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PubMedDate not supplied

[Action of vasoactive drugs in male sexual impotence].

Intracavernous injection of papaverine and phentolamine (Regitine) was performed in 223 impotent men. These patients had been previously evaluated at another department. Patient failure to obtain spontaneous erection during sleep or on waking was a prerequisite for inclusion in the study. Following evaluation of the penile brachial pressure index (PBI), patients under 50 years received an intracavernous injection of 0.5 mg. Regitine and papaverine 30 mg; patients over 50 years received 1 mg. Regitine and 30 mg. papaverine. Patients were observed for a minimum of 30 minutes. Fifty-eight attained erection and the remaining patients achieved varying degrees of penile tumescence. Patients were advised to have sexual intercourse within two hours following injection. Fifty-eight patients attained erection immediately and 132 achieved erection following immediate sexual stimulation. Of these 132 patients, 72 (54.5%) had successful sexual intercourse, 60 (45.5%) failed to obtain erection sufficient for coitus. We are unaware of the result in the remaining 33 patients who had none or late sexual stimulation. Of the 58 patients who achieved erection, the PBI could be quantified in 53 (mean 0.84). Likewise, the PBI could be determined in the 141 patients who had failed to achieve erection immediately (mean 0.77). Priapism was the only serious complication observed. Seven (3.1%) patients who presented with this condition were treated with the intracavernous injection of dopamine.

Drug Combinations↗
PubMed1989

[Pharmacocavernosography: a worth-while examination in the evaluation of venogenic impotence].

From November 1988 till July 1989, a total of 78 patients consulted our OPD with a chief complaint of impotence. These patients underwent evaluation with pharmacocavernosography alone, or combined with color duplex sonography (Acuon 128). Sixty-three (80.8%) patients were found to have abnormal venous drainage which, in one case, was associated with peyronie's disease. Among these patients, the sites for the contrast medium in the venous drainage system from the penis were determined as follows: the preprostatic plexus for 53 (67.9%) patients, the proximal (cavernosal or crural) vein for 50 (64.1%) patients; the internal pudendal vein for 46 (58.9%) patients; the deep dorsal vein for 31 (39.7%) patients; the glans of the penis for 8 (10.3%) patients; the external pudendal vein for 8 (10.3%) patients and the corpus spongiosum for 3 (3.8%) patients. So the venous ligation for venogenic impotence had to include all these visible veins, especially the proximal vein. Among the 52 patients who once had received duplex scanning, 43 (82.7%) patients had abnormal venous drainage. So the duplex sonography did not seem to influence the population of venous leakage and 12 patients exhibited moderate to severe degree of arteriogenic insufficiency. Pharmacocavernosography in these patients was less valuable. No severe complications, such as priapism, were found. We found pharmacocavernosography to be a simple, practical and useful tool for evaluating patients suspected to have venogenic impotence. It can determine the sites of venous leakage (the key information for planning venous ligation) and provides good morphological information in the study of cavernous bodies. But it was not reliable in the evaluation of the severity of venous leakage.

Adult↗
PubMedDate not supplied

Prostaglandin E1 in the therapy of erectile deficiency.

We describe the management of 47 patients suffering from erectile dysfunction with prostaglandin E1. Positive response was reached in 38 patients. Self-injection was proposed and accepted by 30 patients. In our series neither systemic reactions nor priapism occurred.

Adolescent↗
PubMed1989

[Prostaglandin E1 in erectile dysfunction].

Of 447 presenting with erectile dysfunction, 322 (72%) responded to intracavernous injection of PGE1 with erections that were adequate for sexual intercourse. A multidisciplinary comparative study of PGE1 and other vasoactive drugs, e.g., papaverine or the combination of papaverine and phentolamine, was performed in 249 patients. Whereas 180 of the 249 patients (72.3%) showed adequate erections after 10 or 20 micrograms PGE1, only 79 of them (31.3%) did so after papaverine. A further 72 of the 249 patients (29%) had adequate erections after papaverine/phentolamine; thus, a total of 151 of 249 patients (60.3%) developed good erections after papaverine/phentolamine. Whereas after PGE1 no patients at all suffered from priapism lasting more than 6 h, this occurred in 13 of 249 patients (5.2%) after papaverine or papaverine/phentolamine. After intracavernous injection of PGE1, 9.4% of the patients complained of uncomfortable penile sensations during erection interfering with sexual intercourse. Since the initial study, 60 patients have been instructed in self-injection therapy and a further 45 patients obtain intracavernous PGE1 injections periodically, with very promising results. In vitro studies of cavernosal tissue samples obtained from potent men with penile deviations showed both the excellent relaxation of the smooth muscles of cavernous bodies by PGE1 and the antiadrenergic effect of the drug.

