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At least 685 records · Page 38Linked to original sources

PubMed2005

[1H-MRS of the hippocampus of psychogenic erectile dysfunction].

OBJECTIVE: To study the changes of the hippocampus metabolites with MRS to provide some clues for exploring the possible underlying unrecognised factors and pathophysiological mechanisms of psychogenic erectile dysfunction (ED). METHODS: Fifteen cases of psychogenic erectile dysfunction and 15 normal volunteers (the control) were studied by a clinical 1. 5T MRI/MRS system. Proton multi-voxel spectroscopy imaging (1H-MRSI) was obtained from both sides of the hippocampus region. N-acetylaspartate (NAA), creatine and phosphocreatine (Cr) and choline-containing compounds (Cho) were determined and the ratios of NAA/Cr and Cho/Cr were calculated respectively. RESULTS: The NAA/Cr ratio was significantly lower in the ED patients than in the control (P < 0.05). There was no significant difference in the Cho/Cr ratio between the two groups (P > 0.05). CONCLUSION: Psychogenic erectile dysfunction may not be simply a functional disease. The hippocampus may be involved in the pathophysiology of psychogenic ED. The disease may have some previously unrecognised underlying aetiological factors and pathophysiological mechanisms.

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↗

PubMedDate not supplied

[Our clinical experience with the use of ++sildenafil citrate to treat erectile dysfunction].

OBJECTIVE: To evaluate the response and adverse effects to treatment with Sildenefil in those patients with an erectile dysfunction who, according to our protocol, were considered as candidates for this therapeutic option. MATERIALS AND METHODS: We reviewed the clinical histories of 180 patients seen in our service from november 1988 to February 1999 as a result of an erectile dysfunction. Those patients in whom the use of Sildenefil was not contraindicated were prescribed this product at does of 50 mg. The response to treatment was subjectively evaluated based on the option of the patient when comparing his quality of life before and after treatment. RESULTS: Out of 180 patients, 144 started treatment as indicated. Of these, 67% expressed a positive response, while 33% did not respond to treatment. Adverse effects were notice by 26% of patients, but in 97% of them they were not severe enough to withdraw the medication. CONCLUSIONS: Two-thirds of 144 patients with erectile dysfunctions of heterogeneous origin responded positively to treatment with Sildenefil. One fourth of them reported some ort of adverse effect, but almost none of them stopped the medication for this reason.

Adult↗

PubMed2002

Colour duplex Doppler ultrasonography evaluation of non-vasculogenic male erectile dysfunction: An Indian perspective.

We present the study of colour duplex Doppler ultrasonography on Indian patients with non-vasculogenic erectile dysfunction. Patients with a history suggestive of psychogenic impotence along with a normal clinical response to intracavernosal papaverine were presumed to have non-vasculogenic erectile dysfunction. In our patients, the incidence of psychogenic impotence was much higher and the mean age of patients presenting with erectile dysfunction was lower as compared to patients from developed countries reported in research. The Doppler flowmetry showed much higher mean peak systolic velocities (PSVs) with a negative correlation between age and PSV. End diastolic velocity, resistive index and acceleration time values conformed to the literature.

Adolescent↗

PubMedDate not supplied

[Cavernous vegetative innervation and hemodynamics in patients with fibroplastic induration of the penis and erectile dysfunction].

Different versions on pathogenesis of Peirony's disease (PD) and erectile dysfunction in this disease made us to investigate cavernous innervation and hemodynamics in patients with fibroplastic induration of the penis. We have detected characteristic changes of cavernous electric activity and histochemical picture in biopsies of all our patients with PD. Of them, 61% had cavernous hemodynamic disorders. Our findings suggest that early affection of cavernous innervation may trigger PD pathogenesis and erectile dysfunction in this disease.

Autonomic Nervous System↗

PubMed2003

Treatment responsiveness of the Self-Esteem And Relationship questionnaire in erectile dysfunction.

