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PubMed1998

Is apolipoprotein-(a) an important indicator of vasculogenic erectile dysfunction?

We aimed to investigate whether high peripheral and cavernosal plasma levels of apolipoprotein-(a) [Lp (a)] is an indicator for vasculogenic erectile dysfunction. We determined Lp (a), total cholesterol (TC), triglyceride (TG) and high density lipoprotein (HDL) levels in peripheral and cavernosal blood in 39 patients with erectile dysfunction. Thirty-nine impotent patients have been divided into two groups: vasculogenic erectile dysfunction (VED) and nonvasculogenic erectile dysfunction (NVED), according to colour Doppler ultrasonic flowmetry, dynamic infusion cavernosometry, and the pressure difference between the brachial arterial systolic pressure and cavernosal arterial systolic pressure measurements. Biochemical values were compared in both groups. Lp (a) and TC levels were higher in both peripheral and cavernosal samples of VED group than in NVED group, with no differences between peripheral and cavernosal blood levels within the same groups. There were no significant changes in TG and HDL levels in either group. The detection of more than 31 mg/dl in Lp (a) level solely shows the vascular origin with a sensitivity and specificity of 95 and 82.3%, respectively. High Lp (a) levels can be considered an indicator of vasculogenic erectile dysfunction.

Adult↗

PubMed1989

Standardized evaluation of erectile dysfunction in 95 consecutive patients.

We investigated 95 patients referred for erectile dysfunction by penile blood pressure measurement, the intracavernous papaverine test and Doppler investigation of the penile arteries. Furthermore, penile cutaneous perception threshold, bulbocavernosus reflex latency and somatosensory cortical evoked potentials of the pudendal nerve were measured. In selected cases cavernosometry, cavernosography and corpus cavernosum electromyography were performed. Doppler investigation of the cavernous arteries after papaverine injection was more reliable than penile blood pressure measurement in the diagnosis of arteriogenic erectile dysfunction. Decreased sensibility of the penis may be the sole factor responsible for inability to sustain an erection. Erectile dysfunction may be provoked by impaired function of the pudendal nerve. Penile cutaneous perception threshold measurement and corpus cavernosum electromyography are mandatory in the evaluation of neurogenic etiology. Cavernosometry and cavernosography are reliable methods in the determination of abnormal drainage from the corpus cavernosum.

Adult↗

PubMed1998

Opportunities for the treatment of erectile dysfunction by modulation of the NO axis--alternatives to sildenafil citrate.

Erectile function in man depends upon a complex interaction of psychogenic, neurologic, hormonal and vascular factors, and therefore the management of erectile dysfunction (ED) reflects this complexity of control. Therapeutic options include psychological and non-pharmacological approaches as well as drug treatments. The effectiveness of the type-5 cGMP phosphodiesterase inhibitor sildenafil citrate (Viagra) confirms the pivotal role of the NO-cGMP axis in promoting and maintaining erection. Although widely acclaimed, sildenafil leaves many questions unanswered, especially regarding its susceptibility to pharmacokinetic drug interactions, and its safety in patients with ischaemic heart disease and those taking nitrates. In view of the epidemiological link between erectile dysfunction and cardiovascular disease in the elderly, this limitation might have much broader implications. The presently available scientific documentation, although less extensive, indicates that NO donors, such as topically applied nitroglycerin (GTN; for example, 1-2 puffs of an ordinary GTN spray applied to the shaft of the penis), might be a reasonable alternative. Further larger-scale research on the efficacy and tolerability of topical GTN is needed to establish its full therapeutic potential in the treatment of erectile dysfunction.

Cyclic GMP↗

PubMed1996

[Neurologic diagnosis of erectile dysfunction].

OBJECTIVES: To describe a clinical method for the evaluation of neurological disorders in erectile dysfunction. METHODS: A new method for neurological evaluation in erectile dysfunction is presented. CONCLUSIONS: Although the study is complex, the method of evaluation described herein is considered to be indicated basically in erectile dysfunction highly suspected as having an underlying neurogenic cause.

