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PubMed1986

Venous thromboses in particular organs.

Although venous thrombosis most often occurs in the return circulation of the legs and pelvis, it may also occur in the veins of several organs and compromise venous return. Thus, the clinician, in any field will regularly be confronted with manifestations of venous thrombosis in particular organs. This review summarizes the pathogenesis and the main clinical features of venous thrombosis in the central retinal vein, the cerebral veins and sinuses of the skull, the renal and the portal veins and the hepatic and mesenteric veins as well as priapism. The principles of treatment are outlined.

Budd-Chiari Syndrome↗
PubMed1988

Surgery of the penis and prepuce.

Treatments of penile and preputial injuries, anomalies, tumors, "summer sores," paraphimosis, phimosis, and priapism are presented. Surgical procedures described include preputiotomy, reefing, penile retraction, amputation, and relocation. Treatment of hemospermia by means of urethrotomy is discussed.

Animals↗
PubMed2006

Inhibitors of phosphodiesterase 5 (PDE 5) inhibit the nerve-induced release of nitric oxide from the rabbit corpus cavernosum.

BACKGROUND AND PURPOSE: Nitrergic neurons are important for erectile responses in the corpus cavernosum and impaired signalling results in erectile dysfunction, today treated successfully by oral administration of the selective phosphodiesterase 5 (PDE 5) inhibitors sildenafil, tadalafil and vardenafil. Although the importance of nitrergic neurons in urogenital function has become evident, it has not been investigated if the PDE 5 inhibitors affect the nerve-induced release of nitric oxide (NO). In a previous study we found that the soluble guanylate cyclase (sGC)/cyclic guanosine 3',5'-monophosphate (cGMP) pathway might modulate nerve-induced release of NO in isolated cavernous tissue. EXPERIMENTAL APPROACH: Electrical field stimulation (EFS 5 Hz, 40 V, 0.3 ms pulse duration, 25 pulses at intervals of 2 min) of rabbit isolated cavernous tissue elicited reproducible, nerve-mediated relaxations in the presence of scopolamine (10(-5) M), guanethidine (10(-5) M) and phenylephrine (3 x 10(-6) M). In superfusion experiments, nerve stimulation (20 Hz, 40 V, 1 ms) of the cavernous tissue evoked release of NO/NO2-, measured by chemiluminescence. KEY RESULTS: Sildenafil, tadalafil and vardenafil decreased the muscular tone and prolonged the relaxations to nerve stimulation. The evoked release of NO decreased to 72+/-11%, 55+/-16% and 61+/-14% of control, respectively after addition of sildenafil, tadalafil or vardenafil (all 10(-4) M, n=6-8, p<0.05). CONCLUSIONS AND IMPLICATIONS: Selective PDE 5 inhibitors influence the nerve-induced release of NO, probably via cGMP-mediated negative feedback. This negative feedback might explain why priapism is not seen during monotherapy with the PDE inhibitors.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed1998

The role of nitric oxide in vivo feline erection under hypoxia.

Previous in vitro studies have demonstrated that the cavernous relaxation under hypoxia does not involve the endothelium dependent mechanism. However, the mechanism of nitric oxide pathway under hypoxia are not fully evaluated or understood yet in vivo. The changes of intracavernous pressure to various vasoactive substances were monitored in 45 mature male cats in vivo under normoxia and hypoxia (pH: 7.03, PO2: 25.52 mmHg, PCO2: 84.66 mmHg). L-arginine and SNAP (s-nitroso-n-acetyl-penicillamine) produced cavernous relaxation under normoxia, but not under hypoxia (n = 19, P < 0.01). The L-arginine-induced relaxations were inhibited by L-NAME (N omega-nitro-1-arginine-methyl-ester) or methylene blue under normoxia (n = 19, P < 0.01). The cavernous relaxation was 58% suppressed under hypoxia compared to normoxia with 10(-3) M/0.2 ml of acetylcholine (n = 22, P < 0.01). Moreover, L-NAME attenuated the acetylcholine-induced relaxation under normoxia, but not under hypoxia (n = 22, P < 0.05). Epinephrine suppressed the acetylcholine-induced relaxation in both conditions (n = 10, P < 0.01), while indomethacin significantly potentiated the acetylcholine-induced relaxation under normoxia compared to hypoxia (n = 6, P < 0.05). However, none of these substances responded in severe hypoxia (PO2 < 15 mmHg, n = 3). These results suggest that erectile and contractile responses are attenuated under hypoxia. The endothelium derived relaxation via nitric oxide does not play a role in cavernous relaxation under definitive hypoxia with acidosis like in ischemic priapism (PO2 < 30 mmHg, pH < 7.25).