Alprostadil↗
PubMed1989

Thrombosis in particular organ veins.

Renal vein thrombosis in early infancy is a complication of dehydration and prolonged hypotension. The onset is usually acute and the most common clinical signs are uni- or bilateral frank masses, hematuria, proteinuria and thrombocytopenia. In most cases, with conservative management, the late outcome is favorable. In the adult, renal vein thrombosis is often a silent complication of the nephrotic syndrome, the hypercoagulability of which may be an important factor in the pathogenesis of the thrombosis. Clinically, the presentation of a sudden complete occlusion is that of severe abdominal and lumbar pain with hematuria and loss of function of the kidney that suffers hemorrhagic infarction. Physical examination often reveals an enlarged kidney. With gradual occlusion, renal function is preserved. The initial diagnostic approach is with ultrasound studies and computed tomography; definitive diagnosis is established by renal venography or by selective renal arteriography. In general, a conservative approach including the use of anticoagulant treatment is preferred to surgical intervention. Priapism is a persistent painful penile erection due to ischemic or non-ischemic causes; therapeutic intracavernosal injection of papaverine is becoming the most common cause. In early and mild stages, aspiration of blood from the corpora cavernosa supplemented with intracavernosal irrigation with alpha-stimulating agents is the procedure of first choice; in late and severe ischemia, a shunt procedure may become necessary. Hepatic vein thrombosis occurs in association with a number of conditions considered predisposing factors including the use of oral contraceptives. The clinical picture may be that of an acute illness with abdominal pain, hepatomegaly, ascites and hepatic failure as well as early death. More often, the onset is insidious with slowly developing ascites and wasting. For the diagnosis, hepatic scintigraphy may be helpful but, at present, ultrasonography, computed tomography and magnetic resonance scanning are procedures of choice. There is, as yet, no adequate treatment. A fatal outcome may be prevented by surgical decompression of the congested liver and, in recent years, liver transplantation has been employed. Portal vein thrombosis, in children, is usually considered a complication of umbilical sepsis or a result of a congenital abnormality of the portal vein. In adults, the most frequent causes are hepatic cirrhosis and neoplasia. Clinically, there may be a sudden appearance of ascites with resolution in a symptom-free interval until the onset of other features of portal hypertension occur. Currently, ultrasound real-time imaging supplemented with Doppler capability, computed tomography and magnetic resonance scanning provide the necessary diagnostic information. Variceal hemorrhage is often the first major complication requiring treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Budd-Chiari Syndrome↗
PubMed1989

[Evaluation of impotence: intracorporeal injection of papaverine by color duplex sonography].

From February 1989 to June 1989, 49 patients consulted our OPD for the complaint of impotence. The average age was 46.9 +/- 11.2 y/0. We applied intracorporeal injection of papaverine (60 mg) by color duplex sonography (Acuson 128) for evaluation. The results of the papaverine test were: good response in 6 (12%), imperfect response in 21 (43%) and impaired response in 22 (45%). So the total positive response rate was 55%; and the total negative response rate was 45%; two patients (4%) experienced priapism. Spontaneous detumescence occurred after aspiration of the corpus cavernosum and no complications ensued. We utilized duplex sonography for evaluating penile blood flow before and after papaverine injection. Diameters of the deep artery was: right artery increased from 0.42 +/- 0.13 mm to 0.76 +/- 0.26 mm, while the left artery increased from 0.43 +/- 0.19 mm to 0.64 +/- 0.31 mm. Following injection, the peak velocity and the increased change of peak velocity were higher in patients in the positive response group than in the negative response group. There was no correlation for the percent of increase in diameter of the deep arteries. This technique provides a safe method with few complications for the objective assessment of response to intracorporeal papaverine injection and the anatomic structure of the penis. Use of this technique can also avoid unnecessary examinations and influence the strategy of treatment. After normal values and parameters are established, this method should be a useful diagnostic tool.

Adult↗
PubMed1989

[Impotence in a urologic service].

