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PubMed1995

Papaverine topical gel for treatment of erectile dysfunction.

Intracavernous injection of vasoactive substances has been shown to be an effective means of treatment of organic erectile dysfunction. However, up to 50% of men eventually discontinue treatment often because of lack of spontaneity and needle phobia. This study was done as a phase I, placebo controlled, nonblinded investigation of the safety and efficacy of a topical papaverine gel in the treatment of erectile dysfunction. Of 20 men with organic impotence 17 completed the trial and 13 of these patients had spinal cord injuries. After application of a 15% and 20% papaverine base gel to the scrotum, perineum and penis, cavernous artery diameter was significantly increased (36%, p < 0.001) as assessed by color flow Doppler ultrasound. Peak systolic flow velocity increased 26%. Only 3 of 14 patients achieved an increase in cavernous artery diameter of 75% or more and 2 of 14 had a peak systolic flow velocity of 25 cm. per second or more after application of a topical base gel. Similar findings were present when only the patients with spinal cord injury were analyzed. The effect of a papaverine base in producing flow alterations to the penis is dose-dependent. A diminution in blood pressure was present at 15 and 30 minutes after application to the forearm, and the heart rate diminished from 68 to 62 beats per minute after application to the genitalia. No patient was symptomatic. Serum papaverine levels were not elevated over pre-application values. No hepatotoxic effects were demonstrated. Full clinical erections (mean duration 38.7 minutes) were present in 3 patients but were also present with the placebo preparation (mean duration 8.0 minutes). In conclusion, topical papaverine gel appears to be safe and well tolerated after application to the genitalia, and increases blood flow to the penis with a 15% and 20% base preparation. Minimal systemic absorption occurs and, thus, effects are probably from local absorption. Topical therapy appears to augment reflex erections in the spinal cord injury patient and may be especially beneficial in this population. Further investigation is warranted at higher concentrations or in combination with different skin absorption enhancers.

Administration, Cutaneous↗

PubMed1992

Radiographic diagnosis and treatment of erectile dysfunction.

Within the past 10 years, the study of erectile function has witnessed a rapid expansion of knowledge. New anatomic and physiologic theories, diagnostic procedures, and treatments have all been developed. As with all new medical concepts, there is active and healthy controversy. The papers reviewed demonstrate an early consensus of opinion for some ideas and a difference of opinion for others. Published ideas and conclusions have been strongly influenced by the incomplete evolution of the diagnostic methods, by patient psychologic inhibition interfering with objective testing, and by particular perspectives of the investigator biasing the final interpretation. This update of the radiologic assessment and therapy of erectile dysfunction presents recently published works and background related to their development.

Angiography↗

PubMed1989

Erectile dysfunction in hypertensive men: sleep-related erections, penile blood flow and musculovascular events.

To explore how hypertension affects penile erection, we studied erectile hemodynamics during nocturnal penile tumescence in 3 groups of middle-aged men: hypertensive patients with and without erectile dysfunction, and normotensive controls without erectile problems. The hypertensive patients were not taking antihypertensive medication. Evaluations included standard monitoring of penile circumference change as well as noninvasive monitoring of penile segmental pulsatile blood flow and activity in the bulbocavernosus-ischiocavernosus muscles. Variables differed in how they discriminated among groups. Median amplitude of penile blood flow during rapid eye movement sleep differed significantly among all 3 study groups: controls had the highest amplitudes, patients without erectile problems had lower values and patients with erectile complaints had the lowest values. By contrast, standard measures of nocturnal penile tumescence (that is based on penile circumference change during sleep) only distinguished the patients with erectile problems from the 2 other groups. Density of musculovascular event clusters during rapid eye movement sleep (nearly simultaneous muscle activity burst, blood flow burst and circumference pulsation) distinguished the 2 groups of hypertensive men from controls. The sensitivity of the blood flow measure to changes in the hypertensive men without erectile complaints may indicate that the measure can reveal subclinical signs of developing vasculogenic erectile dysfunction.

Hemodynamics↗

PubMed1988

Iatrogenic causes of erectile dysfunction.

