Recovery Of Erections Research Articles

POTENCY, CONTINENCE AND COMPLICATION RATES IN 1,870 CONSECUTIVE RADICAL RETROPUBIC PROSTATECTOMIES

Purpose We update results in a series of consecutive patients treated with anatomic radical retropubic prostatectomy regarding recovery of erections, urinary continence and postoperative complications. Materials and Methods One surgeon performed anatomic radical retropubic prostatectomy on 1,870 men, using the nerve sparing modification when feasible. We evaluate recovery of erections and urinary continence in men followed for a minimum of 18 months. Patients who were not reliably potent before surgery, did not undergo a nerve sparing procedure, or received hormonal therapy or postoperative adjuvant radiotherapy were excluded from the analysis of potency rates but not of continence rates. Other postoperative complications were evaluated for the entire patient population. Results Recovery of erections occurred in 68% of preoperatively potent men treated with bilateral (543 of 798) and 47% treated with unilateral (28 of 60) nerve sparing surgery. Recovery of erections was more likely with bilateral than with unilateral nerve sparing surgery in patients less than 70 years old (71 versus 48%, p <0.001) compared with patients with age 70 years old or older (48 versus 40%, p = 0.6). Recovery of urinary continence occurred in 92% (1,223 of 1,325 men) and was associated with younger age (p <0.0001) but not with tumor stage (p = 0.2) or nerve sparing surgery (p = 0.3). Postoperative complications occurred in 10% of patients overall and were associated with older age (p <0.002) but the incidence declined significantly with increasing experience of the surgeon (p <0.0001). There was no operative mortality. Conclusions Anatomic radical retropubic prostatectomy with the nerve sparing modification can be performed with favorable results in preserving potency and urinary continence. Better results are achieved in young men with organ confined cancer. Other complications can be reduced with increasing surgeon experience.

Intracavernosal self-injection therapy in men with erectile dysfunction: satisfaction and attrition in 119 patients.

This study describes a 12-24 month follow-up on 119 ED patients in an attempt to understand satisfaction with and dropout from ICI use. Results indicate 40% attrition, attributed primarily to a lack of efficacy of ICI, but also to spontaneous return of erectile function and to negative reactions surrounding the injection procedure. Multivariate analyses indicated that ICI dropouts were more likely to have co-existing premature ejaculation, low responses during psychophysiological screening, a lack of spontaneous erections prior to ICI, and an etiology that included an organogenic component. These same factors, along with low satisfaction with their sex life, were related to attrition due specifically to a lack of drug efficacy. In contrast, attrition due to recovery of spontaneous erections was associated with high sexual satisfaction. Among ongoing users, dissatisfaction was associated with higher age, shorter erections during ICI use, and low satisfaction with sex life. These findings identify a number of factors related to attrition and satisfaction, emphasizing the importance of specifying the cause for ICI attrition and, demonstrating that a substantial portion of patients who dropout do so for positive reasons.

7-Nitroindazole: A selective inhibitor of penile erection: An in vivo study in a rat animal model

Objectives. The neuronal isoform of nitric oxide synthase (nNOS) has been localized in neurons innervating the penis and is believed to be an important mediator of erection. Using the selective inhibitor 7-nitroindazole (7-NI), we evaluated the possible role of nNOS in penile erection using a rat animal model. Methods. Eighteen Sprague-Dawley rats were divided into three study groups. A sham group (n = 6) received the vehicle arachis oil, a low-dose group received 5 mg/kg (n = 6), and a high-dose group received 50 mg/kg (n = 6) of 7-NI prior to measurement of blood pressure and cavernous nerve stimulation-induced rise in intracavernous pressure. Results. A dose-dependent inhibition of erection by 7-NI was seen. Control animals had an intracavernous pressure rise of 55.5 ± 4.0 cm H 2O, whereas the low-dose group had 26.5 ± 2.8 cm H 2O and the high-dose group had 6.2 ± 2.1 cm H 2O. A partial recovery of erection was seen in the low- and high-dose groups after 3 hours. Blood pressure was unaffected by 7-NI administration. Conclusions. 7-NI induced a reversible, dose-dependent inhibition of erection without affecting blood pressure. This in vivo study provides further evidence of the role played by nNOS in erection. UROLOGY ® 47: 93–96, 1996.

