Cause Of Impotence Research Articles

Surgical treatment of impotence caused by megalourethra

A twenty-three-year-old impotence patient is presented who had never achieved penile erection and who suffered megalourethra and megaloureter. Through a penothermocurve the cause of impotence was diagnosed as megalourethra and extensively thickened penile skin. Plastic surgery was performed, and sufficient resection of the enlarged urethral wall and penile skin resulted in successful penile erection and satisfactory intercourse. The usefulness of the penothermocurve was demonstrated as a means for the differential diagnosis of impotence.

Erectile impotence in chronic alcoholics.

Erectile impotence is a common complaint in alcoholics, but its mechanism is unknown. We have studied nocturnal penile erection in 13 alcoholics who complained of impotence. Seven had normal erections and their impotence was therefore psychogenic. Six were found to have diminished or absent nocturnal erections. Plasma concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were elevated in this latter group, with the exception of one patient who had only raised FSH. They also had more evidence of neurological damage than the other seven alcoholics, and two had evidence of damage to the parasympathetic nervous system. Investigation of erection during sleep in alcoholic patients with impotence may be useful in differentiating clinically between patients with psychogenic causes and patients with organic causes of impotence.

Causes of Impotence

To the Editor.— The report by Slag et al (1983;249:1736) entitled in Medical Clinic Outpatients indicated that 14% of the patient study group had impotence of psychogenic origin. Final diagnosis for each of the patients was made at the conclusion of history taking, physical examination, and elaborate endocrine laboratory studies. Those with psychogenic impotence were said to have normal physical examination and normal endocrine study findings. The rest of the patients were classified into their diagnostic categories based on drug history and abnormal laboratory test results and physical findings. The most frequent cause of impotence was drug effects. Medication effect was prominent in those with hypertension. Some antihypertensive medications such as methyldopa, β-blockers, and reserpine could cause depression. Impotence per se, whatever its cause, is anxiety provoking for many. Both depression and anxiety have profound effects on sexual performance. The impression one gets from reading the study is that

Selective arteriography for vascular impotence

Selective pudendal arteriography plays an important role in clinical research into the vascular causes of primary and secondary impotence and forms the basis for microsurgical penile artery revascularization. Arteriography has identified a heretofore undescribed cause for impotence, arteriovenous malformation. Despite potential risks, this should be performed where revascularization is a possibility. Many patients find penile implantation undesirable and are willing to be studied in this manner.

Endocrine causes of impotence. Optimistic outlook for restoration of potency.

Endocrine disorders are important, potentially reversible causes of impotence. Impotence may be an early manifestation of hypopituitarism, nonfunctioning pituitary tumors, prolactin-secreting pituitary tumors, or hyperthyroidism. Treatment of these disorders, as well as many of the other endocrinopathies with which impotence may be associated, usually leads to restoration of libido and potency. When impotence is caused by the autonomic neuropathy of diabetes, however, treatment of the endocrinopathy rarely restores sexual function. Sex therapy or implantation of a penile prosthesis may be useful in selected patients with this cause of impotence.

The Inflatable Penile Prosthesis

Only five years ago, it was widely believed that 90 percent of erectile impotence resulted from psychogenic factors. But recent research demonstrates that many such cases may have an organic basis. And the criteria for surgical insertion of a penile prosthesis, a device that produces erections, have also changed. The extensive psychiatric counseling and requirement that the surgical candidate have a sexual partner, once considered prerequisites for undergoing the procedure, are no longer mandated. Spinal cord injury is the most publicized cause of impotence; however, many more common conditions also lead to this sexual dysfunction. It is estimated, for example, that 50 percent of diabetic men are permanently impotent and that 13 percent of this group present with impotence as an initial symptom of their diabetes(1). Arterial ischemia also leads to erectile dysfunction in many men who have atherosclerosis of the aorta and common iliac arteries(2). Extensive pelvic surgery, such as radical prostatectomy or cystoprostatectomy, can be expected to destroy the prostatovesical nerve plexus, and impotence almost invariably follows(3). Long-term use of certain drugs, such as antihypertensives, may also bring about impotence. When the cause is prostatitis or another acute infection that responds to antibiotics, impotence is usually temporary. Hormone therapy may resolve temporary impotence caused by endocrine disorders. The most frequent cause of impotence in our patients is arteriosclerotic vascular disease. Other common causes are radical pelvic surgery and diabetes mellitus. A history and physical are essential first steps in determining if impotence is organic. The physical should include a neurologic exam to determine if there is nerve damage and, if so, how extensive it is. Specific diagnostic tests then may be indicated, especially if examination reveals no obvious organic cause. One such diagnostic tool is the nocturnal penile tumescence test, in which electrodes are placed on the penis to monitor erections during sleep. A normal recording should indicate three to five involuntary erections during REM (rapid eye movement) sleep. An absence of sleep erections usually indicates that impotence is physical in origin. The Doppler ultrasound flow meter may be used to detect obstruction of blood flow through the arteries of the penis, suggesting atherosclerosis of femoral or iliac vessels. PsychoMARY CATHERINE SHORT GOOGE, RN, MSN, is the surgical patient care coordinator at WillisKnighton Medical Center, Shreveport, La. One of her responsibilities is supervision of a 32-bed urology unit.

