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Biomedical subjects

R Virag

Publications and source records attributed to R Virag.

At least 19 recordsLinked to original sources
PubMed1991

Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8-year experience with 615 cases.

Of 615 patients with impotence of varying etiologies who were followed from 12 to 96 months after the institution of intracavernous self-injection therapy with vasoactive drugs (papaverine alone, papaverine and alpha-blockers, and Ceritine, a new multilevel acting drug) 87% (533 patients) returned for followup visits or were regularly contacted. Of these patients sexual activity was restored in 91%. The dropout rate was 11.25%. The 114 episodes of prolonged erections among 51 patients (4.57%) represented less than 3 per 1,000 of the 34,875 recorded injections. All patients were treated without complications. The percentage of patients suffering from nodules or permanent deformations was 2.8%. There were no cases of intracavernous fibrosis. The percentage of satisfied patients (satisfaction index 7 or greater) was 84.8%. Improvement in spontaneous erections during sexual intercourse was obtained in 65% of the cases: 15% no longer needed self-injections and 50% only used them occasionally while 35% remained entirely dependent.

Adrenergic alpha-Antagonists↗
PubMed1989

Human penile erection and organic impotence: normal histology and histopathology.

A very large amount of human material (7 embryos, 12 stillborns, 12 penes of males aged between 2 and 86 years, as well as bioptical material from 80 subjects affected by impotence problems) has been examined so as to study the penis arterial and venous walls, the blood flow regulation mechanisms and the intracavernal trabecular morphology. The amount of muscle tissue and of collagenous connective tissue has been numerically quantified by computer-assisted methods. This study enables the authors to underline three fundamental facts: (a) it confirms the normal penile erection mechanism, and the consequent theory, (b) it confirms that vascular sclerosis is a systemic phenomenon correlated to age, and that the penis is not exempt, and (c) in the case of impotence problems, the same sclerosis phenomenon may appear at an earlier age, and therefore induce pathological impotence.

Aging↗
PubMed1989

[Impotence of vascular origin].

Between 1977 and 1986, 3,500 patients were examined for the symptom of impotence; 1,250 of them received multidisciplinary investigation permitting the diagnosis of a pure organic or mixed disorder in 85% of cases, including 62% of vascular disease subdivided into arterial (40%) and venous (22%). For 1,062 patients, 1 or several of the following therapies were used: intracavernous infusion of vasoactive drugs (N = 725), auto-injections (N = 235), vascular surgery (N = 357) and prostheses (N = 23). The diagnostic approach, formerly analytical and making use of multiple non-invasive methods, such as nocturnal erection plethysmography (NPT) and invasive methods (artificial erection, arteriography) have been transformed by the use of pharmacological tests associated with visual sexual stimulation (VSS) which enable, together with Doppler velocimetric examination, simple screening of vascular impotence based on the study of 4 parameters: penile pressure index (PPI) when less than 0.91 is always a sign of an arterial problem, the severity of which is directly proportional to the lowering of this index and the association with maintenance insufficiency; the initial intracavernous flow rate (IICF) depends overall on the maintenance flow and the state of erectile tissue, resulting from pharmacological stimulation by a low dose of papaverine (8 mg); penile rigidity attained by the combined action of pharmacological and visual sexual stimulation, reflecting the functional erectile capacity; the duration of the rigidity thus obtained on stoppage of VSS indicating the capacity for maintenance of erection. In the event of suspicion of an isolated venous leak or in association with arterial problems, it is the artificial erection with cavernosography, carried out after pharmacological stimulation, which enables the severity of the leak to be assessed. The following specific investigations are carried out to investigate a specific associated etiology: electromyogram for neurological disorders, hormone assay for endocrine disorders and psychological study using the MMPI questionnaire (Multiphasic Minnesota Personality Inventory). One can thus distinguish several groups of patients suffering from vascular impotence depending on the degree of arterial involvement: minor (PPI between 0.75 and 0.9), moderate (PPI between 0.65 and 0.75) and severe (PPI less than 0.65); depending on the degree of venous leaking: absent (MI less than 0.3 and/or MF less than 25 ml/min), minor (MI between 0.3 and 0.5 and MF between 30 and 50 ml/min), moderate (MI between 0.5 and 75 ml/min) and severe (MI greater than 0.75 and/or MF greater than 75 ml/mn).(ABSTRACT TRUNCATED AT 400 WORDS)

Erectile Dysfunction↗
PubMed1988

The morphological basis for the Polster theory of penile vascular regulation.