Animals↗
PubMed1999

Intracavernous self-injection of prostaglandin E1 in the treatment of erectile dysfunction.

In a three-year follow-up study of 69 patients found that erectile dysfunction (ED) impairs many elderly men's life: up to 25% of the men aged 65 y and 80% of those aged 75 y suffer from erectile dysfunction. The most effective non-surgical treatment of ED is intracavernosal pharmacotherapy, and the most common vasoactive agent currently used is prostaglandin E1 (PGE1). The purpose of this study was to assess the long-term outcome of PGE1 treatment and the patients' overall satisfaction with their sexual life. Sixty-nine patients who had started ICI therapy three years earlier were invited to a control examination. The mean age of the patients was 60.5 y. The patients filled in a questionnaire, which included questions about the use of PGE1 treatment at home. All the patients evaluated their own satisfaction with their erection, ejaculation, orgasm and libido on a visual analytical scale (VAS, 0-100%). A clinical examination was made, and the penile shaft was examined by ultrasonography. Erection with the home dose of PGE1 was estimated by Rigiscan, and the degree of erection was also estimated clinically (grades 0-5) by a doctor. The most common doses of PGE1 used at home were between 10 and 20 m (58%), 46.4% of the patients had discontinued PGE1 therapy, the mean time of using PGE1 was 23.3 months. The mean coital frequency with PGE1 was 2.8 times per month. 34.8% of the patients (24 out of 69) reported that their own spontaneous erections had improved after the beginning of PGE1 therapy. The most common problem was hematomas in 10.1% of the patients (7 out of 69), which, however, were small and did not cause discontinuation of the therapy. There were three instances of priapism (4.3%), and four patients (5.8%) had fibrosis in ultrasonography. The patients' satisfaction with their erection at home was 67.3% with PGE1. The mean coital frequency with PGE1 therapy was quite low, 2.8 times per month, even though the patients' mean age was only 60.5 y, one reason may be the high price of PGE1 injections. The rate of improvement of spontaneous erections while using PGE1 was quite high, accounting for 34.8% of the patients. Most of the patients who discontinued the PGE1 therapy had a psychogenic etiology. There were no systemic side-effects with PGE1. Only 7.2% of the patients had prolonged pain after the injection, leading to drug discontinuation. It can be concluded that treatment with intracavernous injections of PGE1 is well tolerated and involves only minor problems. The patients' satisfaction with their erections at home with PGE1 therapy was good. Precise determination of the home dose of PGE1 and the teaching of the technique of injection are important at the beginning of this treatment modality.

Adult↗
PubMed2000

Corporeal counter incisions: a simplified approach to penile prosthesis implantation in fibrotic cases.

OBJECTIVE: To evaluate the effectiveness of the technique of corporeal counter incisions for penile prosthesis implantation in cases with marked corporeal fibrosis. METHODS: Creating subtunical tunnels that are stretched transversely by the dilamezinsert instrument & Heggars dilators with its tip entering from one side and protruding from the counter incision to avoid urethral or corporeal perforation. PATIENTS: Seventeen patients underwent this technique, mean age 56 y (range 42-71 y); 12 post removal of an infected prosthesis and five post priapism. RESULTS: In all cases, two rods were successfully implanted. In one case, a crural perforation occurred that was repaired intra-operatively. CONCLUSION: Corporeal counter incisions with transverse tissue stretching is a relatively simple technique to implant semirigid implants in fibrosed corpora.

Adult↗
PubMed2004

Oral terbutaline in the management of pharmacologically induced prolonged erection.

