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E J Meuleman

Publications and source records attributed to E J Meuleman.

54 records · Page 3Linked to original sources
PubMed1994

Erectile dysfunction in diabetic men: the neurological factor revisited.

In the literature the importance of the neurological factor in the etiology of erectile dysfunction in patients with diabetes mellitus is subject to debate. We report on the findings of neurophysiological investigations in 27 impotent and 30 potent diabetic patients, as well as 102 impotent nondiabetic patients. Additionally, hormonal and vascular evaluations were done. The neurophysiological evaluations consisted of assessment of somatic as well as autonomic sensory nerves, by measuring the latencies of somatosensory evoked potentials of the posterior tibial and pudendal nerves, and of the bulbocavernosus and urethro-anal reflexes. The results show a higher incidence of more severe peripheral and autonomic sensory neuropathy in impotent diabetic men. Also, a preponderance of abnormal intracavernous pharmacological tests, suggesting vasculogenic impotence, was found in impotent diabetic patients. No important endocrinological differences were found among the 3 groups under investigation. Significant differences occurred for plasma glucose and glycosylated hemoglobin. We conclude that diabetic urogenital sensory neuropathy has a crucial role in the etiology of diabetic impotence. Angiopathy seems to be of secondary importance. The results show that poor diabetes regulation is associated with diabetic impotence.

Adult↗
PubMed1993

[Experiences with intracavernous auto-injection for the treatment of erection disorders].

We report on our experience with autoinjection therapy in 72 patients with erectile dysfunction. We analysed factors that have an impact on the outcome of autoinjection therapy, and we focused on psychological, sexological and relational issues. In 53 (74%) patients an organic aetiological factor was found. Although with the aid of injection 82% of the men were able to achieve an erection adequate for penetration, only 39% continued treatment beyond one year. Lowest drop-out rates were encountered among patients with diabetes mellitus and men without organic aetiology (50% and 53% respectively). The most important reason for discontinuation was lack of acceptance of autoinjection therapy by the partner. Other reasons were prolonged erection, haematomas, ineffectiveness and fear of self-injection. Although autoinjection provides a safe and effective long-term method for the treatment of erectile dysfunction, the drop-out rate is strikingly high. Apparently, the acceptance of the partner is the most important determinant of the result of autoinjection therapy. Therefore, the partner should be involved in the counselling and treatment from the beginning.

Adult↗
PubMed1993

[Experiences with a vacuum apparatus in the treatment of erection disorders].

The efficacy of two types of an external vacuum device designed to overcome erectile dysfunction was evaluated in 78 unselected patients. In 80% an organic aetiological factor was found. Although 77% of the men were able to achieve an erection adequate for penetration, only 46% continued treatment after 1 month. Among the reasons for discontinuation were ineffectiveness in 18 (23%), side effects in 7 (9%), recovery of spontaneous erection in 6 (8%), the time-consuming nature of the procedure 5 (6%), lack of acceptance of patient and partner 4 (5%), the high costs of the pump 2 (3%). The highest discontinuation rate was encountered in patients without signs of organic aetiology (81%). The device provides a non-invasive, reversible and safe alternative for the treatment of erectile dysfunction. It does not necessitate comprehensive aetiological assessment of erectile dysfunction. There are no differences between the results of vacuum device therapy (this study) and autoinjection therapy (the literature). The selection of patients who may profit by the vacuum device is enhanced if the patient is allowed to practice in his own private environment before purchasing the device.

Adult↗
PubMed1993

Diagnosis and treatment of 409 patients with prostatitis syndromes.

We reviewed 409 patients who had prostatitis syndromes during the period 1985-1991. Urine analysis, x-ray film of abdomen, and sonograms of the kidneys did not contribute to the diagnosis of prostatitis. In 22 percent of the urine samples, slight-to-moderate atypia was seen in urine cytology but no malignancy was found. Uroflowmetry data were abnormal for 30 percent of the patients, and thus uroflowmetry may contribute to treatment selection of patients who may gain from specific drugs such as the newly developed alpha-1 receptor blocking agents. Positive bacteria cultures were found in 10.4 percent of the prostatic fluid cultures and in 14.3 percent of cultures of the urethra. Ureaplasma urealyticum was seen in 19.6 percent of the prostatic fluid cultures and in 32 percent of cultures of the urethra. Prostatic fluid cultures did not give additional information, and the outcome of semen cultures showed a poor correlation with urethra or prostatic fluid cultures. In this series, the most advocated treatment remains the antibiotic treatment (75% of patients) bringing relief of complaints in 35.6 percent of the patients and cure in 23.8 percent. However, similar results were found if no antibiotics were administered (relief of complaints in 31.6% and cure in 30.5%) and more than one course of antibiotics did not improve these results. Consequently, we advocate the use of specific antibiotics only when the causative bacterial agent has been identified.

Adult↗
PubMed1992

Penile pharmacological duplex ultrasonography: a dose-effect study comparing papaverine, papaverine/phentolamine and prostaglandin E1.

