Normal Potent Men Research Articles

A reassessment of penile sensory pathways and effects of prilocaine–lidocaine cream in primary premature ejaculation

To assess the penile sensory pathway abnormalities of the patients with primary premature ejaculation (PPE) and effects of prilocaine-lidocaine (PLA) cream, we enrolled 82 PPE patients and 34 normal potent male volunteers. Somatosensory evoked potentials of dorsal nerve (DNSEP) and glans penis (GPSEP) were performed in each subject. In addition, among the 82 patients, 60 were selected and randomly divided into PLA and placebo subgroups, each with 30 patients. Cream was applied evenly on the glans penis for 10 min and washed off just before DNSEP and GPSEP were repeatedly measured. Mean latencies of DNSEP and GPSPE were both remarkably shorter in the patients than those in the normal potent men (P<0.001, both). Compared with the control group, the mean amplitudes of GPSEP were significantly greater in the patient group (P<0.001), but not considerably on the amplitudes of DNSEP (P=0.229). After cream application, the latencies and amplitudes of both DNSEP and GPSEP were significantly prolonged and reduced, respectively, in the PLA cream subgroup (P<0.001, all). These results showed that hyperexcitable ejaculatory reflex neurological factor was linked to PPE, because of hypersensitivity of the penile, accelerated conduction and cortical amplification of the genital stimuli. The PLA cream could delay sensory latency and decrease glans penile hyperexcitability, which may be the mechanism for PPE treatment.

Preliminary study with bicalutamide in heterosexual and homosexual patients with prostate cancer: a possible implication of androgens in male homosexual arousal

• Not only has a precise characterization of libido and sexual arousal in men as a central neural process been lacking, but the interactive role of gonadal hormones and sexual orientation in such processes has never been investigated. We investigate the relationships among sexual hormones, sexual arousal, and sexual orientation in men by comparing the self-reported sexual response of heterosexual and homosexual men with locally advanced prostate neoplasm, receiving the non-steroidal anti-androgen bicalutamide as monotherapy. • 29 Romanian men participated in this study: 17 heterosexual and 12 homosexual. Patients were undergoing treatment for prostate cancer consisting of a standard daily dose of 50 mg bicalutamide, a fast acting non-steroidal anti-androgen with action comparable to other anti-androgen drugs but with reportedly fewer sexual side effects. • Patients retrospectively provided information regarding their sexual functioning measured by the IIEF prior to commencing bicalutamide treatment. • Then, about five weeks later, patients were asked to prospectively provide information regarding their current sexual functioning while undergoing bicalutamide treatment. • Overall IIEF scores as well as the Erectile Function, Orgasmic Function, Sexual Desire, and Overall Satisfaction subscales showed group, treatment, and group by treatment effects. • The Intercourse Satisfaction subscale showed group and group by treatment effects. • On most subscales, homosexual men showed lower functioning than heterosexual men, primarily in response to treatment with bicalutamide. • Treatment with an anti-androgen in a clinical population of men undergoing therapy for prostate cancer affected homosexual men more than heterosexual men, although not all heterosexual men were unaffected. • These results are discussed in the context of dual sexual natures, a concept recently developed in the sexual literature. • Furthermore, these findings reiterate the importance of incorporating such variables as sexual orientation into studies investigating medical treatments on sexual response.

Comparing Penile Measurements in Normal and Erectile Dysfunction Subjects

With the increase in penile augmentation procedures it becomes important to assess what is the normal erect penile size in both potent men and men with erectile dysfunction (ED). The aim of this work is to define the average stretched penile size in normal men and ED patients. Penile length and girth. This study included 1,027 adult men presenting to a university hospital outpatient clinic. Two groups of patients were included in this research work. Group I comprises normal adult men (949) and Group II, ED patients (78). There were no differences of race, age, height, and weight. Penile length and girth were measured using a tape measure and rigid ruler in the fully stretched states in both groups. All penile measurements were performed by the same physician. In normal men (Group I) the mean of the fully stretched length was 12.9 +/- 1.9 cm and the mean of the fully stretched girth was 8.9 +/- 0.9 cm. In ED patients (Group II), the mean of the fully stretched length was 11.2 +/- 1.5 cm and the mean of fully stretched girth was 8.8 +/- 0.8 cm. Comparing the mean of fully stretched penile lengths in both groups revealed statistical significant difference (P < 0.001) between them, whereas comparing the mean of fully stretched penile girths in both groups revealed statistical nonsignificant difference (P = 0.474) between them. There were significant positive correlations between fully stretched penile lengths and fully stretched penile girths in both groups. The average of fully stretched penile length in normal potent men is 12.9 cm, whereas the patients with ED tend to have significantly shorter penises (11.2 +/- 1.5 cm).

