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PubMed1985

Psychogenic erectile impotence--a useful or a misleading concept?

Psychological factors alone may not fully explain some cases of apparently purely psychogenic acute situational impotence. Chronic impotence is often due to a combination of aetiological factors. Erectile selectivity is not a reliable means of diagnosing purely psychogenic impotence. Nocturnal penile tumescence monitoring is not absolutely reliable in making a distinction between organic and psychogenic impotence. The either/or concept of impotence being organic or psychogenic should be abandoned as serious errors can be made by adhering to it.

Adult↗

PubMedDate not supplied

[The combination of oral trazodone-moxisylyte: diagnostic and therapeutic value in impotence. Report of 110 cases].

An oral drug treatment was prescribed systematically for one month in 110 unselected patients suffering from impotence: Tradozone (75 mg/day)+Moxisylite (180 mg/day) daily, or at higher doses if possible, and Trazodone (25 mg/day)+Moxisylite (60 mg/day) one hour before any sexual intercourse. Adverse effects were uncommon (6.3%). Satisfactory sexual activity was restored in 28% of cases and an improvement in spontaneous erections was obtained in 42% of cases. No improvement was observed in 30% of cases. This oral drug test therefore presents 3 advantages: a) it facilitates the diagnosis and treatment of impotence by eliminating moderate forms of psychogenic impotence, b) it reduces both the morbidity and cost of investigation of impotence by reducing the number of tests performed, c) it emphasizes the role of oral treatment in impotence. In conclusion, this oral drug test should be used because of its simplicity, safety and real efficacy. The current objectives of this test are to improve the efficacy of oral treatment as a result of pharmacological progress.

Administration, Oral↗

PubMed1991

[Surgical treatment of impotence].

In recent years, several procedures have been successfully employed for the treatment of patients with impotence. Implantation of penile prosthesis is favored for organic impotence. Surgical revascularization of penile artery is attempted for arteriogenic impotence and surgery for producing a mechanical obstruction in the penile venous outflow for venous impotence. Here in, the current surgical procedures for the treatment of erectile dysfunction are reviewed and our experience on the treatment of venous impotence is described.

Adult↗

PubMed1991

Non invasive detection of venogenic impotence: real-time US evaluation of periprostatic (Santorini's) venous plexus after (PGE1) induced erection.

The diagnosis of venous impotence is actually reached through cavernometry and cavernography. These procedures are somewhat painful, invasive, time consuming and not always free from side effects. Anatomo-physiological studies have assessed connections between periprostatic (Santorini's) plexus and deep venous drainage of the penis. Moreover, dilated periprostatic plexus is a common ultrasound finding in the phlogistic pathology of the prostate and it is often the cause of temporary functional impotence. 20 Patients suffering from venous impotence, previously assessed by flow/pressure studies, underwent real time transrectal scan (Kretz Combison 330 equipped with 7.5 MHertz multiplanar probe) before and after Prostaglandins E1 (PGE1) (Prostin VR-Upjohn) induced erection recorded by computerised rigidometer (RigiScan-Dacomed). Dilated periprostatic venous plexus associated with tumescence or unstable valid erection ("tooth-saw-trace") was considered diagnostic for venogenic impotence. Real time ultrasound evaluation after PGE1 induced erection is to be considered a reliable method in the qualitative assessment of venogenic impotence. The procedure allows, moreover, a more accurate urologic assessment and is also useful in the early detection of various prostatic disease which are, like erection disorders, often age-related. Customary diagnostic procedures (cavernometry and caverography) may represent a second-line or pre-surgical assessment policy.

Adult↗

PubMed1989

[Diagnostic and therapeutic applications of intracavernous injection of vasoactive drugs in impotence. Defense for the use of facilitating drugs. Part I--Pharmacology, classification and complications of active drugs].

The article discusses drugs which promote erection when injected via the intracavernous (IC) route during consultation. The diagnostic and therapeutic applications in the treatment of impotence are discussed also. 25% of impotent patients noted an improvement after this treatment while 50% of patients suffering from impotence of psychological origin noted an improvement. Auto-injection is also discussed. IC treatment now seems justified in most cases which have not responded to traditional therapeutic approaches and this includes cases of psychological origin. Vasoactive drugs can be described as being inducers (use of these drugs induces a rigid erection, even in the presence of the doctor), facilitating drugs (which produce a rigid erection only if sexual stimulation is present also) and inhibitors (which stop the erection). The former group (which has papaverine as leader) produces a significant number of side effects, not least of these being priapism; there is a risk of lasting iatrogenic impotence which is not negligible. These risks are reduced considerably when one uses facilitating drugs which, although less powerful, suffice in treating a large proportion of cases of impotence. Papaverine can not be replaced as a diagnostic drug but facilitating drugs should be used first in therapy and inducers should be used only if these facilitating drugs have failed.

