Persistent Erectile Dysfunction Research Articles

Male Sexual Dysfunction After Pelvic Fracture

The assessment of multiple aspects of male sexual function after pelvic fracture. A cross-sectional retrospective study of male sexual function was conducted. Patients admitted with traumatic pelvic fracture between January 1995 and June 2001 were included. One hundred and two patients were invited by mail. After performing a standardized clinical examination including an interview, the patients were asked to answer a questionnaire at home. Sexual dysfunction was classified as erectile dysfunction (ED), ejaculatory dysfunction, sensory loss in genital region, and pain during sexual activity. ED was assessed by the International Index of Erectile Function (IIEF). The pelvic injury was classified using Tile's classification. Complete data of 77 men were available (age 35 +/- 13). A total of 47 patients (61%) reported limitations in sexual function. Persistent ED was found in 15 patients (19%). The patient's report of ED could be verified by a low IIEF score in 14 cases. Injury patterns, which may increase the incidence of sexual dysfunction, could be identified. A ruptured symphysis appeared to bear a risk of temporary ED. Comparing compression and distraction in type B injuries, patients with distraction injury showed more severe sexual function. Posterior ring disruptions seemed to increase the risk of persistent problems, possibly caused by nerve damage. This study emphasizes that major pelvic trauma may impair sexual function in men. The results demonstrate an objective measurement of ED by the IIEF as well as an extended spectrum of complaints. The IIEF questionnaire might be considered to identify patients that need further medical evaluation.

Alpha-adrenoceptors are a common denominator in the pathophysiology of erectile function and BPH/LUTS - implications for clinical practice

A literature search of PubMed documented publications and abstracts from proceedings of scientific meetings was made to review the available data on benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED) with a special focus on the role of alpha-adrenoceptors as critical mediators of pathophysiology. The reader is introduced to clinical results on the therapeutic potential of alpha-blockers alone and in combination with phosphodiesterase type 5 (PDE-5) inhibitors in the treatment of ED associated with LUTS/BPH. Epidemiological studies clearly show that an association exists between ED and LUTS/BPH. The severity of LUTS is correlated with the risk for ED. A significant number of LUTS/BPH patients are nonresponsive to the common ED treatment with PDE-5 inhibitors. As smooth muscle contractility is regulated by adrenoceptors in the corpus cavernosum, prostate and detrusor, the alpha-adrenoceptor system may be considered a common pathophysiological mediator in the development of ED and LUTS/BPH. Blockade of alpha-adrenoceptors for the treatment of BPH/LUTS may have the potential of improving sexual function. Conversely, PDE-5 inhibitors may exhibit positive effects in LUTS patients. Pilot studies on combination regimens of alpha-adrenoceptor antagonists and PDE-5 inhibitors have yielded encouraging results in LUTS patients with persistent ED. On the basis of pharmacological and clinical evidence, it is established that the alpha-adrenoceptor system plays an important role in the pathophysiology of ED and LUTS secondary to BPH. Larger trials on the combination of alpha-adrenoceptor antagonists with PDE-5 inhibitors are necessary to develop an integrated treatment approach for BPH/LUTS patients with comorbid ED.

Investigating a patient with erectile dysfunction: Is it really necessary?

The National Institute of Health defined erectile dysfunction as the persistent inability to achieve and/or to maintain an erection for a satisfactory sexual performance. Erectile dysfunction must be considered a public health problem for its high prevalence worldwide. Aetiology of erectile dysfunction can be classified as organic, psychogenic or mixed. Erectile dysfunction must be considered the first sign of many diseases. Thus, a correct diagnostic approach is essential before starting an effective therapeutic regimen. Current guidelines concerning management of erectile dysfunction agree on the great importance of anamnesis as being the basis of a correct diagnosis of erectile deficit. First level diagnostic tests, including anamnesis, validated questionnaire, routine laboratory tests and hormonal profile seem enough to make an aetiological diagnosis of erectile dysfunction and to identify and remove any erectile dysfunction (ED) risk factors in most cases. First level tests should be performed, so than urologists can accurately diagnose ED and prescribe relevant treatment. Second level diagnostic evaluation includes specialistic instrumental exams that can be helpful for accurate aetiological diagnosis of erectile dysfunction. These exams, including Penile dynamic colour-duplex. Doppler ultrasonography, nocturnal penile tumescence recording, cavernosometry/cavernosography and neurological investigation, should be performed when first level diagnostic assessment is not clear, when the presence of an underlying organic pathology should be excluded in young patients with persistent ED, when veno-occlusive or neurogenic ED is suspected and when a better definition of the disease is needed.

Penile blunt trauma induced veno-occlusive erectile dysfunction.