Prolonged erection and priapism are common complications following intracavernosal injection of vasoactive agents in the management of erectile dysfunction. It is usually treated by intracorporeal drainage and irrigation with sympathomimetic agents. There is no established oral therapy . To study the effect of oral terbutaline on prolonged erection following intracavernosal injection of vasoactive agent, a controlled randomized study was done in 68 patients. Detumescence was achieved in 42 and 15% of the cases with oral terbutaline and placebo, respectively. Results of this study suggest that an initial trial with oral terbutaline for pharmacologically induced prolonged erection may be successful.

Adrenergic beta-Agonists↗
PubMed2004

Tissue expression, distribution, and regulation of PDE5.

Phosphodiesterase 5 (PDE5) has been identified in many species. The three isoforms, PDE5A1, PDE5A2, and PDE5A3, differ only in their N-terminal sequence. PDE5A1 and PDE5A2 are ubiquitous, but PDE5A3 is specific to smooth muscle. The initial three exons (A1-A3-A2) of PDE5A, located on chromosome 4q26, are alternative first exons encoding the isoform-specific sequences. The PDE5A promoter overlaps with the A1-specific exon, while the PDE5A2 promoter is located between the A3- and A2-specific exons. Both respond to cyclic guanosine monophosphate (cGMP) or cyclic adenosine monophosphate (cAMP) stimulation. The PDE5A2 promoter contains an Sp1-binding sequence critical for basal and cGMP/cAMP-inducible promoter activities. PDE5A is induced by adjacent sequences (enhancers) containing Sp1-binding sites. The potential role of PDE5A promoters in the tachyphylaxis effect of PDE5 inhibitors is currently being investigated. Preliminary data suggest that hypoxia might down-regulate PDE5A promoters, implying an involvement of PDE5 in stuttering priapism.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMedDate not supplied

The effect of a surgically created shunt between the corpus cavernosum penis and corpus spongiosum penis of stallions on erectile and ejaculatory function.

OBJECTIVE: To evaluate the effect of a shunt created between the corpus cavernosum penis (CCP) and corpus spongiosum penis (CSP) on erectile and ejaculatory function of normal stallions and to verify persistence of the shunt. STUDY DESIGN: The capability of stallions to develop an erection and to ejaculate was evaluated before and after creation of a corporeal shunt. Persistence of the shunt was determined by dye injection into the CCP at necropsy. ANIMALS: Six stallions. METHODS: A CCP-CSP shunt was created in five stallions. Semen was collected before and 4 to 14 weeks after surgery, before the horses were euthanatized. Dye was injected into the CCP to determine persistence of the shunt. Dye was also injected into the CCP of a control stallion. RESULTS: All stallions had normal erectile and ejaculatory function before and after surgery. Dye, injected into the CCP, entered the CSP in three of five treated stallions, demonstrating persistence of the shunt, whereas in two stallions, dye was found only in the CCP, indicating closure of the shunt. No dye was detected in the CSP of the control stallion. CONCLUSIONS: Creation of a corporeal shunt does not interfere with normal erection and ejaculation of stallions. Shunt closure is not necessary for stallions to retain normal erectile and ejaculatory function. CLINICAL RELEVANCE: Failure of a stallion affected by priapism to achieve normal erection or to ejaculate after creation of a corporeal shunt would likely be because of damage to corporeal tissue than from an effect of the shunt.

Animals↗
PubMed1985

[Status of penis sonography in andrology].

Good visualization of the anatomic structures of the penis can be achieved by application of high-resolution real-time sonography and a water path. Penis sonography is painless, free of risk and easy to perform. It is ideal for documentation and assessment of pathological alterations of the penis. 80 patients with penile deviation were examined sonographically. In cases of Peyronie's disease, the most frequent clinical picture, it is possible to achieve good localization and measurement of the fibrotic plaques in the area of the tunica albuginea. Calcifications can be clearly detected. In cases of penile deviation associated with the urethral manipulation syndrome, no fibroses are seen in the corpus spongiosum. In 3 patients with erectile impotence after priapism, sonography permitted precise determination of the extent of fibrosis formation in the corpora cavernosa.

Adult↗
PubMed1981

Method, indications and results of corpus cavernosography.

Patients complaining of erectile dysfunction present with symptoms that are not readily reproduced for clinical observation. Corpus cavernosography provides a visual and radiographic diagnosis of the problem and may help in the understanding of the pathological process involved. Seventy-three cavernosograms were performed on 68 patients for symptoms relating to erectile deformities, both congenital and acquired, impotence and priapism. The indications, technique and results of corpus cavernosography are described.

