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CLINICAL EFFICACY OF KOREAN RED GINSENG FOR ERECTILE DYFUNCTION H K Choi, D H Seong, K H Rha
To investigate the efficacy in treating erectile dysfunction and to develop a natural drug without complications, the results of Korean red ginseng treatments are compared to placebo and other drug. A total of 90 patients with 30 patients in each group were closely followed. Changes in symptoms such as frequency of intercourse, premature ejaculation, and morning erections after treatment were not changed in all three groups (p>0.05). However in the group receiving ginseng, changes in early detumescence and erectile parameters such as penile rigidity and girth, libido and patient satisfaction was significantly higher than that of other groups (p<0.05). The overall therapeutic efficacies on erectile dysfunction were 50% for ginseng group and 30% for placebo and traxodone treated groups, statistically confirming the effect of ginseng. (p<.05). No cases of aggravation of symptoms were reported. AVS-penogram pattern and testosterone level were not changed after administration of ginseng. However, if administered for a prolonged period of time, the cumulative effect on vascular flow might be seen. The administration of Korean red ginseng has shown to have superior effects compared to the placebo or trazodone. Definitely more researches are required to elucidate the mechanism of ginseng. As more information is available, possible breakthrough in treatment of erectile dysfunction could be arisen from active saponin extracted from red ginseng, bringing hopes to many sufferers of erectile dysfunction.
LONG TERM EXPERIENCES OF PENILE PROSTHESIS IN PATIENTS WITH ERECTILE DYSFUNCTION Young Deuk Choi, Doo Whan Seong, Zhong Cheng Xia, Rha Koon Ho, Hyung Ki Choi 380 patients received penile prosthesis implantations from December 1983. Malleable type of prosthesis were 207 cases (AMS malleable 161, Jonas 46), and the self-inflatable 44 cases (Dynaflex 36, Hydroflex 8), the two-piece inflatable (Uni-Flate 1000) 2 cases, and three-piece inflatable 127 cases (AMS 700CXM 117, AMS Ultrex 5, Mentor 5). The most common diameter of prosthesis used was 9.5mm with 217 cases (57.1%), and the most common length used was 16-18cm with 270 cases (71.5%). When the implantations were reviewed in different time periods, during the early period between 1983 to 1987, 57 cases were performed with 50 (94.3%) being malleable (AMS malleable 33, Jonas 17) and 3 cases of self inflatable type. Only one case of urethral erosion occurred during this period, which was treated with prosthesis removal. A total of 142 case were performed from 1988 to 1991 112 cases being malleable type (AMS malleable 99, Jonas 13), self-inflatable 27, two-piece inflatable 2, and 1 three-piece inflatable type. The intraoperative complications were 1. corporal rupture and the postoperative complications were 2 prosthetic infections. 2. Mechanical failure. 185 patients received penile prosthesis from 1992 to present, most of them being three-piece inflatable with 126 (AMS 700CXM 117, Mentor 5, AMS Ultrex 4). 14 self-inflatable and 45 flexible types were also immolated. A bladder contusion which was managed conservatively was seen during this period. We concluded that when the sufficient experiences and skills are provided, the inflatable type of the prosthesis is most physiologic one among the various penile prosthesis. AMS-700CXM is suitable for Koreans and is excellent in quality.
LONG-TERM FOLLOW-UP OF 500 HYDRAULIC 3-COMPONENT AMS – PENILE PROTHESES Professor Friedhelm Schreiter From 1974 to 1994, 506 hydraulic 3 – component AMS – Penile Prostheses have been implanted. In 316 of these the CS – respectively, the Ultrex cylinders are used. The youngest patient was 19 years, the oldest 79 years old (average 62 years). In 97% the indication was an organic erectile dysfunction. Generally, we used the infra pubic approach. Since its introduction by Brandly Scott in 1973, the 3-component hydraulic penile prosthesis was found to be best regarding concealment and comfort. But a number of mechanic failures became evident in this early years. In the following years the 3-component AMS-prosthesis underwent numerous improvements and continuous evolution in an attempt to improve longevity. The most important changes were made on the cylinders to prevent cylinder rupture, aneurysmatic bulging and tube leak or – kinking. Compared to the former generations of this prosthesis, the 742 type and the IPP 700, we saw in the CX – and Ultrex type, available since 1987, a significant improved overall survival rate. No cylinder failure occurred in this group over a period of years. Furthermore, the CX-and Ultrex type was proven as excellent also in complex cases, for example in fiarotic corpora cavernosa following priapism, Peyronie’s disease or secondary to explanation of infected prostheses. A total failure rate of 6% in a period of 6 years has recommended this type of hydraulic prosthesis as superior.
Dr L Dean Knoll
Several surgical techniques have been applied for the treatment of veno-occlusive dysfunction sufficient enough to create erectile dysfunction. However, long-term success rates have been dismal. Twenty-six patients (mean age 41 years) with documented venogenic erectile dysfunction by dynamic pharmacocavernosometry and cavernosography, who had normal pelvic arteriograms, underwent deep dorsal vein arterialization. All patients pre-operatively were non-responders to injected intracavernosal vasoactive agents. These patients have been followed up from 18 to 52 months (mean 37 months). Overall success rates show that 8 patients (31%) are able to have unaided satisfactory intercourse and 9 patients (35%) have become responders to intracavernosal vasoactive injection therapy. Postoperative complications were minimal and no patient developed hypervascularization of the glands. Deep dorsal vein arterialization remains a viable treatment option for the properly selected, motivated, young patient who does not with to pursue other treatment options for his veno-occlusive dysfunction.
INFLATABLE PENILE PROSTHESIS IN TRANSSEXUAL NEOPHAULLUS Tan Hua Meng and Peter Ng
The arterior abdominal subcutaneous flap is the most common pedicle used in neophallus reconstruction in transsexual patients in this region. The malleable rod is the usual prosthesis used but has a high failure rate because of pressure necrosis attributed to poor blood supply and poor coetaneous sensation.
In April 1994, we successfully inserted an inflatable prosthesis, AMS CX in a 42 year old transsexual with a neophallus constructed from the lower anterior abdominal subcutaneous flap done 9 years ago. The neophallus was a huge fat pedicle measuring 19 cm long, with a circumference of 14cm at the proximal part and 16cm at the distal part of the shaft. The overlying skin was sensitive to touch and pinprick. A midline suprapubic incision was employed. Dilatation of the infrapubic space hugging the left ischial ramus was done up to 18mm diameter. Dilatation of the whole shaft of the neophallus was done up to 14mm diameter. A dacron tubular graft, 16mm diameter and 8cm length, with one end closed like a windsock was sutured and anchored to the ischial bone and symphysis pubis. A single cylinder of the AMS CX prosthesis was placed up to the closed end of the tubular dacron graft. The loose open end of the tubular graft was further anchored to the symphysis pubis acting like a neosuspensory ligament. The pump was inserted into the labium and the 50ml reservoir deep to the rectus muscle in the retropubic space.