Blunt trauma to the pelvic or perineal region of the corpora cavernosa is a risk factor for the subsequent development of persistent erectile dysfunction. The hemodynamic investigation of the integrity of the veno-occlusive mechanism has been rare in cases of traumatic impotence. We present two young men with erectile dysfunction following blunt penile or perineal trauma. Combined intracavernous injection and stimulation test, color duplex ultrasonography, and pharmacologic cavernosometry and cavernosography revealed normal arterial velocity and pulsation without cavernosal arterial fistula, but severe venous occlusion and site-specific abnormal veins were noted in both patients. They received penile vein ligation procedure and resulted in near-completely normal erectile function after a four-year followup. Penile venous ligation, especially on the site-specific veins, is still the choice of treatment for the trauma-induced penile veno-occlusive erectile dysfunction, and the result is satisfactory.

Pelvic venoablation with ethanol for the treatment of erectile dysfunction due to veno-occlusive dysfunction

Objectives. To perform pelvic venoablation with ethanol injection into the deep dorsal vein for the treatment of 10 patients with venogenic erectile dysfunction. This procedure was easily performed without any selective embolization technique. The efficacy and safety of this technique are discussed. Methods. A total of 10 patients with veno-occlusive dysfunction, severe enough to make vaginal insertion impossible, underwent pelvic venoablation with ethanol. The mean patient age was 67.1 years. Under spinal anesthesia, after the venous leaks were identified by cavernosography, a 20-gauge flexible needle was inserted into the deep dorsal vein. The pelvic venogram obtained with deep dorsal venography was included in what was revealed by the venogram obtained with cavernosography. A mixture of absolute ethanol and contrast medium (4:1) was used as a sclerosing agent. Under fluoroscopic control, the sclerosing agents were injected into the deep dorsal vein through a flexible needle. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Results. The follow-up ranged from 25 to 37 months (mean 32.3). At the short-term follow-up visit (less than 6 months), 7 patients (70%) reported erections sufficient for vaginal insertion; at the long-term follow-up visit, 5 men (50%) reported sustained, sufficient potency and 5 (50%) reported persistent erectile dysfunction. No serious complications occurred. Conclusions. Our pelvic venoablation technique using ethanol was effective, minimally invasive, and cost-effective.

Retrospective review of flow patterns following retropubic prostatectomy.

We retrospectively evaluated penile inflows in 103 previously potent individuals who underwent standard nerve sparing radical retropubic prostatectomy (RRP) for the treatment of prostate cancer. No effort to identify or spare the accessory pudendal artery (APA) was made in any case. Our goal was to investigate the role of the accessory internal pudendal artery (APA) in the maintenance of erections in this population. We hypothesize that if the APA is present in a significant number of men, and its ligation significantly contributes to post-RRP impotence, then there should be an increased incidence of asymmetry between R/L cavernous arterial flows among post RRP patients with vascular impotence. One hundred and three previously potent individuals complaining of persistent erectile dysfunction for at least six months after RRP were studied with color duplex Doppler, following age specific dosing of PGE1. Vascular assessment was performed before and after self-stimulation, measuring peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI). Erections were visually rated as inadequate (INA), adequate (ADE) for penetration, or excellent (EXC) with sustained rigidity for at least 20 min. Cavernous artery asymmetry (CAA) was defined as a >10 cm/s difference between right and left sided arterial flows. Mean duration between surgery and Doppler study was 14.7 months. 27 out of 103 (26%) of patients developed excellent rigidity consistent with isolated neurogenic impotence (PSV=32.0 cm/s, mean RI=0.95); 24 out of 103 (23%) had adequate vascular responses making it impossible to infer presence or absences of neurogenic impotence; 52 out of 103 (51%) had inadequate rigidity consistent with vascular insufficiency (PSV=23.7 cm/s, mean RI=0.66). We noted that of patients with EXC response, 48% (13 out of 27) had CAA. Among patients with severe inflow disease (INA responders), CAA was seen in only 21% of cases (11 out of 52). The incidence of APA has been reported as being from 4-70%, and its significance in the maintenance of erections has been questioned. Assuming that the APA provides significant inflow in some patients, we expected an increase in CAA in individuals in whom it was sacrificed. We found a higher incidence of CAA among post-RRP patients with normal vascular erectile responses to PGE1 (48%) compared to men with true vasculogenic impotence post-RRP (21%). These data do not support the importance of the APA in the maintenance of erections in the post-RRP patient.

Experience of intracavernous silicone prosthesis implantation for erectile impotence

At present time surgical treatment of erectile impotence is gaining more and more supporters.
 40 surgical aids for persistent erectile dysfunction were performed at the urological department of the Republican Clinical Hospital of the TASSR Ministry of Health Care in 1985-1987. Prostheses were implanted in both cavernous bodies in 30 patients and in one body in 10 patients. The indications for surgical treatment were complete absence of adequate and spontaneous erections during three years of unsuccessful treatment by a sexopathologist, absence of auditory and visual stimulation, partial regression of libido.