Penile vascular evaluation and sexual function before and after radical retropubic prostatectomy: 5‐year follow‐up

Sexual dysfunction is common after surgery for prostate cancer. The aetiology of changes in sexual potency after radical prostatectomy is probably multifactorial, including neurogenic, vascular and psychosexual factors. A prospective study was designed to investigate haemodynamic and psychosexual changes before and after radical retropubic prostatectomy (RRP) for organ-confined prostate cancer. Penile haemodynamic evaluation and an assessment of sexual excitement were performed preoperatively and 3 months after RRP by colour Doppler ultrasonography (CDU) with visual erotic stimulation combined with a single intracavernous injection of a mixture of papaverine/phentolamine. Questionnaires on sexual function [International Index of Erectile Function (IIEF)], general health and quality of life were sent to the patients preoperative, 3 months and 5 years after operation. Forty-eight men participated in the study. Mean age was 62.6 years (range 55-69). CDU did not show any significant reduction in mean peak systolic flow velocity and mean resistance index. From the men who preoperatively had normal arterial inflow 18% developed arteriogenic insufficiency. Some form of veno-occlusive insufficiency and low resistance indices were already present in the majority of normal potent men preoperatively. Surgical technique did not influence penile arterial blood flow after the operation. Three months and 5 years postoperatively, there was a highly significant reduction in erectile function, intercourse satisfaction, overall satisfaction, orgasmic function and sexual desire. However, with respect to the outcome at 3 months there was a significant improvement of orgasmic function 5 years after operation, especially after a bilateral nerve sparing procedure. Erections sufficient for vaginal penetration (questions 3 and 4 of the IIEF, score >or=8) improved from 2% to 11% 3 months and 5 years after RRP respectively. Total IIEF score was significantly better after a bilateral nerve-sparing procedure compared with non-nerve sparing. No structural vascular changes were observed 3 months after operation. Vascular factors appear to be less important in the aetiology of ED after RRP. There seems to be a trend of a better improvement of sexual function over time, especially orgasmic function, in patients with bilateral nerve-sparing surgery.

Novel image analysis of corpus cavernous tissue in impotent men

Objectives. To objectively evaluate the contents of corpus cavernous tissue in impotent men using an automated novel image analysis system. Methods. Thirty-three impotent men and 2 normal potent men (controls) underwent corpus cavernous biopsies. The procedures were performed using a Biopty gun under local anesthesia. The obtained specimens were stained with Masson’s trichome technique, and the collagen fiber contents were evaluated by a computerized morphometric analysis method. In addition, we estimated the intraobserver and interobserver reliability of this automated image analysis system. Results. No major complication was noted during or after the biopsies. Of the 33 impotent patients, 3 were diagnosed as having psychogenic, 11 as having arteriogenic, 13 as having venogenic, 1 as having neurogenic, and 5 as having idiopathic impotence. The collagen fiber percentages in the 35 men were as follows: normal potent: 48.2% ± 1.4%, psychogenic 55.2% ± 11.6%, arteriogenic 73.2% ± 4.4%, venogenic 66.5% ± 4.2%, neurogenic 76.9%, and idiopathic 77.4% ± 4.2%. Significant differences were found between the normal potent and arteriogenic groups ( P <0.05) and between the normal potent and idiopathic groups ( P <0.05). Patients older than 60 years had a higher collagen fiber content (70.4% ± 3.7%) than those younger than 50 years old (58.6% ± 5.2%). The interobserver and intraobserver variances were both negligible for this automated image analysis system. This method significantly reduced the amount of variation introduced by the intra-rater reliability of a technician compared with the manual method. Conclusions. The present automated image analysis system is believed to be a reliable, accurate quantitative measurement tool for studies of penile tissue. Cavernous biopsy is a rapid, safe, and representative modality to study penile disease. An increase in cavernous collagen fibers (or corporal fibrosis) is considered an important factor in impaired erectile function.

