SEARCH · PubMed Health

Results for “Erectile Dysfunction”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed1986

Erectile dysfunction in narcoleptic patients.

Many male narcoleptic patients complain of erectile dysfunction related to chemotherapy, and some find it so distressing that they fail to continue treatments. This is a potentially dangerous situation. We studied the erectile capabilities of 28 narcoleptic men who had complaints of erectile dysfunction with our objective sleep laboratory measurement of nocturnal penile tumescence (NPT) for diagnostic workup. We found that while short REM latency, a classic indicator of narcolepsy, was present in all patients, NPT, which is associated with REM sleep, did not coincide with the short REM latencies in about half the patients. This may be partially due to the fact that first-cycle REM is often not accompanied by NPT episodes (even in the control population). We also found that, in a few cases, the patients' subjective beliefs about their erectile capacity tended to underestimate our measurements. The patients receiving drug treatment already had some vasculogenic or neurogenic genital impairment, which probably made them more vulnerable to the effects of the drugs. Patients who had none of these complications showed similar erectile impairment under the influence of medication. Additionally, we found unique manifestations of the disease in three drug-free patients; one had cataplectic attacks upon arousal, and two had unexplained erectile impairment.

Adult↗

PubMed1994

Intracavernous prostaglandin E1 in erectile dysfunction.

Prostaglandin E1 (PGE1) is a naturally occurring substance that is present in a variety of mammalian tissues, including the semen of fertile men. Its use in the diagnosis and treatment of erectile dysfunction has been extensively studied. In doses of 10-20 micrograms, PGE1 produces full erections in 70-80% of patients with erectile dysfunction. In diagnostic use PGE1 is employed as a simple office test and in conjunction with various hemodynamic tests. Self-injection of PGE1, either with the patient or his partner administering the injection, is a minimally invasive and effective treatment for erectile dysfunction in patients with organic or psychogenic erectile dysfunction. Its use is contraindicated in patients with sickle cell anemia, severe coagulopathy, schizophrenia or severe psychiatric disorder, poor manual dexterity, severe venous incompetence, or severe systemic disease. As calculated from data in the published literature, the most frequent side effects are pain at the injection site or during erection (occurring in 16.8% of patients), hematoma/ecchymosis (1.5% of patients), and prolonged erection/priapism (1.3% of patients). The potential for prolonged erection/priapism, the most serious side effect, can be minimized by careful titration of the dose and through patient education. Systemic side effects occur rarely during PGE1 use. During extended use, patients should be monitored for potential long-term side effects, such as fibrosis and angulation.

Alprostadil↗

PubMed1998

Prospective comparative study with intracavernous sodium nitroprusside and prostaglandin E1 in patients with erectile dysfunction.

PURPOSE: To compare the effectiveness of intracavernous administration of sodium nitroprusside and prostaglandin E1 to induce penile erection in men with erectile dysfunction. MATERIAL AND METHODS: 100 patients with erectile dysfunction entered the study prospectively. As part of the diagnostic workup, each patient received an intracavernous injection of 20 microg prostaglandin E1 and a second injection of 600 microg sodium nitroprusside 1-7 days later. A tourniquet was placed at the base of the penis before each injection. The data recorded included time required to initiate tumescence, local and systemic side effects, objective and subjective quality of erections, duration of tumescence and patient satisfaction by means of a personal questionnaire. RESULTS: Prostaglandin E1 induced better overall responses than sodium nitroprusside, the difference being almost significant (p = 0.055). The overall duration of erections was also significantly longer with prostaglandin E1 (mean 81.3 min) than with sodium nitroprusside (mean 65.4 min; p < 0.04). 67% of the patients considered the erections induced with prostaglandin E1 to be of better quality than those with sodium nitroprusside, and only 11% stated that sodium nitroprusside was superior. Side effects were minimal with both drugs, the most frequent side effect being systemic hypotension, which was induced by sodium nitroprusside in 7% of the patients. CONCLUSIONS: The moderate risk of systemic hypotension and the lower potency of sodium nitroprusside to induce erections compared to prostaglandin E1 rules out sodium nitroprusside as a routine alternative intracavernous drug in men with erectile dysfunction at the doses employed. Sodium nitroprusside, however, could be used in patients who have intolerance or penile pain with intracavernous prostaglandin E1.

Adult↗

PubMed1998

Efficacy and safety of transurethral alprostadil therapy in men with erectile dysfunction. MUSE Study Group.