In a recent experience we have studied 297 patients for impotence. 102 were considered psychogenic and 195 organic; 105 of the latter had isolated or associated arterial or venous lesions. The remaining 81 patients had preponderant organic pathology: Peyronie's disease, neurological disease, diabetes and pelvic trauma. All patients were explored by NPT (nocturnal penile tumescence), Doppler examination, intra-cavernous papaverine test, angiography and erectile flow associated with cavernography. We report our microvascular surgery results from the last seven years. 80 reconstructive vascular procedures were performed on a population of patients who averaged 50 years of age. 50 epigastric-cavernous by-passes were performed. Complete recovery has been observed in 14% with an average of 42 months follow-up. Erection improvement with possibility of vaginal intromission in 58%. Immediate or secondary thrombosis and priapism in 28%. 21 arterial epigastric-dorsal unilateral by-passes were performed with an average follow-up of 20 months. In 11 cases the arterial micro-revascularization was associated with deep dorsal vein ligature. Results are as follows: 10 excellent, 4 significant improvement, 3 failures and too short follow-up in three. 9 isolated venous ligature with a mean follow-up of 15 months. Complete recovery was observed in 3 patients, improvement in 3 and failure in 2. The author emphasizes the interest of a better selection of surgical indications, improvement of microsurgical techniques with epigastric-dorsal anastomosis associated with postoperative anticoagulant therapy whenever possible.

Erectile Dysfunction↗
PubMed1989

[Intracorporeal injection of papaverine for diagnosis of impotence: clinical evaluation of 120 patients].

Intracorporeal papaverine injections were performed for evaluation of penile erection on 120 patients with sexual impotence. This diagnostic technique was found to be simple, objective, realistic, and more precise in the differentiation of sexual dysfunction in men. In addition to observing the onset and duration of erection after papaverine injection, we could also classify the erectile rigidity by measuring the erectile angle while standing. The penile deformity after erection that possibly contributed to the etiology of patient's impotence could also easily be detected after papaverine injection. Thus we could differentiate 120 cases of impotence into the following types: psychogenic (26 cases), neurogenic (2 cases), mild vasculogenic (including physiologic) (33 cases), severe vasculogenic (54 cases) and pure venous leakage syndrome (5 cases). None of our patients developed fatal complications during or after the papaverine intracorporeal injection test; however, we experienced 5 cases of priapism requiring emergency management. Therefore, the injection must be done under the supervision of an experienced urologist.

Adult↗
PubMedDate not supplied

[Induction of an erection using papaverine].

In 61 patients erectile impotency was treated with papaverine injections into penile spongy body: initially 20-30 mg/day, then followed several days of intermittence, and then the dosages were built up with regard to the optimum time of erection for each person. Dosages higher than 80-100 mg were not advisable because of the evidence of prolonged erections. Recorded in 6 patients (7 times) prolonged erections lasted from 5 to 16 hrs (in 5 cases it was stopped by intracavernous injection of dopamine but in 2 patients cavernotomy was performed). A total of 300 sessions of papaverine intracavernous injections were made in 61 patients before the copulation (out of them 16 patients injected the drug themselves). During the treatment the patients were warned against prolonged erections: when it lasted for more than 4 hrs emergency clinical treatment be required for priapism prevention. It was proved that an adequate dosage of papaverine autoinjections into a spongy body was a simple, safe and effective method to cure erectile impotency, especially in patients with nonadvanced psychoneurological or vasculogenic disorders.

Adult↗
PubMed1986

Sexual dysfunction with antihypertensive and antipsychotic agents.

The physiology of the normal sexual response, epidemiology of sexual dysfunction, and the pharmacologic mechanisms involved in antihypertensive- and antipsychotic-induced problems with sexual function are discussed, with recommendations for patient management. The physiologic mechanisms involved in the normal sexual response include neurogenic, psychogenic, vascular, and hormonal factors that are coordinated by centers in the hypothalamus, limbic system, and cerebral cortex. Sexual dysfunction is frequently attributed to antihypertensive and antipsychotic agents and is a cause of noncompliance. Drug-induced effects include diminished libido, delayed orgasm, ejaculatory disturbances, gynecomastia, impotence, and priapism. The pharmacologic mechanisms proposed to account for these adverse effects include adrenergic inhibition, adrenergic-receptor blockade, anticholinergic properties, and endocrine and sedative effects. The most frequently reported adverse effect on sexual function with the antihypertensive agents is impotence. It is seen most often with methyldopa, guanethidine, clonidine, and propranolol. In contrast, the most common adverse effect on sexual function with the antipsychotic agents involves ejaculatory disturbances. Thioridazine, with its potent anticholinergic and alpha-blocking properties, is cited most often. Drug-induced sexual dysfunction may be alleviated by switching to agents with dissimilar mechanisms to alter the observed adverse effect while maintaining adequate control of the patient's disease state.

Adrenergic beta-Antagonists↗
PubMed1986

[Intracavernous injections of vasoactive drugs. Evaluation of their diagnostic and therapeutic value in 65 cases of erectile impotence].