The discovery of the papaverine erection test by Virag in 1982 stimulated the interest of research workers in the physiology of the penis. Since then, the scheme of functioning proposed by Conti [Acta anat. 14:217-262, 1952] in 1952 has been frequently cited in the literature, although its finalism is evident. It is based upon the presence of regulatory mechanisms along penile arteries, veins and arteriovenous anastomoses. In spite of the fact that these anastomoses were unanimously admitted, recently the presence of arterial and venous cushions has been controverted or even denied. Before attempting any functional explanation using nerves and chemical mediators, we made sure first of the concrete material reality of these anatomical structures. Thirty-five years after the main study, the present observations confirm the morphologic descriptions made in 1952. The contrary would have been astonishing. In fact, arterial and venous cushions were demonstrated by the School of Anatomy of Padova, the most ancient and venerable of all (Fallope, 1550), then by other institutes of morphology that dealt with these cushions in practically all the organs of the human body. It remains to establish their role in erection - whether it is null, complementary or primordial: that is the question.

Adult↗
PubMed1987

[Significance of the penile pressure index and value of the papaverine mini-test (8 mg)].

The main non invasive test to quantify arteriogenic impotence is the penile blood pressure (P.B.P.I.). However, its signification is still in discussion. In this work, after discussion of the previous literature, we have revisited the P.B.P.I. signification by quoting it in comparison to the dynamic tests of erection (artificial erection, papaverine test, nocturnal penile tumescence (N.P.T.) with the findings of arteriography. A series of 51 cases having been studied with the multidisciplinary evaluation that we recommend were analyzed and compared to the location of the arterial lesions (aorto-iliac and/or internal pudendal) and to the response to the 80 mg papaverine test (rigidity and initial intracavernous flow (I.I.F.). A significant difference (p less than 0.05) for P.B.P.I. has been demonstrated between normal arteriograms and bilateral lesions. The P.B.P.I. is significantly lower when the lesions are located to the main arteries and bilateral. I.I.F. helps to differentiate hemodynamically severe arterial lesions where surgery is recommended from mild lesions where intracavernous drugs are first proposed. After discussion of the risks of the 80 mg papaverine test in unspecialized units, the authors propose a standardized method to evaluate the penile arteries, using the Doppler and the 8 mg papaverine mini-test which does not carry the risks of prolonged erection. This approach allows a precise morphologic and hemodynamic evaluation for the arterial impotence.

Blood Pressure↗
PubMed1986

[Dimensions, volume and rigidity of the penis. Fundamental elements in the study of the erection and its dysfunctions].

The length and the proximal and distal circumferences of the flaccid and erect penis were measured as part of the aetiological investigation of 62 impotent patients. These measurements, compared with the quantitative study of penile rigidity, demonstrate the lack of correlation between circumference changes and rigidity and constitute a simple method for the measurement of penile volume variations and, when compared with penile rigidity, provide important information concerning the physiology of erection and its dysfunction.

Erectile Dysfunction↗
PubMed1985

Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men.

The distribution of four main arterial risk factors (ARF) (diabetes, smoking, hyperlipidaemia (HLP), and hypertension) was investigated in 440 impotent men (mean age 46.8) in whom the penile blood-pressure index (PBPI) (ie, the ratio of the lowest systolic pressure in one of the four main arteries of the penis to the systolic pressure in the arm) was measured. In 222 the cause (organic or functional) of impotence was sought by further investigations, such as cavernosonography. 80% of this subgroup had organic impairment of erection. In 53% of these there was evidence of an arterial lesion. Smoking (64%), diabetes (30%), and HLP (34%) were all significantly more common in the 440 impotent men than in the general male population of a similar age. Whenever two or more ARFs were present mean PBPI was significantly lower. The frequency of organic impotence increased from 49% in the absence of any ARF to 100% in patients with 3 or 4 ARFs. It is concluded that increase in the frequency of impotence with age is mainly related to arteriosclerotic changes for the arteries of the penis and that the ARF and PBPI should be evaluated first in any patient complaining of impotence.

Adult↗