Adolescent↗
PubMed1990

Penile prostheses in the management of impotence in sickle cell disease.

Priapism lasting more than 24 h in adults with homozygous sickle cell disease usually results in impotence. The dense fibrosis of the corpora cavernosa which destroys the normal vascular erectile system of the penis also complicates insertion of penile prostheses. Our experience in 5 patients is reviewed. Sharp dissection and dilatation were necessary to form a tunnel for the prosthesis, which was more easily excavated anteriorly and posteriorly through a dorsal incision than for the length of the corpora through a traditional perineal-scrotal incision. Damage to the tunica was common and subsequent migration of the prosthesis necessitated an additional 11 procedures under general anaesthesia. Despite these technical difficulties, the procedure allowed satisfactory intercourse. The average interval between onset of impotence and implantation was 4 years. Early implantation before the dense fibrosis develops might give more satisfactory results.

Adult↗
PubMed2006

alpha-Adrenoceptor subtypes in isolated corporal tissue from patients undergoing gender re-assignment.

OBJECTIVE: To investigate the pharmacology and functionality of alpha(1)-adrenoceptors in human corpus cavernosum, and to determine the predominant subtype. MATERIALS AND METHODS: Cavernosal tissue specimens were obtained from the penises of 22 men (mean age 37.4 years) removed during gender re-assignment surgery. The men had been maintained on long-term oestrogen therapy before surgery, to aid the development of secondary feminine characteristics (oestrogen treatments were stopped 6 weeks before surgery). Corpus cavernosum strips were mounted in organ baths perfused with Krebs' solution. A control concentration-response curve (CRC) to phenylephrine (a nonselective alpha(1)-agonist) was obtained. Then the tissues were incubated with the alpha(1A) antagonist, WB4101; the alpha(1B) antagonist, chloroethylclonidine; or the alpha(1D) antagonist BMY 7378 (all at 1 microm) and the CRC to phenylephrine was repeated. The concentration producing a half-maximal response (EC(50)) and pK(B) values (logarithm of the dissociation constant, a measure of affinity) were determined. RESULTS: WB4101 produced a parallel rightward shift of the CRC to phenylephrine, with a pK(B) of 7.49. BMY 7378 also produced a parallel rightward shift of the CRC to phenylephrine with a pK(B) of 6.45. Chloroethylclonidine had a similar effect on the phenylephrine CRC, with a pK(B) of 5.90. CONCLUSION: Alpha(1)-adrenoceptors in human cavernosal tissue have a relatively low affinity for BMY 7378 and chloroethylclonidine, but are more sensitive to WB4101. This confirms that the predominant alpha(1)-adrenoceptor subtype in human corpus cavernosum is the alpha(1A) subtype and this might help in developing more selective antagonists and agonists for managing erectile dysfunction and priapism.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1992

Staphylococcal septicaemia complicating intracavernosal autoinjection therapy for impotence in a man with diabetes.

Intracavernosal injection of vasoactive drugs is a safe, effective, and commonly used treatment for impotence in diabetic men. In prospective studies infection has rarely occurred. We report a case of life-threatening Staphylococcal septicaemia complicating this treatment in a 61-year-old man with Type 2 diabetes, probably due to a combination of an unsterile technique and drug-induced priapism. Infection is a potential risk in diabetic men using intracavernosal injection therapy and those offered it should be informed of the importance of a scrupulous sterile technique and the need to seek urgent medical help for decompression if an erection persists for more than 4-6 h.

Bacteremia↗
PubMed2005

Intracavernous sodium nitroprusside (SNP) versus papaverine/phentolamine in erectile dysfunction: a comparative study of short-term efficacy and side-effects.