Adrenergic alpha-Antagonists↗

PubMed1987

[Mechanisms of diabetic impotence. 25 cases].

Twenty-five impotent diatetics were investigated by means of nocturnal penile tumescence monitoring, hormone determinations, penile blood pressure measurement, artificial erection test and dynamic cavernosography, bulbocavernous reflex latency time measurement and cortical evoked responses from pudendal nerves. Sexological treatment was then attempted for a better evaluation of the psychogenic element. Penile blood pressure was also measured in 15 non-impotent diabetics and was found to be abnormal as often as in impotent diabetics. The results as a whole demonstrated that impotence was predominantly psychogenic in 9 cases, predominantly organic in 12 cases and mixed psychogenic and organic in 4 cases. Diabetic impotence is often due to several causative factors, as was the case in 12 of our patients. The factors most frequently responsible were psychological (present in 13 cases), neurological (present in 12 cases) and vascular factors (arterial abnormalities in 7 cases, "venous leakage" in 4 cases). Endocrine abnormalities were observed in only 2 cases.

Diabetes Complications↗

PubMed1987

Czechoslovak contribution to current concepts in impotence, its pathogenesis, diagnosis and treatment.

Czechoslovak contribution to the current concepts in impotence, its pathogenesis, diagnosis and treatment, consists especially in: the recognition of the haemodynamics of erection. The process involves two stages; in the first one, the arterial bed must deliver to the corpora cavernosa (CC) threshold values of volume and pressure needed for filling and distention of the CC, in the second period, the CC function as a closed system on the hydraulic principle, and contractions of the ischiocavernous muscles increase intracavernous pressure to suprasystolic values, the observation that it is just failure of the haemodynamics of erection that plays an important role in the pathogenesis of impotence in a majority of patients. The development of artificial erection into a real functional examination of the CC enables to differentiate: disorders with normal haemodynamics of erection, those due to insufficient arterial supply, insufficient blockage of venous return, or insufficient and ineffective contractions of the ischiocavernous muscles. the development of the phalloarteriographic technique which allows a precise anatomical diagnosis of the lesions in the afferent arterial bed, providing the basis for the development and indication of a number of reconstructive procedures in the arterial bed supplying the CC. In addition, the examination has also helped to clarify the relationship between erectile disorders, arterial disease and their risk factors. In retrospect, Czechoslovak research into impotence has substantially contributed to the recognition of vasculogenic impotence, to the therapy of arteriogenic erectile disorders and to a basic change in the concepts of the aetiology and pathogenesis of impotence.

Arterial Occlusive Diseases↗

PubMed1988

Suction device therapy in the management of erectile impotence.

The ErecAid System is based on the simple concept of entrapment of blood in the penis following vacuum-assisted penile engorgement by proximally placed elastic constriction bands. The SYNERGIST Erection System is a semirigid external appliance shaped like a condom that is left on the penis after vacuum tumescence has been achieved. Both devices can be used safely by any man who feels that he has an impotence problem, and the outcome is fairly predictable. These devices seem to be especially effective in men with partial impotence, and they offer the impotent man an alternative to surgical placement of penile prosthesis, a surgical revascularization procedure, intracavernosal injection of vasoactive drugs, or sexual abstinence. These devices appear to be safe and relatively inexpensive ways for the impotent man to make his penis rigid enough to engage in sexual intercourse. An impotent man who selects suction-device therapy may still be able to use other forms of treatment should he need or choose it.

Equipment Design↗

PubMed1986

[Impotence with venous leakage. An extensive study of 49 cases detected by the artificial erection test].

Fourty nine men seeking advice for erectile impotence, in whom the serum flow rate necessary to maintain an artificial erection (MFR) exceeded the upper limit of the normal range proposed by most authors (75 ml/mn), underwent different investigations (including a study of their penile arteries, Nocturnal Penile Tumescence monitoring (NPT) and a papaverine test) in order to ascertain the organic basis of their impotence, and to define the diagnostic criteria for "venous incompetence". Several other types of treatments were attempted. Two thirds of the patients were found to have occlusions of their sexual arteries, and these were severe in one third of cases. Our overall results suggest that only cases of MFR exceeding 120 ml per mn. were due to a true organic abnormality (severe venous incompetence, SVI), able to induce impotence, and possibly warrant surgical treatment, on condition that the organic nature is confirmed by NPT. 40% of the cases of impotence with SVI start before the age of 40, and 15% are primary. 37.5% of the cases never achieve rigid erection, and 37.5% have only rigid erections of short duration. Very few plausible etiological factors were found, except fibrosis of the cavernous bodies in 5 cases. The prognosis of impotence with SVI seems very bad, since only 4 of the 35 patients were clearly improved by non surgical treatments, while only 1 out of the 10 patients who underwent a surgical ligation of the deep dorsal vein of the penis was improved.

