PTSD were surveyed regarding their use of trazodone in the treatment of insomnia or nightmares. Patients were asked to complete a questionnaire regarding trazodone's effectiveness, side effects, and optimal doses. RESULTS: Of 74 patients surveyed, 60 patients were able to maintain an effective dose of trazodone. The other 14 patients were unable to tolerate the medication. Seventy-two percent of the 60 patients assessed found trazodone helpful in decreasing nightmares, from an average of 3.3 to 1.3 nights per week (p<.005). Ninety-two percent found it helped with sleep onset, and 78% reported improvement with sleep maintenance. There was a significant correlation between the effectiveness in decreasing nightmares and improving sleep (r= .57, p < .005). The effective dose range of trazodone for 70% of patients was 50 to 200 mg nightly. Of the 74 patients surveyed, 9 (12%) reported priapism. CONCLUSION: Trazodone appears effective for the treatment of insomnia and nightmares associated with chronic PTSD. However, controlled trials are needed before any definite conclusions can be drawn. The higher than expected occurrence of priapism warrants clinicians asking directly about this side effect.

Adult↗
PubMedDate not supplied

Risk factors for microalbuminuria in children with sickle cell anemia.

PURPOSE: To determine the prevalence of microalbuminuria and to establish clinical characteristics associated with microalbuminuria in children with sickle cell anemia. PATIENTS AND METHODS: Urine samples of all children (homozygous SS) followed in the Medical College of Georgia's Children's Medical Center Sickle Cell Clinic were screened for microalbuminuria. Random samples were obtained from continent patients at routine office visits between September 1996 and November 1999. A retrospective chart survey was performed to determine clinical correlates for microalbuminuria. Medical records were reviewed for age, sex, hemoglobin, and episodes of pneumonia, pain, aplasia, acute chest syndrome, priapism, and avascular necrosis. Demographic and clinical variables were compared with microalbuminuria by univariate and multivariate logistic regression. RESULTS: One hundred forty-two patients ages 21 months to 20 years made up the study group. The prevalence of microalbuminuria was 19%. Both increasing age and a lower hemoglobin level were found to correlate with microalbuminuria. By multivariate analysis, boys with microalbuminuria were likely to have a lower hemoglobin level and girls with microalbuminuria were likely to be older. None of the following factors were significantly related to microalbuminuria: pain, pneumonia, acute chest syndrome, priapism, avascular necrosis, or aplastic episodes. CONCLUSIONS: Microalbuminuria is strongly and directly related to age and strongly and inversely related to hemoglobin levels. Identification of risk factors for microalbuminuria may allow earlier intervention to prevent renal complications in patients with sickle cell disease.

Adolescent↗
PubMed2004

Summary of the recommendations on sexual dysfunctions in men.

INTRODUCTION: There are few published guidelines for the management of sexual dysfunctions in men and women, despite the prevalence and lack of attention to these problems. Disorders of sexual function in men include erectile dysfunction, orgasm/ejaculation disorders, priapism, and Peyronie's disease. AIM: To provide evidence-based and expert-opinion consensus guidelines for the clinical management of men's sexual dysfunctions. METHODS: An International Consultation in collaboration with major urological and sexual medicine societies assembled over 200 multidisciplinary experts from 60 countries into 17 consultation committees. Committee members established the scope and objectives for each chapter. Following intensive review of available data and publications, committees developed evidence-based guidelines in each area. MAIN OUTCOME MEASURE: New algorithms and guidelines for assessment and treatment of men's sexual dysfunction were developed. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of the medical literature, in addition to cultural and ethical considerations. RESULTS: Recommendations and guidelines for men's sexual dysfunction are presented. These guidelines were developed as evidence-based, patient-centered, and multidisciplinary in focus. For the clinical assessment and diagnosis of ED, a basic evaluation was recommended for all patients, with optional and specialized testing reserved for special cases. A new treatment algorithm is proposed. This algorithm provides a clinically relevant guideline for managing ED in the large majority of men. New treatment guidelines and algorithms are provided for men's orgasm and ejaculation disorders, including premature ejaculation, retrograde and delayed ejaculation. Finally, expert opinion-based guidelines for the clinical management of priapism and Peyronie's disease are provided. CONCLUSIONS: Additional research is needed to validate and extend these guidelines. Nonetheless, this summary encompasses the recommendations concerning men's sexual dysfunctions presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28-July 1, 2003.

Algorithms↗
PubMed2004

Sequelae of parenteral drug abuse involving the external genitalia.