Intracavernous injection (IC) of vasoactive drugs (papaverine (ICP) in 115 cases and different alpha-blockers in 65 cases) were administered to 65 patients with erectile impotence to evaluate diagnostic and therapeutic interest of this procedure. Immediate (induction of erection) and medium term (lasting improvement in impotence) results were correlated with those of investigations of multidisciplinary etiologies. Comparison of results of ICP with those of plethysmography of nocturnal erections (PEN, 52 cases) gave negative results for the papaverine test (lack of erection or one without rigidity) in 67% of cases of impotence of organic origin (PEN abnormal). However, the test was positive (totally rigid erection) in 17% of cases of organic etiology and only 40% of psychogenic cases (PEN abnormal). Comparison of results with those of selective hypogastric arteriography and of the artificial erection test with dynamic cavernography (43 cases) showed that the papaverine test was never positive in patients with severe arterial occlusion or obvious venous leaks. However, an elevated proportion of cases with a negative test failed to show signs of marked vascular anomalies. Integration of results of total multidisciplinary explorations showed that most patients with organic or mixed impotence producing a positive or intermediary type papaverine test were cases of neuropathic impotence or had major neuropathic elements. Repeated IC of different vasoactive drugs (excluding the use of autoinjection techniques) failed to provide lasting improvement except for psychogenic impotence (5 of 9 cases). But it is in this group that IC is the most dangerous (2 cases of priapism and 8 cases of rigid erection prolonged over more than 4 hours).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1988

Neurological dysfunction after intrathecal injection of dynorphin A (1-13) in the rat. II. Nonopioid mechanisms mediate loss of motor, sensory and autonomic function.

The kappa opioid agonist dynorphin A (Dyn A) (1-13) produced dose-related neurological deficits after subarachnoid injection in the lumbar spinal cords of rats. Whereas the neurological dysfunctions produced by low doses of Dyn A (1-13) were transient, higher doses caused persistent deficits, characterized by motor and nociceptive impairment in hindlimbs and tail, hindlimb edema, priapism, bladder infarction and atony and urinary incontinence. These deficits appeared to result from nonopioid actions of Dyn A (1-13), as they were: 1) not blocked by the opioid antagonists naloxone or WIN 44,441-3; 2) shared by Dyn A (3-13), which lacks opioid activity; and 3) not produced or altered by the selective kappa opioid agonist U 50,488. Coinjection of a combination of peptidase inhibitors, shown previously to enhance the actions of Dyn A fragments in vitro, significantly increased the paralytic actions of Dyn A (1-13). The peptidase inhibitors did not by themselves cause neurological dysfunction, and they did not alter the paralytic potency of the peptidase-resistant delta opioid antagonist ICI 174864. These findings indicate that Dyn A effects were: 1) limited appreciably by its rapid enzymatic degradation after injection and 2) most likely the result of actions of the intact peptide rather than proteolytic products generated after injection. Neuroanatomical evaluations revealed extensive neuronal and axonal injury in the lumbosacral spinal cords of rats injected with 25 nmol of Dyn A (1-13). Collectively, these results indicate that Dyn A (1-13) acts through nonopioid mechanisms to cause the injury and death of neurons involved in diverse spinal cord functions.

Animals↗
PubMed1988

Neurologic deficits and neuronal injury in rats resulting from nonopioid actions of the delta opioid receptor antagonist ICI 174864.

The delta opioid receptor antagonist ICI 174864 produces postural abnormalities and barrel rolling after i.c.v. injection and hindlimb and tail flaccidity after spinal subarachnoid injection in rats. These effects appear to result from nonopioid characteristics of ICI 174864 because they are neither shared nor blocked by other opioid antagonists (naloxone, ICI 154129 and WIN 44,441-3) and are produced by two compounds (ICI 174644 and ICI 178173) that are structurally related to ICI 174864 but lack its delta antagonist properties. Barrel rolling and hindlimb paralysis are also produced by dynorphin A-related peptides; however, rats failed to demonstrate tolerance or cross-tolerance to the hindlimb paralytic actions of ICI 174864 or dynorphin A (1-13) after 7 days of continuous spinal intrathecal infusion of either of these compounds. Whereas hindlimb responses to low doses of ICI 174864 (1.6-6.2 nmol intrathecally) were usually transient, higher doses (6.2-25 nmol intrathecally) produced persistent hindlimb motor dysfunction, altered nociception, priapism, hindlimb edema, bladder infarction and atony and urinary incontinence. Neuronal and axonal changes in the lumbosacral spinal cords of rats with persistent and transient neurologic deficits provided direct evidence of the neuropathologic actions of ICI 174864 (3.1 and 6.2 nmol) and ICI 174644 (25 nmol). These results indicate that 1) use of ICI 174864 as a selective delta opioid receptor antagonist is potentially compromised by its nonopioid neuropathologic actions and 2) ICI 174864 and dynorphin A-related peptides are unique among opioid agonists and antagonists in sharing barrel rolling and hindlimb paralytic effects. A similar mechanism of action may underlie the shared nonopioid actions of these peptides.

