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At least 1,711 records · Page 95Linked to original sources
PubMed1984

Sickle cell anemia. Pathophysiology and treatment.

Current concepts of the pathophysiology of the sickling process are reviewed. New approaches to treatment - including induced hyponatremia, membrane-active antisickling agents, and gene manipulation - are described.

Anemia, Sickle Cell↗
PubMed2000

Three-year outcome of a progressive treatment program for erectile dysfunction with intracavernous injections of vasoactive drugs.

OBJECTIVES: To perform a comparative evaluation and follow-up of patients with erectile dysfunction (ED) who were treated with intracavernous injection of vasoactive drugs, starting with simple drugs and advancing to complex combinations. METHODS: The study included 625 patients, 26 to 85 years old, with ED. Four intracavernous injection protocols were used: protocol 1, papaverine plus phentolamine; protocol 2, prostaglandin E(1); protocol 3, papaverine, phentolamine, and prostaglandin E(1); and protocol 4, atropine sulfate, papaverine, phentolamine, and prostaglandin E(1). A positive response was defined as an erection sufficient for penetration. Patients for whom the basic protocol failed were successively switched to the more advanced protocols until a positive response was achieved. RESULTS: A positive response was achieved by 415 (66.4%) of the 625 patients given protocol 1; 75 (36%) of the remaining 210 patients given protocol 2; 98 (72.6%) of the 135 patients given protocol 3; and 22 (59.5%) of 37 patients given protocol 4. All four protocols failed in only 15 patients (2. 4%). At the 3-year follow-up visit (n = 610), 349 had achieved coitus, 65 (10.6%) without an injection and 202 (33.1%) with an injection. Eighty-two patients sometimes performed coitus without an injection. Sixty-three patients (10.3%) abandoned the program because of marital or health problems; 198 asked to be switched to Viagra during the follow-up period, and 120 returned to the program. CONCLUSIONS: Overall, our progressive treatment yielded a high positive response rate (97.6%), with 57.2% achieving successful coitus on follow-up. The main advantage of the program is that it spares patients who are responsive earlier from using more complex, painful, and costly drugs.

Adult↗
PubMed2003

Urologic complications of nonurologic medications.

A physician must be aware of common drug side effects and interactions before prescribing a certain agent. In addition to the drugs that we, as urologists, prescribe, we must also be aware of the urologic side effects of drugs that are commonly prescribed by nonurologists. The mechanisms of the pharmacologic causes for voiding dysfunction, erectile and sexual dysfunction, infertility, and urolithiasis are often mutifactorial and incompletely understood. The recognition and association of a particular drug's potential side effects may save valuable time and money involved in the workup of a patient with a new urologic complaint. It is incumbent on the practicing urologist to be able to recognize the common, and sometimes subtle, urologic complications of medications that are used for nonurologic conditions.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2003

Urologic manifestations of hematologic disease sickle cell, leukemia, and thromboembolic disease.

Advances in medicine are allowing patients with hematologic disease to live longer and healthier lives than ever before. As these patients age, however, manifestations of their disease processes may develop as complications in other organ systems. We discussed the major genitourinary complications of sickle cell anemia, leukemia, and thromboembolic disease. These range from the benign inability to concentrate urine that is seen in sickle cell disease to renal infarction that results from nephrotic syndrome. Our ability to treat and prevent these complications will improve as our understanding of these disease processes and their pathophysiology grows. Additionally, it is important for urologists to understand the underlying pathophysiology of hematologic disease to best serve the patients. For example, it may be the urologist who makes the diagnosis of ovarian vein thrombosis in a pregnant woman with right lower quadrant pain and fever. This diagnosis, with the proper treatment of antibiotics and anticoagulation, could prevent the potential development of septic thrombophlebitis. Urologists will increasingly be called upon to deal with the manifestations of these complex diseases as these patients are living longer. It is our duty to educate ourselves about these disease processes so that we can make the best clinical decisions for our patients.

Adrenergic alpha-Agonists↗
PubMed1996

Intracavernous pharmacotherapy: treatment for the aging erectile response.

