Management Of Impotence Research Articles

Supporting Patients Treated for Prostate Cancer: A Video Vignette Study With an Email-Based Educational Program in General Practice

BackgroundMen who have been treated for prostate cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following treatment. However, there is no evidence that such men are consistently advised by GPs and patients experience substantial unmet need for reassurance and advice.ObjectiveThe intent of the study was to evaluate a brief, email-based educational program for GPs to manage standardized patients presenting with symptoms or side effects months or years after prostate cancer treatment.MethodsGPs viewed six pairs of video vignettes of actor-patients depicting men who had been treated for prostate cancer. The actor-patients presented problems that were attributable to the treatment of cancer. In Phase 1, GPs indicated their diagnosis and stated if they would prescribe, refer, or order tests based on that diagnosis. These responses were compared to the management decisions for those vignettes as recommended by a team of experts in prostate cancer. After Phase 1, all the GPs were invited to participate in an email-based education program (Spaced Education) focused on prostate cancer. Participants received feedback and could compare their progress and their performance with other participants in the study. In Phase 2, all GPs, regardless of whether they had completed the program, were invited to view another set of six video vignettes with men presenting similar problems to Phase 1. They again offered a diagnosis and stated if they would prescribe, refer, or order tests based on that diagnosis.ResultsIn total, 64 general practitioners participated in the project, 57 GPs participated in Phase 1, and 45 in Phase 2. The Phase 1 education program was completed by 38 of the 57 (59%) participants. There were no significant differences in demographics between those who completed the program and those who did not. Factors determining whether management of cases was consistent with expert opinion were number of sessions worked per week (OR 0.78, 95% CI 0.67-0.90), site of clinical practice (remote practice, OR 2.25, 95% CI 1.01-5.03), number of patients seen per week (150 patients or more per week, OR 10.66, 95% CI 3.40-33.48), and type of case viewed. Completion of the Spaced Education did impact whether patient management was consistent with expert opinion (not completed, OR 0.88, 95% CI 0.5-1.56).ConclusionsThe management of standardized patients by GPs was particularly unlikely to be consistent with expert opinion in the management of impotence and bony metastasis. There was no evidence from this standardized patient study that Spaced Education had an impact on the management of patients in this context. However, the program was not completed by all participants. Practitioners with a greater clinical load were more likely to manage cases as per expert opinion.

Is management of impotence with sildenafil changing clinical practice?

After a report of acute myocardial infarction, possibly due to sildenafil use,1 more side-effects of the drug may be seen in future. The drug's effect on clinical practice is, however, already being observed. Impotence is more frequently reported by patients and the drug is prescribed more frequently by doctors. Guidelines on the management of impotence are commonly forgotten and sildenafil is an easy solution. Erection improves in most patients, irrespective of aetiology. Diagnoses of potentially curable or serious diseases may therefore be missed.

Spinal cord lesions.

Selected topics related to rehabilitation of individuals with spinal cord lesions are reviewed and commented upon. A 10-week arm-cranking programme improved aerobic capacity and endurance in tetraplegics. Furthermore, endurance training and forced vital capacity were found to be positively correlated. Rowing had additional positive effects for scapular retractor recruitment, which may well improve the shoulder stability. Increased abdominal circumference is an important correlate to dyslipidaemia. beta 2-adrenergic agonists can improve muscle strength and size even without simultaneous exercise. Hydrophilic low-friction catheters, for clean intermittent catheterization have performed as well as, or better than, conventional catheters in a long-term follow-up study. Urethral stenting of the bladder neck and the external sphincter seems, in selected patients, to be an attractive alternative to indwelling urethral catheter drainage or sphincterotomy. The majority (> 80%) of the first 500 sacral anterior root stimulators are still in use for micturition and for defecation. The management of impotence in men with spinal cord lesions using intercavernous injections has been confirmed, and oral terbutaline (5 mg) may be used to achieve penile detumescence in cases of prolonged erection. The use of penile implants in men with spinal cord lesions is a problem. Penile vibration with a peak-to-peak amplitude of 2.5 mm is sufficient to obtain ejaculation in most of these men. Age is more important for sexual adjustment than whether the relationship is established before or after the injury. Regular and frequent follow-up of patients with spinal cord injury is the best way to ensure that post-traumatic syringomyelia is diagnosed and managed (surgically drained) early in order to avoid further disability. Two-thirds of individuals with spinal cord injury rate their quality of life as good. Socialization is important in obtaining a good quality of life. Psychological morbidity in the first 2 years after the injury is found in approximately one-third of the population with spinal cord injury; antidepressant drugs should perhaps be used more widely.