OBJECTIVES: To determine the treatment responsiveness of the disease-specific Self-Esteem And Relationship (SEAR) questionnaire in erectile dysfunction. METHODS: The SEAR questionnaire was administered at baseline and at the end of the study in 93 patients with erectile dysfunction enrolled in a 10-week, open-label, flexible-dose (50-mg sildenafil, adjustable to 25 mg or 100 mg) trial. Changes from the baseline score were analyzed using the paired t test. The correlation between the changes from baseline on the SEAR questionnaire and the Erectile Function domain of the International Index of Erectile Function was examined. RESULTS: Significant and meaningful differences (P = 0.0001) from baseline were observed in the two primary domains (Sexual Relationship and Confidence) and the two Confidence domain subscales (Self-Esteem and Overall Relationship). The magnitude of the change was quite high for most aspects (Sexual Relationship, effect size [ES] = 1.6; Confidence, ES = 1.0; Self-Esteem, ES = 1.1) and moderate for one (Overall Relationship, ES = 0.6). Changes in Erectile Function domain score correlated moderately with changes in the SEAR domain and subscale scores (Sexual Relationship, r = 0.69; Confidence, r = 0.48; Self-Esteem, r = 0.47; and Overall Relationship, r = 0.35; P <or=0.001). CONCLUSIONS: The SEAR questionnaire is responsive to effective treatment of erectile dysfunction. These data suggest that the SEAR questionnaire is a valid instrument for detecting psychosocial gains from beneficial intervention.

Adult↗

PubMed2004

Erectile dysfunction and radiation dose to penile base structures: a lack of correlation.

PURPOSE: To evaluate the relationship between the dose and volume of radiation to proximal penile structures and the development of erectile dysfunction after external beam radiotherapy (RT) for localized prostate adenocarcinoma. METHODS AND MATERIALS: The study cohort comprised 28 patients who were enrolled our in-house three-dimensional conformal RT dose escalation protocol. The patients were treated to 78 Gy between 1995 and 1998. This protocol included a planned quality-of-life questionnaire to assess sexual function 2 years after completing RT. All the study patients were potent before RT. The median follow-up was 66 months (range 39-95). Penile base contents were outlined retrospectively in restored treatment plans. The dose-volume histograms (DVHs) for the corpus spongiosum (penile bulb), corpora cavernosum and crura, and total penile structure (corpus spongiosum plus corpora cavernosum and crura) were calculated. Statistical significance was defined as p < 0.05. The Bonferroni correction was used to adjust for multiple comparisons. Power calculations showed that our study sample would detect radiation- induced impotence with a very high power. We also estimated that a relatively small difference of 10-15% in the DVHs between the potent and impotent patients could be detected. RESULTS: At 2 years after RT, 10 patients (35.7%) reported new-onset erectile dysfunction and were unable to attain firm enough erections to have intercourse. Only hypertension was observed to affect erectile dysfunction after external beam RT. We found no statistically significant correlation among age, diabetes, or heavy alcohol consumption and post-RT potency. The mean radiation dose +/- standard deviation delivered to the corpus spongiosum, corpora cavernosa and crura, and total penile structure was, respectively, 42.2 +/- 8.4 Gy, 36.3 +/- 8.0 Gy, and 38.2 +/- 7.5 Gy. t test comparisons were performed between DVHs of post-RT potent and impotent patients on multiple cutpoints. No dose-volume effect was found. Analysis of the DVHs when the patients were subdivided into normotensive and hypertensive groups also showed no dose-volume response. CONCLUSION: Our analysis did not show statistically significant correlations between potency preservation and radiation dose to the proximal penis. The entire etiology of radiation- induced erectile dysfunction remains unclear and further research is needed.

Adenocarcinoma↗

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↗

PubMed1999

Progressive treatment of erectile dysfunction with intracorporeal injections of different combinations of vasoactive agents.

To account for severity of disease in patients with erectile dysfunction, we introduced a progressive treatment technique using four protocols of drug injections. The study group consisted of 452 men aged 26-85 gamma with erectile dysfunction. Protocol I. All patients began with a combination of papaverine and Regitine in doses adjusted to the estimated severity of dysfunction and to age, up to a maximum dose of 25 mg papaverine and 1.5 mg of Regitine. Protocol II. Patients who could not achieve sufficient rigidity on protocol I were switched to prostin VR, to a maximum of 25 mcg. Protocol III. Patients who failed protocol II received papaverine, Regitine and prostin VR. Protocol IV. Patients who failed protocol III received atropine sulfate (0.02-0.06 mg) in addition to papaverine, Regitine and prostin. Sufficient rigidity was achieved as follows: Protocol I=305 (67.4%) of the original cohort; Protocol II= 61 of the 147 failures with Protocol I (41.5%); Protocol III = 55 of the 86 failures with Protocol 11 (63.9%); Protocol IV = 20 of the remaining 31 patients (64.5%). Overall, sustained rigidity was achieved in 441 of the 452 patients (97.5%). Eleven patients (2.5%) failed all four protocols and were offered a penile prosthesis. Therefore, using our progressive method, by starting with the most available and inexpensive drugs, patients with erectile dysfunction can be given optimal treatment according to the severity of their disease. The success rate is high while costs are kept to a minimum.