Daily recycling of the prosthesis was commenced on the second post operative day and there were no complications. To date, the prosthesis remains in good function. In conclusion, the inflatable penile prosthesis is possible and viable even in a neophallus constructed from subcutaneous skin flap.
Dr Chris G McMahon
20 men with chronic impotence with a mean age of 46 years (range 26-63 years) were treated with self administration of 0.35ml of Vasopotin 1 and 2, a combination of 30mg Vasoactive Intestinal Peptide (VIP) and either 1.0 or 2.0 mg Phentolamine Mesylate. All patients were assessed using a standard protocol which included history and examination, vibratory penile biothesiometry, colour flow duplex Dappler ultrasonography and where indicated, Rigiscan nocturnal penile turnescence testing. DICC and angiography. Impotence was classified as psychogenic in 6 patients, arteriogenic in 9 patients, neurogenic in 2 patients and cavernosal venous leakage in 3 patients. A total of 60 injections was given. After sexual stimulation, an erection of sufficient rigidity for intercourse occurred in all six patients with psychogenic impotence, 7 of 9 patients with arteriogenic impotence, all 2 patients with neurogenic impotence and 1 of 3 patients with cavernosal venous leakage. No patients experienced priapism, 2 patients complained of postinjection penile pain and 3 patients experienced transient facial flushing intracavernous self injection of Vasopotin appears to be a useful treatment for erectile dysfunction. Further studies are planned.
TRIMIX INTRACAVERNOSAL INJECTION THERAPY IN ERECTILE DYSFUNCTON AHA T Y, Chung T K, Park H K, Kim G S, Choo M S
Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. But the individual vasoactive agent has limitations in its clinical success and potential for side effects. So, the synergistic effect and low drug, volume of each vasoactive drug in polypharmacotherapy of erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. A total of 344 patients with erectile dysfunction underwent a trial of intracavernosal self injection therapy with Trimix (the mixture of papaverine, phentolamine and prostaglandin E). Major underlying diseases were Vascular 46.2%, hypertension 5.2%, prior pelvic surgery 2.0%, spinal injury 0.9%, and cerebrovascular accident 1.1%. The volume of drug used ranged between 0.04 and 0.4ml (average: 0.18ml). After a mean follow-up of 9.6 months (1-19 months), 202 patients (58.8%) were left in the home injection program and among them, 173 patients (85.6%) had very high satisfaction. The drop-out rate was 41.2% (142 of 344) with most of the cases during early home phase. The causes of drop-out were the fear of needle or injection, inadequate response to injection, loss of interest and complications. Priapism (11 patients, 4.7%) pain (10 patients, 4.3%) and granuloma on injection site (one patient, 0.4%), were noticeable complications. Corporal fibrosis and systemic side effect were not noticed.
In conclusion, Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and, most of all, very effective method for the treatment of the patients with erectile dysfunctions.
A DISCUSSION OF TREATMENT OF SEX IMPOTENCE BY CONJOINT WESTERN AND TRADITIONAL CHINESE MEDICINE Yin-Zhou Ji
Since April, 1984 – May, 1995 we had treated 84 cases of sex impotence. Age 20-50 and duration 3 months to 5 years. Conjoint Western and traditional Chinese medicine therapy was applied. The effective rate was 87% (patients were followed up for 3 years). Among them 24 cases (29%) were of psychological group, 20 cases (84%) effective 4 cases (16%) without any effect. The pharmaceutical group, 26 cases (31%); good effect 24 cases (92%), 2 cease without effect (8%). The pathological group (due to Chronic prostatitis, of inflammation of seminal vessicle etc). 34 cases (40%) effective 30 cases (88%), no effect 4 cases (8%).
Comment.
Note: Thanks should be given to honorable Prof. Feng Yi-ping for his direction during the therapy. Part of the patients in this paper are collected from the first Affiliated hospital when the author had been serving there.
CAVERTJECT, A LICENSED PROSTAGLANDIN PREPARATION FOR USE IN ERECTILE DYSFUNCTION C Settocchi, D J Ralph, C B Coker, J P Pryor
Prostaglandin E1 (PGE 1) is the drug of choice for intracavernous injection because of its efficacy and low incidence of serious side effects. Caverject is a new freeze dried formulation and this paper describes some of the studies that have led to it being licensed in the United Kingdom. In the first phase, 14 men with erectile dysfunction of varying etiology and known responders to at least 10 micrograms of PEG1 were recruited into a multicentre, double-blind, crossover of Alprostadil sterile solution (Prostin VR Pediatric, Upjohn) and Alprostadil sterile powder (Caverject). Subjects were randomly allocated to receive a single fixed intracavernosa dose of either 0 (placebo), 2.5, 5/ 10 and 20 micrograms of both formulations. Each subject received a total of two intracavernosal injections, each separated by a washout period of at least 7 days. The response was measured by rigiscan and there was no difference in the response to the two formulations. In the second phase, 30 patients were recruited from the outpatient clinic for home self injection programme with Caverject. The aim of this arm of study was to determine the response to and the acceptability of home self injection with the new formulation. All patients underwent full clinical evaluation and laboratory investigation and they were assessed at monthly intervals by means of diaries. 9 patients withdrew from the study and the reasons wee a failure of response (2), dissatisfaction with treatment (5), the inability to learn the technique (1), and progression of multiple sclerosis (1). The remaining 21 patients were self injecting the drug at home and were still satisfied after six months, 76% of patients achieving full erection more than 75% of the time. The median frequency of injection was 5(1-12) times a month. Mild pain after injection was reported in 8 patients (38%). No patient complained of severe pain or discontinued use because of discomfort. One patient sustained a prolonged erection of 340 minutes but this subsided after brief exercise. Subsequent dose reduction prevented recurrence. The efficacy and low incidence of serious side effects makes this preparation the ideal choice for self injection and it is the only preparation licensed for this purpose.