Aetiopathogenesis and Management of Impotence in Diabetic Males

Aetiopathogenesis and Management of Impotence in Diabetic Males

Aetiopathogenesis and Management of Impotence in Diabetic Males: Four Years Experience from a Combined Clinic

The contribution of organic and psychogenic factors in the aetiopathogenesis of impotence was studied in a large number of diabetic males, to develop an algorithm for its management. We examined 110 consecutive patients who were referred to the Impotence Clinic of the Diabetes Centre. All patients were initially evaluated by a diabetologist and then underwent psychosexual assessment by a specialized psychiatrist. Patients with primarily organic disease were referred to a urologist for further management while those with psychogenic impotence received psychosexual counselling. Peripheral neuropathy was present in 71 (65%) and two or more autonomic tests were abnormal in 22 (20%) patients. Neuropathy was the only cause detected in 29 (27%) patients, the main cause in 22 (20%), and contributing, but not the main factor, in 20 (18%). Psychogenic factors were the only cause detected in 12 (11%) patients, the main cause in 26 (24%) and contributed in 19 (17%). Marital disharmony, medical treatment, and peripheral vascular disease were the main aetiopathogenic factors in the remaining cases. Psychosexual counselling resulted in successful intercourse in 17 (60%) out of the 24 treated patients and papaverine injections in 31 (61%) out of 56 treated patients. It is concluded that although organic factors are mainly responsible for the development of impotence in diabetic males, psychological factors contribute significantly and psychosexual assessment and counselling are essential adjuncts to its management. Treatment with papaverine injections is generally inexpensive and effective to overcome the multifactorial causes of erectile dysfunction in this population. An algorithm which may facilitate the investigation and treatment of impotent diabetic males is proposed.

Management of impotence. Diagnostic considerations and therapeutic options.

Impotence affects an estimated 10 million American men. The cause is usually organic in men over age 50; psychogenic impotence is more common in younger men. Vascular disease is the most common cause of impotence. Evaluation in patients with impotence includes thorough history taking and diagnostic testing. Once the cause of impotence is determined, appropriate management can be chosen. Current therapeutic options include vacuum tumescence devices, self-injection, oral therapy, psychotherapy, and penile prostheses.

Book Reviews

British Journal of UrologyVolume 69, Issue 5 p. 557-560 Book Reviews First published: May 1992 https://doi.org/10.1111/j.1464-410X.1992.tb15621.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Book reviewed in this article: Complications of Urologic Surgery. Prevention and Management. Second edition. Edited by R. B. Smith and R. M. Ehrlich. Current Genitourinary Cancer Surgery. Edited by E. D. Crawford and S. Das. Current Medical Diagnosis and Treatment. 30th edition. Edited by S. A. Schroeder, M. A. Krupp, L. M. Tierney, Jr. and S. J. McPhee. Neuropathic Bladder in Childhood. (Clinics in Developmental Medicine No. 111). Edited by M. Borzyskowski and A. R. Mundy. Advances in Urology. Volume 3. Edited by B. Lytton, W. J. Catalona, L. I. Lipshultz and E. J. McGuire. Recent Advances in Urology/Andrology, Number 5. Edited by W. F. Hendry. Adult and Pediatric Urology. Volumes 1 and 2. Second edition. Edited by J. Y. Gillenwater, J. T. Grayhack, S. S. Howards and J. W. Duckett. Tumors and Tumor-like Conditions of the Kidneys and Ureters. (Contemporary Issues in Surgical Pathology, Volume 16). Edited by J. N. Eble. Orgasm–New Dimensions. By P. Kothari. Essentials of Uroradiology. By E. S. Amis, Jr. and J. H. Newhouse. Long-term Paediatric Urology. By C. R. J. Woodhouse. Diagnosis and Management of Impotence. By A. W. Zorgniotti and E. F. Lizza. Infertility in the Male. Second edition. Edited by L. I. Lipshultz and S. S. Howards. Magnetic Resonance Imaging of Carcinoma of the Urinary Bladder. (Series in Radiology, Volume 21). Edited by J. O. Barentsz, F. M. J. Debruyne and S. H. J. Ruijs. Volume69, Issue5May 1992Pages 557-560 RelatedInformation

