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PubMedDate not supplied

Impotence.

The National Institutes of Health Consensus Development Conference on Impotence was convened to address (1) the prevalence and clinical, psychological, and social impact of erectile dysfunction; (2) the risk factors for erectile dysfunction and how they might be used in preventing its development; (3) the need for and appropriate diagnostic assessment and evaluation of patients with erectile dysfunction; (4) the efficacies and risks of behavioral, pharmacological, surgical, and other treatments for erectile dysfunction; (5) strategies for improving public and professional awareness and knowledge of erectile dysfunction; and (6) future directions for research in prevention, diagnosis, and management of erectile dysfunction. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) the term "erectile dysfunction" should replace the term "impotence"; (2) the likelihood of erectile dysfunction increases with age but is not an inevitable consequence of aging; (3) embarrassment of patients and reluctance of both patients and health care providers to discuss sexual matters candidly contribute to underdiagnosis of erectile dysfunction; (4) many cases of erectile dysfunction can be successfully managed with appropriately selected therapy; (5) the diagnosis and treatment of erectile dysfunction must be specific and responsive to the individual patient's needs and that compliance as well as the desires and expectations of both the patient and partner are important considerations in selecting appropriate therapy; (6) education of health care providers and the public on aspects of human sexuality, sexual dysfunction, and availability of successful treatments is essential; and (7) erectile dysfunction is an important public health problem deserving of increased support for basic science investigation and applied research.

Erectile Dysfunction↗

PubMed1978

Preservation of erectile function after aortoiliac reconstruction.

Men with aortoiliac atherosclerosis exhibit organic erectile dysfunction caused by inadequate blood flow and/or psychological factors. After aortoiliac reconstruction, organic erectile dysfunction may be due primarily to surgical interruption of autonomic nerve fibers. To avoid this, dissection principles preserving genital autonomic plexi were developed. The results of these dissections were compared with those of conventional bypasses. Thirty nondiabetic men (age range, 43 to 67 years) were studied. A history of erectile capacity was elicited preoperatively and evaluated postoperatively in follow-up interviews every six months. Normal postoperative erectile function was not affected by nerve-sparing dissections. Each of the 11 patients requiring conventional dissections was both preoperatively and postoperatively impotent. Four of the 19 patients who underwent nerve-sparing dissection were preoperatively and postoperatively impotent. Seven of these 19 patients maintained preoperative potency after nerve-sparing dissection. The potency of the remaining eight patients was either completely restored or improved after nerve-sparing dissection. This report emphasizes the importantance of a preoperative determination of a complex interplay of physical and psychological factors in erectile dysfunction.

Adult↗

PubMed1992

[Test with vasoactive drugs: its predictive value in the diagnosis of erectile sexual dysfunction of venous origin].

The practicability and sensitivity of the test with vasoactive drugs, the first method performed in our flow studies, make it an invaluable method for orienting the diagnosis. Our findings show that in 65% of the patients with a partial response to the drug-induced erectile test, dysfunction may arise from pure or associated venous leakage, which must be confirmed by dynamic cavernosometry and/or cavernosography.

Adult↗

PubMedDate not supplied

[Clinical and instrumental evaluation of erectile impotence: a proposal of a diagnostic protocol].

There has been increasing interest in recent years in patients complaining of erectile dysfunction. This has prompted research and the development of diagnostic procedures aimed at allowing increasingly rapid characterization of the type of impotence involved (psychogenic or organic) and thus the most effective treatment. In this preliminary study, we present our study methodology in patients with erectile dysfunction, emphasising in particular the diagnostic procedures best suited to revealing the presence of an organic cause in the pathogenesis of impotence.

Erectile Dysfunction↗

PubMed1992

Pudendal nerve palsy complicating intramedullary nailing of the femur.