Adult↗

PubMed1996

Men treated with hypolipidaemic drugs complain more frequently of erectile dysfunction.

The objective of this study was to assess whether there is an association between impotence and treatment with hypolipidaemic drugs. We asked patients referred to a lipid clinic for primary hyperlipidaemia whether they were complaining of erectile dysfunction. All the patients with a previous cardiovascular history were excluded. The main cardiovascular risk factors and the treatments currently being taken were carefully recorded to analyse their association with erectile dysfunction. The population consisted of two groups (treatment group and control) of 339 age-matched men (mean age: 48 +/- 9.5 years). Our results revealed that there were more impotent men in the group of patients treated with hypolipidaemic drugs (12% vs. 5.6%, P = 0.0029). Multivariate analysis showed that erectile dysfunction was dependent on treatment with fibrate derivatives (odds ratio: 1.46; 1.27-1.68) and statins (odds ratio: 1.51; 1.26-1.80). We conclude that erectile dysfunction is a frequent disorder in hyperlipidaemic men. Our results suggest that this symptom could be a side-effect of hypolipidaemic drugs. If further studies confirm our data, the search for the mechanism and the consequences of this possible side-effect will be useful and important.

Adult↗

PubMed2000

The prevalence and influence of significant psychiatric abnormalities in men undergoing comprehensive management of organic erectile dysfunction.

Psychiatric factors are etiologically important in a proportion of patients with erectile dysfunction. We determined the prevalence of psychopathology and the impact it has on current erectile dysfunction (ED) assessment and management. A group of 120 consecutive men with ED presenting to the Human Sexuality Clinic for the first time was prospectively investigated. All patients participated in a standardized evaluative protocol, including history, physical exam, assessment by a psychiatrist (using DSM-IV criteria), selective hormonal screen, and diagnostic intracavernosal injection. Follow-up appointments were to discuss diagnostic findings and, eventually, treatment choices. The prevalence of significant psychiatric pathology, excluding interview stress, was 33%. Only 16 of 40 cases were recognized and highlighted in the initial assessments by urological staff. There was no significant difference in the modalities of treatment choices between patients with psychiatric problems and those without. 10% of the patients had multiple organic risk factors, normal ICI, and significant psychiatric pathology. Psychopathology or emotional factors play a significant role in the etiology of ED and they are difficult to identify in a non-directed assessment. Even in the face of significant vascular risk factors, psychological abnormalities may be the primary etiology. Treating the 'phallodynamically challenged' individual without adequately addressing the possible presence of psychopathology, will account for treatment failures and have the potential for leaving untreated serious emotional problems.

Erectile Dysfunction↗

PubMed1999

Is obesity an underlying factor in erectile dysfunction?

OBJECTIVES: We conducted a study to evaluate the impact of obesity on erectile function in men with erectile dysfunction. METHODS: Three hundred and twenty-five consecutive patients with erectile dysfunction were evaluated. We classified the men into 2 groups according to body weight: <120% of the ideal body weight, and >/=120%. We compared several erectile capacities and the findings of penile duplex ultrasonography. RESULTS: There was a statistically significant decrease in the quality of residual erectile function in patients with obesity (penile rigidity grade 1.32 versus 1.62 in the nonobese patients). Obese patients also have an increased prevalence of vascular risk factors based on a review of the medical records and vascular impairment by duplex ultrasound study (43 and 62% in the obese patients versus 30 and 42% in the nonobese patients, respectively, p < 0.05). However, when we focused only on the patients without any vascular risk factors, no significant difference between the 2 groups was noted in the quality of residual erectile function and also the prevalence of penile vascular impairments (p > 0.05). CONCLUSIONS: These data demonstrate that obesity in itself does not seem to be an underlying factor, but does impose a risk to vasculogenic impotence by developing chronic vascular disease.

