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PubMed1992

[Transdermal therapy of erectile insufficiency].

The introduction of intracavernosal (i.c.) administration of vasoactive drugs has revolutionized diagnosis and treatment of sexual impotence. This procedure, though, carries some risks and undesired side-effects, such as fibrosis, priapism, hematomas, etc. Thus, at our Centre has been evaluated the possibility of a transdermal (TS), either active or passive, treatment of impotence. In a first trial, double blind crossover, 62 patients have been treated with yohimbine (YOH) as ointment. About 5 mg of the drug were applied at the balanopreputial sulcus, twice daily. In 10 patients YOH was also assayed by HPLC in the blood drawn from the corpora cavernosa after the application of the drug: a rapid adsorption of the drug was demonstrated and a peak value of 58 ng/ml at 25 min. Treatment with YOH was particularly satisfactory in patients with impotence of recent onset and mild degree, that is without major vascular alterations. The active TD drug administration was tested with papaverine delivered with cavernous bodies by a C.T.D.A.S. (Controlled Transdermal Drugs Administration System). Thin layer chromatography has shown the passage of about 10% of patients a relevant amelioration of erectile function was observed.

Erectile Dysfunction↗
PubMed2004

[Emergencies in adults with sickle cell disease].

Sickle cell disease is an inherited disease characterized by the presence of an abnormal haemoglobin. It is the more prevalent genetic disease at birth in Ile-de France area. Sickle cell disease can be complicated by acute vaso-occlusive crisis, chronic visceral involvement related to ischemic process, and infectious complications. In adults, acute vaso-occlusive crisis is the major clinical problem prompting admission to hospital and the main cause of death. It mainly manifests by osteoarticular pain and acute chest syndrome and can be complicated by multiorgan failure. Acute vaso-occlusive crisis can be also manifested by priapism, ischemic or haemorrhagic stroke, or abdominal pain. The main treatment of severe acute vaso-occlusive crisis is based on transfusion.

Adult↗
PubMedDate not supplied

The progression of the penile vein: could it be recurrent?

Our aim was to study retrospectively the destiny of the deep dorsal vein of the penis in the event of its stripping surgery or its simple ligation in patients diagnosed with venoocclusive dysfunction 17 years ago. From June 1986 to May 1987, a total of 31 men were seen for erectile dysfunction due to venous leakage resulting from priapism, aging, or congenital or idiopathic factors. Of these, 23 men underwent venous stripping of the deep dorsal vein and are referred to as the stripping group. The remaining 8 patients received a simple ligation of the deep dorsal vein and are classified as the ligation group. A total of 21 patients (16 of the 23 and 5 out of the 8) were available for follow-up by using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) scoring system and cavernosograms. In the ligation group, the imaging demonstrates some compensatory veins that are commensurate with impotence postoperatively. In the stripping group, however, the follow-up cavernosograms disclosed no venous recurrence, but residual ones that were not crucial to the rigidity. The IIEF-5 scoring in the ligation group changed from a preoperative mean IIEF-5 score of 10.0 +/- 4.5 to 9.8 +/- 3.6 postoperatively. In the stripping group, however, the mean preoperative IIEF-5 score of 9.8 +/- 4.1 increased to a mean postoperative IIEF-5 score of 18.9 +/- 2.1. Although there was no significant difference between the 2 groups' preoperative IIEF-5 score, there was a statistically significant difference between treatments (P <.001). The penile venous vasculature bears no evidence of regeneration even as long as 17 years after their removal. This finding is in contrast to what is commonly believed, that erectile dysfunction will recur about 2 years after ligation of the deep dorsal vein. We therefore believe that the clinical recurrence may not be due to venous regeneration, and penile venous surgery, if properly performed, may be durable, although larger studies will be required.

Adult↗
PubMed1992

[Prospective study of the effectiveness and side effects of intracavernous prostaglandin E1 versus papaverine or papaverine phentolamine in the diagnosis and treatment of erection dysfunction. Review of the literature].