Arteries↗

PubMed1979

Erectile impotence treated with an implantable, inflatable prosthesis. Five years of clinical experience.

Erectile impotence can now be treated with a device that mimics a natural erection. Between 1973 and 1977, we implanted an inflatable prosthesis in 245 men (235 with organic impotence and ten with psychogenic impotence). Of these, 234 are able to use the device to their satisfaction; no failures have occurred in the 152 cases treated in 1976 and 1977. The success of this treatment rests in part on the careful selection of patients by a team--a urologist, a sleep researcher, a psychologist, and a psychiatrist--each evaluating the patient independently. Our experience suggest that erectile impotence may be more common than generally believed and that impotence from organic causes may account for a greater percentage of cases than formerly thought.

Adult↗

PubMed1978

Impotence--some causes and cures.

Transient organic causes of impotence include alcohol consumption, drug use or inflammatory genital disease. Many diagnoses of organic impotence, with diabetes, for example, have been premature and have resulted in iatrogenic, psychogenic impotence. After a stroke, heart attack or major surgery, depression may cause impotence. Anxiety and sexual ignorance are major etiologic factors. Thus, sex education and uncomplicated sex therapy can achieve a high percentage of cure. Penile plethysmography during sleep provides useful information. Penile prostheses are helpful for appropriately motivated couples when there is permanent impotence.

Depression↗

PubMed1984

Issues in the psychiatric diagnosis and management of impotence.

The evaluation and management of impotence has received increasing attention in recent years, largely because of the development of new techniques of diagnosis and treatment discussed in the present review. The author reviews the role of psychiatry in (a) understanding psychogenic impotence, (b) differentiation of psychogenic from organic impotence and (c) developing the rationale and methods of the newer treatment modalities. The impact of the availability of surgical penile prosthesis implantation on the role of psychiatry in evaluating impotent subjects is discussed. The author indicates that much remains to be learned about the indications for surgical versus psychological treatment of impotence, and about the effectiveness of psychological interventions.

Behavior Therapy↗

PubMed1983

Multidisciplinary survey of erectile impotence.

A study was done of 220 men referred principally by family physicians to a multidisciplinary erectile dysfunction study group to determine the factors causing or contributing to impotence that had persisted for more than 2 months and for which no cause was apparent. The men were aged 21 to 79 (mean 50.3) years, and the duration of impotence was a few months to 15 years (mean 2.65 years). The men were to be assessed from general medical, endocrinologic/metabolic, psychiatric and urogenital viewpoints. The significance of the causal or contributory factors detected was scored by application of defined criteria and a four-point scale. The degree of loss of potency and of libido as well as level of concern were also scored by each specialist. Impotence was complete in 60%, and an associated decline in libido was reported by 38%. The level of concern was high--that is, normal--in 81% and slightly reduced in 9%. Full investigation by all the specialists was precluded by the severity of other conditions in 16 patients, by the return of potency following relief of anxiety/depression or genitourinary tract infection in 16 and for logistic or other reasons in 34. Although the cause of the impotence could be attributed in 186 of the patients, only 154 were fully assessed. Among these patients general medical factors were contributory in 46%, endocrinologic/metabolic factors in 44%, psychogenic factors (primary or secondary) in 60% and urogenital factors in 49%. Multiple contributing factors were identified in 65%, which underscores the importance of a multidisciplinary approach to assessing many cases of impotence.

Adult↗

PubMed1982

Erectile impotence precipitated by organic factors and perpetuated by performance anxiety.

A survey of 72 men with erectile impotence showed that for 14 the onset had been concurrent with the start of a temporary physical disability (in 8), temporary exposure to a chemical agent in doses thought to be significant (in 4) or the return of sexual opportunity after a long period of celibacy or near-celibacy (in 2 older men). After elimination of that possible cause the impotence had persisted owing to anxiety about sexual performance. In another 6 of the 72 there were persistent nonpsychic causes for the impotence. Thus, in 28% of the men surveyed the precipitating cause of erectile impotence was organic. A large proportion of the cases of erectile impotence participated by a temporary nonpsychic factor could probably have been prevented with appropriate professional advice--for example, at the time an antihypertensive drug capable of causing the dysfunction was first prescribed.