Adolescent↗

PubMed2004

Tadalafil in the treatment of erectile dysfunction following bilateral nerve sparing radical retropubic prostatectomy: a randomized, double-blind, placebo controlled trial.

PURPOSE: We evaluated the efficacy and safety of tadalafil 20 mg, taken on demand, in men with erectile dysfunction following bilateral nerve sparing radical retropubic prostatectomy (BNSRRP). MATERIALS AND METHODS: This randomized, double-blind, placebo controlled multicenter study consisted of a 4-week treatment-free run-in period (baseline) followed by 12 weeks of treatment. A total of 303 men (mean age 60 years) with preoperative normal erectile function who had undergone a BNSRRP 12 to 48 months before study were randomized (2:1) to tadalafil (201) or placebo (102). The 3 co-primary end points were changes from baseline in the International Index of Erectile Function erectile function domain score, and the percentage of positive responses to Sexual Encounter Profile questions 2 (successful penetration) and 3 (successful intercourse). The Global Assessment Question and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire were secondary end points. We defined a priori a subgroup of 201 patients reporting evidence of postoperative tumescence, defined as 50% or greater "yes" responses to Sexual Encounter Profile question 1 (ability to achieve at least some erection) during baseline intercourse attempts and stratified randomization based on this criterion. RESULTS: Patients receiving tadalafil reported greater improvement on all primary and secondary end points (p <0.001) compared to placebo. For all randomized patients and for the subgroup with evidence of postoperative tumescence, the mean International Index of Erectile Function erectile function domain score increased for patients receiving tadalafil (mean +/- SEM 5.3 +/- 0.5 and 5.9 +/- 0.7, respectively, p <0.001 vs placebo for both). For all randomized patients who received tadalafil, the mean percentage of successful penetration attempts was 54% and the mean percentage of successful intercourse attempts was 41%. For the subgroup with evidence of postoperative tumescence these values were 69% and 52%, respectively. Of all patients randomized to tadalafil 62% and of the subgroup patients randomized to tadalafil 71% reported improved erections. Patients receiving tadalafil reported greater treatment satisfaction on the Erectile Dysfunction Inventory of Treatment Satisfaction than those receiving placebo. Headache (21%), dyspepsia (13%) and myalgia (7%) were the most commonly reported adverse events. CONCLUSIONS: Tadalafil 20 mg, taken on-demand, was an efficacious and well tolerated treatment for erectile dysfunction following BNSRRP.

Carbolines↗

PubMed1994

Use of intracavernous injection of prostaglandin E1 for neuropathic erectile dysfunction.

The administration and suitability of intracavernous PGE-1 in men with neuropathic erectile dysfunction is reported herein. Twenty-seven men with neuropathic erectile dysfunction (SCI, 14; multiple sclerosis, 7; discogenic disease, 6) were evaluated and treated with intracavernous PGE-1. An average of 3.2 office sessions were required to learn adequate self-injection technique and determine optimal dosage requirement. Initial dosage for SCI men was 2.5 micrograms and increased in 2.5 micrograms increments to a mean maintenance dose of 6.2 micrograms. Quarterly monitoring up to 28 months demonstrated satisfactory erectile rigidity and duration of erection in all patients electing to pursue home administration of PGE-1. During this interval, over 40% of patients dropped out of the treatment program. No priapism or changes in serum chemistries, CBC, or platelets were observed during this period. Corporal fibrosis although not palpable, was detected subclinically by penile ultrasound in two men. This study confirms the safety and efficacy of self-administered intracavernous PGE-1 for neuropathic impotence. However, because of a significant rate of voluntary cessation, patients should be counseled regarding the full range of therapeutic alternatives to intracavernous therapy.

Adult↗

PubMed2004

Erectile dysfunction and comorbid diseases, androgen deficiency, and diminished libido in men.