E1 prostaglandins (E1-PG) by intracavernous injection has been given for diagnostic purposes to 70 randomly selected patients visiting the practice with erectile dysfunction (ED). Sixty-one were suggested to begin a weekly intracavernous self-injection (WICSI) according to the established protocol. Fifty-one patients (83.6%) started the therapy and within an 18-months follow-up interval only 2 (3.27%) preferred to return to papaverine, since 20 patients had previously undergone the papaverine test and 6 were on WICSI with this preparation. Fifty-three patients (75%) achieved complete erection, 8 (11.4%) enough erection to penetrate without manual help, representing a total efficacy of 87%. E1-PG dosage varied from 10 to 40 mcg based on diagnosis, and was readjusted in 6 of the 9 patients which in the initial tests had not obtained sufficient erection, therefore bringing about a final 91.4% erections of sufficient characteristics for intercourse to be considered normal. During the year and a half follow-up a total of 2,880 E1-PG self-injections were injected without during this time cases of priapism, systemic reactions, cavernous bodies infections, arteriovenous fistulae, fibrosis of the cavernous bodies, etc, being observed. Two patients showed prolonged erections of 3-5 hours during the E1-PG tests which remitted spontaneously without sequelae and now continue the WICSI programme after dosage readjustment. In our experience, E1-PG intracavernous injection has proven to be more effective than papaverine in the treatment of erectile dysfunction and therefore, added to its safety and degree of acceptance, we consider it a first choice approach in the diagnosis and treatment of erectile dysfunction in males.

Adult↗
PubMed2006

[Effect of co-expressing M-bcr/abl and m-bcr/abl fusion gene transcripts on the clinical features of patients with chronic myelogenous leukemia at diagnosis].

OBJECTIVE: To study the effect of co-expressing M-bcr/abl and m-bcr/abl fusion gene transcripts on the clinical features of the patients with chronic myelogenous leukemia (CML) at diagnosis. METHODS: m-bcr/abl fusion gene transcripts were detected by nested PCR. RESULTS: The percentage of the CML patients who co-expressed M-bcr/abl and m-bcr/abl was 51.4% at diagnosis. Comparison of the patients who co-expressed and those who expressed M-bcr/abl alone showed there was no difference in their hemoglobin concentrations, WBC counts, neutrophilic alkaline phosphatase (NAP) stains, Ph chromosomes and hepatosplenomegaly; however, significant difference in platelet count was seen. In the patients with b3a2 who co-expressed m-bcr/abl, an increased platelet count was noted, compared with that of patients with M-bcr/abl alone. But in patients with b2a2, the two groups showed no difference in all clinical features. Two patients had priapism, their m-bcr/abl being negative. CONCLUSIONS: CML patients who co-expressed b3a2 and m-bcr/abl showed a tendency to have an increased platelet count at diagnosis. Co-expressing m-bcr/abl has no the effect on the clinical features of CML patients with b2a2.

Adolescent↗
PubMedDate not supplied

Evaluating erectile dysfunction: oral sildenafil versus intracavernosal injection of papaverine.

BACKGROUND: Intracavernosal injection of vasoactive drugs is an established method of evaluating erectile dysfunction. However, it is invasive and may be associated with pain and priapism. We investigated the use of oral sildenafil as a possible substitute for intracavernosal agents. METHODS: Men with erectile dysfunction were randomized into two groups of 25 each. One group of 25 men received injection papaverine initially followed by oral sildenafil, and another 25 received oral sildenafil followed by injection papaverine. Genital self-stimulation was used in both the groups. Penile length and circumference as well as angle of erection, before and after each medication, were recorded. Two days later, the intervention arms were crossed over. Subjective responses were obtained. The effect of medication on each outcome variable was studied by using analysis of variance models in relation to patient, period and medication. RESULTS: There was statistically significant improvement from the baseline value in both the arms, i.e injection papaverine and oral sildenafil (p<0.001, p<0.001, respectively) for both penile length and circumference. No significant difference was observed between the two medications in the outcome measures. CONCLCUSION: Oral sildenafil was as effective as injection papaverine in evaluating erectile dysfunction.

Administration, Oral↗
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↗
PubMedDate not supplied

Prostaglandin E1 and papaverine: a comparative study on the ability to increase the penile bloodpool as measured by the 99mTc-penogram in the baboon model.

The evaluation of arterial blood supply and venous drainage of the penis is essential in assessing the impotent male. The vaso-active drugs prostaglandin E1 and papaverine, as intracavernous injections, cause penile erections in humans by influencing the arterial blood supply and venous drainage. These drugs were used in the normal baboon and in vascular compromised baboons using a 99mTc-penogram to quantify the vascular status of the penis. Ligation of the A. Iliaca Interna was performed to change the penile blood supply, thus compromising the vascular supply. It was observed that pre- and post-operatively, the increase in the penile bloodpool was more dramatic although not significantly so (P less than 0.05), but more variable after papaverine than with prostaglandin E1. The effect was even more enhanced (P less than 0.05) in the vascular compromised baboons so that the occurrence of priapism after papaverine can speculatively not be excluded. Also the more consistent vasoactive response after prostaglandin E1 seems to establish it as the superior intracavernous injectable agent.