Erectile Dysfunction↗

PubMed1988

Differentiating the etiology of male erectile dysfunction using the Millon Behavioral Health Inventory and self-report measures.

This study examines the effectiveness of using the Millon Behavioral Health Inventory in conjunction with self-report measures of erectile dysfunction to classify the etiology of erectile dysfunction in males. Subjects were 70 males with erectile dysfunction. The results indicate that 47% of the subjects with psychogenic etiology, 65% with mixed etiology, and 71% of the subjects with organic etiology were correctly classified. These and previous findings indicate that the MBHI is an effective method of assessing the etiology of erectile dysfunction.

Adult↗

PubMed1998

[Erectile dysfunction secondary to hyperprolactinemia. Apropos of 13 cases].

Hyperprolactinemia is the cause of erectile dysfunction in less than 1% of cases. From 1989 to 1996, 13 patients consulted for erectile disorders associated with hyperprolactinemia. The mean age was 47.5 years. 10 patients complained of decreased libido. 3 patients had gynecomastia. Plasma prolactin levels ranged from 31.3 ng/ml to 1,300 ng/ml. 7 patients had a plasma testosterone less than 4 ml/ng. 7 patients had a micro- or macroadenoma of the sella turcica visualized by MRI. After drug treatment, plasma prolactin levels returned to normal in all patients in whom assays were performed. 6 patients considered that their erectile function was restored. 5 of the 6 patients with no improvement of their sexual function had a concomitant disease able to explain the impotence. Hyperprolactinemia is a rare cause of erectile dysfunction, but it must be considered in any patient presenting with idiopathic erectile dysfunction associated with decreased libido, gynecomastia, and decreased plasma testosterone. Drug treatment is effective and MRI of the sella turcica should be performed looking for a pituitary adenoma.

Adult↗

PubMed1997

Cavernous oxygen tension in the patients with erectile dysfunction.

We designed a study consisting of 27 consecutive patients with erectile dysfunction in order to evaluate the role of cavernous oxygen tension. Patients were completely evaluated by history, physical examination, multiple blood analyses, serum testosterone level measurements, papaverine test, color duplex sonography and dynamic infusion cavernosometry-cavernosography. Blood gas samples were obtained from femoral artery and corpus cavernosum before drug injection and also from corpus cavernosum at 5, 10, 20, 30, 40 min following drug injection. Aetiologic classification of erectile dysfunction in our patients was as follows: psychogenic in 8, cavernosal failure in 14 and arterial disease in 5 cases. At flaccidity, no significant differences were found in the mean pO2, sO2, pCO2 and pH values of patient groups. After injection of intracavernous papaverine, results of the cavernous pO2 (P < 0.05), sO2 (P < 0.05) levels were found to be statistically significantly different between patients with vascular and psychogenic erectile dysfunction. Analysis of maximal cavernosal oxygen tension and PSV revealed statistically significant correlation (r = 0.66, P < 0.001). The results of this study suggest that changes in arterial and cavernosal pO2 and sO2 values may be contributing factors or co-factors in erectile failure.

Adult↗

PubMed1998

Clinical safety of oral sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction.

Sildenafil citrate has been shown to be effective in a wide range of patients with erectile dysfunction and has been approved in the United States for this indication. The overall clinical safety of oral sildenafil, a potent inhibitor of phosphodiesterase type 5, in the treatment of erectile dysfunction was evaluated in more than 3700 patients (with a total of 1631 years of exposure worldwide). Safety and tolerability data were analysed from a series of double-blind, placebo-controlled studies and from 10 open-label extension studies of sildenafil in the treatment of erectile dysfunction. A total of 4274 patients (2722 sildenafil, 1552 placebo; age range 19-87 y) received double-blind treatment over a period of up to six months' duration, and 2199 received long-term, open-label sildenafil for up to 1 y. The most commonly reported adverse events (all causes) were headache (16% sildenafil, 4% placebo), flushing (10% sildenafil, 1% placebo), and dyspepsia (7% sildenafil, 2% placebo) and they were predominantly transient and mild or moderate in nature. These adverse events reflect the pharmacology of sildenafil as a phosphodiesterase type 5 inhibitor. No cases of priapism were reported. The rate of discontinuation due to adverse events (all causes) was comparable for patients treated with sildenafil (2.5%) and placebo (2.3%). In open-label extension studies, 90% of patients completed long-term sildenafil treatment, with only 2% withdrawing due to adverse events. Sildenafil is a well-tolerated oral treatment for erectile dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1993