Fueled by serendipity, observation, and direct scientific investigations over the last 15 years the normal mechanisms of erection, and the pathophysiology of erectile dysfunction have been revealed. The demonstrations that vasoactive injections could produce penile erection without benefit of psychic or tactile stimuli revolutionized the diagnosis and treatment of erectile dysfunction by providing a direct test of end organ integrity or deficiency. This article reviews the clinical pharmacology of vasoactive corporal agents and outlines what has been surmised about the aging erectile response.

Adult↗
PubMed2005

Sleep-related painful erections.

BACKGROUND: A 45-year-old man presented with repeated awakenings at night caused by nocturnal painful erections, in sharp contrast with normal erections at other times, 2 years after surgical removal of a thoracic (Th6-7) ependymoma. INVESTIGATIONS: Physical examination, pharmaco-sensitized penile Doppler ultrasound, spinal and brain MRI, neurophysiological work-up (tibial and perineal somatosensory-evoked potential; hand, foot and perineal sympathetic skin response assessment), polysomnography with recording of nocturnal penile tumescence. DIAGNOSIS: Sleep-related painful erections, characterized by penile pain during nocturnal erection, typically during rapid eye movement sleep, in the presence of a residual thoracic spinal cord syndrome. MANAGEMENT: Amitriptyline, an antidepressant that suppresses rapid eye movement sleep, was ineffective. Treatments with other antidepressants, clozapine and beta-blockers were suggested, but the patient declined because of potential severe side effects.

Central Cord Syndrome↗
PubMed1986

Intracavernous injection of vasoactive drugs, an alternative for treating impotence in spinal cord injury patients.

We report on our results with the intracavernous injection and self-injection of papaverine-phentolamine in a group of spinal cord injury patients with erectile impotence. This technique offers the possibility of achieving a full erection which continues for a few hours and disappears afterwards. In our limited experience no major complications have occurred. If our findings are confirmed, in future, the self-injection technique may become a valuable alternative to implanting a prosthesis in impotent paraplegics and tetraplegics.

Drug Combinations↗
PubMed1994

Management of pharmacologically induced prolonged penile erection with oral terbutaline in traumatic paraplegics.

Intracavernosal administration of papaverine or prostaglandin E1 for erectile impotence in paraplegics is being practised widely. One of the complications of this therapeutic regimen is prolonged erection which is at present being treated by aspiration of corporeal blood and intracavernosal administration of alpha-adrenergic agonist such as phenylephrine. We report successful management of pharmacologically-induced prolonged erection in three traumatic paraplegics with oral terbutaline therapy. The indications for oral terbutaline therapy were (1) absence of significant coronary artery disease and (2) full erection persisting for more than 2 1/2 h, but less than 4 h duration. The initial dose of terbutaline was 5 mg and the same dose was repeated after 15 min as full erection persisted. Within the next 15 min, penile detumescence was achieved in two paraplegics with papaverine-induced prolonged erection. However, full erection still persisted 15 min after the second dose of terbutaline in the third patient who had received intracavernosal administration of 3.25 micrograms of prostaglandin E1. Therefore, he was given the third and final dose of 5 mg of terbutaline under cardiac monitoring. Penile detumescence was achieved within the next 15 min. It was ensured before administration of the third dose of terbutaline that (1) his blood pressure was within the normal range (for his paralysed status), (2) the heart rate was less than 100 per min and (3) there was no cardiac arrhythmia. Occasional premature ventricular contraction was observed only in the patient who received the third dose of terbutaline, but it was transient, self-limiting and did not warrant any treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed2006

Doppler evaluation of erectile dysfunction - part 2.

Doppler evaluation in erectile dysfunction (ED) has a significant role in determining the cause of ED. The advantages of penile Doppler and pharmacologic duplex ultrasonography include objective, minimally invasive evaluation of penile hemodynamics at a relatively low cost. Arteriogenic ED may be secondary to peripheral vascular disease and diabetes, or may be seen in association with coronary artery disease. Various parameters, such as diameter of the cavernosal artery, peak systolic flow velocity, degree of arterial dilatation and acceleration time, have been suggested for the diagnosis of arteriogenic ED, but peak systolic flow velocity is the most accurate indicator of arterial disease. This second part of the review article describes the various causes of ED and the interpretation and evaluation of color flow Doppler examination in ED.

Erectile Dysfunction↗