PubMed Health⌕ Search

Biomedical subjects

W Bähren

Publications and source records attributed to W Bähren.

At least 19 recordsLinked to original sources
PubMed1992

[Failed sclerotherapy trials with the V. spermatica interna. A retrospective analysis in 1141 patients with idiopathic varicocele].

From July 1988 until December 1990 1141 patients with left-sided idiopathic varicocele underwent phlebography of the spermatic internal vein, and percutaneous sclerotherapy with sodium morruate (Varicocid) was intended to be performed. In 125 of these patients sclerotherapy was not feasible. The reasons for this were analysed in a retrospective study. According to the anatomical situation of the spermatic vein, there were significant differences in technical success. In case of incompetent valve of the spermatic vein at the renal origin (type I, 2A, 3, 4A), selective probing and following sclerotherapy was possible in 97%. Anatomic variations with competent valve of the spermatic vein (type 0, 2B, 4B) led to difficulties in selectively probing the vessel, and sclerotherapy was feasible in only 72.7%. In these angiographically difficult cases, spasm of the spermatic vein and/or perforation prevented sclerotherapy in 29 of 125 patients.

Adolescent↗
PubMed1992

[Long-term results of corpus cavernosum auto-injection therapy in treatment of patients with chronic erectile dysfunction].

From May 1985 to July 1989, 143 patients suffering from chronic erectile dysfunction (21-70 years old) underwent constant corpus cavernosum auto-injection therapy (CCAT) with papaverine alone (1257 injections) or with a standardized papaverine-phentolamine mixture (11035 injections). On the basis of these 12,292 protocol auto-injections and over 4 years' experience with intracavernosal auto-injection therapy we conclude: CCAT, especially with the papaverine-phentolamine mixture, constitutes an effective therapy (full rigidity in 95.9%) with tolerable side-effects for chronic erectile dysfunction when preceded by careful patient selection and thorough multidisciplinary evaluation, especially in the case of arterial and/or neurogenic aetiology of the erectile dysfunction; in addition, the contraindications must be strictly observed, the treatment and technique fully explained, and a regular system instituted. CCAT is generally well accepted by the patients and their partners (100%/98.3%) and has distinct positive effects on self-esteem (77.8%), performance anxiety (84.4%) and partnership (79.5%). The most serious side-effect was prolonged erection (25 out of 12,292 injections). In 3 patients reversible fibrotic changes near the tunica albuginea were observed.

Dose-Response Relationship, Drug↗
PubMed1991

[Nitroglycerin test for the diagnosis of erectile dysfunction].

In 33 patients with erectile dysfunction arterial inflow was measured by Doppler-sonography over the superficial dorsal and deep cavernous arteries in the proximal section after local application of 1.6 mg glycerol trinitrate (nitroglycerin) to the glans penis. With this test we were able to reveal a minimal increases in maximal systolic flow over both arteries at 29/66 measurement sites. This is thus an easier way of localizing penile vessels in the flaccid state. In no case did we see tumescence or rigidity.

Administration, Topical↗
PubMed1990

Diagnosis of venous incompetence in erectile dysfunction. Comparative study of cavernosography and Doppler ultrasound.

In 26 of 214 patients with erectile dysfunction and proved venous incompetence by cavernosography, an additional bidirectional Doppler ultrasound was performed also to demonstrate venous outflow disturbances. All except one leakage in the superficial and deep dorsal veins could be demonstrated as well as 4 of 6 cavernosum-glandular shunts. Bidirectional Doppler ultrasound visualized a continuous retrograde blood flow from the sulcus coronarius to the root of the penis in superficial and deep dorsal penile veins as well as in ectopic penile veins, an orthograde blood flow in the sulcus coronarius in cavernosum-glandular shunt.

Erectile Dysfunction↗
PubMed1990

Erectile response to intracavernous injection of vasoactive drugs after penile prosthesis removal.

Two patients with a history of penile prosthesis removal presented for non-prosthetic treatment of their erectile dysfunction. The first patient had a penile implant for two years before it was removed and showed extensive cavernosal fibrosis. He did not respond to intracavernosal injection of vasoactive drugs. The second patient had the prosthesis for four weeks. He showed no evidence of cavernosal fibrosis and responded well to the intracavernous injection. He has been in an intracavernous autoinjection program for more than one year without complications.

Aged↗
PubMed1990

[Results of multidisciplinary assessment of patients with erectile dysfunction].

