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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↗
PubMed1994

The corpus cavernous electromyography in the erectile dysfunction diagnosis.

The single potential analysis of cavernous electric activity (CC-EMG), registration bands were studied in 144 patients with erectile dysfunction followed from November 1992 to March 1993. We attempted to correlate abnormal electromyographic records with reduction of the cavernous bodies and albuginea expansibility, as measured by cavernosometry/rigidometry. In this selected group of patients, with venous leak of different flow, the main associated causes of the erectile dysfunction were cavernous neuromyopathy (91), diabetes mellitus (20), disturbances of the arterial influx (7), endocrinological factors (4), Peyronie's disease (3). Some patients (15) presented with a penile bend. A history of alcohol and tobacco use was obtained: 38 patients smoked 15 to 60 cigarettes/day and 43 patients drank moderate to heavy. The coexistence of other pathologies, has been investigated, showed many other associated diseases. The study attempts to determine if some electromyographic standards in patients with erectile dysfunction, could, by themselves, be a formal indication to penile implant, for a PGE1 self-injection program or for use of a vacuum device. Our results suggest that at least in some cases CC-EMG studies may be clinically relevant and allow choice of optimal therapy.

Action Potentials↗
PubMed1994

[Etiological analysis of male diabetic erectile dysfunction with particular emphasis on findings of vascular and neurological examinations].

We studied the nocturnal penile tumescence (NPT) value obtained by simple method and the vascular and neurological findings closely related to the ability to achieve/maintain an erection in order to investigate the causative factors of organic erectile dysfunction seen in diabetes. Studies were carried out on 62 male diabetics (32-78 y.o.). The results were as follows. 1. There were no cases of a decrease in the nocturnal penile tumescence (NPT) value among eight subjects who showed no erectile dysfunction. However, a decrease in the NPT value was recorded in 28 (85%) of 34 subjects who showed complete failure to achieve/maintain an erection. It was, therefore, surmised that there is a large organic contribution to the erectile dysfunction seen in diabetes. 2. We determined the penile blood pressure index (PBPI), the reactions of papaverine tests, conduction velocity of the dorsal nerve of the penis and the latency of the bulbocavernosus reflex. 42 (67.7%) of the 62 subjects had penile vascular disorders and the cases with severe vascular disorders were skewed to the high age brackets. There were also many cases with neuropathy involved in the ability to achieve/maintain an erection: 38 (61.2%) of the 62 subjects. Moreover, many of the subjects were found to have damage to both the blood vessels and the nerves relating to an erection, and these forms of damage were surmised to be deeply involved in the decrease in the NPT value. 3. Multivariate analysis indicated that the most important factor involved in the decrease in the NPT value was vascular damage (contribution rate: 30.8%), followed by neuropathy (6.9%). These two factors represented the most important explanatory factors of the organic erectile dysfunction seen in diabetes. 4. The contribution rate of vascular damage to the decrease in the NPT value was 18.8% for diabetic subjects under the age of 60 years, but 45.1% for subjects aged 60 years or more. The contribution rate was thus higher in the elderly subject group. On the other hand, the contribution rate of neuropathy to the decrease in the NPT value was 7.7% for diabetic subjects under the age of 60 years, but the rate decreased to 4.7% for subjects aged 60 years or more.

Adult↗
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↗
PubMed1994

Treatment of male erectile dysfunction using the active vacuum assist device.

Erectile dysfunction is a common feature in men with diabetes. The efficacy and acceptability of a new battery-powered vacuum assist device, the 'Active' was assessed over 6 months in 19 diabetic men, median age 59 (38-66) years, of whom 9 had ECG evidence of autonomic neuropathy. Their pre-treatment duration of impotence was 24 (12-168) months and their expectation of restored sexual activity was 8 (1-28) times per month. The effect of the device was assessed using visual analogue scales (range 1-10) at 3 and 6 months. Eleven patients continued to use their device over 6 months. Self-assessment values for sexual satisfaction, partners's sexual satisfaction, and self-esteem significantly increased over 6 months. In those continuing to use the device, it was considered highly effective, painless in use and not embarrassing. Despite wearing a constriction ring to maintain their erection, ejaculation was satisfactory. The device was used four times per month on average.