Normal penile erection is a complex event dependent upon the proper sequential function of the endocrine, nervous, and vascular systems. Medical or surgical therapy can influence those systems and so cause erectile dysfunction. Physicians must understand these iatrogenic causes of erectile dysfunction in order to prevent or reverse them.

Drug-Related Side Effects and Adverse Reactions↗

PubMed1990

High resolution ultrasonography and pulsed wave Doppler for detection of corporovenous incompetence in erectile dysfunction.

Cavernosometry and cavernosography have been the primary modalities available for detection and mapping of corporovenous incompetence in patients with erectile dysfunction. These procedures are expensive, time-consuming and associated with some morbidity, prompting us to study a less invasive method, high resolution ultrasonography and pulsed wave Doppler ultrasound. We evaluated 13 patients with nonendocrinological, nonneurological erectile dysfunction by high resolution and Doppler ultrasound for flow in the dorsal and cavernosal veins after intracorporeal papaverine. All patients had a nonrigid response to papaverine and a mean maximum cavernous arterial systolic velocity of greater than 25 cm. per second. The 13 patients were subsequently studied by dynamic cavernosometry and cavernosography, which revealed evidence of venous incompetence (12 with dorsal venous leaks and 11 with cavernous venous leaks). Only 5 of the 12 patients with dorsal venous incompetence had flow detected in the dorsal vein by ultrasound and Doppler studies. High resolution and Doppler ultrasound was unable to detect leakage in the cavernous veins. Among the 2 groups of patients with dorsal venous leaks (those with and without flow detectable by Doppler ultrasound) there was no significant difference in mean cavernous artery diameter or mean cavernous arterial maximum velocity. Similarly, there was no significant difference between the 2 groups in induction, maintenance or initial decompression rates on cavernosometry. We conclude that high resolution and Doppler ultrasound cannot replace dynamic cavernosometry and cavernosography as the diagnostic modality for venous incompetence.

Blood Flow Velocity↗

PubMed1994

Erectile dysfunction in multiple sclerosis. Associated neurological and neurophysiological deficits, and treatment of the condition.

Forty-eight men with multiple sclerosis and erectile dysfunction were evaluated. Emphasis was placed on the neurological features and the relationship between impotence and the bladder dysfunction in multiple sclerosis. Erectile failure was invariably associated with pyramidal signs in the lower limbs and with urinary symptoms. All of the men with impotence and marked pyramidal dysfunction in their legs were found by cystometric studies to have bladder hyperreflexia. The severity of the urinary symptoms was related to the degree of pyramidal impairment in the lower limbs. The posterior tibial and the pudendal cortical evoked potentials were abnormal in most of the men with multiple sclerosis and erectile failure. However, recording the pudendal cortical responses in patients with multiple sclerosis and impotence provided no more information than the tibial cortical evoked potentials. The neurological examination findings together with the results of the neurophysiological and cystometric tests suggest that erectile dysfunction in multiple sclerosis is due to spinal lesions situated proximal to the sacral cord. The feasability of papaverine intracorporeal injection therapy for men with multiple sclerosis and impotence was assessed. Papaverine intracorporeal injections produced satisfactory erections in the majority of the impotent men. Erectile failure in patients with multiple sclerosis was successfully managed for up to 2 years, by intracorporeal self-injection therapy.

Adult↗

PubMed1991

[Erectile dysfunction. Current diagnosis and therapy].

Today the cause of erectile dysfunction can be evaluated by multidisciplinary diagnostics. Currently, medical treatment, external devices, operative procedures and self-injection of vasoactive drugs are used for therapy. We can therefore offer effective therapeutic options with a low risk, providing an acceptable solution for the patients.

Adult↗

PubMed1991

[Erectile dysfunction: principles of radiologic clarification and therapy].

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.

Catheterization↗

PubMed1989

Quantitative and qualitative analysis of dynamic cavernosographies in erectile dysfunction due to venous leakage.

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.

Adult↗

PubMed1988

Experience in the management of erectile dysfunction using the intracavernosal self-injection of vasoactive drugs.

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.

Adult↗

PubMed1993

A pilot study of flaccid penile blood flow patterns in normal subjects and patients with erectile dysfunction.