Erectile dysfunction affects an estimated one in ten men in the United States. According to one study, the prevalence of impotence at all degrees is approximately 52% in men aged 40 to 70 years. This prevalence rate might be underestimated, given patients' reluctance to discuss the issue with their physicians. Erectile dysfunction is often accompanied by comorbid conditions because of overlapping risk factors. It is important that physicians be aware of the frequency of this coexistence so that they may monitor all potential health concerns and treat patients optimally.

Adult↗

PubMed2005

Hemodynamic effects of sildenafil citrate and isosorbide mononitrate in men with coronary artery disease and erectile dysfunction.

INTRODUCTION: Mild hemodynamic effects have been reported with sildenafil citrate therapy. AIM: To compare the hemodynamic effects of sildenafil and isosorbide mononitrate (ISMN) in men with coronary artery disease and erectile dysfunction. METHODS: A total of 31 men aged 35 years or older with coronary artery disease (at least 50% narrowing of the left main stem or at least 70% narrowing of any other coronary artery) and erectile dysfunction (receiving medication for erectile dysfunction or scoring less than 26 out of a maximum score of 30 on the erectile function domain questions of International Index of Erectile Function) were randomized to sildenafil 100 mg (n = 10), ISMN 40 mg (n = 11), or placebo (n = 10) in this single-dose multicenter study. MAIN OUTCOME MEASURES: Hemodynamic parameters were measured at baseline, 1, 2, 4, and 6 hours post dose. RESULTS: Compared with baseline, cardiac index increased slightly with sildenafil (0.29 L/min/m2 at 1 hour) and decreased slightly with placebo (-0.12 L/min/m2 at 4 hours) and ISMN (-0.14 L/min/m2 at 1 hour). The stroke volume index increased from baseline at each time point post dose with sildenafil (4.4 mL/m2 at 2 hours), but decreased with ISMN (-5.8 mL/m2 at 1 hour) and placebo (-2.8 mL/m2 at 4 hours). ISMN reduced mean arterial pressure more than sildenafil did (-22 vs. -10 mm Hg at 2 hours, respectively). Both sildenafil and ISMN increased heart rate (4 vs. 7 beats/minute at 1 hour, respectively) and decreased systemic vascular resistance, but sildenafil produced greater reductions in pulmonary vascular resistance. There were no serious adverse events in the sildenafil group. CONCLUSIONS: Sildenafil 100 mg was well tolerated and induced smaller changes in central and peripheral hemodynamic pressures compared with ISMN 40 mg. Moreover, sildenafil selectively reduced pulmonary resistance, which may have clinical importance in pulmonary hypertension.

Adult↗

PubMed2005

Are dehydroepiandrosterone sulphate and lipids associated with erectile dysfunction?

OBJECTIVE: Considering the results of the Massachusetts Male Aging Study (1994) we undertook the current investigation in an attempt to clarify the role of dehydroepiandrosterone sulphate (DHEAS), testosterone and lipids on age related deterioration of erectile function. METHODS: Forty males (13 under 40 years of age and 27 over 40) with erectile dysfunction were investigated. Seventeen healthy subjects (8 under 40 and 9 over 40 years) volunteered as controls. Serum levels of DHEAS, testosterone, total cholesterol, high-density lipoprotein cholesterol (HDL-ch), low-density lipoprotein cholesterol (LDL-ch) and triglycerides were assessed in blood samples. RESULTS: Plasma levels of DHEAS in patients over 40 years of age (4.17 +/- 2.76 micromol/l) were significantly lower in comparison with the younger group of patients (10.49 +/- 3.87 micromol/l), P < 0.001. There was no statistically significant difference in the DHEAS levels between patients and controls in the same age group. DHEAS in the patients showed an inverse correlation with age (r = -0.705, P < 0.001) and a positive correlation with testosterone (r = +0.402, P < 0.01). The same was found in the controls. The HDL-ch results were in the reference range. The total cholesterol levels (5.35 +/- 0.74 mmol/l) and LDL-ch levels (3.58 +/- 0.76 mmol/l) of the patients with erectile dysfunction in the group under 40 years were significantly higher in comparison with the controls (4.21 +/- 0.69 and 2.46 +/- 0.74 mmol/l, respectively, P <0.01). CONCLUSION: The data indicates that the decline in DHEAS is an age-related process rather than a causative factor of erectile dysfunction; total cholesterol and mainly LDL-ch may contribute to erectile dysfunction, especially in younger men.

Adolescent↗