Non‐invasive Management of Impotence with Transcutaneous Nitroglycerin

Nitroglycerin plasters were applied to the penis in 10 impotent men and the erectile effect assessed. During laboratory testing all patients achieved an erectile response. Self-administration of nitroglycerin patches restored potency in 4 patients and was preferred to papaverine auto-injection by 3. Headache was a common side effect during initial administration. An attempt to treat impotence with nitroglycerin plaster seems worthwhile before starting extensive investigations or invasive treatment.

Use of a Vacuum Tumescence Device in the Management of Impotence in Men with a History of Penile Implant or Severe Pelvic Disease

To evaluate the use of a vacuum tumescence device in the treatment of impotence in couples wishing to restore coital function, whose male partners had unsatisfactory results from penile implants or in whom the man was impotent following treatment for prostate or colon carcinoma. Convenience sample of seventeen couples seeking treatment of male factor sexual dysfunction. After completion of a comprehensive diagnostic evaluation of the male partner, couples who expressed a wish to restore coital function were instructed in the use of the vacuum tumescence device. Partners each filled out and initialled a daily diary of sexual activity and returned to clinic for followup at 3 and 6 months. Sixteen patients were able to obtain firm to hard erections lasting an average of 14.9 minutes and had satisfactory coitus with vaginal ejaculation an average of 3.9 times per month. There were no significant complications. The vacuum tumescence device can be effective in the treatment of impotence after penile prosthesis explantation, in enhancement of inadequate erections with a prosthesis in place, and after surgical or radiation therapy for prostate or colon carcinoma.

The Management of Impotence in Diabetic Men by Vacuum Tumescence Therapy

The treatment of impotence in diabetic men with vacuum tumescence therapy was studied in a specialist clinic. Of 54 diabetic men referred with impotence, seven declined treatment, three chose self-injection with papaverine, and 44 chose vacuum therapy. Patients underwent autonomic function testing (heart rate response to respiration), measurement of penile blood flow (duplex Doppler scanning), and estimation of serum prolactin and testosterone levels. After 2 months, 33 men (75%) were able to have satisfactory intercourse using vacuum therapy. Three others could produce a satisfactory erection with vacuum therapy but their partners found it unacceptable. Eight men (18%) were unable to have satisfactory intercourse; six of these were later treated by self-injection. The median frequency of use of vacuum therapy was 5.5 (1-26) times a month. Outcome was independent of penile blood flow, autonomic function or endocrine status. Impotent diabetic men should be given counselling and offered a choice of the available treatments. Vacuum tumescence therapy is an effective and simple treatment which requires little investigation.

Why are impotent diabetic men not being treated?

AbstractThe prevalence of impotence among a group of 158 consecutive men attending a diabetic clinic was studied by questionnaire. The frequency of reporting of impotence and the advice and treatment patients had received were determined.The prevalence of impotence was 36.7%. Forty‐nine of the impotent men (84%) wanted treatment; 21 had never asked for medical advice because of embarrassment, ignorance of availability of treatments or a belief that impotence was normal at their age. Twenty‐eight had consulted a doctor, nine presented at the diabetic clinic and were treated successfully; 19 consulted their general practitioner alone and were advised incorrectly.Most impotent diabetic men want treatment but do not ask for help or are advised incorrectly. Both patients and doctors need to be better informed about the management of impotence in diabetes.