Animals↗
PubMed1988

[Penile metastasis of a prostatic neoplasm. Apropos of a case. Long-term survival].

Penile metastases are uncommon lesions. They are most often secondary to a primary pelvic cancer (bladder, prostate, rectum). The appearance of a penile lesion may differ; priapism may or may not be present. The mode of dissemination is still controversial. The authors report one case and review the literature on penile metastases secondary to prostatic cancer. The essential point of their observations is the prolonged survival of their patient (7 years) whereas in the literature, the prognosis of these lesions is a rapidly fatal outcome.

Adenocarcinoma↗
PubMed1988

Evaluation of vasculogenic impotence.

Penodynamics, the functional evaluation of erection after intracavernous injection of vasoactive drugs, is a simple screening test that excludes significant vascular problems if full erection occurs within a reasonable period of time. Although it is more invasive than the penile brachial index (PBI), it is well tolerated and easy to perform. There is good evidence that studies on the flaccid penis are less accurate and do not correlate well with the results of functional papaverine testing. To evaluate arteriogenic impotence, sonography and pulsed Doppler analysis combined with papaverine injections provide objective and reproducible measurements of diameter increase and blood flow of each penile artery and have the advantage of being a functional study. Although this equipment is expensive, it is available in many centers where noninvasive vascular flow studies are performed. With training, the technique can be mastered by anyone. The arterial response to papaverine and the resulting erection allow indirect judgment about the venous system. Therefore, the whole penile vasculature can be evaluated with this technique. Currently, many drugs or drug combinations are used to induce artificial erection, not only for diagnosis but also as a therapeutic alternative to penile prostheses. The only physiologic agent is prostaglandin E1, a substance that seems to be as effective as papaverine but can be metabolized within the cavernous tissue and reportedly results in fewer incidences of prolonged erection and priapism. The use of vasoactive drugs is also very helpful for angiographic studies by improving flow and diameter of the penile vessels, which will result in better images of the arterial lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1987

[The acute external genital].

Under the heading "acute diseases of the external genital organs" affections of the scrotal contents and the penis (without urethra) demanding immediate therapy are summarized. Crucial is the differential diagnosis epididymitis vs. torsion of the spermatic cord for an error may have very serious consequences for the patient as well as for the physician undertaking primary care. As to the other acute diseases of the scrotal contents the increasingly important role of scrotal sonography is stressed. Among the relatively rare acute affections of the penis traumatic rupture of the corpus cavernosum and priapism of various origin deserve particular interest because delayed wrong treatment may lead to loss of erectile potency.

Acute Disease↗
PubMed1988

Increased libido in three men treated with trazodone.

Two sexual side effects associated with trazodone have been reported: priapism in men and increased libido in women. This report describes three depressed men who had increased libido while receiving trazodone. Possible mechanisms are suggested. Research is needed to explore trazodone's usefulness in treating disorders of sexual desire.

Adult↗
PubMed1986

[Diagnosis and therapy of erectile impotence with special reference to papaverine].

The introduction of intracorporeal papaverin injections has significantly changed the investigation and treatment of erectile dysfunction. Papaverin acts on the smooth (vascular) muscle cell and induces erection. A good response to papaverin injection excludes major vascular disturbances within the penis. The interpretation of a negative result is more difficult. Depending on the Doppler blood-flow measurements, further radiological investigations (dynamic cavernosography or selective angiography of the pudendal arteries) may be needed. Treatment of impotence with papaverin is most successful in patients with psychogenic disturbances, which are often coincident with minor vascular pathology. Autoinjection is easily learned for long-term treatment by patients with moderate vascular disorders or neurogenic dysfunction. Major vascular disturbances, e.g. occlusion of the penile arteries or marked venous shunt, require surgery by a trained urologist. Papaverin may cause side effects, especially priapism, which may lead to definitive impotence. Careful investigation of erectile disturbances and search for the appropriate papaverin dosage are therefore crucial.

Erectile Dysfunction↗