A prospective study of 106 patients who had static interlocking nailing of the shaft of the femur was performed to determine the relationship between the duration and magnitude of intraoperative traction and the development of a pudendal nerve palsy. A strain-gauge, mounted in the countertraction post, measured the magnitude of the perineal pressure over time. All nailings were performed with the patient in the supine position. Postoperatively, the patients were interviewed by one of us, who had been blinded from the results of the recordings of intraoperative pressure, for a history of erectile dysfunction and changes in labial, scrotal, or penile sensation. A light-touch sensory examination of the genitalia was performed on all patients. Ten patients (six men and four women) had a pudendal nerve palsy: nine had sensory changes only, and one complained of erectile dysfunction. The symptoms had resolved at the three-month follow-up evaluation in all patients except one man who complained of dysesthesia six months postoperatively. The patients in whom a palsy did not develop had been positioned on the fracture-table and the perineal post for an average of 2.6 hours (range, 1.4 to 5.2 hours) compared with an average of 2.8 hours (range, 2.0 to 4.3 hours) for those in whom a palsy did not develop (p = 0.15). The magnitude of the total traction forces averaged 34.9 kilogram-hours for the patients who did not have a palsy compared with 73.3 kilogram-hours for those who did (p < 0.03). Adduction of the hip, as well as manipulations for reduction of the fracture, significantly increased the traction forces.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed2025

Mendelian randomization reveals causal relationships between cytokines and male reproductive diseases.

This study aims to explore the causal links between cytokines and four male reproductive disorders, namely abnormal spermatozoa (AS), male infertility, erectile dysfunction (ED), and hyperplasia of prostate (HP), employing a two-sample Mendelian randomization (MR) approach. Genetic associations with male reproductive diseases were derived from the IEU OpenGWAS project, with cytokine data from two GWASs focused on the human proteome and cytokines. Estimations were derived using inverse variance weighting, MR-Egger regression, weighted median, weighted model, and simple mode. Furthermore, the robustness of the findings was evaluated through Cochran's Q-test, MR-Egger regression, and leave-one-out sensitivity analysis. Fifteen unique cytokines were identified as having causal relationships with the risk of four male reproductive disorders. Specifically, for AS, interleukin-22 (IL-22), IL-12, and macrophage migration inhibitory factor were negatively correlated with AS, while tumor necrosis factor β levels were positively correlated with AS. In the context of male infertility, IL-2 receptor antagonist levels, IL-34, and granulocyte-colony stimulating factor levels were positively linked to male infertility, whereas IL-21 showed a negative relationship. Regarding ED, IL-19, IL-1β, and eotaxin levels were negatively associated with ED risk, while macrophage inflammatory protein 1β (MIP-1β) levels and interferon gamma-induced protein 10 levels were positively associated. As for HP, stromal-cell-derived factor 1α levels and MIP-1α levels revealed negative associations with HP. In conclusion, this MR analysis revealed that several cytokines were causally associated with male reproductive diseases and could be valuable in offering new insights for further mechanistic and clinical investigations of cytokines-associated male reproductive diseases.

Male↗

PubMed1992

Comparative value of prostaglandin E1 and papaverine in treatment of erectile failure: double-blind crossover study among Egyptian patients.

In a double-blind, crossover designation penile intracavernous prostaglandin E1 and papaverine hydrochloride were compared in regard to effectiveness and safety in 52 patients investigated and treated for sexual erectile dysfunction. In evidence of the reliable effectiveness, prostaglandin E1 (20 micrograms/ml.) induced significant positive erectile response in 42 of 52 patients (81%). This rate reached 100% with neurogenic, hyperprolactinemic and/or psychogenic impotence. However, with papaverine hydrochloride (30 mg./ml.) and exclusively in cases of vasculogenic (most probably arteriogenic) impotence, negative erectile response was revealed as absent erection in 6 of 52 patients (11.5%) and nonrigid tumescence in 13 (25%) versus 2 (3.8%) and 8 (15.4%), respectively, with prostaglandin E1. Moreover, with prostaglandin E1 the regional pain was tolerable and transient, and the positive erectile response was not attended by priapism even in patients who formerly had priapism with papaverine hydrochloride. However, presently with prostaglandin E1 the relatively higher cost and shorter expiration period would probably limit its diagnostic and therapeutic use in Egypt, and probably in other developing countries.

Alprostadil↗

PubMed1992

Impotence in the elderly. Evaluation of erectile failure in men older than seventy years of age. Jefferson Sexual Function Center.