Penile Sensitivity in Patients with Primary Premature Ejaculation

Purpose We investigated penile sensory levels in patients with primary premature ejaculation to determine whether there is an etiological basis for this condition. Materials and Methods Penile biothesiometry was performed in 120 patients with primary premature ejaculation without erectile dysfunction and neurological deficit, and in 66 normal potent male volunteers. Vibratory thresholds were recorded at the glans penis, penile shaft, scrotum and index finger using a biothesiometer. Results On the glans penis and penile shaft the values in patients with premature ejaculation were significantly less than those in normal potent men (p less than 0.001). In normal potent men an age dependency of biothesiometric parameters was noted, with a significant increase in vibratory threshold at the glans penis and penile shaft in older patients. However, in patients with premature ejaculation there were consistently decreased values without age dependency at the glans penis and penile shaft (p greater than 0.05). Conclusions Patients with primary premature ejaculation have penile hypersensitivity, which provides further implications for an organic basis of premature ejaculation.

Difference in glycohistochemical lectin staining of collagen fibers in the corpora cavernosa of normal and impotent men.

The objectives of this study were to investigate the value of glycohistochemical staining with three lectin types specific to a particular glycan structure (Arachis hypogaea [PNA], Triticum vulgare [WGA], and concanavalin A [Con A]) as a method of defining possible changes in the collagen structure in the corpora cavernosa in potent and impotent men. The study group consisted of 4 normal potent men and 22 men with various etiologies of impotence. The quantitative histochemical measurements were performed by means of a cell image processor. Two variables for each of the three types of lectins were studied. These were the mean optical density (MOD), which relates to glycohistochemical staining intensity, and the labeling index (LI), which is positively related to the percentage of immunostaining. Only WGA staining made it possible to discriminate significantly between the normal and pathological groups under study. The two parameters (LI, MOD) were significantly higher in the case of WGA staining in the normal group (P = 0.004 and 0.013, respectively). In contrast, only the mean LI value, in the case of the psychogenic and venogenic patients, reached a level of statistical significance (P = 0.005 and 0.001, respectively), when it increased from PNA through WGA to Con A histochemical staining. The two variables (LI, MOD) changed markedly from PNA through WGA to Con A in the arteriogenic patients (P = 0.003 and P < 0.001, respectively). WGA is of diagnostic value in distinguishing between normal and abnormal collagen in the corpora cavernosa. The difference in the lectin staining of the other groups, particularly the arteriogenic group, may be attributed to alterations in the glycosylation of the procollagen that are probably due to changes in the partial pressure of oxygen (PO2) level, an important cofactor in normal glycosylation. WGA staining may therefore be used as a marker to distinguish true psychogenic patients from those with organic diseases. Moreover, it may be used as an additional parameter in selecting the best candidates for penile revascularization.

Comparison of anti-desmin and anti-actin staining for the computerized analysis of cavernous smooth muscle density.

To compare the staining properties of anti-desmin and anti-actin in cavernous biopsies and thus determine the optimal antibody for quantifying intracavernous smooth muscle content in the evaluation of erectile dysfunction. Twenty-two penile biopsies were taken from five normal potent patients, seven with venous leak and 10 with arterial disease, with mean ages of 34.4, 48.8 and 54.8 years, respectively. Biopsies were sectioned and successive sections stained immunohistochemically with antibodies for actin or desmin. Image analysis was used to quantify the proportion of smooth muscle fibres in the cavernous tissue. There was a significant difference (P = 0.0001) between the mean percentage of cavernous smooth muscle fibres in normal potent men, stained with anti-desmin (38.5%, SD 3.2) or anti-actin (45.2%, SD 3.2) and that in the venous group (anti-desmin 27.4%, SD 4.0%; anti-actin 34.2%, SD 5.3%) or the arteriogenic group (anti-desmin 23.7%, SD 4.4, anti-actin 28.9%, SD 4.9). There was no significant difference in the estimates with either staining method between the venogenic and arteriogenic patients. There was a direct relationship between the cavernous smooth muscle density estimated by anti-desmin and anti-actin staining (r = 0.96). The anti-actin and anti-desmin staining methods gave equivalent results for discriminating between normal and impotent patients on the basis of the percentage of cavernous muscle fibres. However, anti-actin staining tended to be more sensitive than anti-desmin.

Objective Quantification of Cavernous Endothelium in Potent and Impotent Men

Penile corporeal lacunar endothelium is active in the local neural control of corporeal smooth muscle relaxation by producing nitric oxide, a potent vasodilator neurotransmitter. Via computerized image analysis we quantified objectively the percentage of endothelial cells in corpus cavernosum tissues of potent and impotent men. Immunohistochemical staining factor VIII was used to identify the endothelial cells. Five normal potent men had a mean of 2.8 percent cavernous endothelial cells, compared to 2.4 percent in 12 patients with venous leakage and 2.8 percent in 10 with arterial disease. Objective quantification showed no difference in the numbers of cavernous endothelial cells between potent and impotent men.