OBJECTIVE: To examine the safety and efficacy of transurethral pharmacotherapy for erectile dysfunction, involving the use of a novel therapeutic system to administer alprostadil (prostaglandin E1) to the urethral mucosa in a double-blind, randomized, parallel, placebo-controlled study conducted in five countries in Europe. PATIENTS AND METHODS: In an outpatient setting, patients with primarily organic erectile dysfunction of at least 3 months' duration were treated with transurethral alprostadil, in an open-label, dose-escalating study. Testing stopped when the dose provided an erection sufficient for intercourse, as assessed by the patient and the investigator. Patients who achieved a sufficient response were then randomized to either active medication at the selected dose or to placebo for use at home for 3 months. After each home administration, patients recorded in diaries whether or not sexual intercourse occurred and any adverse reactions to the drug. RESULTS: A total of 249 patients were treated in an outpatient setting; of these patients, 159 (64%) achieved an erection sufficient for intercourse and were randomized (1:1) to either active medication or placebo for home treatment. Of the patients randomized to alprostadil for home treatment, 69% reported intercourse at least once, compared with 11% of patients randomized to placebo (P < 0.001). The most common adverse reaction, urethral pain/burning, was reported by 7% of patients in the clinic. Most patients (83%) graded transurethral alprostadil as causing minimal or no discomfort in the clinic. No patient reported priapism or developed penile fibrosis. CONCLUSION: Alprostadil delivered transurethrally by this system was well tolerated and effective in treating erectile dysfunction.

Adult↗

PubMed1988

Mid-term results of autoinjection therapy for erectile dysfunction.

Of over 300 patients with erectile dysfunction, 186 were selected for intracavernosal autoinjection therapy with a standardized papaverine-phentolamine mixture. A total of 156 patients performed 4,813 protocol autoinjections with a minimum of 10 and a maximum of 230 per patient. The dose that induced a full erection at the hospital could be reduced under home conditions by a mean of 35 per cent. Systemic side effects were not observed. The most inconvenient local side effects were prolonged erections in 24 patients in diagnostic use and in 3 patients in therapeutic use. There were treated easily without further consequences.

Dose-Response Relationship, Drug↗

PubMed1992

Noninvasive treatment for erectile dysfunction in the neurogenically disabled population.

Erectile dysfunction is the most prevalent sexual dysfunction in neurogenically disabled men. Studies of rehabilitation patients indicate that the restoration of sexual functioning is considered an important priority. This article reports on a pilot study of vacuum tumescence constriction therapy as a noninvasive method for use by a population with traumatic or nontraumatic neurologic disorders such as spinal cord injury, stroke, multiple sclerosis, and diabetes mellitus. Of the 30 patients who participated in the study, 17 purchased the device and over 50% of them reported using the device on a long-term basis. Frequency of coitus increased from 0.3/wk to 1.5/wk. Included in the study are methods used by patients to integrate the device into their sex life, the role of the patient's partner in the decision to purchase the device, and the rate of partner satisfaction. There were no reports of substantial morbidity. Thus, this method shows promise as a noninvasive treatment for men who are moderately to severely neurogenically disabled.

Equipment and Supplies↗

PubMed1994

Communication patterns in patients with erectile dysfunction and their partners.

Patients with erectile dysfunction (ED) and their partners (n = 18) were compared on perceived distress caused by the ED, attribution of responsibility for the ED and marital communication. Comparisons were also made between couples in whom the ED was organically based versus those in whom it was psychogenically based. No differences were found between organic versus psychogenic ED couples on perceived distress, attributions, or marital communication skills. Patients and partners differed on communication (P < 0.001), attributions (P < 0.001) and perceptions of distress experienced by their spouse (P < 0.001). However, both members of the couple found the ED equally distressing. Partners tended to attribute more responsibility for the ED to themselves when they believed it was psychogenic (P < 0.001), while patients claimed sole responsibility regardless of their perceptions of its etiology. Patients had clinically problematic communication scores (P < 0.001), while partners did not. Contrary to initial hypotheses, communication scores did not predict agreement/disagreement between patients and partners on perceived etiology, attributions or distress. Discussion is focused on the need for therapy to address couples' communication specific to sexual activity and the effects of the ED.

Communication↗

PubMed1996

Erectile dysfunction in hypertensive subjects. Assessment of potential determinants.

