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Diagnosis of erectile dysfunction is performed by means of Doppler sonography, cavernosography and cavernosometry, as well as by angiographic methods. Interventional radiological treatment methods are, arterially, vasodilatation or vasorecanalisation, and, as far as the venous approach is concerned, percutaneous venous occlusion. The article reviews the diagnostic and therapeutic radiological methods.
Of 521 patients with erectile dysfunction in whom a multidisciplinary approach was used, 145 (27.8%) showed venous leakage as (concomitant) etiology of the impotence in dynamic cavernosography. The rate of the maintenance flow corresponded well with the response to a standardized intracavernosal injection of vasoactive drugs (p less than 0.05) in patients with venous leakage. The maintenance flow increased with the age in secondary impotent men. It was not statistically different in patients with or without concomitant arterial insufficiency (p = 0.19). Fifty-one of 145 patients (32.2%) presented a pathologic cavernosal drainage via a single venous system; 94/145 (64.8%) showed a combined venous leakage. The type of leakage corresponded neither to the maintenance flow nor to the response to intracavernosal injections. Our findings show that standardized intracavernosal testing and Doppler have a high predictive value for the status of the venous occlusive system. Exact evaluation of the type of leakage can be made by bidimensional cavernosography only.
We report the results of a survey of 75 patients with erectile dysfunction, all of whom were treated by self-injection of the corpora cavernosa with vasoactive agents. At the time of the survey each patient had been self-injecting at home for at least 3 months. Of the patients 62 were followed for 3 to 21 months. Patients used this form of treatment with minimal assistance from our clinic staff. It was acceptable to them with few complications except for prolonged erections in 11 per cent of the men. Fifteen patients (24 per cent) with psychogenic impotence reported spontaneous improvement in erections during treatment and 4 discontinued treatment for this reason. Another 26 patients (42 per cent) continue to use self-injection as the definitive mode of treatment for erectile dysfunction.
In a sample of 29 impotent men with multiple sclerosis and erectile problems, penile arterial inflow and venous outflow were within normal limits. In 26 patients, the pudendal evoked potential (PEP) was abnormal, and eight of these also had abnormal bulbocavernous reflex (BCR). Three patients had abnormal PEP and normal BCR, and of these, two had normal and one had abnormal nocturnal erectile activity. The validity of PEP/BCR testing was supported by normal findings in six patients with MS and without erectile problems. Nocturnal erectile activity was normal in 11 patients, of whom nine had abnormal PEP and/or BCR. A high disability score corresponded poorly with both reduced sexual function, insufficient nocturnal erectile activity, and abnormal PEP and/or BCR. Intracavernous injection of papaverine gave erection in 27 patients, the dose needed to create an erection being inversely related to the level of disablement. PEP and BCR testing may be more sensitive in defining neurogenic erectile dysfunction (ED) than nocturnal erectile activity. We considered 26 of the cases to have a neurogenic cause of ED and three to have mainly a psychogenic cause.
The introduction in 1982 of vasoactive agents for intracavernous injection represents a milestone in the diagnosis and treatment of erectile dysfunction. Two preparations, the single drug papaverine hydrochloride and the combination of phentolamine mesylate and papaverine hydrochloride, hold great promise. In the last few years, the use of vasoactive drugs for evaluation and treatment of erectile dysfunction has become accepted worldwide. This paper explores the diagnostic and therapeutic possibilities and hazards implied in the method, assessing the advantages and drawbacks of papaverine and the combination product.
Herein we report our experience with a clinical trial of intracavernous injection of vasoactive substances (Papaverin, Dibenzyran, Regitin) in 41 patients suffering from erectile dysfunction for longer than 1 year. In 14 out of 33 patients the application of papaverin alone was already sufficient to produce an excellent erection (T/E-grade 4) under clinical conditions. The simultaneous injection of two agents (Papaverin + Dibenzyran or Papaverin + Regitin) in patients with no or insufficient response to papaverin improved the results additionally. Besides a positively effect of delay from the injection to the erection could be observed in comparison with an injection of only papaverin. In conclusion, this method combined with an autoinjection therapy is an alternative approach to treat certain patients with erectile dysfunction.
Sleep-related erections were assessed in conjunction with polysomnography in 100 diabetic and 400 nondiabetic men with complaints of erectile problems. We also measured bulbocavernosus reflex latency, heart rate response to deep breathing, postural-related blood pressure changes, penile arterial sufficiency, and brachial blood pressures. To investigate the relationship between diabetes and erectile capacity, the results obtained from men with and without diabetes were compared. Men with diabetes had fewer sleep-related erections, less tumescence time, diminished penile circumference increase, and lower penile rigidity than nondiabetic men. These diabetes-related differences were found regardless of the maximum penile rigidity observed. The diabetic group had less heart rate response to deep breathing and lower penile blood pressures than the nondiabetic group, but only among men with maximum penile rigidity less than 500 g. These data indicate that both neurological and vascular mechanisms are involved to a greater degree in organic diabetic impotence than in the organic erectile dysfunction that occurs in nondiabetic men. Finally, the pattern of lower values for measures of nocturnal tumescence among diabetic men, compared to nondiabetic men, occurred in all age groups, except the oldest. Among impotent men, age 65 years or older, no difference was found between men with and without diabetes. This suggests that diabetes may foreshadow some of the age-related pathophysiological processes associated with erectile dysfunction.