Alprostadil↗
PubMed1991

Relationship of clinical severity to packed cell rheology in sickle cell anemia.

There is wide variation in the clinical manifestations of sickle cell disease (SCD) from one affected individual to another. Many investigators have sought to discern parameters that would explain this variability. In the present studies we have attempted to correlate the frequency of painful events and the extent of end organ failure in SCD with rheologic properties of packed suspensions of sickle cells, using a magneto-acoustic ball microrheometer developed in our laboratory. Using this device we have measured the steady-state viscosity, and the viscous and elastic moduli of cell suspensions in 16 individuals with hemoglobin SS disease who were untransfused and in their steady state. The rheologic parameters were then correlated with clinical parameters. The clinical parameters measured were emergency department visits, hospitalizations, hemoglobin, reticulocyte count, age, and end organ failure (nephropathy, avascular necrosis of bone, stroke, retinopathy, resting hypoxemia after acute chest syndrome(s), leg ulcer, and priapism with impotence). The P value for the correlation between the steady state viscosity and end organ failure was .001 with a correlation coefficient (R value) of .73. The P value for the correlation between the viscous modulus of viscosity and end organ failure was .00006 with an R value of .83. The P value for the correlation between the elastic modulus of viscosity and end organ failure was .0006 with an R value of .76. However, there was no significant correlation between any component of packed cell rheology and emergency department visits or hospitalizations for pain.

Adult↗
PubMed1991

[Penile metastasis of prostatic carcinoma: a case report].

Penile metastases are uncommon lesions: most often secondary to a primary pelvic cancer (prostate, bladder and rectum) they have a unfavourable prognosis. The appearance of disseminations is still controversial and there is not an efficacious therapy. Priapism may be present or not. The Authors report their experience on a penile metastasis secondary to prostatic cancer and about the evolution of this pathology. A review of the Literature is done.

Adenocarcinoma↗
PubMed1991

[Echography in andrological emergencies].

Ultrasonography is the first imaging method to undertake in all acute andrological disorders. It gives an accurate diagnostic picture in a high percentage of cases and is extremely useful for following patients during therapy and after surgery. The forms of acute andrological disorders, of both medical and surgical pertinence, that can be evaluated ultrasonographically include many prostate, seminal vesicle and external genital afflictions. Among the prostate and seminal vesicle disorders, of particular importance are acute prostate vesiculitis and prostatic abscess. Ultrasonography can be used to advantage in the latter as a guide to percutaneous transperineal drainage. The acute penis disorders that can be assessed by are essentially vascular affections (priapism and thrombosis of the corpus cavernosum). Ultrasonography, however, find its widest field of application in acute scrotum disorders. Ultrasonography is the most valid diagnostic aid for confirming clinical data in all forms of these disorders. It allow these that need medical treatment to be differentiated from those requiring surgery. Ultrasonography has good specificity in the differential diagnosis of spermatic cord and Morgagni's hydatid torsion, an acute scrotal affliction not uncommon in childhood, which is often self-limiting and, therefore, does not necessitate emergency surgery. Finally, ultrasonography is useful for distinguishing minor scrotal trauma which can be treated medically from major scrotal trauma which requires surgical intervention.

Acute Disease↗
PubMed1991

[Acute urinary retention secondary to cavernous metastases from a prostatic tumor].

Prostatic carcinoma metastatic to the penis is a rare phenomenon. We report two cases of acute urinary retention due to penile metastases from a prostatic carcinoma. Patients may have a penile mass or diffuse swelling of the penis. Some patients develop priapism and urinary retention can be rarely observed. The most effective treatment seems to be local excision with wide resection and, if necessary, total penectomy. The prognosis remains poor regardless of the type of therapy employed.

Adenocarcinoma↗
PubMed1991

[Purulent cavernitis as a complication of self injection into the cavernous body].

Intracavernous self-injection of vasoactive drugs is commonly prescribed for the treatment of erectile failure. Cavernitis is a serious complication of this treatment. The case of a 63-years-old patient with cavernitis following intracavernous injection of papaverine and subsequent priapism is reported. He had a phlegmonous infection of both corpora cavernosa without infection of the corpus spongiosum. The treatment consisted in surgical debridement of the corpora cavernosa with intracavernous drains inserted for continued irrigation and suction. Complete remission of the infection was ultimately obtained, but fibrosis of the remnants of both corpora cavernosa remained.