ALPROSTADIL : DOSE TITRATION STUDY IN PHILIPPINO AND MEXICAN MEN Telesforo Gana This open-label, dose-escalating study was conducted to investigate the efficacy and safety of aprostadil (PGE1, Prostaglandin E1). Sterile Powder (S.Po x Caverject) for the treatment of erectile dysfunction (ED). Sixty patients from Philippines and 45 patients from Mexico with diagnosis of ED of 4 months or longer and who met the eligibility criteria were entered into this study. Single injections of fixed dose of Caverject starting with 2.5mcg. then 5 mcg, 10 mcg, 15 mcg, 20 mcg, 30 mcg, and 40 mcg were given in a dose escalating regimen until an erection was achieved sufficient to permit vaginal penetration lasting for 30-60 minutes (this was defined as the optimal response). Clinical observation of erection was assessed a minimum every 10 minutes after injection. Patients assessment of response and side effects was obtained for each injection. Patients were from age 24 to 76 (mean 49.8). The probable causes of ED were arteriogenic (54%), psycogenic (41%), neurogenic (23%) and/or venogenic (5%). Thee were 24 case of mixed etiology. Duration of ED ranged from 0.3 to 17 years (mean 3.4). Ninety-eight of 105 patients established their optimal doses in this study. About 70% of the patients had their optimal dose at < 15mcg. The average optimal dose was 15.0 mcg. The average minimal effective dose defined as the lowest PGE 1 dose at which the patient had a full erection lasting a minimum of 10 minutes and not more than 4 hours was 10 mcg. More than half (60%) of patients with ED with a psychogenic etiology had their optimal doses at or lower than 5 mcg. Local side effects such as penile pain at or after injection and pain at injection sites occurred in 11% of the patients (12/1.5). Of these local pain were tolerable and did not result in patients discontinuation of the study. There wee no other medical events rather than the local side effects reported in this study. The results of this study indicated that Caverject is both safe and effective and comparable to those reported in other studies on ED.
Jacqueline C El-Saleh, Edward J Keogh, Kew K Chew, Carolyn M Earle, John L Lee, John W Wearmounth, Sally E Coulden A randomised controlled study. Introduction. The rationale of the study was to evaluate the effect of massaging the shaft of the penis on the efficacy of intracavernosally injected prostaglandin E1. This massaging technique was then tested on impotent men to determine erectile response by the RigiScan monitor, palpitation by a nurse (JCE) and the patients subjective assessment for 35 minutes following injection. Result. All subjects had some degree of tumescence after injection. The RigiScan monitoring demonstrated the response at both tip and base of the penis was greatest at 2 minutes. The nurse assessment showed there was no significant difference, irrespective of the use and duration of massage. The patients own subjective assessment showed a greater response at 2 minutes of massage than o or 5 minutes. Conclusions. From the three assessment techniques (Rigiscan, subjective, palpitation) used to measure erectile response following intracavernosal injection of Prostaglandin E1 there was no consistent evidence in favour of massaging the shaft of the penis. The results suggest that spreading a critical mass of prostaglandin E1 to interact with receptors throughout the corpora cavernosa is not essential in the establishment of an erection. Rather there appears to be a cascade of events triggered by prostaglandin E1 when injected into a small area of the corpus cavernosum. Our inability to demonstrate a clear-cut benefit of massaging the shaft of the penis for any period of time eliminates an added complexity from the injection procedure which interrupts the natural sequence of events leading to coitus.
PENILE FIBROSIS IN INTRACAVERNOSAL PROSTAGLANDIN E1 INJECTION THERAPY FOR IMPOTENCE KK Chew, E J Keogh, CM Earle Introduction. Fibrosis involving subcutaneous tissues, the tunica albuginea or intracavernosal sinusoids may be a complication of intracavernosal injection therapy. Usually associated with papaverine, penile fibrosis has now also been reported with Prostaglandin E1 (PGE1). This study was undertaken to assess the frequency of fibrotic changes in the penis in patients using PGE1 for secondary impotence. Material and Methods. Over a 6 week period in June/July 1995. 65 consecutive patients who returned for a further supply of PGE 1 were interviewed and examined. Any adverse symptoms related to their use of PGE 1 were documented. A specific inquiry was made regarding penile curvature or deviation and/or any form of swelling in the penis. Results. 19 patients were found to have penile induration, nodules, bands, curvature or deviation. In 6 of these, the cause may be attributed to trauma due to faulty self-injection technique. Penile lumps and curvature were already present in 6 of the remaining patients prior to commencement of intracavernosal injection therapy, suggestive of Peyronie’s Disease. Hence, there were 7 patients who appeared to have developed fibrotic changes in their penile shaft in the course of self-injections of PGE1. These 7 patients, mean age 62.6 years (range 52-75) had been self-injecting an average of 4.4 times per month (range 0.7-12) for an average period of 29.7 months (range 5-67). The mean dose of PGE1 used was 20.4 ug (range 8-40ug) and an average of 71ug of PGE1, (range 10-140ug) was used per month. Pain was present in 2 patients. There were 2 patients with hypertension and 1 patient with diabetes mellitus. Conclusion. 7 of 65 patients (10.8%) were found to have evidence of penile fibro the cause of sesis in the course of self-injecting with PGE1 for secondary impotence. Further study is required to determine if this is a direct effect of PGE1 or a concomitant occurrence of Peyronie’s Disease.
PHARMACOPHYSIOLOGICAL CHANGES OF RABBIT CORPUS CARVERNOSUM UNDER HYPOXIA J J Kim, H J Park and S K Koh
Of the three known neuroefflector systems that locally control penile erection, adrenergic system causes contraction via alpha adrenoreceptors while cholinergic and nonadrenergic noncholinergic (NANC) systems mediate relaxation of corpus cavernosum under normal oxygen tension. However, the effects of these systems under hypoxic condition is not fully understood. The aim of this study was to detect the pharmacophysiological changes of corporal smooth muscle in local nerceffector systems under hypoxia in rabbit. The strips of rabbit corporal tissues were studied in the organ chamber for isometric tension measurement under various conditions; normoxia, hypoxia and hypothermia. The responses of NG monomethyl-L-arginine (L-NMMA) and L—arginine to acetylcholine under normoxia and effects of phenylephrine, norepinephrine, acetylcholine, VIP, endothelin 1, papaverine and KC1 on the rabbit corpus cavernosal tissue were monitored under normoxia, hypoxia and hypothermia.
Relaxing effect of acetylcholine under normal oxygen tension was suppressed by L-NMMA and was reversed with L-arginine. Relaxation with acetylcholine and contraction with endothelin 1 were suppressed in hypoxic condition. Norepinephrine and phenylephrine potentate contraction effects under hypoxia and hypothermia. However, the relaxing effects of VIP and papaverine were similar under normoxia or hypoxia. These results indicate that endothelium-dependent relaxation by cholinergic and NANC systems and endothelium-dependent contraction by endothelin 1 are suppressed under hypoxia condition. Moreover, VIP related NAC relaxation and direct relaxation effect of papverine to corporal smooth muscle are preserved under hypoxia. These findings suggest that the application of adrenegics and local irrigation with cold saline may be effective in the management of priapism.