[Erectile dysfunctions in patients treated with hemodialysis and kidney transplantation].

The incidence of erectile dysfunction in patients suffering from severe renal diseases in the stage of renal insufficiency is significantly higher in comparison with healthy men of the same age. In the etiopathogenesis of erectile disorders, both organic and psychogenic factors participate in combination. By means of a questionnaire, the authors have collected information from 53 men treated by hemodialysis and kidney transplantation because of renal failure. Erectile disorders occurred in 41.5 per cent of men with chronic renal insufficiency. On one side hemodialysis improved the erectile dysfunction in two patients, in total, however, the incidence of impotence increased to 64.2 per cent. Erectile dysfunction was reported by 71.7 per cent of patients after kidney transplantation. The authors describe two cases of iatrogenic arterial insufficiency of the penis as the cause of impotence after secondary renal transplantation. In uremic patients as possible therapeutic methods, intracavernous application of vasoactive drugs or penile prostheses implantation should be considered. (Fig. 2, Ref. 20).

Adult↗

PubMed1994

[Erectile dysfunction and hypogonadism. Is routine endocrine screening necessary?].

Erectile dysfunction is rarely caused by hypogonadism. We distinguish between primary and secondary hypogonadism. Among 70 consecutive men treated for impotence within 1 year in the authors' clinic, the rate of endocrinopathy was 4.3%. The exact role of testosterone in male sexual function is unclear. Testosterone replacement may be helpful only in patients with low serum testosterone and decreased libido. Endocrine screening is necessary in impotent patients with clinical signs of hypogonadism. Patients with decreased libido and no signs of hypogonadism should also be undergo endocrine evaluation. Routine endocrine testing for all patients with erectile dysfunction is expensive and not productive.

Adult↗

PubMed1999

Male infertility and erectile dysfunction in spinal cord injury: a review.

OBJECTIVE: To review the pathophysiology, evaluation, and management of erectile dysfunction and infertility in spinal cord injury (SCI). STUDY SELECTIONS: Studies that covered various treatment options and their contraindications, complications, or side effects, including sildenafil (Viagra), intracavernosal injection therapy, topical medications and a urethral delivery system, a vacuum erection device, and penile prostheses. Other studies covered the effects of SCI on reproduction: spermatogenesis and testicular function, and seminal constituents. In addition, assisted reproductive techniques were compared: external vibratory stimulation, electroejaculation, testicular sperm aspiration, and intracytoplasmic sperm injection. CONCLUSION: Goal-directed therapy is the mainstay of treatment of erectile dysfunction in men with or without SCI. The choice of therapy is often defined more by the needs of the patient's sexual relationship than by his erectile dysfunction. The majority of men with SCI are infertile because of a combination of ejaculatory dysfunction, impaired spermatogenesis, and poor semen quality. Although many technological advances have evolved to overcome ejaculatory dysfunction, the sperm density, motility, and function remain poor. Until these parameters are improved, men with SCI will have to pursue more financially and emotionally taxing procedures. Further studies to elucidate the cellular and molecular mechanisms of diminished sperm quality are needed. Addressing the issues of erectile dysfunction and male infertility may help to preserve the relationship between the patient and his partner.

Erectile Dysfunction↗

PubMed1999

[The impact of creating andrology units on the treatment of erectile dysfunction with intracavernosal injections].