Adult↗
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↗
PubMed1990

[Pharmacocavernosometry and pharmacocavernosography in erectile dysfunction].

In about 30% of patients with erectile dysfunction (ED), insufficiency of the corpus cavernosum, or a so-called venous outflow disturbance, pharmacocavernosometry (PCM) and pharmacocavernosography (PCG) are at present the most physiological modes of investigation for the use of vasoactive substances. The investigation technique is described and the results of 364 studies are reported. Using PCM, it is possible to quantify venous outflow disturbances and PCG permits them to be localized. In 111 patients, both PCM and PCG were performed, using a new cavernosography pump (AP300, Fresenius). Much lower flow values were found for maintenance flow than had previously been assumed (normal value: less than 15 ml; suspect: 15-30 ml; pathological: greater than 30 ml/min). Pressure drop time was the new measurement used, i.e., the time required for an intracorporal pressure drop from 150 to 50 mmHg. A value of greater than 1 min was established to be the normal value. In cases of pronounced insufficiency of the corpus cavernosum, the pressure drop time amounts to only a few seconds. Evaluation of 200 PCGs showed that an isolated pathological outflow via the deep dorsal vein of the penis could be demonstrated in only 10%, whereas in 72% the deep veins of the penis were involved. These results show that the operative indications for so-called venous outflow disturbances are considerably restricted.

Alprostadil↗
PubMed1987

Relevance of dynamic cavernosography to the diagnosis of venous incompetence in erectile dysfunction.

Dynamic cavernosography with flow and cavernosometric studies was performed on 140 patients, 18 of whom served as a control group. Of the 122 multidisciplinary investigated patients with erectile dysfunction 66 (54.1 per cent) showed associated venous leakage. Insufficiency of the dorsal penile veins (29 patients, 44 per cent) and complicated venous leakage (23 patients, 34.8 per cent) were predominate. In 63 patients with erectile dysfunction the results of an additional papaverine test were compared to the results of dynamic cavernosography, and they indicated a sensitivity of more than 90 per cent in regard to evidence or exclusion of venous incompetence in erectile dysfunction.

Adult↗
PubMed1995

Topical prostaglandin-E1 for the treatment of erectile dysfunction.

This study was undertaken as a phase I, placebo controlled, nonblinded investigation of the safety and efficacy of topical prostaglandin-E1 for the treatment of erectile dysfunction. Nine men with erectile dysfunction secondary to spinal cord injury and 1 man with mild arterial insufficiency were enrolled in the trial and underwent color flow Doppler ultrasound of the penis after application of topical prostaglandin-E1 to the penis, scrotum and perineum. Eight men completed all phases of the study. Mean cavernous artery diameter increased from 0.09 to 0.11 cm. (p < 0.05) and mean peak systolic flow velocity increased from 15.4 to 22.8 cm. per second (p < 0.05) using color flow Doppler ultrasound. Peak systolic flow velocity increased in both cavernous arteries in 7 of 10 patients. Clinical erections were observed in 2 patients but they were not present with placebo application. Diastolic blood pressure and heart rate varied after application of prostaglandin-E1 to the genitalia. No patient was symptomatic and no adverse skin effects were observed in the 8 patients completing all phases of the study. In conclusion, topical prostaglandin-E1 appears to be safe and well tolerated after application to the genitalia, and significantly increases blood flow to the penis. Further investigation is being pursued.

Administration, Cutaneous↗
PubMedDate not supplied

Our experience with pharmacological erection treatment of erectile dysfunction.

Administration of vasoactive drugs intracavernously is a well-known easily used and inexpensive alternative in treatment of a certain group of patients with erectile dysfunction. There are a few drugs used for this purpose, but we prefer papaverine as the first choice because it is easily available and inexpensive in our country. We used alprostadil only in nonresponders to papaverine or if there was any complication with papaverine. We present a series of 69 patients, 24 with psychogenic (34.8%), 27 with organic (39.1%), and 18 (26.1) with mixed etiology of erectile dysfunction, treated with intracavernous self-injection therapy. Mean follow-up of the patients was 13.6 months (7-30 months). In this study, 3,430 papaverine and 780 alprostadil injections were performed in 56 and 13 patients, respectively. In 75% of the papaverine injections and in 83% of the alprostadil injections, erections were achieved sufficient for sexual intercourse. During the follow-up, there were not any abnormal alterations in liver function tests. The main complaint of the patients who used papaverine was a burning sensation (98%) during administration of the drug, which did not last more than 1 minute. Of 13 patients in the alprostadil group, 56.9% of the patients complained mainly of discomfort during erection. We concluded that intracavernous therapy is a good and inexpensive option in the management of erectile dysfunction in carefully selected patients.

