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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↗

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↗

PubMed1990

Corpora cavernosa ultrastructure in vascular erectile dysfunction.

Open biopsy of the corpus cavernosum was performed in 13 nondiabetic patients with erectile dysfunction. The history and physical examination, sleep rigidity and tumescence monitoring, hormonal assays, duplex ultrasonography with papaverine, and cavernosometry and cavernosography, formed the basis of categorizing each patient into 1 of 5 etiological groups. These groups included neurogenic, moderate arterial, severe arterial, venous and fibrotic causes for organic erectile dysfunction. The cavernous smooth muscle and endothelium in each patient appeared to be normal on light and electron microscopy. We conclude that cavernous biopsy is of limited value to determine therapeutic options in patients with erectile dysfunction.

Biopsy↗

PubMedDate not supplied

Long-term results of corpus cavernosum autoinjection therapy for chronic erectile dysfunction.

Between May 1985 and March 1992, 172 patients suffering from chronic erectile dysfunction (21-70 years old) underwent constant corpus cavernosum autoinjection therapy (CAT) with a standardized papaverine phentolamine mixture (16385 injections). Thereafter 41 patients continued CAT with the single agent papaverine (1257 injections). On the basis of both these 17642 protocol auto-injections, and over 6 years of experience with intracavernosal autoinjection therapy we conclude that, especially with the papaverine-phentolamine mixture, CAT constitutes an effective therapy (full rigidity in 95.8%) with tolerable side-effects for chronic erectile dysfunction when preceded by careful patient selection and thorough multi-disciplinary evaluation. This is especially so 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 follow-up instituted. CAT is generally well accepted by the patients and their partners (98.8%/97.6%) 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 17642 injections). In 6 patients reversible fibrotic changes near the tunica albuginea were observed.

Adult↗

PubMed1986

Erectile dysfunction in narcoleptic patients.

Many male narcoleptic patients complain of erectile dysfunction related to chemotherapy, and some find it so distressing that they fail to continue treatments. This is a potentially dangerous situation. We studied the erectile capabilities of 28 narcoleptic men who had complaints of erectile dysfunction with our objective sleep laboratory measurement of nocturnal penile tumescence (NPT) for diagnostic workup. We found that while short REM latency, a classic indicator of narcolepsy, was present in all patients, NPT, which is associated with REM sleep, did not coincide with the short REM latencies in about half the patients. This may be partially due to the fact that first-cycle REM is often not accompanied by NPT episodes (even in the control population). We also found that, in a few cases, the patients' subjective beliefs about their erectile capacity tended to underestimate our measurements. The patients receiving drug treatment already had some vasculogenic or neurogenic genital impairment, which probably made them more vulnerable to the effects of the drugs. Patients who had none of these complications showed similar erectile impairment under the influence of medication. Additionally, we found unique manifestations of the disease in three drug-free patients; one had cataplectic attacks upon arousal, and two had unexplained erectile impairment.

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↗

PubMed1992

Noninvasive treatment for erectile dysfunction in the neurogenically disabled population.

Erectile dysfunction is the most prevalent sexual dysfunction in neurogenically disabled men. Studies of rehabilitation patients indicate that the restoration of sexual functioning is considered an important priority. This article reports on a pilot study of vacuum tumescence constriction therapy as a noninvasive method for use by a population with traumatic or nontraumatic neurologic disorders such as spinal cord injury, stroke, multiple sclerosis, and diabetes mellitus. Of the 30 patients who participated in the study, 17 purchased the device and over 50% of them reported using the device on a long-term basis. Frequency of coitus increased from 0.3/wk to 1.5/wk. Included in the study are methods used by patients to integrate the device into their sex life, the role of the patient's partner in the decision to purchase the device, and the rate of partner satisfaction. There were no reports of substantial morbidity. Thus, this method shows promise as a noninvasive treatment for men who are moderately to severely neurogenically disabled.

Equipment and Supplies↗

PubMed1990

[Erectile dysfunction of male spinal cord injury patients].

Different problems regarding erectile dysfunction in men with spinal cord-injury are outlined. Neuroanatomical and neurophysiological aspects of erection and ejaculation are outlined and brought into relation with the different clinical pictures of such lesions. Different therapeutical possibilities are presented, particularly the new treatments like intracavernous papaverine (autoinjection), prostaglandin E1 and transcutaneous nitroglycerin; action, advantages and indications are discussed. The experience in ten para- or tetraplegic patients are discussed. It seems that even in spite of the higher price of PGE1 this treatment of the erectile dysfunction in spinal cord-injured men should be preferred, since it shows more advantages and less complications than other treatments.