THE RABBIT AS A MODEL OF INTRACAVERNOUS INJECTION STUDY Chung-Shin Liu, Yung-Ming Lin & Johnny S N Lin
We investigated the feasibility of the rabbit as a possible animal model for intra-cavernous injection studies. The rabbit, having a penile structure rather similar to that of human, offers the advantage of a strain-specific, adequate size, and easily controlled experimental animal. By the intracavernous injections of prostaglandin E1 (m g/kg) and papaverine (PAP, 0.25-1 mg/kg), which have been commonly used in the management of erectile dysfunction in man, the two vasoactive drugs induced increases of intravacernous pressure (D ICP), respectively. After intracavernous injection of PGE1, the maximal D ICP ranged from 18 to 44 mmHg (mean: 29.25 + 7.85) with duration of tumescence from 3.1 to 13.3 minutes (mean 8.6 + 3.71). Intracavernous injection of PAP also induced ICP rises, with maximal D ICP ranged from 24 to 56 mmHg (mean: 43.5 + 11.35) and duration of tumescence from 5.3 to 15 minutes (mean 10.25+3.39). The systemic blood pressures were unchanged in all the intracavernous injections. Besides, administration of CAMP antagonist in combination with PGE1 could inhibit the relaxing effects of PGE1 in a dose-dependent manner. Our results suggest that the manifestations of vasoactive drugs in rabbit’s corpus cavernosum is similar to that of human, thus the rabbit model can be suitable alternative for further physiological and pharmacological studies of penile erection.
TREATMENT OF PREMATURE EJACULATION WITH SERTRALINE Chris G McMahon
46 normally potent men, aged 22 to 63 years (mean 42 years) with premature ejaculation were treated with oral Sertraline, a selective serotonin re-uptake inhibitor (SSRII, between June 1994 and March 1995. All men were either married or in a stable relationship. The mean ejaculatory interval was 1 minute (range 0-5 min). All men were started on Sertraline 25mg daily and were increased to 50 mg after 3 weeks and 100 mg after a further 3 weeks. None of the patients received any formal psychosexual therapy. With a dose of 25mg the mean ejaculatory interval increased to 7.6 min. (range 3.20 min). With adose of 50 mg, the mean ejaculatory interval increased to 13.1 min. (range 7 min anejaculation) with 4 patients experiencing anejaculation. With a dose of 100mg, the mean ejaculatory interval increased to 16.4 min. (range 7 min anejaculation), 10 patients experiencing anaejaculation. With a dose of 25mg, 1 patient described transient dizziness. With a dose of 50 mg, 1 patient described some drowsiness and anorexia. With a dose of 100mg, 2 patients described erectile dysfunction and reduced libido, 2 patients described transient drowsiness and anorexia and 2 patients described feelings of anxiety. Sertraline appears to be a useful agent in the pharmacological treatment of premature ejaculation. Further studies are planned.
THE EFFECT OF SS-CREAM ON PREMATURE EJACULATION Zhong Cheng Xin, Young Deuk Choi, Do Hwan Seong, Hyung Ki Choi From the Department of Urology, Yonsei University College of Medicine, Seoul, Korea SS-cream was made of with extracts of herb medicine for treatment of premature Ejaculation (PE1) Based on its active compositions, the mechanisms of SS-cream on PE is believed to be two fold. Local desensitizing effect and enhancement of local blood flow. In order to confirm the local desensitizing effect of SS-cream on PE, we performed penile biothesiometry in 60 cases and Pudendal SEP in 16 cases with PE before and after applying SS-cream on glands penis. The mean age of patients was 39.4(20-57) years and none of the patients exhibited had any neurologic disorder. The results of biothesiometry measured at glands penis were significantly different before(0.06o æ0.01 Microns) and 1 hour after (0.19o æ0.02 Microns) application of SS-cream(p<0.001). The latency of SEP at glands penis were significantly different before (53.76o æ3.5o m/sec) and 1 hours after (45.12o æ3.85 m/sec) the application (p<0.01). The amplitude of SEP at glands reduced 30% after applying SS-cream. Therefore we suggest that SS-cream has the local desensitizing effect overcome the hypersensitivity of glands penis.
K Marumo, S Baba, M Murai
Introduction. Leuprolide acetate, a highly active agonistic analogue of luteinizing hormone – releasing hormone (LH-RH) potently inhibits pituitary gonadotropin secretion and suppresses testicular steroidgenesis. We have studied the effects of leuprollde acetate on erectile function and sexual activity in patients with prosthetic cancer.
Patients & Methods: Leuprolide acetate was given to 5 patients at a dose of 3.75 mg by subcutaneous injection every 4 weeks. The ages of the patients were ranged from 53 to 71 years. And all had been sexually active before initiation of the therapy. Nocturnal penile tumescence (NPT) was measured using Rigiscan for 2 or 3 consecutive nights. NPT frequency was counted for episodes with a penile rigidity more than 40% for more than 5 minutes both at base and tip of the penis.
Results: The mean serum testosterone level was 4.6+ 0.4 (+SE) mg/ml before the therapy, and less than 0.1mg/ml 4 weeks after the therapy. NPT was significantly suppressed by leuprolide acetate. The mean number of NPT episodes was 3.4 + 0.2 / 8 hours before the therapy, and 0.4 +-4/8 hours after the therapy. The mean maximum penile rigidity was 83 + 5% before the therapy, and 54 + 11% after the therapy. The mean maximum circumferential increase was 3.5 + 0.3 cm before the therapy, and 1.9 + 0.3 cm after the therapy. Libido disappeared in all the patients, and no patients had intercourse for more than 12 weeks after initiation of the therapy.
Conclusion: LH-RH agonist strongly suppressed serum testosterone and sexual activity c the patients. The number of NPT episodes penile rigidity and penile circumferential increase were remarkably reduced by the therapy. Quality of life or sexual activity should be considered carefully when patients receive therapy which has an effect on pituitary-gonadal axis.
PRACTICE EXPERIENCE IN MANAGEMNT OF TRANSIENT IMPOTENCE IN CORRELATION WITH GENITAL HERPES INFECTION M Goedadi, Harijono Ks, Suwita Ps A study of sexual activity among 16 male patients (aged between 27 – 45 years) with the genital herpes infections has been done. Most of the cases have sexual complaints of transient impotence in sexual activities, especially of painful erection, during intercourse and ejaculation. In attempt of better solving the problem we introduce an early administration of suppressive dose regimen of a cyclovir, after the first attach and prior to recurrences. Results after 6 months follow up show an improvement of the transient impotence by the schedule of this treatment.