UNLABELLED: Intravenous drug abuse continues to be a major social problem in the USA. Many drug abusers eventually run out of usual intravenous sites and begin to utilize more unusual sites. Some of these sites include the cervical veins and the superficial dorsal vein of the penis. Sometimes the vein is missed and there is extravasation of the drug subcutaneously or intracorporeally. Acute cavernositis, priapism, penile subcutaneous hematoma, penile ulcerations and corporal fibrosis as well as Fournier's gangrene are some of the sequelae of these adventures. We describe our experience with these situations and review the management of penile ulcers. MATERIAL AND METHODS: Six patients who were seen in our general urology practice in Washington, D.C., with parenteral drug abuse involving the external genitalia were studied. RESULTS: Complications of acute cavernositis, priapism and penile ulcers were observed in this group. CONCLUSION: It is essential to be aware that these habits occur as well as some of the complications outlined here. We review the management of penile ulcers.

Adolescent↗
PubMed2006

Secondary penile tumours revisited.

OBJECTIVE: To highlight the salient features of metastatic malignancies involving the penis, with special reference to the primary tumour sites, metastatic mechanisms, clinical features, differential diagnosis, treatment and prognosis. METHODS: A comprehensive search of the literature was performed using MEDLINE and EMBASE, using the keywords 'penis', 'secondary malignancy', 'metastasis' and 'malignant priapism' to identify reviews and case reports of secondary penile malignancy. A case of rare clinical presentation of metastatic penile lesion is presented along with the review of the literature. CONCLUSION: Secondary malignancy of the penis is a rare clinical entity, despite the rich vascularisation of this organ. The majority of metastatic lesions take their origin from the neighbouring genito-urinary organs, mainly prostate and bladder. These lesions are often associated with disseminated malignancy and hence have a poor outcome. Nodular or ulcerative lesions involving the corpora cavernosa or priapism are the main modes of clinical presentation. In most cases, only palliative or supportive therapy is indicated.

Journal Article↗
PubMed2004

Phentolamine re-dosing during penile dynamic colour Doppler ultrasound: a practical method to abolish a false diagnosis of venous leakage in patients with erectile dysfunction.

Increased sympathetic tone may cause an equivocal response to a prostaglandin E1 (PGE1) penile Doppler ultrasound (US) examination interpreted as a venous leak. We evaluated the US parameters and erectile response to the addition of phentolamine to a PGE1 penile Doppler US examination to ascertain whether addition of phentolamine would abolish a suboptimal response. 32 patients (median age 29 years, range 17-70 years) with either a previous Doppler US pattern of venous leakage or a clinical suspicion of venogenic impotence, underwent Doppler US after a total dose of 20 microg of PGE1. Peak systolic velocity (PSV), end diastolic velocity (EDV) and grade of erection were documented. If erectile response was suboptimal irrespective of the EDV measurement, 2 mg-intracavernosal phentolamine was administered and measurements repeated. Six patients had a normal erectile response, the remaining 26 received phentolamine. A significant increase in PSV between baseline and 20 microg PGE1 (p<0.001) was observed in all cases. Following phentolamine there was a significant increase in grade of erection (p=0.0001) and a significant reduction in the EDV (p=0.0001). A reduction of the EDV to below 0.0 cm s(-1) was observed in 16 patients. Four patients with EDV <5.0 cm s(-1) but >0.0 cm s(-1) had improved erectile response following phentolamine while six showed persistent EDV elevation >5 cm s(-1). No priapism was documented. It is essential to ensure cavernosal relaxation using phentolamine before a Doppler US diagnosis of venous leak is made. This two-stage assessment will allow this to be done efficiently and with a low risk of priapism.

Adolescent↗
PubMed2000

Erectile dysfunction.

Erectile dysfunction (ED) is a common condition and can usually be managed pharmacologically, with drugs delivered by intracavernosal injection (ICI), transurethrally or orally. The cardiovascular status of the patient and his overall fitness for renewed sexual activity must be assessed before treatment for ED is initiated. The efficacy of sildenafil is related to the extent and severity of ED, and is significantly reduced in patients with severe vasculogenic ED, ED associated with diabetes and after radical prostatectomy. Alprostadil (prostaglandin E1) is the drug of first choice in patients treated with ICI; it is effective in 72.6% of men with ED and is associated with a low risk of priapism and cavernosal fibrosis. Transurethral alprostadil is significantly less effective than alprostadil ICI, producing improved erections in 30%-40%, but rigid erections in only 10%, of men with ED. There is Level II evidence that: alprostadil ICI is an effective treatment for ED papaverine ICI is associated with a high risk of cavernosal fibrosis and priapism papaverine ICI should be restricted to informed patients refractory to treatment with alprostadil ICI transurethral alprostadil is less effective than alprostadil ICI sildenafil is an effective treatment for ED.