Hand and Genital Sympathetic Skin Potentials in Flaccid and Erectile Penile States in Normal Potent Men and Patients With Premature Ejaculation

Sympathetic skin potentials were recorded from the hand and genital region in 14 normal potent men and 18 patients with premature ejaculations. With the penis flaccid the sympathetic skin potentials obtained did not differ significantly in both groups. However, when erection was induced by 50 mg. intracavernous papaverine injection, the genital sympathetic skin potentials were significantly suppressed in all but 3 normal men, while the hand potentials did not change. In subjects with premature ejaculation genital and hand sympathetic skin potentials were suppressed during erection as a generalized bodily reaction except in 1 patient. This phenomenon may indicate that the specific and regional suppression of genital sympathetic activity during erection could not be properly adjusted in patients with premature ejaculation.

The Value of Dynamic Color Duplex Scanning in the Diagnosis of Venogenic Impotence

To determine the value of color duplex scanning in the diagnosis of venogenic impotence we examined 53 patients. The control population consisted of 26 psychogenically impotent men and 8 normal potent men who all had a firm erection after pharmacological stimulation. There was no significant difference in the values of duplex parameters between these 2 groups. The venous leak population was characterized by a bad erectile response to pharmacological stimulation despite a good arterial compliance and by a persistent diastolic flow as shown by duplex scanning. There was a significant difference with the control population for the parameters of resistance index after 10 minutes (p = 0.001), minimal resistance index (p = 0.016) and corporeal volume increase (p = 0.010). There was a good correlation between the results of duplex scanning and those of pharmacocavernosography-pharmacocavernosometry (93%). We conclude that dynamic color duplex scanning can be used as a screening procedure to diagnose significant venous leakage in an objective manner with the resistance index.

Diagnostic Value of the Radioisotope Erection Penogram for Vasculogenic Impotence

Radioisotope erection penography of 113 consecutive impotent patients (41 with psychogenic and 72 with vasculogenic impotence) and 15 normal potent men were obtained. Twenty minutes after intracavernous injection of 99mtechnetium-pertechnetate 40mg. papaverine hydrochloride were administered into the corpus cavernosum to induce erection. A gamma camera with a pinhole collimator was used to monitor the radioactivity. Various penogram indexes were calculated from the time activity curve and their usefulness was evaluated. Index A1 was useful to differentiate vasculogenic and psychogenic impotence. Indexes V1 and V2 were useful to differentiate arteriogenic and venogenic impotence.The radioisotope erection penogram is a simple, less invasive and valuable screening test in the identification of vasculogenic impotence, and is effective in differentiating arteriogenic and venogenic impotence. (J. Urol., 144: 888–893, 1990)

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.

Bulbocavernosus reflex latencies and somatosensory evoked potentials after pudendal nerve stimulation in the diagnosis of impotence

The bulbocavernosus reflex (BCR) was examined in 39 normal potent men and in 252 patients with impaired potency of varying aetiology. For BCR evaluation minimum, maximum and mean latencies, the temporal dispersion in ten successive responses, together with minimum and maximum side differences from simultaneous recordings of the left and right bulbocavernosus muscles were determined. Pathological findings were detected in 125 patients. Somatosensory evoked potentials (SSEPs) recorded from the scalp after stimulation of the penile dorsal nerves and the terminal branches of the pudendal nerve were investigated in 30 controls and in 246 patients. An abnormal SSEP was found in 63 patients.

Somatosensory evoked potentials after stimulation of the dorsal penile nerve: normative data and results from 145 patients with erectile dysfunction.

Somatosensory evoked potentials (SSEPs) recorded from scalp after stimulation of the dorsal penile nerves, terminal branches of the pudendal nerve, were examined in 30 normal potent men and in 145 patients with erectile dysfunction of different etiologies. In the control group there was a significant relationship between latencies P1 and N1 and the subjects' height. In the patient group SSEPs were absent in 12 subjects, a prolonged latency was found in 28 patients.

Dynamic cavernosography. Radiologic diagnosis of venous induced erection disorders and erectile body diseases

In 30 to 50% erectile dysfunctions are due to vascular disorders. Roughly a third of these vasculogenic disturbances is based on venous disorders. These venous-induced erectile failures may be objectivated and radiologically located via dynamic cavernosography, combined with a simultaneous recording of a cavernous pressure profile. Based on over 130 examinations it was possible to provide both an exact description of the normal venous drainage in normal potent men and to give a good idea of the different venous leakages in patients complaining of erectile dysfunctions. Congenital and acquired penile deviations along with Peyronie's disease may also be appropriate for dynamic cavernosography.