Impotence after Radical Pelvic Surgery: Physiology and Management

Impotence has been a common problem after radical surgery of the colon, rectum, prostate, bladder, and seminal vesicle. However, a better understanding of the neuroanatomy of erection has resulted in its decline. When impotence does result, in cases where the extent of tumor involvement renders preservation of the neurovascular bundle impossible, the variety of treatments available is now improved: these include intracavernous injection of vasodilators, vacuum constriction devices, penile arterial and venous surgery, and penile prostheses. The improved understanding and management of impotence has greatly enhanced the quality of life of patients after radical pelvic surgery.

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.

Penile Prostheses in the Management of Impotence in Sickle Cell Disease

Priapism lasting more than 24 h in adults with homozygous sickle cell disease usually results in impotence. The dense fibrosis of the corpora cavernosa which destroys the normal vascular erectile system of the penis also complicates insertion of penile prostheses. Our experience in 5 patients is reviewed. Sharp dissection and dilatation were necessary to form a tunnel for the prosthesis, which was more easily excavated anteriorly and posteriorly through a dorsal incision than for the length of the corpora through a traditional perineal-scrotal incision. Damage to the tunica was common and subsequent migration of the prosthesis necessitated an additional 11 procedures under general anaesthesia. Despite these technical difficulties, the procedure allowed satisfactory intercourse. The average interval between onset of impotence and implantation was 4 years. Early implantation before the dense fibrosis develops might give more satisfactory results.

Use of a Vacuum Tumescence Device in the Management of Impotence

This study evaluated the use of a vacuum tumescence device in the treatment of impotence in older men. Twenty couples with sexual dysfunction due to erectile impotence and who were interested in restoration of sexual function were treated by providing them with both a vacuum tumescence device to engorge the penis and an obstructing band to impede venous return. Nineteen patients established firm to hard erections lasting an average of 16 minutes and were able to have satisfactory coitus with vaginal ejaculation an average of three times per month. The penile-brachial pressure index, supine and after exercise (a measure of the adequacy of penile arterial flow), exhibited a significant increase following six month's use of the vacuum tumescence device. The only significant complications were mild, self-limited hematomas on three occasions of use. Thus in this limited series the vacuum tumescence device provided a well-accepted, relatively inexpensive therapeutic approach to impotence.

Intracorporeal Papaverine Injection in Androgen Deprived Men

The intracorporeal injection of papaverine (ICP) is now a well recognized therapeutic option in the management of impotence. The current treatment of advanced prostatic carcinoma causes erectile failure. Although intracorporeal papaverine can induce erections in these men, libido is also reduced so that the role of ICP is limited to those men complying with the wishes of a highly motivated partner.

The Role of Dynamic Corpora Cavernosography in the Management of Impotence

Sixty eight impotent men underwent corpora cavernosography and corpora cavernosal pressure measurements during saline infusion. Nineteen of the men had internal pudendal arteriograms. Correlation between the cavernosograms and saline infusion induced pressure measurements was "good" in 56/66(84%), "approximate" in 5/66(8%) and there was no correlation in 5/66(8%). Two patients were excluded for technical reasons. The spread of results and the good correlation of the two tests speaks for the accuracy of the method. It was of value in diagnosis and will be of paramount importance if veno occlusive surgery becomes a reliable method of treatment.

Use of the "Correctaid" device in the management of impotence.

A series of 20 unselected patients with impotence of various aetiologies were given a custom fitted external erection assistance device, the Correctaid. They have been followed up for 14 months. Only 4 patients are still using the device regularly to attain satisfactory intercourse and a further 4 use it occasionally. This device is a useful, non-invasive alternative for the treatment of impotence in well selected, motivated patients and their partners.

Penile prostheses.

Penile prostheses represent the most often used approach to the surgical management of impotence. These devices can be classified into semirigid and inflatable types. The advantages and disadvantages of each type as well as a description of their construction are provided here. Appropriate images are provided to illustrate the components of the various devices available.

Cavernosography in the management of impotence

Cavernosography in the management of impotence