A total of 102 patients over seventy years of age were evaluated in a multidisciplinary center for erectile dysfunction. The primary diagnosis was organic in 80 percent, but there were multiple associated factors. Erectile failure had persisted more than twenty-four months in 84 percent and the last successful intercourse was over one year prior to evaluation in 68 percent. There appears to be distinct differences in the pattern and etiology of erectile failure in elderly patients.

Aged↗

PubMedDate not supplied

Surgical treatment of veno-occlusive dysfunction: evaluation of short-term and long-term results.

The abnormal venous drainage of the penis is an important cause of erectile dysfunction. Until recently the best choice for treatment was the venous surgery. We studied 21 patients submitted to radical vein ligation due to venous leakage. Their age ranged from 27 to 69 years (mean 53 years). A total of 14 patients evaluated after a mean follow-up of 13 months showed a 64% success rate. At a mean follow-up of 25 months the success rate of the 21 patients operated on, decreased to 38%. Therefore, we concluded that in a long-term follow-up the results are not quite satisfactory, which brings us much concern about the efficacy of the operation.

Adult↗

PubMed1979

Impotence, smoking, and beta-blocking drugs.

Four patients complaining of erectile dysfunction and using tobacco or propranolol were examined with penile blood pressure measurements and Doppler recordings, calculating the penile acceleration ratio (PAR). After a change in regimen, erectile capacity was restored, PAR returned to normal, and blood pressure measurements revealed increased systolic penile blood pressure in three patients. The changes, especially in PAR, indicate a marked penile vascular reaction during smoking and beta-blocking treatment in these men.

Adult↗

PubMed1992

[The prognosis of the efficacy of revascularization of the penile corpora cavernosa in the surgical treatment of Leriche's syndrome].

The authors have developed a procedure for predicting the efficiency of penal spongy body revascularization in surgical management. Thirteen qualitative parameters, such as duration of sexual dysfunction, libido, having a sexual intercourse partner, degree of intermittent claudication, duration of lower extremity diseases, penal erection angle after drug test and ultrasound Doppler echography with drug test, were evaluated in 36 patients with Leriche's syndrome and erectile dysfunction. The qualitative parameters obtained were converted to quantitative discrete characteristics. The set of characteristics was used to predict the postoperative parameter--the value characterizing the sexual function by using the well-known methods of regression analysis on a PS/XI personal computer by the multiple regression programme in the Statgraphics program package. The high accuracy of prediction of the value characterizing the sexual function by this method makes it possible to substantiate the expediency of penal spongy body revascularization and opens up new ways for improving its outcomes.

Adult↗

PubMed1992

[Neuro-urology--development of a new focus in rehabilitation of the spinal cord injured patient].

While preservation of renal function continues to be the primary objective in the urological care of spinal cord injured patients, new treatment principles have resulted in increased attention being given also to restoration of lost urinary continence, a goal shared by the patient as well. The fact that intermittent catheterization has stood the test also for the long-term management of micturition, as well as the development of effective medication for hyperreflective detrusor relaxation have resulted in a treatment concept that enables 70 percent of those treated to achieve dry intervals between catheterizations. Effective electromiction is today enabled by the sacral anterior root stimulator (Brindley), with continence ensured by sacral deafferentation performed at the same time; both measures have proved successful at medium term. Bladder augmentation is another operative measure for controlling detrusor hyperreflexia. Neurogenic urinary stress incontinence can be tackled successfully by implanting an hydraulic sphincter system (Scott). Both the advantages and the possible disadvantages or risks of these new management concepts are set out, dealing also with their indications. Successful treatment of erectile dysfunction is possible today, and inseminable sperma can be obtained in some 40 to 50 percent of the spinal cord injured patients.

Combined Modality Therapy↗

PubMed1992

[Duplex scanner in the diagnosis of vasculogenic impotence].