A total of 326 patients with chronic erectile dysfunction were investigated by a multidisciplinary approach. It was found that several causes combined (multifactorial genesis) in 77.1%. Organic causes alone were found quite frequently, viz. in 43.6%, while primarily psychogenic causes alone were found in only 5.5%; in contrast, combined organic and psychogenic causes were found in 46.0%. There were pathologic organic findings in 89.6%: vascular in 74.5% (arterial 64.1%, cavernous/venous 30.4%), neurogenic in 42.0%; side effects of drugs in (10.1%); endocrine (7.7%) and local penile causes (4.3%) are not so important in erectile dysfunction. Treatment suited to the pathogenesis was instituted (psychotherapy, vein ligation, self-injection of vasoactive drugs into the corpus cavernosum).

Adult↗
PubMed1989

Primary erectile dysfunction.

We evaluated 67 patients 18 to 60 years old (mean age 28.5 years) with primary erectile dysfunction (absence of full sustained erections since early childhood or puberty) using a multidisciplinary approach. Organic causes of the erectile dysfunction were found in 57 of the 67 patients (85 per cent): 12 (18 per cent) had neurological, 35 (52 per cent) arteriogenic and 35 (52 per cent) venogenic abnormalities. Psychogenic factors were diagnosed in 11 patients (16 per cent), while in 4 (6 per cent) a classification was not possible. Concomitant psychogenic abnormalities were found in 39 of the 57 patients (68 per cent) with organic primary erectile dysfunction. Our results suggest that primary erectile dysfunction is caused mainly by organic factors. However, for successful therapy the frequent secondary psychogenic abnormalities must be considered.

Adult↗
PubMed1989

Percutaneous sclerotherapy of idiopathic varicocele in childhood: a preliminary report.

Of 31 boys 10 to 16 years old referred for treatment of a left grade II or III varicocele 28 underwent percutaneous sclerotherapy. Due to anatomical and technical obstacles sclerotherapy was not possible in 3 boys. At follow-up 1 of 16 boys (6.2 per cent) had a mild recurrence detected by Doppler sonography of the spermatic cord. Percutaneous sclerotherapy had no serious side effects, and proved to be an efficient and convenient treatment of left varicocele in childhood.

Adolescent↗
PubMed1989

Effects of intracavernosal pharmacotherapy on self-esteem, performance anxiety and partnership in patients with chronic erectile dysfunction.

156 patients undergoing intracavernosal autoinjection pharmacotherapy for periods of 2-36 months were studied for the effect of treatment on self-esteem, performance anxiety, partnership and acceptance using a semi-structured questionnaire. Replies were received from 86.3% of the patients. 93% gave a very good, good or satisfactory rating of intracavernosal pharmacotherapy. 78.2% indicated that their self-esteem had grown. 79.4% said that performance anxiety diminished in the course of therapy (25.6%) or disappeared entirely (53.8%). 71.8% of the replies confirm the positive effect of treatment on marital relations or partnership. 61.9% of the patients used intracavernosal pharmacotherapy permanently. 28.3% needed therapy intermittently or at large intervals only, and 4.5% (7 patients) were cured of their chronic sexual dysfunction. When preceded by thorough multidisciplinary diagnostics and careful patient selection, intracavernosal pharmacotherapy constitutes an efficient mode of treatment for chronic erectile dysfunction.

Anxiety↗
PubMed1989

[Diagnostic value of sonography and double contrast arthrography in meniscus lesions].

Using a real time scanner and a 7.5 mHz transducer, the meniscus can bei visualised as a homogeneous triangle. It is clearly distinguishable from the tibial plane und the condyle of the femur. Tears in the meniscus show up as a double contour rich in echoes with an intervening low-echo area, or as a contour rich in echoes with an adjacent low-echo area. The posterior horn area can be visualised most clearly. Assessment of the interior part of the meniscus is somewhat easier than visualising the exterior part. In a clinical study with 107 menisci examined by sonography and controlled by arthroscopy or arthrotomy the rate of accurate diagnoses by sonography of the meniscus is 82%. 42 of these menisci were additionally examined by double contrast arthrography besides sonography. This yielded an accuracy rate of 74% for double contrast arthrography; the latter is superior to sonography only in the anterior horn area. Problems in respect of meniscus sonography occur only in case of transverse ruptures, scars and longitudinal meniscus ruptures presenting as bucket handle tears near the base. The typical longitudinal tear in the area of the posterior horn can be visualised most clearly. Analysis of the results shows that sonography of the meniscus is a noninvasive, painless and randomly reproducible and risk-free examination method which has a diagnostic value especially in the area of the posterior horn that can be compared with double contrast arthrography. Further studies must show whether with an increasing spread of the method it would be possible to replace double contrast arthrography by sonography in diagnosis of menisceal trouble.