OBJECTIVE: The aim of our work is to evaluate the efficacy of intracavernous sodium nitroprusside (SNP) in management of erectile dysfunction (ED) in a clinical comparative study with papaverine/phentolamine in ED patients. METHODS: The study included 40 patients with ED divided into two groups. Group I include 20 patients receiving intracavernous (30 mg papaverine + 1 mg phentolamine) followed 1 week later by intracavernous 300 microg SNP. Group II included 20 patients receiving the same regimen of group I but with intracavernous SNP first followed by papaverine/phentolamine 1 week later. All patients were assessed clinically for their response and any developing complications. RESULTS: The numbers of good and poor responders were not statistically significant (P > 0.05) among the two groups. The mean erectile duration of SNP was similar to bimix (P > 0.05). No side-effects whether local or systemic occurred with SNP while priapism and local penile pain were recorded with bimix solution. CONCLUSIONS: Intracavernous pharmacotherapy is still a reliable method both for diagnosis and for treatment of ED. While preliminary results of our study show a potential of SNP to be an effective and safe intracavernous agent, long-term self-injection clinical trials are needed before large-scale usage is recommended.

Adrenergic alpha-Antagonists↗
PubMed2005

Intracavernosal irrigation by cold saline as a simple method of treating iatrogenic prolonged erection.

AIMS AND METHODS: The aim of this study was to evaluate the efficacy of aspiration and irrigation of the corpora cavernosa with cold saline as a simple outpatient method for treating prolonged penile erection after intracavernous injection of vasoactive agents. RESULTS: Aspiration and irrigation was needed in 70 out of 122 cases with iatrogenic priapism in whom cooling of the penis and perineum failed to achieve detumescence. According to the temperature of the saline used, patients were randomized into four different groups: A, B, C, and D with a saline temperature 10, 15, 20, and 37 degrees C, respectively. MAIN OUTCOME: We used a significantly larger volume of saline in groups C and D compared to group A. On the other hand there was no significant difference in the volume of saline used between groups A and B. Complete detumescence was achieved in 24/25 (96%) of cases in group A compared to 9/15 (60%) of cases in group D. CONCLUSION: We recommend corporal aspiration and irrigation with 10 degrees C saline for patients with prolonged penile erection who failed to respond to the noninvasive measures using ice-cold compresses and physical exercise.

Adolescent↗
PubMed2006

Corporoscopic excavation of the fibrosed corpora cavernosa for penile prosethesis implantation: optical corporotomy and trans-corporeal resection, Shaeer's technique.

INTRODUCTION: Implantation of a penile prosthesis in cases of neglected or resistant ischemic priapism, or delayed re-implantation following prosthesis infection and extraction, is usually a difficult and risky procedure due to fibrosis of the corpora cavernosa. Among the common complications are perforation of the urethra, tunica albuginea, and infection. The complications are usually due to the use of blind force against resistance. AIM: We propose the techniques of Trans-Corporeal Resection and Optical Corporotomy as adjuvant measures for excavating the fibrosed corpora cavernosa under vision, without the use of force against resistance. METHODS: Six patients with diffuse fibrosis of the corpora cavernosa were operated on. The instruments and technique are the same as for optical urethrotomy and transurethral resection. Optical Corporotomy was started with, where the corpora are incised from within. After establishment of a satisfactory passage, Trans-Corporeal Resection followed to scrape the fibrous tissue. Implantation of penile prosthesis was completed as usual. The procedure was performed through 1.5 cm incision in the tunica albuginea. MAIN OUTCOME MEASURES: Length, girth, and straightness in the erect position, as well as the incidence of complications. RESULTS: Operative time was an average of 90 minutes. No difficulty was encountered during the procedure. No complications were noted through 1 year of follow-up. CONCLUSION: Optical Corporotomy and Trans-Corporeal Resection allow for force-free, visually monitored excavation of the fibrosed corpora cavernosa, aiming at safer penile prosthesis implantation.

Erectile Dysfunction↗
PubMed1990

Intracavernosal metaraminol for treatment of intraoperative penile erection.

Four patients developed penile erection when regional anaesthesia was induced with spinal block. In another patient, penile erection developed during fentanyl-induced general anaesthesia. Injection of metaraminol into corpus cavernosum successfully achieved detumescence in all these patients. The dose of metaraminol ranged from 10 to 25 micrograms, much less than that required for the treatment of vasodilator-induced priapism. Intracavernosal injection of metaraminol is a simple, effective and safe method for immediate relief of intraoperative penile erection. It is most useful when urogenital operation would be delayed by penile tumescence.

Adult↗