Dynamic penile scintigraphy was performed using 99Tcm-labelled autologous erythrocytes in five normally potent volunteers and 22 patients with erectile dysfunction including 11 patients with psychogenic and 11 patients with vasculogenic impotence (four arteriogenic, three venogenic, three arteriogenic and venogenic, one arteriogenic and neurogenic). Penile radioactivity changes in the flaccid state were monitored by a gamma camera for 60 min after injection of the radionuclide. The penile time-activity curves of the normal controls characteristically showed secondary pulses of increased activity of variable amplitude, duration and frequency, consistent with phasic increase in penile blood pool. This normal rhythmic pattern was impaired in patients with penile arterial insufficiency whereas a blunted pattern was seen in most patients with functional impotence as well as in patients with nonarteriogenic organic impotence with a psychological overlay. This study provides new insights into the flaccid penile circulatory physiology, which may contribute to our understanding of the pathophysiology of erectile dysfunction. In arteriogenic subjects, the impaired response may be attributable to an inadequacy of penile arterial inflow as well as secondarily due to the resultant sinusoidal dysfunction subsequent to penile ultrastructural damage due to an altered nutritive environment. Increased adrenergic activity in patients with psychogenic impotence may be responsible for the observed deviation from the normal pattern.

Adolescent↗

PubMed1988

Erectile dysfunction in multiple sclerosis.

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.

Adult↗

PubMed1988

Diagnosis and therapy of erectile dysfunction using papaverine and phentolamine.

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.

Drug Therapy, Combination↗

PubMed1994

Role of penile vascular injury in erectile dysfunction after radical prostatectomy.

OBJECTIVE: To investigate the cause of erectile dysfunction after nerve-sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B). PATIENTS AND METHODS: Erectile function was evaluated in 20 patients, mean age 65 years (range 44-74), both pre-operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) and pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were assessed. RESULTS: Results revealed that the decreased response to intracavernosal injection of a vasoactive agent was associated with a significant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular injury. CONCLUSION: We conclude that post-prostatectomy impotence is multifactorial but vascular injury plays a substantial role.

Adenocarcinoma↗

PubMed1988

[Intracavernous injection of vasoactive substances in the treatment of erectile dysfunction].

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.

Dose-Response Relationship, Drug↗

PubMed1994

[Penile vein resection. Treatment of patients with erectile dysfunction caused by venous leakage].

In the period February 1991 to February 1992, 12 patients underwent penile vein resection as described by Tom Lue for erectile dysfunction caused by venous leakage. The median age of the patients was 43.7 years (range 23 to 46 years). Two patients had haematoma and two had penile oedema postoperatively. Both conditions resolved spontaneously within two weeks. At the first follow up six weeks postoperatively, 10 patients were able to have normal intercourse. After six month this number had declined to eight. After a follow-up period of 18 to 30 months only four patients were able to have intercourse. One of these needed self injection with papaverin/phentolamine. Because of the poor results, penile vein resection as described by Tom Lue cannot be recommended as a routine procedure in patients with erectile dysfunction caused by venous leakage. However the operation may be relevant in younger patients with penile venous leakage, where there are no concomitant causes of the erectile failure.

Adult↗

PubMed1990

Diabetes, erectile dysfunction, and sleep-related erections.

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.

Adult↗

PubMed1994

Vacuum constriction devices in erectile dysfunction: acceptance and effectiveness in patients with impotence of organic or mixed aetiology.

OBJECTIVE: To investigate the value of vacuum constriction devices in the treatment of erectile dysfunction. PATIENTS AND METHODS: A total of 67 patients were treated with vacuum constriction devices. The impotence was of organic origin in 36 men (54%) while in the remaining 31 (46%) it was of mixed aetiology (organic and psychological factors). Forty-seven patients continued to use the device at home for the duration of the practice period. RESULTS: All 67 patients underwent a vacuum test which resulted in nearly half of them achieving an erection sufficient for intercourse. Adequate erections were achieved in 34 of 47 (72%) patients who used the device at home during the practice period. In the group of patients with organic impotence (venous leakage), rigidity was better and the frequency of intercourse higher than in patients with diabetes and in those with neurogenic disorders. CONCLUSION: These findings support further the role for vacuum devices for the treatment of erectile dysfunction in carefully selected patients.

Adult↗