8 Arterial disease as a cause of impotence

The traditional views on the aetiology of impotence, attributing more than 90 per cent of all cases of impotence to psychic pathogenesis, have changed. Measurement of penile blood pressure, nocturnal penile tumescence studies (NPT) and especially new techniques of arteriographic examination of the arterial bed supplying the cavernous bodies have shown that the majority of cases have an organic basis affecting the haemodynamics of erection (limitation of arterial inflow into the cavernous bodies and/or their excessive venous drainage). Arterial disease, which is the most frequent affection in the middle-aged and elderly male population, is also largely implicated in the pathogenesis and aetiology of impotence. Recognition of this role of arterial disease is important not only with respect to the treatment of impotence but above all with respect to prevention of even more serious complications of the former condition such as IHD and MI, cerebrovascular disease and stroke, or intermittent claudication and gangrene.

Impotence Following Radical Prostatectomy: Insight Into Etiology and Prevention

This study was undertaken to identify the cause of impotence in men undergoing radical prostatectomy, with the hope that this information may provide insight into the possible prevention of this complication. The autonomic innervation of the corpora cavernosa in the male fetus and newborn was traced to determine the topographical relationship between the pelvic nerve plexus, and the prostate, urethra and urogenital diaphragm. We have demonstrated that the branches of the pelvic plexus that innervate the corpora cavernosa are situated between the rectum and urethra, and penetrate the urogenital diaphragm near or in the muscular wall of the urethra. Injuries to the pelvic plexus can occur in 2 ways: 1) during division of the lateral pedicle and 2) at the time of apical dissection with transection of the urethra. Thirty-one men who underwent radical retropubic prostatectomy were evaluated to determine risk factors that correlated with postoperative impotence: 5 (16 per cent) were fully potent, 7 (23 per cent) had partial erections that were inadequate for sexual intercourse and 19 (61 per cent) had total erectile impotence. The 2 factors that had a favorable influence on postoperative potency were age and pathologic stage of the lesion: 31 per cent of the patients less than 60 years old were potent versus only 6 per cent of the patients more than 60 years, while 33 per cent of the patients with tumor microscopically confined to the prostatic capsule were potent versus only 5 per cent of those with capsular penetration. When the factors of age and capsular penetration were combined 60 per cent of the men less than 60 years old who had an intact prostatic capsule were potent. Arterial insufficiency and psychogenic factors were excluded as major contributing factors by the finding of normal penile blood flow and absence of nocturnal penile tumescence in the impotent patients. We conclude that impotence after radical prostatectomy results from injury to the pelvic nerve plexus that provides autonomic innervation to the corpora cavernosa. Further studies will be necessary to determine whether refinements in surgical technique, especially during ligation of the lateral pedicle and apical dissection, can prevent this complication.

Impotence in the boar 2: Clinical and anatomical studies on impotent boars.

Six boars were deficient in penile erection and incapable of intromission, but produced ejaculates containing spermatozoa. In five of these boars impotence was primary, but one boar had served normally for two seasons before showing secondary impotence. Sexual libido was good in two, moderate in two and poor in two of these animals. Post mortem studies on the reproductive tracts revealed no abnormalities except in the penes. In one of the boars with primary impotence, the penis showed an abnormal type of spiral deviation during simulated erection, but there was no abnormality in the venous drainage of the organ. In the other five boars, injection experiments revealed venous drainage of the corpus cavernosum penis (ccp) into the dorsolateral (left) tributary of the v dorsalis penis. In four cases, the apical cavernous spaces of the ccp communicated with the vascular spaces of the corpus spongiosum glandis. No direct communications with the corpus spongiosum penis (csp) were demonstrated but the csp was injected from the ccp indirectly, by way of the dorsal venous system. It is suggested that these abnormalities may have been the immediate cause of impotence in these five boars. This possibility is discussed in relationship to the processes of erection and ejaculation and to various clinical signs shown by these animals. The abnormalities of venous drainage were thought to be developmental in origin and the condition may be inherited.