Hypertension is often cited as a risk factor for erectile dysfunction. To clarify the relation between hypertension and erectile dysfunction, we evaluated 32 consecutive hypertensive and 78 normotensive impotent men with respect to multiple potential determinants and parameters of erectile function, including medical and sexual history, depression, hormonal profile, penile nocturnal tumescence, penile vascular supply, and pudendal nerve conduction. The hypertensive men were older, had higher body mass index, and used more medications than the normotensive men. The groups were not different with respect to the prevalence of smoking and peripheral vascular disease, but the hypertensive men had a marginally higher rate of ischemic heart disease (P = .06). The prevalence of depression, abnormal nocturnal penile tumescence, anomalous pudendal nerve conduction, and impairment in arterial supply as determined by penile brachial index were similar in the two groups. Testosterone and bioavailable testosterone levels were lower in the hypertensive men. After stratification by age and body mass index, hypertensive men younger than 50 years with body mass index less than 30 kg/m2 had significantly lower testosterone levels (12.0 +/- 1.7 versus 21.3 +/- 1.4 nmol/L, P < .02) but not bioavailable testosterone levels (3.9 +/- 0.7 versus 6.4 +/- 0.7 nmol/L, P < .17) than the corresponding normotensive group. Prolactin, follicle-stimulating hormone, and luteinizing hormone levels of the two groups were not significantly different. Contrary to common belief and with the exception of lower circulating testosterone levels, the overall analysis showed little difference between hypertensive and normotensive men with respect to a wide range of classic determinants of erectile function. Direct study of the local vascular erectile apparatus appears necessary for further elucidation of the mechanisms underlying erectile dysfunction in hypertensive men.

Adult↗

PubMed1998

The treatment choice of elderly patients with erectile dysfunction.

The aim of this study was to determine treatment preference, commitment to choice of therapy, and the influence of physical disability on treatment choice in a geriatric group of males with erectile dysfunction (E.D.) of various etiologies. Eighty-nine patients aged 65 to 83 years (mean 69.5 years) were assessed and followed at our erectile dysfunction clinic from July 1991 to September 1996. Etiology of ED was based on clinical assessment. Available treatment options included oral medications, vacuum devices, injection therapy, penile prostheses, sex counseling and testosterone when indicated. Median follow-up since initial consultation was 9 months (range 1 to 63 months). Data was retrieved in a retrospective fashion from chart review and selective telephone follow-up. Clinical assessment yielded the following distribution of etiologies: vasculogenic (57.2%), neurogenic (7.9%), hormonal (1.1%), psychogenic (2.2%), and multifactorial (32.6%). The most popular initial treatment choices were injection therapy (30.3%), vacuum device (27.0%), and oral medication (20.2%). Of the 84 patients who chose to be treated, 34 (40.5%) elected to switch to a different form of therapy after a median time of 7.5 months (range 1 week to 63 months). Five patients tried a third form of therapy and two proceeded to a fourth. The remaining patients have continued with their original choice for a median time of 7 months (range 1 to 63 months). A greater drop-out rate (78%) amongst those who initially chose oral medication was statistically significant when compared to drop-out rates for injection therapy (48%) and vacuum devices (29%), p = 0.044 and p = 0.005, respectively. Significant physical disabilities in eight patients did not appear to influence their treatment selection. In conclusion, the elderly are a unique group of patients who are more likely to have an organic etiology to their erectile dysfunction. When they do present with erectile dysfunction, they are inclined to pursue treatment. The choices made by this group of men did not differ from impotent men in general. When unsatisfied with one form of therapy they were inclined to pursue an alternative treatment. A significant physical disability did not preclude a therapeutic choice.

Aged↗

PubMed1996

Induratio penis plastica--a factor of erectile dysfunction?

There are still diverse management options in Peyronie's disease and diverse opinions about the coincidence of Peyronie's disease and erectile dysfunction as well. The connection between Peyronie's disease and ED has been proved by some papers but on the other hand authors have refused to accept this claim. We have found erectile dysfunction in about 30% of our patients. We investigated 61 patients with Peyronie's disease. As diagnostic criteria assessment of angulation and erectile dysfunction are proposed. The tunica albuginea plication technique was used in 35 patients with good results. In our investigation we did not find any coincidence of Peyronie's disease with erectile dysfunction.

Adult↗

PubMed1995

The lowest effective dose of prostaglandin E1 as treatment for erectile dysfunction.