Adult↗
PubMed1985

Bulbocavernosus reflex testing in 100 consecutive cases of erectile dysfunction.

Electrophysiologic testing of the bulbocavernosus reflex is often part of the routine workup of erectile dysfunction. To assess how often prolonged or absent reflexes occur 100 consecutive males with erectile dysfunction, who had been referred to a hospital-based medial sexology program, were tested. Four per cent had prolonged latency times (greater than 43 msec), and an additional 5 per cent had an absent reflex. Bulbocavernosus reflex testing needs to be done in males where penile revascularization, or sex therapy, or both, are being considered as therapeutic options. An abnormal latency would contraindicate revascularization and should limit outcome expectations of sex therapy. It does not need to be a routine part of the diagnostic workup.

Adult↗
PubMed1994

Complications associated with the use of vacuum constriction devices for erectile dysfunction in the spinal cord injured population.

The vacuum constriction device has generally been regarded as a safe and effective alternative to pharmacologic intracorporal injections or surgical placement of a penile prosthesis for the treatment of erectile dysfunction. This paper serves to exemplify the potential complications of the device when used to treat erectile dysfunction in the spinal cord-injured (SCI) population. Two cases of subcutaneous penile hemorrhage in patients using anticoagulant therapy (one treated with subcutaneous heparin and one with coumadin) and one case of penile gangrene occurred in three different SCI males. Physicians managing erectile dysfunction in SCI patients should be aware of these potential serious morbidities. The management and means of prevention of these complications are presented.

Adult↗
PubMed1990

Prevalence of sleep apnea in men with erectile dysfunction.

Sleep studies were performed on 1,025 patients complaining of erectile dysfunction. In addition to standard measures of sleep stage and nocturnal penile tumescence, respiratory activity was evaluated. The number of episodes of sleep apnea per hour (Apnea Index--AI) was calculated for each patient. The overall prevalence of sleep apnea activity in this sample was: 43.8 percent with AI greater than or equal to 5; 27.9 percent with AI greater than or equal to 10; and 19.6 percent with AI greater than or equal to 15. These results confirm that sleep apnea activity is common in men with erectile dysfunction. This high prevalence also indicates that further study is needed to elucidate pathophysiology of erectile failure in men with sleep apnea.

Adult↗
PubMed1994

Erectile dysfunction.

A better understanding of penile physiology and pathophysiology has revolutionized the diagnosis and treatment of erectile dysfunction in the past decade. This article summarizes the current knowledge and presents a patient's goal-directed approach to the evaluation and treatment of erectile dysfunction.

Erectile Dysfunction↗
PubMed1991

Infusion pharmacocavernosometry and nocturnal penile tumescence findings in men with erectile dysfunction.

Infusion pharmacocavernosometry and nocturnal penile tumescence findings were compared in 50 men with erectile dysfunction of either organic or psychogenic etiology. Of the men 29 had abnormal and 21 had normal nocturnal penile tumescence. Infusion pharmacocavernosometry parameters (equilibrium pressure, maintenance flow rate and 30-second pressure fall) were compared to nocturnal penile tumescence status (normal versus abnormal). When traditional normal values were used for infusion pharmacocavernosometry parameters poor correlation with nocturnal penile tumescence status was found. When new cutpoints for infusion pharmacocavernosometry parameters were chosen a stronger correlation was noted. This study suggests that when vasoactive drugs are injected intracavernously for diagnostic purposes, anxiety and/or the absence of sexual stimulation following the injection may prevent complete cavernous smooth muscle relaxation resulting in falsely abnormal values. Therefore, over reliance on infusion pharmacocavernosometry as a single test for evaluation and treatment decisions concerning erectile dysfunction should be avoided.

Adult↗