Complaints Of Erectile Dysfunction Research Articles

Investigation of Vascular Changes Following Penile Vein Ligation

In an effort to characterize the changes in penile vasculature that occur following penile vein ligation, we performed pharmaco-cavernosometry and pharmaco-cavernosography on 20 patients after penile vein ligation for comparison with preoperative studies. Three patients with return of erectile function underwent repeat study: 2 were completely normal and 1 had a mild leak from the deep dorsal vein. The remaining 17 patients had continued complaints of erectile impairment. Of these studies 4 showed no evidence of venous leakage, 11 identified a new site of leakage (7 corporo-spongiosal shunts, 2 crural veins and 2 with multiple sites of involvement) and 1 revealed persistent leak through the proximal stump of the resected deep dorsal vein, while 1 patient had an iodine allergy and underwent pharmaco-cavernosometry only. A repeat study in the latter patient showed flow volumes consistent with continued venous leakage.In summary, penile vein ligation appears to be effective at correcting venous leakage noted on cavernosography. However, new sites of leakage frequently appear postoperatively. A corporo- spongiosal shunt was the most frequent site of recurrent venous leakage. A surprisingly high percentage of patients with continued complaints of erectile dysfunction following penile vein ligation demonstrate no venous leakage on subsequent pharmaco-cavernosography.

Experience with Penile Venous Surgery

Venogenic impotence was detected in 37 out of 141 patients who attended our clinic with a complaint of erectile dysfunction. Eighteen patients presented with primary impotence and the rest had progressive secondary impotence. All 37 patients have shown partial or poor response to 60 mg of intracavernosal papaverine. The corporovenous leak (CVL) was diagnosed on the careful workup of dynamic pharmacocavernosometry and cavernosography. Concomitant arterial cause was noted in 10% cases on the basis of penile duplex Doppler ultrasound study. 24 patients in the age group of 23-60 years underwent the penile venous surgery. The CVL was noted in the deep dorsal vein (23 cases), cavernous vein (16) and in the crural vein (2). The operation consisted of deep dorsal vein (DDV) ligation and excision with all tributaries (8 cases) or DDV ligation and excision+cavernous vein ligation (13 cases), through an infrapubic curvilinear incision. One patient had crural vein ligation and corporoplasty through a perineal incision, one had direct corporeal revascularization for associated arteriogenic impotence with venous leak and another had distal spongiolysis and closure of a corporospongiosal shunt. The results were excellent in 11 cases, improved in 6 and 7 had failures. Surgical intervention is effective in CVL in selected cases but limiting factors in the form of increasing age, concomitant arteriogenic cause, significant crural leak, missing tributaries, recurrent venous leak and unknown factors may also be present to prevent total cure.

Dynamic pharmacocavernosometry: a search for an ideal approach.

Of 141 patients attending the department with complaints of erectile dysfunction, 57 were diagnosed as having organic impotence. Of these 57 patients, 37 were found to have venogenic impotence. All 37 patients had normal Duplex Doppler ultrasound examination and nonvasculogenic factors were ruled out. Corporovenous leak (CVL) was diagnosed on careful workup of dynamic pharmacocavernosometry along with cavernosography. After giving 60 mg of papaverine intracavernosally, dynamic cavernosometry was performed on a Dantec 5000 Urodynamic machine. The vesical or abdominal pressure was taken as intracavernous pressure (ICP) and venous infusion as total intracavernosal flow, measured on a Special User Program. The pressure and maintenance flow criteria were used to diagnose CVL and to define the correlation. Concomitant cavernosography was performed in each case to have radiological evidence. The criteria used to define the leak were: (1) maintenance flow requirement of > or = 30 ml/min, and (2) a fall in ICP of > 40 cm/30 s after achieving full erection when flow is stopped. Apart from these 37 patients, 5 normal controls and 7 patients with psychogenic impotence were also evaluated by this method to establish normal criteria.

Penile Sensory Disorders in Erectile Dysfunction: Results of a Comprehensive Neuro-Urophysiological Diagnostic Evaluation in 123 Patients

A total of 123 patients with complaints of erectile dysfunction and no clinically overt neurological disease underwent a comprehensive neuro-urophysiological diagnostic evaluation. The results were compared with those obtained in 50 healthy volunteers. Data gathered consisted of somatosensory evoked potentials from the posterior tibial nerve (tibial evoked potential) and from the dorsal penile nerve (pudendal evoked potential). Also, 2 sacral reflex latencies were measured (bulbocavernosus reflex and urethro-anal reflex). A total of 58 patients (47%) had at least 1 abnormal neuro-urophysiological measurement. Neuro-urophysiological abnormalities were found more frequently in older patients. The tibial evoked potential was abnormal in 30 patients (24%), pudendal evoked potential in 21 (17%), bulbocavernosus reflex in 26 (21%) and urethro-anal reflex in 32 (26%). It was concluded that somatosensory disturbances constitute an important part of neuro-urophysiological abnormalities. Our results suggest a relationship between erectile dysfunction and subclinical, age-related (penile) sensory disorders. Our study corroborates the importance of penile sensibility for erectile (patho) physiology as suggested by others and supports the concept of sensory deficit impotence as an important cause of erectile dysfunction.