Alternations of penile blood flow are believed to be the most frequent organic cause of erectile dysfunction. Penile duplex ultrasonography following intracavernous injection of a vasoactive agent is an accepted method for diagnosis of penile vascular dysfunction. To determine the diagnostic efficacy of commonly used vasoactive drugs we studied the hemodynamic effects of different dosages of papaverine, the combination of papaverine and phentolamine, and prostaglandin E1 in men with erectile dysfunction and men with normal erectile potency using color duplex ultrasonography. We concluded that 12.5 mg. papaverine and 10 micrograms. prostaglandin E1 are the drugs of choice to be used in conjunction with penile duplex ultrasonography because of optimal effects on cavernous arterial dilatation and low risk of prolonged erection. However, low dose papaverine or prostaglandin E1 has a limited value in evaluating veno-occlusive function.

Aged↗
PubMed1992

Assessment of penile blood flow by duplex ultrasonography in 44 men with normal erectile potency in different phases of erection.

Duplex ultrasonography is important in the diagnosis of vasculogenic erectile dysfunction. We measured the ultrasonographic parameters of cavernous blood flow in different phases of penile erection. We examined 44 volunteers with normal erectile potency. Doppler spectra of the cavernous artery were obtained in a time-dependent manner after intracavernous administration of papaverine. Following intracavernous pharmacological stimulation, the Doppler spectrum alters according to a specific pattern indicating the different hemodynamic phases of erection. Peak flow velocity and acceleration time, measured in the early post-injection phase, may be used to grade arterial inflow. The difference between resistance index in the pre-injection and late post-injection phases may be used to estimate veno-occlusive function. References values are defined.

Blood Flow Velocity↗
PubMed1991

[Experiences of patients with a hydraulic erection prosthesis].

To evaluate the psychological effect of implantation of an inflatable hydraulic penile prosthesis, a follow-up investigation was carried out among 25 patients who between November 1985 and March 1989 received such a prosthesis in the department of Urology at St. Radboud Hospital, and among their partners. The methods consisted of written questionnaires and personal interviews. The mean time between implantation and evaluation was 20 months. Implantation did not improve sexual or general partner relationship. However, the great majority of patients (84%) and their partners (75%) would decide again to have the prosthesis implanted. Some elements of dissatisfaction (concerning the limited length of the erect penis, difficult coital position, and failing ejaculation) were found, that draw attention to the necessity of improving information and psychosexual counselling.

Adult↗
PubMed1991

Penile sensory disorders in erectile dysfunction: results of a comprehensive neuro-urophysiological diagnostic evaluation in 123 patients.

A total of 123 patients with complaints of erectile dysfunction and no clinically overt neurological disease underwent a comprehensive neuro-urophysiological diagnostic evaluation. The results were compared with those obtained in 50 healthy volunteers. Data gathered consisted of somatosensory evoked potentials from the posterior tibial nerve (tibial evoked potential) and from the dorsal penile nerve (pudendal evoked potential). Also, 2 sacral reflex latencies were measured (bulbocavernosus reflex and urethro-anal reflex). A total of 58 patients (47%) had at least 1 abnormal neuro-urophysiological measurement. Neuro-urophysiological abnormalities were found more frequently in older patients. The tibial evoked potential was abnormal in 30 patients (24%), pudendal evoked potential in 21 (17%), bulbocavernosus reflex in 26 (21%) and urethro-anal reflex in 32 (26%). It was concluded that somatosensory disturbances constitute an important part of neuro-urophysiological abnormalities. Our results suggest a relationship between erectile dysfunction and subclinical, age-related (penile) sensory disorders. Our study corroborates the importance of penile sensibility for erectile (patho)physiology as suggested by others and supports the concept of sensory deficit impotence as an important cause of erectile dysfunction.

Adolescent↗
PubMed1991

Comparison of the diagnostic value of pump and gravity cavernosometry in the evaluation of the cavernous veno-occlusive mechanism.

We performed cavernosometry in 96 patients with erectile dysfunction. Two different techniques were compared: pump cavernosometry using a roller pump as the inflow source and gravity cavernosometry using an infusion set as the inflow source. We conclude that the diagnostic value of both techniques is comparable. In pump cavernosometry maintenance flow is the most accurate parameter of veno-occlusive function. Gravity cavernosometry has the advantages of simplicity, cost-effectiveness and a lower complication rate. Incomplete cavernous smooth muscle relaxation appeared to be limiting the diagnostic value of both techniques.

Adult↗
PubMed1989

Sulphasalazine-induced reversible male infertility.

A male patient suffering from ulcerative colitis, presented with primary infertility due to sulphasalazine therapy. Sulphasalazine was discontinued and the patient was treated with a 5-aminosalicylic acid preparation (Salofalk) in the form of an enema. After 3 months, the semen quality was dramatically improved and a successful pregnancy ensued. The sulphapyridine moiety of sulphasalazine seems to be responsible for male infertility and depressed semen quality. The metabolite 5-aminosalicylic acid is proposed as a suitable alternative to sulphasalazine in cases of male infertility.