AGE-DEPENDENT ALTERATION IN THE EFICACY OF PROSTAGLANDINE1 – INDUCED ERECTION IN IMPOTENT MEN YASUSUKE
K. MOTO, Mineo Takei, Hirosi Takeda. We reviewed 296 consecutive impotent men who underwent intracavernous injection of prostaglandin (PG) E1 at our impotence clinic. The mean age was 48 years old (17-87) The etiologies of impotence are neurogenic (50 cases), DM927), psychiatric diseases (22), radical pelvic surgery (17), trauma (11) and others (69). They received 5 to 20 microgram PGE1 (diluted in 1ml normal saline) injection intracavernously on their first or second visit. The efficacy is judged 30 minutes after the injection of PGE1 by the following criteria. Positive, the angle between the penis and vertical line in upright position > 90 degree. Hard enough for penetration (judged by palpation). Negative others. Adverse effects were as follows: pain in 16 cases (5.4%) and burning sensation in 1 (0.3%). No prolonged erection were encountered. One-hundred-fifty-nine patients (54%) showed positive while 137 (46%) showed negative. There were no significant differences between positive and negative groups in the etiological backgrounds, the PGE1 doses used and the duration of erection. However, there was significant difference between two groups in mean age, namely 42 years old in positive group and 54 years old in negative group (p<0.01). Moreover the positive rate showed gradual decrease with the age (i.e. 81% in the 20s vs. 10% in the 70s and over). Our results show that aging has a big impact on the development of the tissue impairment in corpus cavernosum.
COLOUR DOPPLER SONOGRAPHIC EVALUATION OF IMPOTENCE – USEFULNESS AS A SCREENING TEST Dr Ryuta Goto, Haruaki Sasaki, Yasutada Onodera, Takao Ikeuchi and Yoshio Kai We used colour doppler ultrasonography to evaluate the vascular course of impotent patients. Fifty-five patients suffering from impotence were studied. Colour Doppler ultrasonography was used to measure vascular factors in impotence. After initial screening, patients were injected with papaverine (40mg) and doppler / papaverine studies were performed. Blood flow velocity in dorsal penile and cavernous arteries was measured using colour doppler ultrasonography both before and after injection. Fifty five patients were studied, and were divided into two categories depending on strength of erection after papaverine injection. Twenty four patients were good responders and thirty-one were partial responders. In both groups there was no relation to the flaccid or erect state in dorsal arterial velocity. A significant difference is seen in cavernous arterial velocity between both groups (Wilcoxon test). No difference in cavernous arterial velocity was seen between flaccid and erect states. Eight partial responders with cavernous arterial velocity of > 30ml/sec showed cavernous venous leakage as demonstrated by cavernosography and caversonometry.
DIAGNOSTIC IMPLICATION OF PENILE BIOTHESIOMETRY IN PATIENTS WITH PRIMARY PREMATURE EJACULATION Zhong Cheng Xin, Woo Sik Chung, Young Deuk Choi, Do Hwan Seong, Woong Hee Lee and Hyung Ki Choi To quantify penile sensory level in patients with primary premature ejaculation (PE), penile biothesiometry was performed in 120 PE patients without erectile or neurological deficit and 66 normal volunteers. Sensory threshold values were recorded using a biothesiometer at glands penis, penile shaft, scrotum and index finger. On the glands penis the penile shaft, the values of the patients with PE were significantly lower than that of the normal men (p<0.001). The valuers in normal men revealed decreasing dorsal nerve sensitivity at the glands penis and penile shaft with aging (p>0.001) on glands penis; p=0.012 on penile shaft. In patients with PE a consistently high sensitivity was noted, regardless of age (p>0.05). With these results, we suggest that patients with primary PE have penile hypersensitivity and it provides further implications for an organic basis of PE. Penile biothesiometry can be a very useful method to diagnose PE with a discriminating value of 0.09 microns (3 volts) based on the 95% confidence limits of perception threshold in both groups.
A MODEL TO EXPLAIN PSYCHOLOGICAL FACTORS ASSOCIATED WITH IMPOTENCE Professor Marita P McCabe
This paper is concerned with an evaluation of the psychological factors which may contribute to impotence. In order for psychological interventions to be effective it is important to address these factors in treatment. The variables that contribute to impotence can be classified into their groups. Intergenerational (or family of origin) factors, individual factors and relationship factors. Examples of experiences and attitudes that comprise these groupings will be discussed. Data from impotent men who have sought treatment from the Sexual Behaviour Clinic suggest that it is the cognitive evaluation of these attitudes and experiences, and not the events per se, that impact on erectile functioning. A model to explain the mechanism whereby these psychological variables lead to impotence will be presented ad discussed. Data will also be presented which illustrate the utility of this model in explaining impotence.
A CLINICAL STUDY OF EJACULATORY DISTRUBANCE (IN CASES UNRELATED TO SPINAL CORD INJURY) Toshikazu Otani, Shikou Kai, Hirokazu Takeda Purpose: The etiology of ejaculatory disturbance may be complicated and involve psychological factors, in consequence, the treatment of this condition has not been established. Subject: Subjects were 46 men who were initially examined at our hospital (except spinal cord injury). Ages ranged from 20 to 66 years (mean 35.2 ears). The contents of this disturbance varied, with 26 incapable of ejaculation, 8 incapable of vaginal ejaculation, 8 premature ejaculation. The etiology of 26 incapable ejaculation was thought to be psychotropic drugs (6), retropentoneal lymphnode dissection 3, others 8 , unknown 9. Treatment: (1) Premature ejaculation: 4 were given instruction in the Seman’s method, but not effective, 2 tried application of xylocaine gel to the penis, which helped in 1 case (2) Incapable of vaginal ejaculation: 3 were introduced to AIH (1) effective). But psychotherapy (2) or training by wife were not effective. (3) incapable of ejaculation. 15 used the vibrator, 8 underwent electro-ejaculation under general anesthesia, 2 received subarachnoidal injection of vagostigmin and 2 stopped psychotropic drugs. The vibrator method was effective in idiopathic or drug-related cases, and electro-ejaculation was effective in retroperitoneal lymphnoce dissection cases.
IS HYPERPROLACTINEMIA SURELY A CAUSE OF THE ERECTILE DYSFUNTION M. Yamanaka, T Araki, R Mori, N Ishido, K Kunitomi, H Takamoto Introduction: Hyperprolactinemia (HP) is the generally accepted cause of erectile dysfunction (ED). However, from our clinical experiences, we strongly doubt this assumption. So we investigated the cause of ED in our patients whose serum prolactin levels were more than 30 ng/ml (normal range: 5-27 ng/ml) selected from 558 ED patients whose serum prolactin was evaluated between 1981 and 1994. Their HP was divided into the following three types: (1) pituitary adenoma (2 patients), (2) drug-induced (18 patients), and (3) idiopathic (17 patients). Results: (1) Both pituitary adenoma patients showed more than 1000 ng/ml of serum prolactine. One of them was administered bromocriptine, the prolactine level dropped under 100 mg/ml, and he promptly recovered. The other was lost during follow up. (2) of 18 drug-induced HP patients, 6 out of 8 who stopped taking their medicine recovered normal erection. Of the other 10 patients who continued taking their medicine, 4 recovered normal erection. Of the other 10 patients who continued taking their medicine, 4 recovered normal erection (3) of 17 patients who were presumed to be idiopathic HP, 11 recovered normal erections, 3 did not recover normal erections. The other 3 patients with HP only one patent with pituitary adenoma had ED caused by HP. Our results show that HP causes ED in only a few patients among ED patients with HP, and therefore, HP should not be the assumed cause of ED even though ED patients show HP.
