Intracavernosal Papaverine Research Articles

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.

Vacuum constriction devices: second-line conservative treatment for impotence.

Intracavernosal pharmacotherapy is not a universally successful treatment of impotence. Vacuum constriction devices are reported to be an effective non-operative alternative. This study investigated the value of these devices in 45 impotent men who had failed to become established on intracavernosal papaverine. Although 38 were able to obtain an erection-like state using a vacuum constriction device, only 12 were able to enjoy satisfactory sexual intercourse and, of these, just 7 men found them of sufficient benefit to warrant purchase. Success is not predicted by aetiology. Vacuum constriction devices are of some use, but a trial period of use should be allowed to each patient before purchase.

Erectile Response to Visual Erotic Stimuli Before and After Intracavernosal Papaverine, and its Relationship to Nocturnal Penile Tumescence and Psychometric Assessment

Three methods of assessing erectile capacity--nocturnal penile tumescence (NPT), response to visual erotic stimuli (VES) and to intracavernosal papaverine (ICI)--have been assessed in 42 men presenting with erectile dysfunction. There was some overlap but also important differences between the 3 measures. Subjects were divided into "high" and "low" NPT groups. The "high" group produced greater erectile responses to both VES and ICI. The combination of VES and ICI was the best discriminator of the two NPT groups, and may be of diagnostic value, particularly in younger men, reducing the need for repeated injections and higher doses of papaverine. In the "low" NPT group, presumed predominantly organic, the ICI response correlated better than the VES response with NPT. In the "high" NPT group, the opposite applied, suggesting that in "psychogenic" cases, response to ICI may be modified by psychological mechanisms which could be of aetiological importance and which deserve further study. These three methods should be regarded as measuring different aspects of erectile function and not as alternative diagnostic procedures. More research is required before their respective diagnostic values are established.

The results of an intracorporeal papaverine clinic

Abstract One-hundred and ninety-four men presented to a male sexual dysfunction clinic in its first year. The management protocol which is based on the use of intracavernosal papaverine injection is described. Some (41.2%) benefited from this treatment; 83.3% of the remainder declined treatment because they objected to the use of needles. Intracorporeal pharmacotherapy provides a useful treatment option in the management of impotence but is limited by the method of administration. Alternative treatment which is less invasive must be developed.

Effects of Intracavernosal Trazodone Hydrochloride: Animal and Human Studies

Trazodone hydrochloride is an oral antidepressant agent which has been associated with the improvement of erections in impotent men and the development of prolonged erections or priapism in potent men. An in vivo study in animal and human subjects was performed to gain experience with the effect of intracavernosal trazodone. In the anesthetized New Zealand White rabbit, intracavernosal trazodone or its major metabolite m-chlorophenylpiperazine (m-CPP) produced full penile erection in 76% and 84% of animals studied respectively with doses ranging from one to 15mg. On the other hand, intracavernosal administration of five mg. papaverine resulted in a prolonged erection in 90% of animals studied. In 13 selected volunteer patients, intracavernosal trazodone caused tumescence but not full penile erection with corporal body pressures of 28.2 ± 5.8mm. Hg. Intracavernosal papaverine or papaverine and phentolamine in these subjects resulted in significantly higher corporal body pressures of 58 ± 18mm. Hg (p < .05). Intracavernosal administration of alpha adrenoceptor agonists but not normal saline resulted in complete detumescence of trazodone- or m-CPP-induced prolonged erection in the animal studies. Intracavernosal trazodone results in erectile activity that appears in part based on its local alpha blocking activity but like other intracavernosal alpha-blocking agents is not as effective in initiating penile erections as are intracavernosal agents that directly induce smooth muscle relaxation. (J. Urol., 144: 1277–1282, 1990)

841 - Use of Intracavernosal Papaverine for Management of Psychogenic Impotence

No AccessJournal of Urology1 Jun 1987Use of Intracavernosal Papaverine for Management of Psychogenic Impotence C.B. Dhabuwala, and Anil Kumar C.B. DhabuwalaC.B. Dhabuwala More articles by this author , and Anil KumarAnil Kumar More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75991-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Use of Intracavernosal Papaverine for Management of Psychogenic Impotence." The Journal of Urology, 137(6), p. 314A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 314A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information C.B. Dhabuwala More articles by this author Anil Kumar More articles by this author Expand All Advertisement PDF DownloadLoading ...

Penile Pharmacocavernosography and Cavernosometry in the Evaluation of Impotence

Within the past few years, veno-occlusion of the corpora cavernosa has become generally recognized as an essential prerequisite for adequate penile erection. Veno-occlusive incompetence is suspected to be a frequent cause of impotence.Our recent experience with cavernosography in two normal volunteers and 36 impotent patients indicates that angiography is reliable in evaluating the competence of the veno-occlusive mechanism only if both pharmacocavernosography (PCG) and pharmacocavernosometry (PCM) are applied.Twenty minutes after intracavernosal (IC) injection of a mixture of 60mg. papaverine and one mg. phentolamine (regitine), 100ml. of diluted radiographic contrast medium are infused at the rate of one or two ml./sec. while pressure is recorded, and radiographic films are exposed at the rate of one every eight to 15 seconds.PCM and PCG of the corpora cavernosa indicated the overall degree of competence of the cavernosal veno-occlusive mechanisms, and the sites of veno-occlusive incompetence; non-phar-macologic studies were unreliable in these regards. During non-pharmacologic infusion in normals, pressures rose to 40 to 45mm. Hg, and free efflux could be visualized from multiple venous systems. After pharmacologic injection in normals, all venous channels closed, and pressures rapidly rose toward or above 200mm. Hg, at which time the infusion was stopped.Veno-occlusive incompetence was defined angiographically when more than minimal efflux occurred during pharmacocavernosography from any venous system. The incompetence could involve the deep penile system, the deep dorsal system, or the spongiosal system, alone or in combination. Severe veno-occlusive incompetence was considered diagnostic of venogenic impotence, and was defined manometrically when IC pressures failed to exceed 100mm. Hg during infusion of 100ml. of fluid at 2mm./second after IC papaverine and phentolamine injection.We believe these angiographic methods will improve the criteria against which other diagnostic and therapeutic methods can be assessed.