Alprostadil↗
PubMed2000

A clinical comparative study on effects of intracavernous injection of sodium nitroprusside and papaverine/phentolamine in erectile dysfunction patients.

AIM: To study the effect of intracavernous sodium nitroprusside (SNP), a nitric oxide (NO) donor, on penile erection. METHODS: Forty-two patients with erectile dysfunction (ED) were randomly assigned to receive SNP 300 micrograms or the control drugs (papaverine 30 mg + phentolamine 1 mg) intracavernously crosswise one week apart. The penile length, circumference and hardness after the administration of the experimental and control drugs were assessed and compared statistically. RESULTS: (1) There was no significant difference between the changes in penile length and circumference in the two occasions; (2) In 25 SNP and 28 control cases, the hardness of the penis was scored above 100 as evaluated by the Virag method (P > 0.05); (3) The duration of erection in the controls was longer than that in the SNP, but there were three priapism in the controls and not a single one in the SNP; (4) there was no apparent change in the heart rate and blood pressure in both occasions; other side effects were minimal except slight local pain in a few controls. CONCLUSION: SNP facilitates relaxation of the penile smooth muscle and penile erection without significant side effects. SNP may be used in ED patients that experience pain and priapism with papaverine/phentolamine.

Adult↗
PubMed1989

[Possibility of using the piezoelectric lithotriptor in the treatment of severe cavernous fibrosis].

The treatment of serious cavernous corpora fibrosis due to priapism, a prosthesis explantation, iatrogenic causes, or Peyronie's disease, is by now still uncertain. Therefore we tried, when medical and physical therapy failed, to find out the possibility of extracorporeal lithotripter to treat such a complicated cases. From February 88 until now 16 patients underwent extracorporal shock waves treatment, out of 16, 9 had a serious Peronie's disease (a), in 3 fibrosis was a consequence of priapism (b), in 3 of prosthesis explantation (c), 1 patient of cavernosography (d). The treatment was performed by Wolf piezoelectric lithotripter (Piezolith 2300), the patients were treated once a week for 6 weeks. (800 SW; power ranged between 40 and 100 Mpa, frequency between 1 and 2.5 Hertz). In all the patients an orally steroid drugs was administered and a ionophoresis therapy associated. After one year of follow up a penile ultrasound scan, artificial erection tests, rigidometry. None side effects was noted but local ecchimosis. The were done results obtained might support our effort and suggest further studies.

Adult↗
PubMed1988

[Value of prostaglandin El in the diagnosis of erectile dysfunction in comparison with papaverine and papaverine/phentolamine in 61 patients with erectile dysfunction].

In 61 patients with erectile dysfunction a comparative study with intracavernous injection of prostaglandin E1 (PGE1), papaverine and a mixture of papaverine and phentolamine was performed. All patients underwent comprehensive multidisciplinary examinations, including bulbocavernosus reflex (BCR) latencies and somatosensory evoked potentials, penile Doppler sonography, dynamic or pharmaco-cavernosonography, and for 11 patients nocturnal penile tumescence (NPT) was also recorded with the Rigiscan. This diagnostic approach suggested that in 24 (39.3%) of the 61 pts the etiology was psychogenic and in the remaining 37 (60.7%) it was organogenic. PGE1 had a much higher erectile potency than papaverine and a somewhat higher potency than the mixture of papaverine and phentolamine. Complete erection was achieved in 41 of the 61 patients (67.2%) with PGE1, as against 20 of the 61 patients (32.8%) with papaverine alone and 20 of the 61 (32.8%) with papaverine/phentolamine. Whereas 7 of 61 patients (11.5%) had priapism of more than 6 h duration and requiring therapy after injection of papaverine or papaverine/phentolamine, no priapism occurred after PGE1. Thus, compared with papaverine and phentolamine, PGE1 offers important advantages in the diagnosis and perhaps also in the therapy of erectile dysfunction.

Adult↗
PubMed1984

Use of erythrocytapheresis in the treatment of patients with sickle cell anemia.

We performed exchange transfusions, utilizing the technique of automated erythrocytapheresis, for the treatment of patients with sickle cell anemia. In an attempt to determine guidelines for the use of erythrocytapheresis, we studied the use of this procedure in three distinct clinical situations in nine patients with sickle cell disease. Patients with dangerous complications of sickle cell disease such as acute respiratory distress and priapism responded well to erythrocytapheresis, showing marked improvement within 24-48 hours. Patients with prolonged painful vasoocclusive crises showed only variable improvement after erythrocytapheresis therapy, insufficient to justify exposing the patient to the risks of the procedure. Patients treated to decrease the frequency of painful crises demonstrated no prolongation in symptom-free intervals between crises. Therefore, erythrocytapheresis has its main value in the management of acute, dangerous complications of sickle cell disease.