AN ANIMAL MODEL TO EVALUATE THE FUNCTION OF SEMINAL VESICLE – IN VIVO Ju Ton Hsieh and Jyh – Hong Cren 12-14 weeks old mature male Wistar rats were anaesthetised by pentobarbital ( mg/kg, ip) for studies. The lesser splanchnic nerve (LSN) was easily identified and isolated grossly, which was located on the aorto-caval space between the level of renal artery and aorta bifurcation. A Bipolar stainless electrode and Grag SD 9 stimulators were used for electrical stimulation (el.st) A PE 60 tube filled with normal saline was incubated via the tail to the main lumen to seminal vesicle (SV), and connected to viggo-spectramed P 23XL-1 pressure transducer for pressure detection. All the responses wee recorded by Gould RS 3400 polygraph. Varicus frequencies (1,5,10,20,40,80, 160 Hz) were used for 1 min el. St. to LSN under the conditions with 10 volt and 1 msec duration. The highest pressure was obtained at 80 Hz, the optimal pressure was 105 + 7 mm Hg. The vesicle responses to electrical stimulation was constant and reproducible. Clinically, clomipramine has been used to treat the patients with premature ejaculation quite well. We can use this animal model to evaluate the response of rat SV to clomipramine. The vesicle pressure by 2 min el. St (80Hz) was represented as control. After stimulation, SV would be rest for 10 min before clomipramine administration. Different dosages of clomipraurine (0.01 – 3 mg/kg) was injected slowly into femoral vein 10 min before next stimulation. The responses of SV were compared to control and analysed. The vesicle pressure was inhibited about 70-80% with 1-3 mg/kg clomipramine. This animal model is easy to perform. We can use this model for electric-physiologic and pharmacological studies of SV.
J S Paick and J H Lee The Ginkgo biloba extract (GBE) is a complex enriched with many active ingredients prepared from the leaves of Ginkgo biloba several components of which are known to have vasoregulatory activity of arteries, capillaries and veins resulting in increased blood flow. Among the fractions of GBE, nonginkgolide nonflavonoid fraction (NGF) has the most potent relaxing effect on vascular smooth muscle. We subfractionated NGF and speculated that some of subfractions might have very potent relaxing effect on corpus cavernosal smooth muscle in both human and animals. To investigate the effect of subfractions of NGF on the corpus cavernosal smooth muscle and the possibility whether they could be used for the carvernosum using organ bath and electrical field stimulation experiments. The results suggested that subfraction s of NGF, especially 304U-1, have relaxing effect on corpus cavernosum tissue. 304U-1 which showed the most potent relaxing effect can be possibly used as a drug for intracavernosal injection therapy. Considering the fact that the value of ED50 is too high, further fractionation and in vivo study are needed before clinical usage in an oral form.
Yat-Ching tong, Ying Cho Hung, Shim Nan Lin, Juei-Tang Cheng " Ryu-Wei-Ti-Huang-Wan" a Chinese prescription composed of extracts from six plants, has traditionally been used for the treatment of male genitourinary disorders as well as diabetes mellitus Its effect on the treatment of diabetic impotence was evaluated in the present study. Adult male Wistar rates were divided into three groups: (1) rats rendered diabetic with single intraperitoneal injection of streptozotodin (60mg/kg body weight): (2) streptozotocin-induced diabetic rats reacted with "" Ryu-Wei-Ti-Huang-Wan" powder preparation at a dose of 30mg powder/kg body weight twice a day; and (3) control rats received intraperitoneal injection of normal saline. The male rat was caged with an adult ovarirectomized female rat during the dark-cycle. Infra-red light illuminated video recording was performed to evaluate the sexual performances. The mounting latency and frequency (control rats 8.5+1.1 sec & 78.2+17.0, 1-week diabetic rats: 472.4 + 132.0 sec & 46.5 + 28.9, 3-week diabetic rats: 2116.3 + 749.7 sec & 27.5 + 15.2 respectively) intermission latency and frequency (control rats: 13.7+6.7 sec & 42.3 + 4.5 respectively, 1 and 3 week diabetic rats: no intermission), ejaculation latency and post-ejaculatory period (6.1 + 1.8 & 7.4 + 0.5min respectively, diabetic rats: no ejaculation), as well as the hit rate (control: 0.51, diabetic: 0) in the diabetic rats were significantly deteriorated when compared with the control rats. On the other hand, the diabetic rats treated with " Ryu-Wei-Ti-Huang-Wan" showed significant improvement of sexual performances over the non-treated rats when tested after treatment for a1 day or 2 weeks. No significant difference in the blood sugar level was noted between the treatment and non-treatment groups. In conclusion, the diabetic rats showed impairment of both the sexual arousal mechanism as well as the erectile ejaculatory mechanisms " Ryu-Wei-Ti-Huang-Wan" was effective in preserving both functions with a rapid-onset action. It is evident that the extracts exert the therapeutic effects not through a lowering of blood sugar. These substances are potentially useful in the treatment of male impotence.
ROLE OF HYPNOMUSIC THERAPY IN THE TREATMENT OF PSYCHOLOGICAL IMPOTENCE Dr Anil M Patil Hyono-Music Therapy is one of the new avenues in the treatment of psychological impotence. It is a therapy in which patient having psychological impotence is helped by subjecting him to a number of sessions as required in which he is made to listen to the music which is specific to his mental and physical constitution under hypnotic trance with the help of audio music system. 30 patients labelled as psychologically impotent were selected and divided into groups of 10 each, by systematic random sampling. The age group was from 25 to 35 years and was almost equally divided into all three groups (1) the first group was given psychotherapy and behavioral therapy by using modern sex therapeutic methods. (2) the second group was given hypno-music therapy, at least five sessions a week, consisting of half and hour of hypo-music therapy, at least five sessions a week, consisting of half an hour of hypo-music therapy for three months. (3) in the third group both the therapies were combined. The results were as follows. First group significant improvement started in the third month but only two patients (20%) were cured at the end of the three months. In the second group the improvement began at the end of the first month and at the end of the three months seven patients (70%) were cured. In the third group improvement began in the second week itself and nine patients (90%) were cured at the end of three months. Improvement criteria was defined after taking the history of both the partners with physical examination. Follow up was done every 15 days to assess the performance cured ones. Relapse rate was nil up to 6 months after recovery. This show that Hypno-Music Therapy is definitely a better method of curing psychological impotence (Stat. Significant P<0.05) as compared to the other modern methods and if used together gives excellent results.