Adult↗
PubMed1988

Diagnostic efficacy of the combination of urine cytology, urine analysis and history in the follow-up of bladder carcinoma.

In the follow-up of low stage, low grade transitional cell carcinoma of the bladder, cystoscopy is used as a diagnostic standard. Because of the lack of well defined prognostic parameters, cystoscopic follow-up is based upon empirical grounds. In this study, 82 patients with a primary superficial transitional cell carcinoma of the bladder were studied with respect to the time interval before recurrence. The mean number of cystoscopies leading to detection of recurrence (i.e. the ratio of positive to negative cystoscopy) was reviewed. Eighteen cystoscopies had to be done to detect each recurrence. Because of this excessive number of cystoscopies, the diagnostic value of the combination of red cell count in urine, cytology and history of micturition symptoms and haematuria was assessed in a retrospective study of 86 recurrences of bladder carcinoma. The results indicated that the combination of these non-invasive diagnostic tests may constitute a sensitive procedure for the follow-up of bladder tumours. In the case of T1G3 and muscle-invasive recurrences (greater than T1), the sensitivity rate was 100%.

Carcinoma, Transitional Cell↗
PubMedDate not supplied

A neuropeptide in human semen: oxytocin.

The neuropeptide oxytocin (OT) has been detected in testis and epididymis of several mammals. The peptide affects steroidogenesis and sperm transport in vivo. Effects of OT on sperm motility in vitro seems to be contradictory. As no data are available on the presence of OT in human semen and on the relationship of OT with sperm characteristics, we assessed OT level in semen samples in 3 groups of patients: (I) normozoospermic, (II) astheno-/oligo-/teratozoospermic, and (III) azoospermic subjects. Furthermore, we studied the relationship between the concentration of OT in semen and the sperm characteristics. OT was measured in seminal plasma by radioimmunoassay after extraction. OT semen levels did not differ in control patients (I: 1.72 +/- 0.78 pg/mL; n = 10), patients with poor semen quality (II: 1.66 +/- 0.91 pg/mL; n = 11), or in vasectomized patients (III: 1.28 +/- 0.65 pg/mL; n = 11). No statistically significant relationships between the OT levels and sperm characteristics (density: 0.0693; total sperm count: 0.0845; percentage of motility: 0.1341; morphology: 0.3478) have been found. The neurosecretory peptide oxytocin is present in human seminal plasma of normal as well as of vasectomized subjects. OT is not only derived from the testis; OT levels in poor semen samples are not different from controls. No relationship was found between OT seminal plasma levels and sperm characteristics.

Humans↗
PubMedDate not supplied

Enhanced pharmacological testing in patients with erectile dysfunction.

This study was designed to evaluate the practical use of the combination of a low-dose intracavernous injection test (ICI) and visual erotic stimulation (VES) in the assessment of patients with erectile dysfunction. Additionally, a postinvestigation questionnaire (PIQ) was used to rate the erection following the investigation when the patient had left the office. It was hypothesized that the combination (ICIVES) and the PIQ would yield a higher erectile response rate than ICI or VES alone and would minimize the occurrence of prolonged erection. Of the 90 patients studied, 17 (19%) showed adequate erections to VES, 10 (11%) to ICI, and 60 (67%) to ICIVES. Of the 30 non-responders, 7 (23%) reported adequate erections on the PIQ. Overall, in 75% of the patients adequate erections were achieved. No prolonged erections were encountered. It is concluded that the combination of a low-dose ICI and VES, and the application of a postinvestigation questionnaire, is a powerful and safe test to select patients for autoinjection therapy.

Adult↗
PubMedDate not supplied

Increased expression of a 68-kDa protein in the corpus cavernosum of some men with erectile dysfunction.

Erectile dysfunction (ED) may be caused by abnormalities of intracavernous penile structures. In order to investigate whether specific proteins could be identified that might be related to ED, the composition of structural proteins in cavernous tissues of patients with ED was compared to that of normal cavernous tissues by gel electrophoresis. Increased expression of a 68-kDa nonionic detergent extraction-resistant protein was demonstrated in tissues of more than half of the patients with vasculogenic ED, whereas only one out of nine normal cavernous tissues showed the same phenomenon. Increased expression was not related to a specific type of vascular insufficiency, aging, or diabetic constituency. Histochemical and immunochemical studies revealed that the increased amount of the 68-kDa protein is not merely the result of a surplus of nervous, smooth muscle, or elastic tissues. Furthermore, antibodies specific for 68-kDa neurofilament and 62- to 67.5-kDa tropoelastin did not recognize the 68-kDa protein on Western blots. The possibility that the 68-kDa protein may help us understand the etiology of certain cases of erectile dysfunction is discussed.

Antibodies, Monoclonal↗