Adult↗
PubMed1982

Temporary embolization in urological practice: myth or reality?

Clot embolization through percutaneous transcatheter technique has proved to be a highly effective and reliable method for stopping bleeding from renal or pelvic areas. The recanalization of the embolized vessels is constant and the recovery of the renal function quite satisfactory. In case of priapism temporary embolization may be very useful in selected cases.

Adolescent↗
PubMedDate not supplied

Post-traumatic erectile dysfunction: doppler US findings.

Erectile dysfunction can happen after trauma, particularly with vertebral, pelvic, or perineal injuries. Penile Doppler ultrasonographic (US) findings in these patients are various, from normal to serious arterial impairment, according to the severity and type of injury. With neurogenic causes, Doppler US findings are usually normal, but decreased flow in cavernosal arteries may also be encountered due to combined vascular injury. With arteriogenic causes, relatively or absolutely decreased peak velocity in cavernosal arteries can be encountered. Alterations of penile arterial anatomy are frequently found in these patients and can be secondary changes due to proximal arterial insufficiency. After trauma in the penis or perineum, distortion or reconstruction of vascular anatomy in addition to traumatic sequelae in the erectile tissue can be directly visualized on Doppler US. Venogenic impotence can also be a result of trauma, and Doppler US findings are the same as nontraumatic venous leak. High-flow priapism is another category of post-traumatic erectile dysfunction, which can be diagnosed conclusively by Doppler US. It can be managed by angiographic embolization, and Doppler US is useful in evaluating recurrence and erectile dysfunction after embolization.

Erectile Dysfunction↗
PubMedDate not supplied

Use of the 4F Rösch inferior mesenteric catheter in embolization procedures in the pelvis: a review of 300 cases.

The aim of this study is to evaluate the use of a 4F Rösch inferior mesenteric (RIM) catheter for pelvic embolization procedures. Between October 2000 and January 2006, 364 patients (357 female, 7 male; age: 23-67 years) underwent embolization of various pathologies [uterine fibroids (n = 324), pure adenomyosis of the uterus (n = 19), postpartum hemorrhage (n =1), traumatic or postoperative hemorrhage (n = 9), bleeding related to cervical cancer (n =7), AV malformation of the uterus (n = 2) and high-flow priapism (n = 2)] at a single institution. In all cases, bilateral catheterization was primarily attempted with the use of a 4F hook-shaped braided endhole catheter (Rösch-Inferior-Mesenteric, RIM-Catheter, Cordis, Miami, FL). Frequency of initial failure to catheterize the vascular territory of interest and carry out the embolization were recorded and the types of difficulty encountered were noted. Catheterization of the main stem of the vessel territory of interest with the use of a unilateral femoral approach and the 4F RIM catheter was successful in 334/364 (91.8%) the embolization cases. Bilateral catheterization of the internal iliac arteries using a single common femoral artery access and the 4F RIM catheter was achieved in 322/364 (88.5%) patients. In 12/364 (3.3%) patients, a contralateral puncture was performed and the same 4F catheter was used. In 28/364 (7.7%) cases the 4F RIM catheter was exchanged for a catheter with a cobra-shaped or sidewinder configuration. The 4F RIM catheter is a simple and valuable alternative to catheters and techniques commonly employed for pelvic artery embolization.

Adult↗
PubMed1994

Experience with intracavernosal tri-mixture for the management of neurogenic erectile dysfunction.

Using papaverine, papaverine/phentolamine, or prostaglandin E1 (PGE1), intracavernosal pharmacotherapy has been successful in treating erectile dysfunction. The limiting factor of using these medicines is intracorporeal fibrosis with the first two and a high cost with PGE1. Our experience with intracavernosal therapy in patients with impotence secondary to neurogenic disease has included 35 men, 30 of whom are spinal cord injured, 3 after radical prostatectomy, 1 with multiple sclerosis, and 1 with lower extremity weakness after surgery. Patients ranged in age from 22 to 59 years, with an average of 36.3 years; mean follow-up was 13.8 months. Intracavernosal therapy has been performed with a tri-mixture of papaverine hydrochloride (smooth muscle relaxant), phentolamine mesylate (alpha-adrenergic blocking agent) and alprostadil (PGE1- a vasodilator and smooth muscle relaxant). Of the patient population, all 35 patients were able to have adequate erections for sexual relations with minimal complications. Acting synergistically, the ingredients promote erectile activity using small doses and without a significant incidence of priapism or fibrosis. Techniques of injection, dosing and followup are discussed.

Adult↗