The recommended dose of prostaglandin E1 as treatment for erectile dysfunction has been reported to be 10 to 40 micrograms. However, adverse effects probably increase with increasing doses. We conducted a prospective, single-blind, dose-escalating study of prostaglandin E1 on 20 men with erectile dysfunction of various etiologies. The response to prostaglandin E1 was assessed by penile palpation and RigiScan rigidity monitoring. A total of 17 patients completed the study: 1 achieved rigidity with 1 microgram., 2 with 2 micrograms. and 4 with 3 micrograms. prostaglandin E1, while more than 70% achieved rigidity with 5 micrograms. or less and more than 80% had a full erection with 20 micrograms. Of 138 injections there were 2 episodes of pain after injection. We conclude that the often recommended starting dose of 20 micrograms. is too high. A more appropriate starting dose is 2.5 micrograms. with increments of 2.5 micrograms. until the lowest effective dose is achieved. This approach may lessen the major impediments to prostaglandin E1 use, that is burning and pain.

Adult↗

PubMed1997

Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy.

PURPOSE: We reviewed the results of serum testosterone and prolactin determination in 1,022 patients referred because of erectile dysfunction and compared the data with history, results of physical examination, other etiological investigations and effects of endocrine therapy to refine the rules of cost-effective endocrine screening and to pinpoint actual responsibility for hormonal abnormalities. MATERIALS AND METHODS: Testosterone and prolactin were determined by radioimmunoassay. Every patient was screened for testosterone and 451 were screened for prolactin on the basis of low sexual desire, gynecomastia or testosterone less than 4 ng./ml. Determination was repeated in case of abnormal first results. Prolactin results were compared with those of a previous personal cohort of 1,340 patients with erectile dysfunction and systematic prolactin determination. Main clinical criteria tested regarding efficiency in hormone determination were low sexual desire, small testes and gynecomastia. Endocrine therapy consisted of testosterone heptylate or human chorionic gonadotropin for hypogonadism and bromocriptine for hyperprolactinemia. RESULTS: Testosterone was less than 3 ng./ml. in 107 patients but normal in 40% at repeat determination. The prevalence of repeatedly low testosterone increased with age (4% before age 50 years and 9% 50 years or older). Two pituitary tumors were discovered after testosterone determination. Most of the other low testosterone levels seemed to result from nonorganic hypothalamic dysfunction because of normal serum luteinizing hormone and prolactin and to have only a small role in erectile dysfunction (definite improvement in only 16 of 44 [36%] after androgen therapy, normal morning or nocturnal erections in 30% and definite vasculogenic contributions in 42%). Determining testosterone only in cases of low sexual desire or abnormal physical examination would have missed 40% of the cases with low testosterone, including 37% of those subsequently improved by androgen therapy. Prolactin exceeded 20 ng./ml. in 5 men and was normal in 2 at repeat determination. Only 1 prolactinoma was discovered. These data are lower than those we found during the last 2 decades (overall prolactin greater than 20 ng./ml. in 1.86% of 1,821 patients, prolactinomas in 7, 0.38%). Bromocriptine was definitely effective in cases with prolactin greater than 35 ng./ml. (8 of 12 compared to only 9 of 22 cases with prolactin between 20 and 35 ng./ml.). Testosterone was low in less than 50% of cases with prolactin greater than 35 ng./ml. CONCLUSIONS: Low prevalences and effects of low testosterone and high prolactin in erectile dysfunction cannot justify their routine determination. However, cost-effective screening strategies recommended so far missed 40 to 50% of cases improved with endocrine therapy and the pituitary tumors. We now advocate that before age 50 years testosterone be determined only in cases of low sexual desire and abnormal physical examination but that it be measured in all men older than 50 years. Prolactin should be determined only in cases of low sexual desire, gynecomastia and/or testosterone less than 4 ng./ml.

Cost-Benefit Analysis↗

PubMed1990

[Erectile dysfunction of male spinal cord injury patients].

Different problems regarding erectile dysfunction in men with spinal cord-injury are outlined. Neuroanatomical and neurophysiological aspects of erection and ejaculation are outlined and brought into relation with the different clinical pictures of such lesions. Different therapeutical possibilities are presented, particularly the new treatments like intracavernous papaverine (autoinjection), prostaglandin E1 and transcutaneous nitroglycerin; action, advantages and indications are discussed. The experience in ten para- or tetraplegic patients are discussed. It seems that even in spite of the higher price of PGE1 this treatment of the erectile dysfunction in spinal cord-injured men should be preferred, since it shows more advantages and less complications than other treatments.

Adult↗

PubMed1993

Pudendal versus limb nerve electrophysiological abnormalities in diabetics with erectile dysfunction.