This paper is reporting the experience of the Authors in the use of Duplex-scanner and eco-color-doppler in the diagnosis of the erectile dysfunctions and particularly in the importance of vascular (arterious and venous) origin. For this purpose, we selected a sample constituted of 41 patients: 22 with psychogenic, 8 with arterial, 5 with venous impotence, 5 patients with Peyronie's disease and 1 patient with posttraumatic arterio-venous fistula. The Authors, while underlining the remarkable accuracy and diagnostic reliability of eco-doppler, emphasize the indication of the method up to consider it "investigation of prime choice", not only in the patients with the dysfunction of vis erigendi but, in the cases in which a morphological evaluation, besides hemodynamical one, become necessary.

Adult↗

PubMed1992

Preliminary report: penile vein occlusion therapy: selection criteria and methods used for the transcatheter treatment of impotence caused by venous-sinusoidal incompetence.

Penile vein occlusion therapy is a fluoroscopic guided technique developed for treating venous-sinusoidal incompetence in patients with erectile dysfunction. We report our experience with 22 patients who have been followed for greater than 1 year. Catheterization of the veins draining the penis was technically possible in 20 of 22 patients (91%). Of these 20 patients 5 (25%) were cured and 9 (45%) had significantly improved erectile function. All 5 patients (100%) with venous-sinusoidal incompetence plus normal cavernous arterial flow, no glans or corpus spongiosal shunts, and bilateral complete coil occlusion of the crural and common crural veins were cured. No deterioration of function was noted at 1 and 2 years. Patient selection and bilateral occlusion of the penile veins are essential to achieve successful penile vein occlusion therapy.

Adult↗

PubMed1992

Human penile hemodynamics by Xenon-133 clearance method in physiological erection.

We measured penile blood flow during physiological erection using the Xenon-133 clearance method in order to diagnose the exact cause of impotence. In 16 patients, in whom complete erection was obtained after visual sexual stimulation, the mean penile blood flow during erection was apparently higher than that in the flaccid state. On the contrary, in 6 patients whose reaction to visual stimulation was poor, penile blood flow did not change before and after stimulation. We considered that increased arterial flow was indispensable, but complete venous outlet obstruction was not necessary to produce a rigid erection. In addition, in the flaccid state the mean penile blood flow in the poor response group was apparently higher than that in the response group. This means that some patients who fail to obtain sufficient erection after visual sexual stimulation have increased venous outflow from the corpus cavernosum in the flaccid state. Based on these findings, the main cause of erectile dysfunction in such cases is probably attributed to disorders of the venous outlet system in the cavernous body.

Adult↗

PubMedDate not supplied

[Percutaneous use of vasoactive drugs in the diagnosis and treatment of erectile impotence].

The Authors report their experience of topical and intracavernous treatment with papaverine and phentolamine in patients with erectile dysfunction from May 1988 to March 1992. Topical application of drug cream proves efficacious both alone or combined with intracavernous injection with PGE1. Topical treatment besides may be carried out without systemic or local complications.

Administration, Cutaneous↗

PubMed1992

[Impotence of vascular origin. Techniques of exploration and therapeutic orientations].

Vascular problems of arterial and/or venous origin are often found as the cause of erectile dysfunction. Clinical examination alone is insufficient and must followed up by a number of non or minimally invasive tests in order to confirm the etiology. Such testing should include: Doppler measurements or, better, duplex sonography, nocturnal penile plethysmography, psychological status, clinical biochemistry and intracavernous injection of vasoactive drugs. Occasionally, it may be necessary to complete these tests by more invasive examinations: pharmacoarteriography and/or pharmacocavernosography. Several novel therapeutic approaches have been developed in recent years and have given rise to encouraging improvements.

Adult↗

PubMed1992

Significance of cavernosography in standardized cavernosometry.

Ninety-five patients with erectile dysfunction underwent standardized cavernosometry and cavernosography. In a first stage, the investigation was performed in each patient without and in a second stage with 60 mg papaverine injected intracavernously. A pathological maintenance flow rate between 20 and 120 ml/min decreased by 55% on average. The induction flow is of considerable variability and of poor diagnostic value. For quantification of venous leakage, the maintenance flow rate is of great importance and in correlation with the time of pressure decrease. Our results with a sensitivity of 59% suggest that cavernosography as the only screening method for venous leakage is not sufficient. In most of the cases, cavernosography is indicated only in consideration of venous leakage surgery.

Blood Flow Velocity↗