Adult↗

PubMed1992

Radiologic methods used in the diagnostics of vasculogenic erectile dysfunction.

Contemporary methods of assessing erectile dysfunction include instrumental registration of nocturnal penile erections, the penile brachial index, Doppler sonography, use of vasoactive substances and various contrast radiologic methods along with studies of the hormonal profile, the neurologic status, examination of prostate excrements, etc. These methods are still not widely used in Bulgaria although their scope of application is quite well known. We report here our own experience in using the contrast radiologic methods for studying this pathological condition, in particular, the technique of digital subtraction pharmacocavernosography with cavernosometry introduced by us and used for this purpose. In some of the cases we used it in combination with digital subtraction angiography of pelvic arteries. Using these methods we can detect not only morphological but also functional disorders. On the basis of the data obtained we determine the particular therapeutic approach, specify the nature of the disorder and the effect of eventual surgical intervention.

Adult↗

PubMed1990

A critical reevaluation of nocturnal penile tumescence monitoring in the diagnosis of erectile dysfunction.

The use of nocturnal penile tumescence (NPT) monitoring for the differential diagnosis of erectile dysfunction has burgeoned during the last decade. This article reviews the history, development, and attempts at validation of NPT for diagnostic purposes. Problems associated with NPT are discussed, including the potential effects of unrecorded concomitant sleep parameters and variability in data scoring and diagnostic criteria. In addition, less expensive and more convenient methods of NPT monitoring are reviewed, and their strengths and weaknesses are discussed. Finally, theoretical problems related to the use of NPT for differential diagnosis of organic and psychogenic erectile dysfunctions are presented. In light of the problems associated with NPT monitoring, exclusive reliance on this technique for diagnostic purposes is discouraged. Instead, a biopsychosocial approach to the understanding and assessment of erectile dysfunction is advocated.

Ambulatory Care↗

PubMed1987

[Dynamic cavernosonography and intracavernous drug testing in the diagnosis of erectile dysfunction].

Based on 216 dynamic cavernosographies, performed in 25 patients with normal erectile capacity and in 191 patients with erectile dysfunction, an evaluation of this method in regard to its diagnostic validity in erectile dysfunction was possible. An additional comparison of the results of intracavernous application of vasoactive drugs with the outcome of dynamic cavernosography in 141 patients showed that a negative or clearly positive test-outcome indicated in over 90 per cent of the evaluated patients the presence or lack of venous insufficiency during dynamic cavernosography.

Adolescent↗

PubMed1988

Self-monitoring and self-focus in erectile dysfunction.

Self-focused attention can cause anxiety and poor performance in those with low self-efficacy expectations. Self-monitoring is frequently used in sex therapy assessment. If self-monitoring is conceptualized as a self-focusing manipulation, it would be expected to cause "spectatoring," anxiety and deterioration in individuals with erectile dysfunction. Therefore, this investigation explored the relationship between the dispositional tendency to focus attention on the self (self-consciousness) and sexual behavior in males with erectile dysfunction, and evaluated the effects of self-monitoring on erectile dysfunctional males who differed in dispositional self-consciousness. Results indicate that (a) individuals with erectile dysfunction were less dispositionally self-conscious than nondysfunctional individuals, (b) self-monitoring had no adverse effects on any aspect of sexuality investigated, and (c) manipulated and dispositional self-focus had no interactive effects. Implications of these results for sex therapy and for a better understanding of etiological and maintaining factors in sexual dysfunction are discussed.

Adaptation, Psychological↗

PubMed1992

Erectile dysfunction due to atherosclerotic vascular disease: the development of an animal model.