Adult↗
PubMed1989

[Diagnosis of venous insufficiency in erectile dysfunction: comparative studies of cavernosonography and Doppler sonography].

In 26 out of 214 patients with erectile dysfunction and venous insufficiency proven by cavernosography, bidirectional Doppler ultrasound was also performed to demonstrate venous leakage in addition. Except for one, all 25 cases of leakage in the superficial and deep dorsal veins could be demonstrated, as could four of six cases of cavernosoglandular shunts. Using bidirectional Doppler ultrasound, it was possible to visualize a continuous orthograde blood flow from the sulcus coronarius to the root of the penis in superficial and deep dorsal penile veins, as well as in ectopic penile veins, and a retrograde blood flow in the sulcus coronarius in cavernosoglandular shunts.

Blood Flow Velocity↗
PubMed1989

Hemodynamics of varicoceles: venous shunting in grade II and III varicoceles.

In 42 consecutive patients with moderate (grade II) or large (grade III) left-sided idiopathic varicoceles, which were referred for percutaneous sclerotherapy, not only the reflux in the testicular vein but the venous drainage as well was studied by venography. As suggested by bidirectional Doppler sonography the reflux in the testicular vein is always associated with an upward (in physiologic direction) flow in these varicoceles. The draining veins are shown to be the deferential, cremasteric, external pudendal, or any combination of these. Thus, the grade II and III varicoceles are termed shunt-type varicoceles.

Collateral Circulation↗
PubMed1988

Arterial anatomy and arteriographic diagnosis of arteriogenic impotence.

One hundred twenty-six bilateral selective arteriographic examinations of the iliopudendal vascular tree were performed after comprehensive multidisciplinary evaluation in patients with chronic erectile dysfunction. Best imaging results were obtained by performing the arteriography under epidural anesthesia after intracavernous injection of a vasoactive drug combination. The arteriography is mandatory prior to revascularization procedures. It is further indicated in primary erectile dysfunction and posttraumatic erectile failure. The importance of cavernosography and selective arteriography in primary erectile dysfunction is stressed. Increasing knowledge about the influence of vasoactive drugs on penile hemodynamics has led to its application in diagnosis and therapy of erectile dysfunction. Pharmacocavernosography, Doppler-ultrasound of penile arteries after intracavernous injection of a vasoactive drug combination, and pharmacoarteriography are refined techniques to prove a vascular etiology of erectile dysfunction. The results of the morphologic studies of the vascular system are correlated with functional testing of erectile capacity by intracavernous application of a papaverine-phentolamine drug combination.

Adult↗
PubMed1988

Diagnostic accuracy of Doppler ultrasound technique of the penile arteries in correlation to selective arteriography.

In 63% of 265 patients with erectile dysfunction a relevant arterial inflow disturbance was found by Doppler ultrasound examination. Correlation between Doppler and arteriography in 58 patients showed an accuracy of 95% in detecting penile arteries and an accuracy of 91% in discovering a pathological arterial pattern (arterial anomaly or arteriosclerotic obstruction). In 15 patients the arterial inflow was measured additionally by Doppler ultrasound technique after intracavernosal injection of vasoactive drugs (IIVD) (7.5 mg papaverine and 0.25 mg phentolamine). This technique proved to be more reliable than in the flaccid state and markedly facilitated localization and assessment of pathological changes of the cavernosal arteries.

Angiography↗
PubMed1988

Erectile dysfunction due to ectopic penile vein.

A total of 86/260 patients with erectile dysfunction had venous leakage as (joint) etiology. In 5 of 86 patients cavernosography showed pathologic cavernosal drainage only via an ectopic penile vein into the femoral vein. After ligation of this pathologic draining vessel, 4 of 5 patients regained spontaneous erectability. One patient with pathologic bulbocavernosus reflex latencies needed intracavernosal injection of vasoactive drugs for full rigidity.

Adult↗
PubMed1988

Mid-term results of autoinjection therapy for erectile dysfunction.

Of over 300 patients with erectile dysfunction, 186 were selected for intracavernosal autoinjection therapy with a standardized papaverine-phentolamine mixture. A total of 156 patients performed 4,813 protocol autoinjections with a minimum of 10 and a maximum of 230 per patient. The dose that induced a full erection at the hospital could be reduced under home conditions by a mean of 35 per cent. Systemic side effects were not observed. The most inconvenient local side effects were prolonged erections in 24 patients in diagnostic use and in 3 patients in therapeutic use. There were treated easily without further consequences.

Dose-Response Relationship, Drug↗