This study examined previously published decision rules to ascertain the empirical utility of the MMPI in discriminating between organic and psychogenic erectile dysfunction. Subjects were 41 males who were being evaluated for prosthesis implant surgery. The mean overall 1-2-3 MMPI profile revealed diffuse somatic complaints, depression, and denial. Results indicate that the MMPI failed to discriminate between organic and psychogenic subgroups. Men with psychogenic erectile dysfunction evidenced neither significantly more nor less psychopathology on the MMPI than did those with objective organic findings.
Possibilities of radiological cooperation in diagnostics and therapy of erectile dysfunction are demonstrated. Besides SKAT-testing and pharmaco-duplex-sonography, pharmaco-cavernosometry and cavernosography procure the decisive confirmation of venous leakage. The veins which are not compressable during erection can eventually be obliterated under radiological control with the help of mini-coils. Pelvic and penile arteriography are mandatory for the localization of arterial obliterations which can be treated either surgically or by angioplasty. The value of interventional radiological measures in the arterial region can be clearly substantiated in common iliac and internal iliac stenoses. However, the results obtained in the venous region by occluding interventional measures have yet to be evidenced by systematic examinations, as the surgical treatment has not shown much success up to now.
On the basis of 18 months of cooperation between the psychiatric department and the urological department of the medical hospital of the Lübeck University, a model showing how men with erectile dysfunction can receive improved aid with respect to a multidimensional diagnostic evaluation and therapy, is presented. First, the present state of the somatic-urological examination procedures is outlined, and, in the appendix, summarised in the form of checklists. The possibilities of somatic treatment are the described. In the psychiatric-psychotherapeutic section, sexual counselling and couple psychotherapy are briefly considered under the aspect of intra-psychic and interactional causes. Provided that a cooperative sexual partner is available, it is then urged that invasive treatment methods be replaced by couple therapy, and that treatment of erectile dysfunction should not be considered merely a technical repair job.
OBJECTIVE: To explore the medication patterns and mechanisms of action of Shaofu Zhuyu decoction (, SFZYD) in inhibiting ferroptosis through the nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase 1 (HO-1)/glutathione peroxidase 4 (GPX4) pathway to improve diabetes mellitus-induced erectile dysfunction (DMED). METHODS: Firstly, data mining was employed to identify the medication patterns of Traditional Chinese Medicine (TCM) in treating DMED. Secondly, network pharmacology combined with a ferroptosis database was used to predict the targets. Subsequently, cell counting kit-8, 4',6-diamidino-2-phenylindole staining, reverse transcription-polymerase chain reaction (RT-PCR), and reagent kits were utilized to assess the repair effects of SFZYD on corpus cavernosum endothelial cells (CCECs) induced by high glucose (HG). Metabolic indicators, hematoxylin-eosin staining, and Masson staining were performed to observe the restorative effects of SFZYD on erectile function and penile tissue in diabetic rats. Finally, using Nrf2 inhibitors, the expression of related proteins and mRNAs was detected through Western blotting and RT-PCR. Reactive oxygen species levels and mitochondrial membrane potential were detected by flow cytometry. RESULTS: Data mining revealed that the prescription rules for blood stasis-type DMED coincide with the treatment principles of SFZYD. Network pharmacology identified 48 ferroptosis-related targets, primarily heme oxygenase 1 (HMOX1) and GPX4. Kyoto Encyclopedia of Genes and Genomes enrichment analysis associated these targets with the ferroptosis pathway. SFZYD repaired HG-induced CCECs damage and restored HMOX1 and GPX4 mRNA levels. in vivo, SFZYD effectively alleviated erectile dysfunction and repaired blood sinuses and fibrosis in diabetic rats. Following Nrf2 inhibition, the expression of Nrf2, HMOX1, and GPX4 decreased, while SFZYD intervention reversed these effects, improving ferroptosis and oxidative stress indicators. CONCLUSION: This study explored the potential mechanisms and efficacy of the TCM prescription SFZYD in treating DMED through data mining, network pharmacology analysis, cellular experiments, and animal experiments. It verified its effectiveness in repairing HG-induced CCECs damage, improving the pathological state of penile tissue in diabetic rats, and restoring erectile function by regulating the Nrf2/HO-1/GPX4 signaling pathway. This provides new insights and scientific evidence for treating DMED with TCM.