OBJECTIVE: The impact of the creation of the andrology unit on intracavernous injection therapy for erectile dysfunction is analyzed in the present study. METHODS: The records of patients treated by intracavernosal injection of vasoactive drugs for erectile dysfunction from 1990 to 1997 were reviewed. RESULTS/CONCLUSIONS: Demands for solutions to the problem of erectile dysfunction have significantly increased over the last decades. The efficacy of intracavernosal injection of vasoactive drugs in the treatment of erectile dysfunction has been demonstrated. After the creation of the andrology unit within the urology services, patient acceptance of treatment and compliance increased, and complications have diminished.

Erectile Dysfunction↗

PubMed1990

[Results of multidisciplinary assessment of patients with erectile dysfunction].

A total of 326 patients with chronic erectile dysfunction were investigated by a multidisciplinary approach. It was found that several causes combined (multifactorial genesis) in 77.1%. Organic causes alone were found quite frequently, viz. in 43.6%, while primarily psychogenic causes alone were found in only 5.5%; in contrast, combined organic and psychogenic causes were found in 46.0%. There were pathologic organic findings in 89.6%: vascular in 74.5% (arterial 64.1%, cavernous/venous 30.4%), neurogenic in 42.0%; side effects of drugs in (10.1%); endocrine (7.7%) and local penile causes (4.3%) are not so important in erectile dysfunction. Treatment suited to the pathogenesis was instituted (psychotherapy, vein ligation, self-injection of vasoactive drugs into the corpus cavernosum).

Adult↗

PubMed1997

Patient attitudes regarding treatment-related erectile dysfunction at time of early detection of prostate cancer.

OBJECTIVES: To assess potency rate and patient attitudes regarding erectile dysfunction. METHODS: A multiple choice, self-administered questionnaire distributed to 750 men undergoing testing for early detection of prostate cancer was used. RESULTS: Overall, 33.9% of patients reported either partial or complete lack of erections and 31.1% were not sexually active or active less than once per month. Furthermore, 55.4% would be affected or very affected by lack of erections and 73.6% chose definitive treatment despite a 50% chance of erectile dysfunction. Finally, 47.4% found such treatment-induced erectile dysfunction to be an important or very important problem. When asked to ascribe a quantity of life or period of time that they would be willing to sacrifice to preserve sexual function following treatment, only 15.2% of patients were able to do so, but no consensus could be reached regarding its value. CONCLUSIONS: Reported differences in quality-adjusted life expectancy when screening was compared to no screening and definitive therapy was compared to expectant management are marginal. Therefore, close attention to seemingly minor variables such as existing impotence rate, attitude regarding erectile dysfunction, and willingness to undergo therapy despite its inherent morbidity may substantially reduce or even reverse this reported disadvantage.

Adult↗

PubMed1999

[Erectile dysfunction. An update].

Although around 10% of men aged 40 to 70 years have complete erectile dysfunction, only a few seek medical help. As erectile dysfunction is frequently associated with a number of systemic illnesses and surgical treatments, a wide range of doctors should be aware of the condition in their patients. Current effective treatments include psychosexual counselling, vacuum erection devices, intracavernosal and transurethral drug delivery, and penile prostheses. Promising oral treatments are currently being investigated. Both doctors and the public need to be better informed about erectile dysfunction and its treatment.

Adult↗

PubMed2000

Erectile dysfunction: a review of a common problem in rapid evolution.