PSYCHOTHERAPY FOR SEXUAL DYSFUNCTION IN COUPLES Karneya, Yazuru MD Aims: To cure sexual dysfunction, especially difficulty in intravaginal ejaculation (orgasmic disorder) through treatment performed cooperatively between doctor and certified clinical psychologist for the patients and their partners. Methods: The above disorder was mainly accorded behavior therapy by a male doctor, a regular counselling by a female certified clinical psychologist. Results: Thirteen sex-counselling cases were treated in these two years. Of these, the cases are described below that showed good progress principally through psychotherapy. Case 1: Intravaginal ejaculation disorder. After six months of counselling the couple, especially counselling of the husband through the wife by a female certified clinical psychologist, the husband’s systematic desensitization therapy finally showed a ray of hope for positive results. The patient was discovered to suffer from insecurity and a conflict against latent flirtatiousness because both his father and brother tend to indulge in licentious behavior towards women. When the wife changed herself, the husband’s insecurity and conflict diminished, he was released from the pressure of having to fulfil his sexual obligations, and subsequently showed improvement. Case 2: Intravaginal ejaculation disorder. Adjustments in family relations with the patient’s mother and grandmother and psychotherapy to promote independence took quite a long time. The behavior therapy (systematic desensitization therapy) that had been continued since the initial consultation progressed smoothly. Conclusion:: Sex counselling, including the above, is significant in terms of liaison psychiatry in view of the nature of virtually all sexual disorders. The above cases clarified the following points. Even if only the wife or husband has a disorder, it is important if possible for both as a couple to receive counselling. The effectiveness was also clarified regarding counselling cooperatively with doctor and certified clinical psychologist. In as much as psychiatrists tend to be slow in introducing sexual dysfunction therapy, collaboration is hastened between sexology specialists and psychiatrists concerning sexual dysfunction therapy.
G W JUNG
Acetylcholine (ACh) and nitroprusside (SNP) are known to mediate relaxation of cavernous smooth muscle via increasing the levels of cGMP, mediated by nitric oxide (NO). In recent years, the role of K+ channels in the hyperpolarization induced by nitrates and ACh in smooth muscle have been investigated. In this study, we attempted to characterise the role of K+ channel in rabbit cavernous smooth muscle relaxation by Ach and SNP. Strips of rabbit corporal tissues were studied for isometric tension measurement under treatment of drugs in the organ chamber. L-NOARG (3x 10.5M) and methylene blue (3x 10.5M) significantly inhibited the relaxant effect of Ach in cavernous smooth muscle, but that of SNP was not influenced by these drugs. L-arginine (3x 10.4M) reversed the relaxant effect of Ach which was inhibited by L-NOARG. Charybdotoxin (ChTx, 10.7 M) significantly inhibited the relaxant effects of Ach, SNP and 8-Br-cGMP, but gilbenclamide 10.5M) and apamin (10.5M) did not influence those of Ach and SNP. ACh (10-4M) and SNP (10.5M) increased the tissue content of cGMP. The effect of ACh on the tissue content of cGMP was significantly affected by L-NOATG (3x10.5M) and methylene blue (3x10.5M) but that of SNP was not influenced by these drugs. ChTx(10.7M) did not attenuate the accumulation of cHVIP induced by ACh and SNP. Above results suggest that ACh and SNP effectively relax isolated rabbit cavernous smooth muscle associated with an increase in the tissue content of cGMP. Furthermore, ChTx sensitive-K+channel-mediated hyperpolarization by increased cGMP may play a part in the relaxation of rabbit cavernous smooth muscle by ACh and SNP.
ROLE OF G-PROTEIN IN NORMAL CORPUS CAVERNOSAL FUNCTION IN A RABBIT MODEL Young Chan Kim G-Proteins are membrane bound proteins which act as transmembrane signal transducers for many contractile and relaxant responses in the endothelium and the vascular smooth muscle. This study examines the function of G-Protein in the corpus cavernosum of the rabbit. In vitro isometric tension studies on isolated strips of New Zealand White rabbits were performed with and without preincubation with pertussis toxin (PT:a I inhibitor, 0.1 m g/ml), cholera toxin (CTL:a s inhibitor; 2m g/ml), aluminium fluoride (AlF4; non specific a inhibitor; 10 m M) in response to KCI, norepinephrine (NE) and following precontraction to acetylcholine (Ach), calcium ionophore (A23817) and papaverine. Receptor independent KCI responses were unchanged by PT, CT or AIF4 incubation NE induced contractions were not attenuated by PT or CT. AIF4 did attenuated the NE responses (262 vs 163% max. KCI response at 0.1mM NE, control and AIF4 respectively: p<0.5 two way ANOVA with repeated measures). Ach induced relaxation was unaffected by the presence of PT, CT or AIF4. Incubation with PT, CT or AIF4 did not affect A23817 (receptor independent endothelium mediated) or papaverine (receptor independent endothelium independent) induced relaxation. Therefore, these results suggest that PT insensitive species contribute to a species contribute to noradrenergic tone and that other species such as a q and a o are responsible for the relaxation observed. Further studies are needed to identify the family of G-Protein in the corpus cavernosum.
ROLE OF NITRIC OXIDE IN PENILE ERECTION: A MULTIDISCIPLINARY STUDY J K Suh, S C Chung, K H Mun, T C Park, Y C Lee, J M Park, K Huh Nitric oxide (NO) is known to act as an important neural mediator of penile erection. Nitric oxide synthase (NOS), which produces NO, has been recently identified in autonomic neurons supplying pelvic organs including external genitalia. The present study was undertaken to investigate the role played by NO NOS. Initial experiments were performed to elucidate the expression of NOS in the human and rat penis. Western blotting analysis identified a protein of 155 KDa molecular weight identical to neural form of NOS. The NOS blot density in the human and rat penis was similar, which was lower than that in the rat cerebellum. Further investigation of NOS in the rat penis using reduced nicotine amid adenine dinucleotide phosphate (NADPH) diaphoreses histochemical staining localized NOS to neurons innervating the corpora covernosa including the pelvic plexus, cavernous nerves and their terminal fibers within the corporal erectile tissue, and dorsal penile nerves. Additional studies of NOS using assay of NADPH diaphoreses activity and nitrite measurement were performed in various organs of the rat. NOS activity regionally predominated in the cerebellum, urethra, penis, and urinary bladder in order. Subsequent investigations focused on the physiologic role of NO, which was determined using an in vivo electroerection model in the rat intracavernous injections of NOS inhibitor (L-NOARG or L-NAME from 10.6 M to 10.3 M) were found to suppress the nerve-induced erection in concentration dependent manner. Subsequent intracavernous injection of L-arginine (10-2 M) partially restored penile erection suppressed by L-NOARG or L-NAME (10.3M). These results indicate that the neural form of constitutive NOS in the corpora cavernosa of the penis synthesizes NO by its catalytic action, which mediates penile erection. Furthermore, determination of cavernous NOS expression and/or activity may allow to characterize certain pathological conditions which comprise neurogenic impotence.