Nocturnal Penile Tumescence in Healthy 20- to 59-Year-Olds: A Revisit

This report presents data on normative nocturnal penile tumescence (NPT), based on a study of 48 healthy men aged 20-59 years, without complaints of erectile dysfunction. In general, the current measures show good concordance with those reported by Karacan and colleagues in 1976. The effect of "pathology-free" aging (from age 20 to 59) on electrographic measures of NPT is relatively modest, accounting for 8.4-14.4% of the variance. Furthermore, no age effect on visual estimates of erectile fullness or on buckling force estimates of penile rigidity were present. Maximum buckling force and maximum erectile fullness showed stability across the four decades of the Pittsburgh sample.

Evaluation of first 406 patients in urology department based center for male sexual dysfunction

Four hundred six patients with a complaint of erectile dysfunction were evaluated in a urology department based Male Sexual Dysfunction Center. Results of physical examination, medical and psychosexual history, nocturnal penile tumescence (NPT), penile blood pressure, visual sexual stimulation, hormonal screen, and partner interview were used in establishing the final diagnosis. A summary of the final diagnoses is as follows: organic impotence 117 (28.8 %), psychogenic impotence 161 (39.7%), combined factors 102 (25.1 %), and dysfunction of unknown origin 26 (6.4 %). Data analysis confirms that to establish a diagnosis of organic erectile failure multiple objective measurements in combination with patient and partner history are necessary.

Erectile dysfunction in men with diabetes mellitus

During a fourteen-month period, 497 men were evaluated for a primary complaint of erectile dysfunction. The initial evaluation consisted of a history taken in a conventional manner and supplemented by a patient-completed sexual function questionnaire, a physical examination, and serum testosterone, serum prolactin, and nocturnal penile tumescence studies. When appropriate, additional evaluations, including penile vascular studies, two-hour oral glucose tolerance tests, and psychiatric consultation were obtained. Abnormal glucose metabolism was present in 161 men (32 %). Five men (1 %) had insulin-dependent diabetes mellitus (IDDM), 80 men (16 %) had noninsulin-dependent diabetes mellitus (NIDDM), 55 men (11.1 %) had newly diagnosed non-insulindependent diabetes mellitus, and 21 men (4.2 %) had impaired glucose tolerance tests. One hundred forty-seven of these men (91.3 %) had organic pattern impotence, and 14 (8.7 %) had psychogenic pattern impotence.

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.

Use of the evoked sacral potential in the evaluation of erectile impotence

AbstractForty‐six men with complaints of erectile dysfunction underwent multifaceted evaluations at our Center for Male Sexual Dysfunction. In addition, the evoked sacral potential (ESP) as a measure of the bulbocavernosus reflex was determined in each patient. The results were correlated with the final diagnoses obtained from the Center evaluation and analyzed. In nine patients a reproducible response could not be elicited. Of the remaining patients, 13 had abnormal and 24 had normal ESP responses. However, only 3 of the 13 patients who demonstrated abnormal ESPs were found to have organic impotence. Similarly, 10 of the 24 men with normal ESPs were thought to have organic impotence. Thus, a specific relationship between the ESP and erectile ability was not demonstrated. Therefore, the ESP is not useful in differentiating between organic impotence of neurogenic origin and psychogenic impotence.

Discrimination of organic versus psychological impotence with the DSFI: a failure to replicate.

Patients with a presenting complaint of erectile dysfunction were extensively investigated by a research team consisting of a urologist, vascular surgeon, psychiatrist and psychiatric social worker. Patients were assigned to organic and psychogenic groups according to specified criteria. Multiple comparisons of psychogenic and organic impotence cases on scores derived from the Derogatis Sexual Functioning Inventory (DSFI) did not differentiate the two groups. This inventory did, however, manifest numerous relationships with demographic variables. Failure to identify a psychological profile characteristic of psychogenic impotence was attributed to the heterogenity of this diagnostic grouping and selection processes in seeking treatment for such disorders.