Most patients with neurogenic impotence present with a pre-existing neurologic disease. The neurologic assessment in these patients is generally performed to confirm that the underlying neuropathology plays a role in the erectile dysfunction. There are patients, however, with no obvious pre-existing neuropathology who are identified as having a vibratory impairment of the dorsal nerve on penile biothesiometry. Subsequent neurophysiologic testing in several of these patients has confirmed unsuspected neuropathology. An objective evaluation of autonomic cavernosal neurointegrity is still awaited. Such a test may enable the detection of efferent denervation resulting in neurogenic erectile dysfunction that is not clinically obvious.
This study examined the effects of a sex and aging workshop highlighting permission and limited information on the sexual knowledge, attitudes, behaviors, and satisfaction of a group of older heterosexual couples experiencing erectile dysfunction. The workshop focused on disseminating information about the physiological and psychological changes that occur in the sexual response during the aging process. Twenty couples participated in this study: 10 attended a workshop and 10 served as controls. The study utilized a randomized control group pretest/posttest design. Workshop participants completed an evaluation form and were interviewed at the time of follow-up. Data analysis revealed that the workshop participants reported significant increases in knowledge levels and in sexual satisfaction. The workshop evaluations and follow-up interviews reinforced these quantitative results. This study lends support to educational intervention as an adjunct to treatment of erectile dysfunction in the elderly population.
In the course of the evaluation of 500 patients with erectile dysfunction the results of penile Doppler-sonography and penile angiography could be compared in 65 patients, in whom both investigations were carried out under standardized conditions. Criteria for the evaluation of penile Doppler-sonography were the wave form analysis and especially the increase of blood-flow in the investigated arteries after intracavernous injection of papaverine. Criteria for the evaluation of the angiograms were the depiction of the penile arteries as well as the evidence of obstruction and collaterals of the internal iliac and pudendal arteries. In regard to the dorsal penile artery an all over correlation of 96.1% and in regard to the deep penile artery of 92.3% could be found. Based on these findings the conclusion can be drawn that papaverine-induced Doppler-sonography is able to replace penile angiography, thus no longer serving as the golden standard in the diagnosis of arterial insufficiency.
Color Doppler sonography can be useful in the evaluation of erectile dysfunction, which can result from psychogenic, endocrinologic, neurogenic, pharmacologic, and vasogenic causes. It is used to determine the integrity of the vascular mechanism. After an intracavernosal injection of a vasodilatory agent, color Doppler sonography is performed to evaluate cavernosal arteries and dorsal vessels. Color flow imaging allows direct visualization of intrapenile anatomy, vascular variants, and disease. It is also helpful in demonstrating transitions in cavernosal and dorsal blood flow. Color Doppler sonography is combined with spectral interrogation of the cavernosal arteries and dorsal veins to help determine peak systolic and end-diastolic velocities. Cavernosal artery size and systolic velocities help diagnose arterial insufficiency. Recent work on cavernosal artery diastolic flow and dorsal vein flow has indicated that color Doppler sonography, when correlated with cavernosographic findings, may be helpful in diagnosing venous incompetence. Temporal variations in transitions in cavernosal artery and dorsal vein flow during various stages of erection are important in the accurate diagnosis of vasogenic impotence.
We report the results of an open multicenter clinical trial with 115 patients. The results of a pharmacological test using intracavernously applied mixture of papaverine and phentolamine were compared with the results of a multidisciplinary evaluation of erectile dysfunction. Sensitivity and specificity of our test were determined. The injection of our drug solution caused an increase in tumescence and/or rigidity in all patients. The evaluation of the dose dependent erectile response makes it possible to distinguish between the three main pathogenetic principles: non-vascular, arterial and venous etiology of erectile dysfunction. The pharmacological test requires one to four intracavernous injections of 0.5-3.0 ml of the drug solution (7.5-45 mg papaverine hydrochloride, 0.25-1.5 mg phentolamine mesylate).
A Thoroughbred stallion with erectile dysfunction following paraphimosis was managed to allow consistent ejaculation. Ejaculation was elicited in this stallion by applying manual stimulation to the base of the penis. This technique allowed consistent ejaculation, and the stallion was able to return to natural service. Historically, stallions with this degree of penile dysfunction have been considered incapable of ejaculation and unable to continue as breeding animals.
A total of 104 evaluable patients 20-90 years old treated by direct vision internal urethrotomy a.m. Sachse for urethral strictures reported retrospectively via a questionnaire their sexual potency before and after internal urethrotomy. Eleven patients (10.6%) experienced partial or total erectile dysfunction following the operation, most of whom had distal and long strictures. Eight were evaluated for impotence and on grounds of a comprehensive history, physical examination, penile Doppler investigations, and papaverine tests it was concluded that 3 patients might have achieved an abnormal communication between the corpus cavernosum and corpus spongiosum. In two of the patients cavernosographies were carried out and in one total opacification of the corpus spongiosum was demonstrated, but the exact location of the leak could not be pinpointed, and surgical treatment therefore not rendered feasible. Possible factors in the development of erectile dysfunction following internal urethrotomy are analyzed.