Role of frenular penile‐brachial index in the assessment of penile vasculature

AbstractThe evaluation for vasculogenic causes of impotence includes penile Doppler studies. These are often time‐consuming and tedious procedures. A retrospective study of the last 54 penile Doppler examinations was carried out to determine if an abbreviated study would accurately reflect the status of the penile vasculature. The frenular sound is easily auscultated. There is statistically significant correlation between frenular penile‐brachial index (PBI) and corporal PBI. We therefore recommend that the frenular PBI be used as a screening procedure. More complete Doppler studies including corporal measurements are only necessary when the frenular PBI is not normal.

Characteristics of erectile dysfunction as a function of medical care system entry point.

The scientific literature on the treatment of penile erectile dysfunction contains numerous contradictory reports on the relative frequency of organic causes of impotence and the treatment results of behavioral sex therapy. One explanation for these contradictory findings is the hypothesis that different investigators are studying different subsamples of the symptomatic population. This study investigated differences in characteristics of men who initially consulted a urologist with a complaint of impotence versus those who self-referred themselves to a sexual dysfunction clinic. Self-referred sexual dysfunction patients were more often white, more often had psychogenic etiologies to their difficulties, were more often of higher socioeconomic class, and had a much better response to psychological interventions. This study suggests that future studies concerning the etiology and treatment of impotence need to specify population characteristics such as referral source and screening criteria. It may be necessary to develop alternative treatment techniques for men who present to nonpsychiatric sources for help with psychogenic impotence.

Diabetes and impotence

To the Editor.— The authors of the article Previously Unrecognized Diabetes Mellitus in Sexually Impotent Men (1980;244:2430) presented interesting data. The article clearly demonstrates that diabetes may be found in patients with impotence. However, we think that their finding, seven diabetics in 58 patients (12.1%) with secondary impotence (SI), does not influence the previously held assumption that 90% 1 of all impotence is of psychogenic origin. They were specific in excluding from their study those patients with clinical evidence of psychological causes. Thus, they selected for men with an organic cause of impotence. At present there is no evidence to suggest that diabetics have either a higher or lower incidence of psychogenic impotence than nondiabetics (1980;243:750). The authors also concluded that because 12.1% of the SI group had asymptomatic diabetes that localized neuropathy or penile ischemia may produce impotence in otherwise symptomless patients. There was no attempt to confirm this

Penile body temperature as screening test for penile arterial obstruction in impotence

Intraurethral penile body temperature measurement is a simple, inexpensive procedure designed for screening impotent patients which can be done in the physician's office. The results give a reliable index of penile arterial circulation and can suggest possible organic impairment, which can be verified further by other noninvasive vascular studies. In our experience, patients having more than 3°F. difference between sublingual and internal penile temperature are most likely to have significant penile arterial obstruction. This method is recommended as a diagnostic procedure to help detect possible vasculogenic causes of impotence.

Importance of Penile Arterial Pulse Sound Examination in Impotence

Experience with the Doppler ultrasound examination of penile arteries in 93 impotent men is presented. The technique for this examination is a simple, reliable, inexpensive office procedure for the detection of penile arterial obstruction in patients with impotence. With this test 44 per cent of impotent men were found to have obstructive blood flow in the penis as the cause of impotence. A 95 per cent accuracy rate with this technique was confirmed by penile angiography in 22 patients.Since impotence is a common problem facing the clinicians it is important to detect penile arterial disease—a main causal agent of many impotent men.

Sexual function in diabetic patients.

Although sexual dysfunction in the male diabetic has been recognized for many years, only recently has systematic investigation been undertaken to understand the problems involved. The marked increase of impotence in diabetes has been shown to be, to a significant extent, a result of diabetic autonomic pelvic neuropathy. However, awareness of other causes of impotence is essential for proper diagnosis and appropriate therapy. Strikingly, the marked impact of diabetes on male sexual function is not shared by the female diabetic patient, whose sex interest and orgasmic reaction are essentially unimpaired when compared with those of the nondiabetic female.