An animal model was developed to study the pathophysiology of erectile dysfunction due to atherosclerotic vascular disease. Thirty one New Zealand white male rabbits were divided into control (n = 5) and treatment groups (n = 26). The control group was placed on a regular diet while the treatment group underwent balloon de-endothelialization of the aorto-iliac arteries and received 1.6% cholesterol and 4% triglyceride diet for eight weeks. After eight weeks in the control animals (n = 5), blood levels of cholesterol, triglycerides and low density lipoproteins, radiologic studies as well as hemodynamic parameters of erectile function were all normal. In the surviving treatment animals (n = 21) after the same time period, a significant increase in blood levels of cholesterol, triglyceride and low density lipoprotein were observed. In addition, 62% of these animals developed hypertension which was not observed in the control group. Angiographically, 10 animals (48%) demonstrated severe atherosclerotic lesions (75% to 100% occlusion of common or internal iliac arteries on one side and over 50% occlusion of the opposite side), five (24%) had moderate lesions (50 to 75% luminal occlusion of right and left common iliac or internal iliac arteries) and 6 revealed minimal lesions (less than 50% occlusion of the right and left common iliac or internal iliac arteries). Of the 15 animals with 50% or greater luminal occlusion of the iliohypogastric arteries, erectile dysfunction was found in 93% of cases. Due to the development of erectile dysfunction in 33% of animals with minimal occlusive lesions, it appears that factors, other than large vessel luminal occlusion, may exist in this animal model which adversely influence erectile function. This model may therefore be of further benefit in the study of other factors associated with atherosclerosis and impotence, such as the possible concomitant hypercholesterolemic and atherosclerotic-induced alterations in the local reactivity of corpus cavernosum smooth muscle and lacunar space endothelial cells.

Animals↗

PubMed1985

Erectile dysfunction in diabetes and hypertension.

By direct interrogation and specific questions, the erectile function of 1,128 male adults, aged sixteen to eighty years and over, was elicited. The erectile function was based on ability to develop an erectile angle of 90 degrees and more, and this was used for classification purposes. Three hundred seventeen consecutive, unselected male diabetics and 117 nondiabetic male hypertensives were compared with 635 consecutive adult males with neither diabetes nor hypertension. Our results indicate that erectile dysfunction, partial or complete, is more prevalent in diabetics compared with nondiabetics of the same age groups. An unexpected finding was a meager relationship between hypertension and erectile disability. Antihypertensive drugs were responsible for only 2 cases of erectile dysfunction in our male hypertensive patients. The negative impact of age was noted in all age groups and in those with or without diabetes or hypertension.

Adolescent↗

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↗

PubMed1988

Hypothalamic-hypophyseal-testicular abnormalities and erectile dysfunction.

Forty-five men presenting with erectile dysfunction were evaluated through history and nocturnal penile tumescence, Doppler, and EMG studies. Fifteen were classified as having organic and 30 as having psychogenic impotence. Three men had mild hypergonadotropism with low testosterone levels. One had hyperprolactinemia. No case of hypogonadotropic hypogonadism was detected. Six patients who had psychogenic impotence had low levels of testosterone.

Adolescent↗

PubMed1988

Erectile dysfunction and premature ejaculation.

In parallel with the increased recognition of organic causes of erectile dysfunction, several new physical methods of treatment have been developed for this problem. These include intracavernosal injections of vasodilators, penile prostheses, vascular surgery, vacuum condoms, and medication. However, psychological treatment approaches are still of considerable importance in the treatment of both erectile dysfunction and premature ejaculation.

Ejaculation↗

PubMed1992

Intracavernous self-injection therapy for the treatment of erectile dysfunction.

Fifty-one patients with chronic erectile dysfunction were selected for this study involving intracavernous self-injection therapy with papaverine or prostaglandin E1 (PGE1). Patients were screened and grouped as follows: pronounced vasculogenic, mild vasculogenic, venous leakage, neurogenic and psychogenic impotence. The duration of follow-up in these 51 patients was from 1.5-30.5 months (average, 11.8 months). The average effective dosage of papaverine and PGE1 was variable among the different groups. This kind of therapy proved to be effective in our preliminary results, which showed that 35 patients (68.6%) were found to be good responders and eight patients (15.7%) were temporary responders. In our detailed questionnaire, answered by all 51 patients, we found 29 patients (56.9%) had increased their frequency of sexual activity, 38 patients (74.5%) had sustained their erection more than they ever had before, and 43 patients (84.3%) had enjoyed sexual orgasm following this pharmacologically assisted erection. Compared with papaverine, PGE1 was found to have fewer complications. None of the patients complained of any discomfort after long-term, self-injection with PGE1. However, two patients (3.9%) had sustained erections and two patients (3.9%) developed palpable fibrotic plaque after papaverine injection in our study.

Adult↗