Return of Erections and Urinary Continence Following Nerve Sparing Radical Retropubic Prostatectomy

We evaluated recovery of erections and urinary continence following anatomical radical retropubic prostatectomy in a series of 784 consecutive patients with clinical stage A or B prostate cancer. Nerve sparing radical prostatectomy was performed in men deemed appropriate candidates. Recovery of erections sufficient for intercourse and urinary continence were analyzed controlling for patient age, pathological tumor stage and the performance of unilateral or bilateral nerve sparing surgery in men followed for a minimum of 18 months. Erections were regained in 149 of 236 preoperatively potent men (63%) treated with bilateral and 24 of 59 (41%) treated with unilateral nerve sparing surgery. Recovery of erections correlated with patient age and pathological tumor stage in patients treated with bilateral nerve sparing surgery. Continence was regained in 409 of 435 patients (94%) and did not correlate with patient age, tumor stage or nerve sparing surgery. Anatomical radical retropubic prostatectomy can be performed with favorable results in preserving potency and urinary continence. Better results are achieved in younger men with organ confined cancer.

Transition of diagnosis and treatment for impotence

Statistic study was made on 685 outpatients with erectile dysfunction during 13 years periods from 1979 to 1991 in the Department of Urology, Takamatsu Red Cross Hospital. The age distribution showed the highest frequency in the thirties decade (27.9%). 1. Diagnosis Nocturnal penile tumescence monitoring was the only method to distinguish organic impotence from functional impotence during the first 5 years. From 1984 we have been able to diagnose corporal veno-occlusive insufficiency (CVI) by papaverine test and dynamic infusion cavernosometry and cavernosography. Measurement of penile brachial index and pelvic angiography were performed to diagnose arterial insufficiency (AI). In neurological examination we have measured bulbo-cavernosus reflex latency and nerve conduction velocity of the dorsal penile nerve and performed microvibration measurement and sweat spots test. All diagnostic methods were established in 1987 and we have been able to classify about 80% patients. We classified 305 patients during the last 5 years from 1987 as follows: psychogenic; 31.1%, CVI; 20.0%, AI; 7.9%, neurogenic; 7.9%, others; 14.1%, drop-out and unknown; 19.0%. 2. Treatment In the beginning only counseling and drug therapy were performed. However we lately performed various suitable methods for individuals based on their diagnoses. We performed counseling, drug therapy and intracavernous injection of vasoactive drug therapy for recovery of spontaneous erection (vascular training) for psychogenic IMP. The efficacy rate of counseling was low (30.4%) but that of drug therapy was 41.6%, and that of vascular training, 64.2%. For CVI without other factors we performed venous surgeries. Only about 25% of them perform sexual intercourse with or without self injection of vasoactive drug (self injection).(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacologically induced penile erection (PIPE) as a maintenance treatment for erectile impotence: A report of 41 cases

Abstract Forty-one patients with impotence, either organic in origin or unresponsive to psychosexual therapy, were treated by intracavernosal injections, in most cases using papaverine. Small test doses were given, progressing to higher doses if necessary, with instructions for self-injection. Older patients needed significantly higher doses than younger ones. Thirty-six of the 41 patients were able to achieve erections as a result of injections. Seventeen of these have continued self-injection at home; 14 achieved erections but had little or no further use of the injections at home; five achieved erections and used the treatment at home, but then discontinued it after the recovery of spontaneous erections. Five patients failed to achieve erections even with the maximum dose. Five patients early in the series experienced priapism, which was successfully treated. There were few other side effects.