Erectile dysfunction (ED) has been defined by the National Institutes of Health Consensus Conference in 1993 as the inability to achieve and/or maintain an erection adequate for penetration and completion of satisfactory intercourse.1 Erectile dysfunction, the preferred term, is more accurate and less pejorative than impotence.An estimated 20-30 million American men are affected with ED of varying degrees of severity. The Massachusetts Male Aging Study published in 1994 reviewed 1,211 men between the ages of 40 and 70; 52% reported ED with 9.6% having mild, 22.2% moderate, and 17.2% complete or severe ED.2 The National Health and Social Life Survey, authored by Laumann et al.,3 reviewed a population of men and women between the ages of 18 and 59. Of note, female sexual dysfunction exceeded male sexual dysfunction, with 43% of women complaining of sexual function problems. Interestingly, except for lubrication, this seemed to decrease with age in women. On the other hand, 31% of the men complained of sexual problems that increased with age.Erectile dysfunction is an age-dependent problem. Approximately 2% of men are affected at 40 years of age and about 25% or more at 65 years of age.4 However, ED is not an inevitable result of aging. Rather, as a man matures it is most likely that he will experience more of the neurovascular insults resulting in ED.The development of an erection and satisfactory sexual function is a complex process. As suggested by Melman et al.,5 "Erection is truly at least a sensory-motor-neuro-hormonal-vascular-psycho-social-cultural-interpersonal event." There are two main classifications of ED, psychogenic and organic. Current thinking suggests that up to 80% of ED is primarily of organic etiology. Yet, there is always a psychogenic factor.6 Erectile dysfunction may signal serious underlying and potential life-threatening diseases, such as diabetes, hypertension, cardiovascular disease, peripheral vascular disease, and other neurologic and endocrine disorders. Therefore, questions regarding sexual function should be part of routine medical evaluation.

Journal Article↗

PubMed1995

[Erectile dysfunction in patients with type I diabetes mellitus].

To improve diabetes care according to the St. Vincent Declaration an interdisciplinary working group on erectile dysfunction in patients with diabetes was installed in the Departments of Internal Medicine, Urology and Psychiatry at the University of Graz. The screening and basic diagnostic procedures are performed in the diabetes clinic in the Department for Internal Medicine. To inform the patients about the options of treatment of diabetic erectile dysfunction and to determine prevalence data an anonymous questionnaire with a pre-stamped envelope was sent to 133 male patients with diabetes mellitus type I (IDDM). 59 (44%) of the questionnaires were returned and could be analyzed. Mean age and diabetes duration were representative for the male diabetes population. The prevalence of erectile dysfunction in this group was 49%. 7% of the patients were completely impotent. None of the patients reported the use of erection aids as a vacuum device or intracavernosal injection of smooth muscle-relaxant drugs. The prevalence of erectile dysfunction is high among patients with diabetes mellitus type I. Modern management offers satisfactory success in most cases, therefore screening for erectile dysfunction and adequate therapy should be offered to all patients.

Adolescent↗

PubMed1997

Effect of oral administration of prostaglandin E1 on erectile dysfunction.

OBJECTIVES: To investigate the effect of limaprost, an oral prostaglandin E1 (PGE1) derivative, on erectile dysfunction and to compare the effects of limaprost with a Chinese herbal drug, gosyajinki-gan. PATIENTS AND METHODS: The study comprised 50 consecutive patients with mild erectile dysfunction who showed a good erectile response to intracavernosal injection with 20 micrograms of PGE1. Limaprost was administered to the first 25 patients (30 micrograms three times daily) and gosyajinki-gan (7.5 g three times daily) to the next 25 patients, for 8 consecutive weeks. Patients were evaluated by their ability to achieve vaginal penetration and by a subjective assessment of erectile function (penile rigidity and maintenance of erection) before and after the treatment, using a self-administered questionnaire. Objective measurements (nocturnal penile tumescence, NPT, values) were also evaluated. RESULTS: Eleven of the 24 patients who received limaprost without interruption and four of the 24 taking gosyajinki-gan succeeded in vaginal penetration; the difference in the positive response rate was significant. The mean increment of NPT was significantly higher with limaprost treatment. However, all positive responders in both groups did not experience a full erection. There were no side-effects in any patient except one in the limaprost group who developed a facial flush. Thus the treatment was mild enough to be tolerated. CONCLUSION: Limaprost was more effective for mild erectile dysfunction than was gosyajinki-gan.

Administration, Oral↗