Erectile Dysfunction↗
PubMed1990

[Complications and limitations of endoscopic therapy for urethral stenosis].

Endoscopic treatment of urethral stenosis is not an alternative to surgical therapy but is an ideal therapeutical partner. The limits of endoscopic resection lie in the lack of anatomopathologican and clinical knowledge regarding the long-term maintenance of stability of the urethral lumen that in every case the internal urethrotomy manages to create. In fact internal urethrotomy is capable of almost totally eliminating the urethral stenosis but with a higher incidence of relapse, even in the short-term. The complications of endoscopic therapy of urethral stenosis are the usual local complications and of mild seriousness. Among the most frequently noted are the swelling and/or peno-scrotal suffusion by incorrect routes, and post-operative urethraemorrhagia. More rarely, but with serious effects, are purulent urethritis or sepsis. In our case list major complications such as priapism, cavernositis or septic shock were not noted. In conclusion endoscopic therapy of urethral stenosis is a simple technique, repeatable with low morbidity and is the best technique in the congenital 'ring'.

Endoscopy↗
PubMed1990

[Hypercalcemia associated with blast crisis of chronic myeloid leukemia].

We describe a patient with CML who developed hypercalcemia in his course of blast crisis. A 25-years-old man was diagnosed as CML with priapism in April 1985, and controlled with BHAC-DVP, VMP, busulfan therapy. In December 1987, he readmitted to our hospital with abdominal pain. Investigations at that time showed: white blood cell count 11600/microliters (blast cells 9%); hemoglobin 8.4 g/microliters; platelets 19.0 X 10(4)/microliters; serum calcium 13.2 mg/dl; BUN 44 mg/dl; creatinine 2.7 mg/dl. Treatment with predonine, 6-MP and vincristine was begun. But serum calcium level rose gradually up to 16.5 mg/dl. So we tried middle dose Ara-c therapy, serum calcium decreased to 6.8 mg/dl. At once he was in a chronic phase, but he relapsed and died of heart failure. Necropsy showed extensive leukemic blast-cell infiltration of the bone marrow, liver, spleen, lung, and kidney. The cause of hypercalcemia in our case was suspected of local osteolytic hypercalcemia, because multiple bone destruction was found.

Adult↗
PubMed1989

Biweekly intracavernous administration of papaverine for erectile dysfunction.

To determine the efficacy of the intracavernous administration of papaverine hydrochloride every 2 weeks to treat male impotence, we recruited 50 patients from a sexual dysfunction clinic. Of these, 8 did not complete the course of papaverine therapy. A total of 8 had complications, including priapism in 3 and ecchymoses or urethral bleeding in 5. In 30 patients who had substantial vasculogenic disease, there was a notable improvement in the penile blood pressure after papaverine treatment, although only 9 reported successful sexual intercourse. The penile blood pressure in the remaining 12 patients without substantial vascular disease increased modestly after therapy, and 5 persons reported satisfactory sexual activity. We conclude that administering papaverine intracavernosally every 2 weeks improves sexual potency in a subset of sexually impotent patients. Those with severe vasculogenic disease and a penile-brachial pressure index of less than 0.65 are not good candidates for this regimen.

Adult↗
PubMed1989

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

The efficacy of intracavernous autoinjection therapy with prostaglandin E1 was investigated over a period of up to six months in 187 patients with long-term erectile dysfunction. All patients had to undergo an investigation program consisting of routine laboratory tests, directional doppler sonography of the penile arteries, measurements of the BCR-latencies, as well as intracuvernum drug testing with PGE1. Six months follow-up results are available so far in 115 patients. The mean injection dose was 13.5 mcg PGE1 at the beginning of therapy and 12.8 mcg PGE1 at the end of therapy. An average of 24 prostaglandin E1 injections per patient was given. In 16.6% of the 187 patients slight to moderate pain occurred at the injection site, not influencing sexual intercourse. No priapisms lasting more than six hours were observed. A significant improvement of the blood flow in the deep and dorsal penile arteries was shown by penile doppler sonography after 6 months treatment. The efficacy and tolerability of the therapy were designated as very good to good in 91% respectively in 98% of the patients. 94% of the patients would like to continue the therapy. The results indicate that PGE1 due to its erectile potency and great tolerability will occupy an important position in the therapy of the erectile dysfunction.

Adult↗