It is of some interest to diagnose polyneuropathy and/or sacral neuropathy in diabetic males with erectile dysfunction. Non-invasive electrophysiological measurements with surface electrodes, which are widely available, have been applied to determine the diagnostic yield of several electrophysiologic parameters for assessing polyneuropathy including the pudendal nerve in impotent diabetics. Latencies of the bulbocavernosus reflex and the pudendal somatosensory evoked potentials were measured in a group of 28 diabetic patients with an erectile dysfunction as their main complaint, as well as in a group of 20 potent males without systemic disease. In diabetic patients motor conduction measurements of one median and peroneal nerve and sensory conduction measurements of one median and sural nerve were also performed. In 15 patients abnormalities of the peripheral nerve conduction were demonstrated whereas abnormalities of the bulbocavernosus reflex and/or cortical somatosensory evoked potentials were demonstrated in eight. Five patients had both types of abnormalities. In the patient group no differences could be demonstrated between those with Type 1 or Type 2 diabetes. The only significant clinical/neurophysiological correlation was found between the absence of the bulbocavernosus reflex on clinical examination and its prolonged latencies on electrophysiological measurement. The study showed that a bigger yield of abnormal results was obtained when pudendal nerve function parameters were included in the evaluation of diabetics with erectile dysfunction. Considered separately, however, the battery of electrophysiological tests evaluating limb nerve function seems more sensitive in diagnosing neuropathy than electrophysiological assessment of pudendal nerve function alone.

Adult↗

PubMed1997

[The neurological status in patients with erectile dysfunction: somatosensory evoked potentials and the bulbocavernosus reflex].

OBJECTIVES: The present study investigated the somatosensory evoked potential (SSEP) from the dorsal penile nerve and the bulbocavernosus reflex (BCR) in healthy volunteers and patients with erectile dysfunction in order to establish a model of normality and investigate the abnormal neuro-urophysiological measurements in patients with erectile dysfunction and their relationship with different factors (age, neurological disease). METHODS: 30 healthy volunteers and 102 patients who had consulted for erectile dysfunction underwent neuro-urophysiological diagnostic evaluation (dorsal penile nerve SSEP and BCR). The mean age was 51.2 years (range 27 to 66). RESULTS: The group of healthy volunteers showed SSEP mean latency of 46.374 ms and a BCR mean latency of 43.721 ms. Thirty-four patients (33.33%) had at least one abnormal neuro-urophysiological measurement, the SSEP were abnormal in 7 (20.58%), the BCR in 5 (14.70%) and both in 22 (64.70%). We found an increased SSEP latency and BCR latency in the patients with erectile dysfunction and with no urological disease. Comparison of the older with the younger patients was only statistically significant for increased BCR latency in patients > 60 years old. CONCLUSIONS: The study revealed neuro-urophysiological abnormalities in 34 impotent patients (33.33%). The finding of abnormalities in both BCR and SSEP was the most frequent.

Adult↗

PubMed1992

Radiologic methods used in the diagnostics of vasculogenic erectile dysfunction.

Contemporary methods of assessing erectile dysfunction include instrumental registration of nocturnal penile erections, the penile brachial index, Doppler sonography, use of vasoactive substances and various contrast radiologic methods along with studies of the hormonal profile, the neurologic status, examination of prostate excrements, etc. These methods are still not widely used in Bulgaria although their scope of application is quite well known. We report here our own experience in using the contrast radiologic methods for studying this pathological condition, in particular, the technique of digital subtraction pharmacocavernosography with cavernosometry introduced by us and used for this purpose. In some of the cases we used it in combination with digital subtraction angiography of pelvic arteries. Using these methods we can detect not only morphological but also functional disorders. On the basis of the data obtained we determine the particular therapeutic approach, specify the nature of the disorder and the effect of eventual surgical intervention.

Adult↗

PubMed1995

[Results of color-coded duplex ultrasound diagnosis (angiodynography) after intraurethral administration of PgE1 in erectile dysfunction].

When the pathomechanism of erectile dysfunction is obscure, intraurethral administration of prostaglandin E1 is followed by a marked increase in blood flow velocity in the penile arteries as measured by color-coded Duplex sonography. This increase compares to that following intracavernous administration of half the dose of prostaglandin E1. The difference in the effects after intraurethral and intracavernous administration is the missing rigidity after intraurethral application; there must be a loss of pharmacological efficacy to the smooth penile muscles. Clinical efficacy is to be expected with higher intraurethral dosage.

Adult↗

PubMed1996

[Erectile dysfunction in patients with diabetes].

Erectile dysfunction is present in approximately 50% of diabetic men. It is most often caused by diabetic neuropathy and angiopathy but psychogenic factors are also of importance. Treatment includes: elimination of risk factors, psychotherapy, pharmacologic treatment and implantation of penile prosthesis.

Diabetic Angiopathies↗