Impotence after kidney transplantation

Sexual performance was evaluated in 28 men, thirty to sixty years of age, with functioning renal allografts: 13 were potent (controls), 10 had moderate sexual dysfunction, 5 had marked sexual dysfunction. Penile blood pressures, serum hormone levels, plasma zinc levels, and penile venous angiography were evaluated in search of causes of impotence. Thirteen of 15 impotent transplant patients (87 per cent) had marked abnormalities in at least one of the four areas studied. Systematic search for etiologic factors may permit specific therapy for impotence, which occurred in 54 per cent of the 28 kidney transplant patients analyzed.

Hyperprolactinemia: a possible cause of sexual impotence in male patients undergoing chronic hemodialysis.

Hyperprolactinemia is known to cause impotence in patients with normal renal function and elevated serum prolactin levels (SPLs) have also been reported in uremia. This study was undertaken to examine a possible role of elevated SPLs in the impotence of male patients undergoing chronic hemodialysis (CHD). SPLs in 16 male patients undergoing CHD were evaluated using a homologous double-antibody radioimmunoassay with prolactin isohormones isolated from human amniotic fluid. Patients were divided in 2 groups: 6 patients were sexually impotent and 10 sexually potent. Patients with emotional disturbances or marital conflicts known to cause impotence were excluded from the study. The SPLs of the impotent patients were found to be significantly elevated in comparison to the levels of the potent patients (136.7 +/- 28.2 vs. 37.3 +/- 2.7 ng/ml, p less than 0.001). Furthermore, in 2 patients who were successfully treated with bromocriptine to suppress hyperprolactinemia, recovery of sexual potency was noted. Thus, sexual impotence in male CHD patients seems to be associated with marked hyperprolactinemia. It is suggested that elevated SPLs may be an important cause of impotence among CHD patients.

Prolactinomas

In the past ten years, hyperprolactinemia has been implicated as a possible cause of several common medical problems. One of the first recognized was the so-called amenorrhea-galactorrhea syndrome. Subsequently it was learned that not all patients with elevated prolactin levels have galactorrhea 1 (only about 20% of hyperprolactinemic women and even fewer men lactate), so that the absence of galactorrhea does not rule out an elevated prolactin level. Several studies have now shown that 15% to 30% of women with secondary amenorrhea (without galactorrhea) also have hyperprolactinemia. 2,3 Most recently, prolactin has been implicated as a cause of impotence and/or oligospermia in men. 4 It also seems likely that many pituitary tumors that in the past were thought to be nonfunctioning chromophobe adenomas were actually prolactin-producing. Thus, the number of clinical presentations associated with hyperprolactinemia and the number of patients affected are much greater than were originally estimated. What is

Impotence in the bull: (2) occlusion of the longitudinal canals of the corpus cavernosum penis.

Lack of penile erection was diagnosed in nine bulls (Poll Hereford three; Aberdeen Angus two; Friesian two; horned Hereford; Sussex). Five had previously served successfully but four had proved impotent when first put to use. In each bull, the dorsal longitudinal canal of the corpus cavernosum penis (ccp) was occluded by fibrous tissue and this was considered to be the immediate cause of impotence. The ventral canals were also occluded in four bulls. In every case, the lesions were so extensive that treatment would not have been likely to succeed. In two bulls the dorsal canal and the tunica albuginea were ruptured proximal to the sigmoid flexure. Radiography of the cavernous spaces and veins during life, and anatomical injections of post mortem specimens, showed that in four bulls the ccp was drained by the dorsal venous system at or distal to the sigmoid flexure. The aetiology and the diagnosis are discussed and the possible physiological implications of occlusions of the canals are considered in terms of the functional anatomy of the ccp.

Impotence in the bull: (1) Abnormal venous drainage of the corpus cavernosum penis.

Six young bulls (two Friesian, two Charolais, one polled Devon and one North Devon) that had never served successfully, showed good libido but lacked penile erection. In five of these bulls, the short flaccid organ was not protruded during attempted service. Radiography of the cavernous bodies and veins of the penis in the living animal demonstrated major venous drainage of the corpus cavernosum penis (ccp) by the dorsal venous system in all cases. This was not seen in normal bulls. Radiography and anatomical preparations of post mortem specimens showed that the ccp was drained by the dorsal venous system throughout the length of the organ. Proximally, the cavernous spaces of the ccp anastomosed with those of the corpus spongiosum penis (csp) and were drained by numerous small veins. Distally, a system of larger veins, not seen in normal bulls, drained into left and right sides of the dorsal venous system. No microscopical abnormalities of spermatozoa or of testes were found, but there was a marked lack of spermatozoa in the caudae epididymides. The evidence suggests that abnormal venous drainage of the ccp may have been the immediate cause of impotence in these bulls.