Adult↗

PubMed1981

Penile revascularization in the treatment of impotence.

New clinical developments in the diagnosis and treatment of male sexual dysfunction have occurred in the past several years. Much of this information has not been disseminated to the general medical public. Of particular note, a series of reliable penile prosthetic devices for the treatment of advanced erectile dysfunction is now considered to be established and valid surgical therapy. The new diagnostic techniques of nocturnal penile tumescence monitoring, penile plethysmography, penile sphygmomanometry and phalloarteriography are beginning to show that some patients with erectile impotence have arteriosclerosis of the penile arteries. These patients were formerly considered to have psychogenic or idiopathic impotence. Some of these patients with vasculogenic impotence may benefit from the new surgical technique of penile revascularization, thus obviating the need for penile prosthetic implants.A preliminary report of a small series of cases of corpus cavernosum revascularization using the microsurgical implantation of the inferior epigastric artery directly into the corpus cavernosum with prolonged systemic anticoagulation gives a cure/improvement rate of 40 percent. Better selection of patients for operation and perfection of surgical technique offer the chance for improvement in this rate of success. The proper role of corpus cavernosum revascularization in the treatment of impotence remains to be clearly defined. However, these preliminary results, coupled with several reports from Europe, are sufficiently encouraging to justify continued clinical investigation and surgical experience with penile revascularization for vasculogenic impotence.

Adult↗

PubMed1980

Erectile impotence--it can be highly treatable.

In brief, the treatment of impotence is the treatment of the underlying cause whenever possible. When irreversible organic impotence is found, however, penile prosthesis should be considered. Both hydraulic inflatable and semirigid rod types are available. Morbidity with the procedure is relatively low in experienced hands and patient satisfaction has been reported as quite high. Pharmacogenic impotence may require a change or reduction of medication. Depression usually responds to some combination of antidepressants, psychotherapy, or electroconvulsive therapy, while modern short-term sex therapy has proved effective in reversing many of the anxiety-related cases. Deep-seated, anxiety-based impotence may require extensive psychotherapy, but many cases of recent-onset psychogenic impotence can be managed quite successfully with education, reassurance, and the optional short-term use of testosterone.

Aged↗

PubMed1994

Minoxidil versus nitroglycerine: a prospective, double-blind, controlled trial in transcutaneous therapy for organic impotence.

Minoxidil (1 ml, 2% solution) has been tested against nitroglycerine (2.5 g, 10% ointment) and placebo in a prospective, double-blind controlled trial in transcutaneous therapy for organic impotence. A total of 116 patients participated in the study. Impotence aetiology breakdown was as follows: arterial, 61 cases; neurogenic, 34; arterial plus neurogenic, 12; venous leakage, 9. The application sites for treatment were: glans penis (minoxidil and placebo), penile shaft (nitroglycerine). All patients underwent through sexological counselling sessions (at outset and prior to subsequent changes in drug used). The results were considered positive if all symptoms of impotence (ie 'slow' erection, loss of erection, insufficient erection) were resolved; if even one symptom remained the results were considered negative. Side-effects were also considered. Minoxidil proved significantly more active than nitroglycerine which was, in turn, more effective than placebo. Minoxidil proved significantly more active in neurogenic impotent patients. Fewer side-effects were found with minoxidil than with nitroglycerine. These data lead one to consider minoxidil useful in the treatment of selected cases of organic impotence, as long as psychological conflict regarding sex and drug use are carefully removed.

Administration, Cutaneous↗

PubMed1994

[Treatment of impotence with suction pumps].

Suction erectors are not a new idea in the range of treatments available for impotence. However, urologists have been interested in them for less than 10 years, although they have been available in the U.S.A. since 1974. We describe the results of a series of 32 patients with a mean age of 54 years treated by a Erecaid Osbon pump. 84% of them suffered from organic impotence. The success rate was 66% with a mean follow-up of 6.6 months. No serious adverse effect was observed. However, minor problems were reported by 75% of users: inhibition of ejaculation, pain, cold or pivoting penis. This is a safe and effective treatment, provided patients are correctly selected, as cases of partial and psychogenic impotence have a much lower success rate: failure rate in the case of organic impotence: 30%, psychogenic: 40%, total: 26%, partial: 56%. The better results are obtained in patients suffering from organic impotence, in a stable couple and whose partners participate in the therapeutic choice. The literature is reviewed and discussed.

Adult↗