ELICITATION OF PENILE ERECTION AFTER ACTIVATION OF PARAVENTRCULAR NUCLEUS OF HYPOTHALAMUS IN THE RAT K K Chen, J Y H Chan, S H H Chan, L S Chang
To investigate the neural regulation of penile erection, we conducted a study to explore possible central brain loci involved in penile erection. Male, adult Sprague-Dawley rats (200-300 g) anaesthetized with pentobarbital sodium were used. The intracavernous pressure (ICP), systemic arterial pressure (SAP) and heart rate (HR) were monitored simultaneously through a 26 gauge needle inserted into the copus cavernosum and a cannula into the femoral artery respectively. The paraventricular nucleus of hypothalamus was activated by stereotaxically delivered electrical stimulation (30-strain of 30-120 gA, 40-160 Hz, 1-ms rectangular pulses). The resting ICP was 2-8 mmHg. A single for multiple episodes of elevation of ICP was observed. The peak increase in ICP during single episode (n=11) amounted to 53.50"9.6 mmHg, with a latency of 28.8o"7.5 seconds, and a duration of 7.45o"2.7 minutes. Chemical stimulation of the PVN with glutamate also elicited a heightened ICP with peak at 100 mmHg. There was no simultaneous significant alterations in SAP and HR accompanied with the increase of ICP with 25 gm frozen sections of the brain and stained with Cresyl violet or Neutral red. Based on the increase of ICP and visible erectile episodes upon electrical or chemical stimulation to the PVN, we would conclude that the paraventricular nucleus of hypothalamus may be an important locus in the central nervous system that participates in the neural regulation of penile erection in the rat.
PEYRONIE’S DISEASE: SURGICAL MANAGEMENT BY THE NESBIT AND CORPOROPLICATION TECHNIQUES Dr. Dean Knoll The surgical treatment of Peyronie’s disease has been limited only by the physician’s imagination. We report our surgical experience with the Nesbit techniques and a simpler corporoplication procedure over a six year follow-up time period, range – 12 to 72 months: mean – 40 months. Forty men with a mean age of 54 (26 to 62) years were evaluated with color flow duplex doppler scanning and wee considered potent, however, were experiencing mechanical impotence (40 to 70 degrees curvature). Group 1 (20 patients) underwent a Nesbit technique with an ellipse (s) of Buck’s fascia and the tunica alouginea being excised and were closed horizontally with interrupted inverted non absorbable sutures. Group B (20 patients) underwent a corporoplication procedure without excising a wedge of tunica using inverted absorbable (polydioxanone) sutures. Ninety percent of Group A (18 of 20 patients) and 85% in Group B (17 of 20 patients) had a straight penis. Recurrent curvature occurred in one patient in Group A and two patients in Group B. One patient in Group A became impotent. Eighty percent of patients in each group had shortening of the penis from one to two cent metres. Two patients in Group A and three patients in Group B experienced transient penile hypoaesthesia. Overall in each group 80% of the patients stated they had a satisfactory result and had normal intercourse. Each technique provided similar results. Corporoplication without excision of the tunica is simpler, less time consuming and allows for correction of a penile deformity without excising tunica wedges.
Sae Chu Kim, Sung Ho Park, Sung Hak Yang
Two cases of high flow priapism which occurred after blunt perineal trauma and had lasted for 35 days (case 1) and 40 days (case 2) were successfully treated by embolization of the lacerated cavernous arteries with autologous clots. Cavernous arterial blushes were demonstrated on selective internal pudenda arteriograms in both cases. Case 1 of left cavernous arterial laceration restored 80% of premorbid erectile function with successful intercourse 4 months after the superselective embolization. In case 2 of bilateral cavernous arterial lacerations, premorbid erectile function was fully resumed 2 months after bilateral embolization of the cavernous arteries at intervals of 15 days. None developed local or systemic complication.
ALPROSTADIL S PRO-OFFICE VS HOME DOSE. RESULTS OF CLINICAL TRIAL IN TAIWAN, CHINA AND THAILAND Charles Chi-Ju Wu, Zkao-Yong Xue, Aplchat Kong/Canaca A mulicenter (the Taiwan P.R. of China, Thailand) study was conducted to establish the optimal dose of alprostadil terile Powder (S.Po) (Caverject) for the treatment of erectile dysfunction (ED) in the office, and if this dose would change during self-injection use at home. Injections of Caverject in a dose escalating regimen starting with 5 m g to a maximum of 60 m g until an erection with a rigidity sufficient to achieve vaginal penetration lasting 30-60 minutes was achieved. Patients who reached optimal dose in the office were instructed in self-injection and were followed for one month of self injection use at home. The study included 150 patients aged 21 to 74 (mean 48.3) years with Ed of various origins and duration of 3 years and 8 months.
WORLDWIDE CLINICAL STUDIES WITH ALPROSTADIL STERILE POWDER (CAVERJECT) IN ERECTILE DYSFUNCTION Ottod Linet Alprostadil Study Group
In three pilot dose-escalation studies (N=219), the intolerance to alprostad (defined as erection lasting = 4 hrs or adverse local or systemic reaction ) was reached at 30 mg, 65mg and 70 mg, respectively. The lowest dose of alprostad producing = 70 rigidity for = 10 min (Rigiscan) investigated in two trials was 1,2,5, and 2.5 mg for patients with neurogenic (N=16), arteriogenic (N=25), and venogenic (N=25) ED, respectively. Significant dose response relationships were observed in a double-blind, placebo (PBO) controlled, parallel design study (N=296) over the dose ranges of 2.5, 5, 10, and 20 mg for erectile response by clinical and Rigiscan (= 70 rigidity of = 10 min) assessment. There was no response to PBO. Similar results were obtained in two additional dose-response, crossover PBO-controlled studies. In an open-label, self-injection study (N=683) lasting for 6 months, alprostadil doses ranged from 0.2 to 140 mg. Satisfactory sexual activity was reported by patients and partners after 87% and 86% of injections, respectively. In 1881 ED patients exposed to alprostadil in all clinical trials, the following side effects were reported.: penile pain (mostly mild) – 37% (11% of injections), fibrosis – 3% (in one study up to 18 months of duration – 7.8%), injection site hematomas – 5%, prolonged erection (4-6 hrs) – 4% and priapism (> 6 hrs) – 0.4%. The frequency of systemic side effects possibly related to drug was < 1%: none of them were clinically significant. Data obtained in special patient populations will also be discussed.
K Nagao, M Takanami, M Matsuhashi, N Ishii, K Miura, M Shirai Purpose: Subjects
and Methods:
Conclusions
Statistically significant differences were found in all parameters between the results of tests (1), (2), and (3) evaluated by the student’s test. It was demonst |