Biomedical subjects

H Nisén

Publications and source records attributed to H Nisén.

5 recordsLinked to original sources

PubMed1996

Aortofemoral surgery and sexual function.

OBJECTIVES: To determine the incidence and pathophysiology of erectile dysfunction (ED) in patients with aortoiliac occlusive disease (AIOD) and the effects of aortofemoral surgery, including endarterectomy (E) and reconstruction (R), on erectile function (EF). DESIGN: Evaluation of EF before and 3 months after surgery. METHODS: 31 out of 40 male patients scheduled for aortofemoral surgery were given multiple choice questionnaires and penile dynamic Colour Doppler Ultrasonography. RESULTS: Of the 31 who agreed to enter the study five (16%) were found to be potent and 26 (84%) to suffer from ED. This was purely arteriogenic in 8% of the cases, purely venogenic in 23%, combined arteriogenic and venogenic in 53%, and neurogenic in 16%. Twenty patients returned for postoperative evaluation of EF, nine who had undergone E and 11 who had undergone R. Improvement of EF, in terms of increased penile arterial inflow, occurred in seven patients, six who had undergone E and one who had undergone R. EF remained unchanged in nine patients, three who had undergone E and six who had undergone R. Deterioration of EF occurred in four patients, all who had undergone R, and was attributable to decreased arterial inflow in two cases and to neurogenic surgical injury in the other two. CONCLUSIONS: The majority of patients with AIOD suffers from ED. Reduced penile arterial inflow and cavernovenous leakage are equally important in the pathophysiology of ED in patients with AIOD, suggesting that atherosclerosis may also compromise the penile veno-occlusive mechanism. Endarterectomy seems more likely than reconstruction to improve or maintain EF.

Aorta, Abdominal↗

PubMed1996

A positive pharmacological erection test does not rule out arteriogenic erectile dysfunction.

PURPOSE: We tested the assumption that a positive pharmacological erection test implies normal penile vascular status. MATERIALS AND METHODS: From March 1991 to February 1995, 372 patients with erectile dysfunction were referred to our institutions. Penile hemodynamics were studied in 205 patients with color coded Doppler ultrasonography after intracavernous injection of 40 micrograms. prostaglandin E1. RESULTS: Of the 205 patients undergoing color coded Doppler utrasonography 92 had a rigid erection, that is a positive pharmacological erection test. Doppler wave analysis showed that 76 of the 92 patients (82%) had normal and 7 (8%) had borderline arterial function (peak systolic velocity greater than 35 and 25 to 35 cm. per second, respectively), while 9 (10%) had arterial insufficiency (peak systolic velocity less than 25 cm. per second). All 92 patients had a normal veno-occlusive mechanism (resistance index greater than 0.90). Of the 9 patients with pure arteriogenic erectile dysfunction 8 had risk factors for arterial insufficiency, such as aortoiliac occlusive disease (5), diabetes mellitus (3), longer than 20-year smoking history (8) and hypertension (7). CONCLUSIONS: Our study shows hemodynamically that a positive pharmacological erection test does not rule out arteriogenic erectile dysfunction.

Adult↗

PubMed1996

Etilefrine in the prevention of prolonged erection after diagnostic pharmacological stimulation.

The aim of this study was to verify the efficacy and safety of intracavernous injection of etilefrine hydrochloride in the prevention of pharmacologically induced prolonged erection. Two hundred rigid erections due to diagnostic pharmacological stimulation were treated with immediate intracavernous injection of 5 to 10 mg etilefrine hydrochloride. Penile response and general side effects after the injection were recorded. Patients were interviewed after 1-2 weeks about possible side effects. Detumescence occurred within 10 minutes in 194 (97%) cases. In the remaining six (3%), detumescence occurred after cavernous aspiration and additional injection of 5 mg etilefrine. Thirteen patients (6.5%) had transitory palpitations. None of the patients had hypertensive crisis, cardiac arrythmia or ischaemic events. Intracavernous injection of etilefrine is effective and safe in preventing prolonged erection after diagnostic pharmacological stimulation.

Adult↗

PubMed1993

Pharmacotesting with high dose prostaglandin E1 in impotence.

The diagnostic value of pharmacotesting in impotence is controversial. The results of high dose prostaglandin pharmacotesting were compared with those of colour duplex Doppler scanning and pharmacocavernometry in 82 impotent patients and 10 control subjects. Based on the results of 10 control subjects, the prostaglandin test was defined as positive if intracavernous pressure 200 minutes after injection of 40 micrograms prostaglandin E1 was > or = 42 mm Hg and negative if intracavernous pressure was < 42 mmHg. The test was repeated in 29 subjects and classified results were consistent in 24 subjects (86%, k = 0.65). The test was negative in 52 out of 56 patients (sensitivity 93%) with vasculogenic impotence (arteriogenic and/or cavernovenous factor involved) and the test was positive in 21 out of 26 patients (specificity 81%) with non-vasculogenic impotence (arteriogenic or cavernovenous factor not involved). The majority, 27 out of 31 patients (87%) with arteriogenic impotence showed simultaneous dysfunction of cavernovenous occlusion mechanism. In conclusion, pharmacotesting with high dose prostaglandin is a useful screening test of vasculogenic impotence.

Alprostadil↗

PubMed1993

Cavernous auto-injection therapy with prostaglandin E1.

During 1990-1992, 176 consecutive patients (aged 18-83 years, mean 53 years) with erectile dysfunction were personally investigated by the author in the private office setting at Eira Hospital. Pharmacotesting with 20 micrograms prostaglandin was positive in 89 of 138 patients (64%) tested. Eleven per cent of the patients complained of pain during erection. Of 131 patients, who initially were offered auto-injections as a primary treatment modality, 99 (76%) began the therapy. Seventy-four per cent of the patients continued auto-injections after three months. The overall efficacy of prostaglandin E1 to induce adequate erections for sexual intercourse was estimated to be 71%. One prolonged erection without medical intervention and no penile fibrotic lesions were recorded. In conclusion, cavernous auto-injection therapy with prostaglandin E1 is a well accepted, effective and safe treatment alternative in psychogenic as well as organic impotence. Every impotent patient should be informed of this therapy.

Alprostadil↗