Skip to main content
NCBI home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1996 Jan;164(1):54–61.

New developments in the diagnosis and treatment of impotence.

R G De Palma 1
PMCID: PMC1303294  PMID: 8779203

Abstract

New developments in the diagnosis and treatment of impotence or erectile dysfunction are increasingly based on better understanding of the erectile process. In 1978 it was thought that the failure of arterial inflow was the main cause of male erectile dysfunction. Emphasis was placed on methods of corpus cavernosal revascularization. In recent years, interest has shifted to abnormal cavernosal smooth muscle function. An understanding of the erectile process was greatly enhanced by intracavernosal administration of vasoactive agents in 1982 and, more recently, the use of prostaglandin E1. These agents promote erection by causing smooth muscle to relax. The intracavernosal administration of vasoactive agents is now used in diagnosis and in therapy. Standard approaches to diagnosis and therapy still vary, but more rational steps are evolving. Considerable progress has been made in quantifying penile blood flow. Increasingly effective therapies are available for an estimated 10 million American men suffering from erectile dysfunction. Therapies include the use of drugs, administering vasoactive agents intracavernosally, vacuum constrictor devices, and vascular interventions in highly selected cases of arterial or venous disease. These procedures are being carefully reevaluated. Critical analysis of recent results suggests that about 7% of men are amendable to vascular interventions, with success rates approximating 70% when supplemental therapy is used.

Full text

PDF
54

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brindley G. S. Pilot experiments on the actions of drugs injected into the human corpus cavernosum penis. Br J Pharmacol. 1986 Mar;87(3):495–500. doi: 10.1111/j.1476-5381.1986.tb10191.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Broekman C. P., van der Werff ten Bosch J. J., Slob A. K. The patient with erection problems and his general practitioner. Int J Impot Res. 1994 Jun;6(2):59–65. [PubMed] [Google Scholar]
  3. DePalma R. G., Emsellem H. A., Edwards C. M., Druy E. M., Shultz S. W., Miller H. C., Bergsrud D. A screening sequence for vasculogenic impotence. J Vasc Surg. 1987 Feb;5(2):228–236. [PubMed] [Google Scholar]
  4. DePalma R. G., Levine S. B., Feldman S. Preservation of erectile function after aortoiliac reconstruction. Arch Surg. 1978 Aug;113(8):958–962. doi: 10.1001/archsurg.1978.01370200052010. [DOI] [PubMed] [Google Scholar]
  5. DePalma R. G., Michal V. Point of view: deja vu--again: advantages and limitations of methods for assessing penile arterial flow. Urology. 1990 Aug;36(2):199–200. doi: 10.1016/0090-4295(90)80229-g. [DOI] [PubMed] [Google Scholar]
  6. DePalma R. G., Olding M., Yu G. W., Schwab F. J., Druy E. M., Miller H. C., Massarin E. Vascular interventions for impotence: lessons learned. J Vasc Surg. 1995 Apr;21(4):576–585. doi: 10.1016/s0741-5214(95)70189-3. [DOI] [PubMed] [Google Scholar]
  7. DePalma R. G., Schwab F. J., Emsellem H. A., Massarin E., Bergsrud D. Noninvasive assessment of impotence. Surg Clin North Am. 1990 Feb;70(1):119–132. doi: 10.1016/s0039-6109(16)45039-5. [DOI] [PubMed] [Google Scholar]
  8. Glina S., Reichelt A. C., Leão P. P., Dos Reis J. M. Impact of cigarette smoking on papaverine-induced erection. J Urol. 1988 Sep;140(3):523–524. doi: 10.1016/s0022-5347(17)41708-3. [DOI] [PubMed] [Google Scholar]
  9. Krane R. J., Goldstein I., Saenz de Tejada I. Impotence. N Engl J Med. 1989 Dec 14;321(24):1648–1659. doi: 10.1056/NEJM198912143212406. [DOI] [PubMed] [Google Scholar]
  10. Leriche R., Morel A. The Syndrome of Thrombotic Obliteration of the Aortic Bifurcation. Ann Surg. 1948 Feb;127(2):193–206. doi: 10.1097/00000658-194802000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lue T. F., Hricak H., Marich K. W., Tanagho E. A. Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology. 1985 Jun;155(3):777–781. doi: 10.1148/radiology.155.3.3890009. [DOI] [PubMed] [Google Scholar]
  12. May A. G., DeWeese J. A., Rob C. G. Changes in sexual function following operation on the abdominal aorta. Surgery. 1969 Jan;65(1):41–47. [PubMed] [Google Scholar]
  13. Opsomer R. J., Guerit J. M., Wese F. X., Van Cangh P. J. Pudendal cortical somatosensory evoked potentials. J Urol. 1986 Jun;135(6):1216–1218. doi: 10.1016/s0022-5347(17)46040-x. [DOI] [PubMed] [Google Scholar]
  14. Rajfer J., Aronson W. J., Bush P. A., Dorey F. J., Ignarro L. J. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med. 1992 Jan 9;326(2):90–94. doi: 10.1056/NEJM199201093260203. [DOI] [PubMed] [Google Scholar]
  15. Schiavi R. C., Schreiner-Engel P., Mandeli J., Schanzer H., Cohen E. Healthy aging and male sexual function. Am J Psychiatry. 1990 Jun;147(6):766–771. doi: 10.1176/ajp.147.6.766. [DOI] [PubMed] [Google Scholar]
  16. Virag R. Intracavernous injection of papaverine for erectile failure. Lancet. 1982 Oct 23;2(8304):938–938. doi: 10.1016/s0140-6736(82)90910-2. [DOI] [PubMed] [Google Scholar]
  17. Waldhauser M., Schramek P. Efficiency and side effects of prostaglandin E1 in the treatment of erectile dysfunction. J Urol. 1988 Sep;140(3):525–527. doi: 10.1016/s0022-5347(17)41709-5. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES