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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to review the current situation of penile prostheses in the treatment of erectile dysfunction and to analyze the indications, degree of acceptability and complications in our experience. From 1987 to 1993, 35 implants were inserted in men suffering from impotence due to different etiologies. The mean age was 54 years and the mean duration of erectile dysfunction was 37 months. Diabetes, vascular disease and pelvic surgery were the most common pathologies recorded. We utilized the penoscrotal approach in 97.14% of the cases and implanted the following prostheses: 12 Hydroflex, 7 Uniflate 1000, 6 Acuform, 4 Mark II, 3 Dynaflex and 3 Alpha 1. The mean follow-up was 38 months. Infection of the prosthesis by Staph. epidermidis was observed in 5.71% of the cases. This infectious complication required removal of the prosthesis. Two patients with a Uniflate prosthesis complained of mechanical failure. Eighty percent of the patients and 74.28% of their partners were satisfied with the results. When asked if they would undergo another operation again if it were necessary, 71.42% answered "yes". Penile prostheses have withstood the test of time and continue to be an effective and valid therapeutic alternative in impotent men. Although the complication rate is low, adequate information must be provided to the patient and partner in order to enhance the results.
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PMID:[Penile prosthetic implant in the treatment of impotence: our experience]. 780 74

A potent man with early signs and symptoms of Peyronie's disease 3 months in duration received 1,200 rad of external beam radiation to the penis and presented 5 months later with impotence. Physical examination revealed diffusely woody indurated corporeal tissue. Nocturnal penile tumescence testing was abnormal and pharmaco-cavernosometry demonstrated diffuse corporeal veno-occlusive dysfunction. Treatment by penile injections was unsuccessful. During penile prosthesis implantation bilateral rubbery erectile tissue was encountered, requiring extensive bilateral corporotomy and sharp corporeal tissue excision for prosthesis insertion. Histological analysis of excised corporeal tissue demonstrated extensive corporeal fibrosis and arterial vasculopathy. Computer assisted color histomorphometry revealed that the mean percentage of trabecular smooth muscle area to total erectile tissue area was 26.5 +/- 15.8 (normal 40 to 52%). Immunohistochemical staining with desmin confirmed extensive fibrosis. The most likely explanation for severe corporeal fibrosis is penile irradiation. The hypothesized mechanism of radiation associated fibrosis is ionizing injury to the endothelial cells of the lacunar spaces and cavernous/helicine arteries, which induced irreversible corporeal extracellular matrix structural changes. Penile irradiation, like vascular disease and priapism, is a potential cause of diffuse corporeal fibrosis.
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PMID:Extensive corporeal fibrosis after penile irradiation. 781 87

Many types of vacuum constriction devices (VCDs) are used for the treatment of impotence, but the VCDs made in the USA are too large for Japanese males, and air leakage occurs. Therefore, we examined the erectile response of 47 impotent men to a vacuum constriction device that is made in Japan and can be applied suitably for Japanese men, and compared the response to intracavernous injection of prostaglandin E1 (PGE1). When the 47 cases were divided into two groups by nocturnal penile tumescence, twenty of the impotent men were regarded to have fewer organic factor (group A) while 27 were regarded to have more organic factor (group B). All (100%) of the 20 cases of group A achieved a complete erection with the VCD, but only 11 (55%) of them achieved a complete erection with PGE1. Twenty-three (85%) of the 27 cases of group B achieved a complete erection with the VCD, but only nine (33%) achieved a complete erection with PGE1. Two of the four patients who did not achieve a complete erection with the VCD stopped pumping the VCD because of penile pain, and the other two patients had a penile-brachial pressure index (PBPI) of under 0.65. It was suggested that patients with no severe vascular disease can show a good erectile response with the VCD.
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PMID:[A study on the erectile response with the vacuum constriction device compared with intracavernous injection of a vasoactive drug]. 789 34

The authors sought to determine whether current cigarette smoking was associated with impotence among middle-aged men. This is a secondary analysis of a cross-sectional survey of 4,462 US Army Vietnam-era veterans aged 31-49 years who took part in the Vietnam Experience Study in 1985-1986. The main outcome measurement was the odds ratio for reported impotence, which was calculated by comparing current smokers with nonsmokers while controlling for multiple confounders. The study sample consisted of 1,162 never smokers, 1,292 former smokers, and 2,008 current smokers. The prevalence of impotence was 2.2% among never smokers, 2.0% among former smokers, and 3.7% among current smokers (p = 0.005). The unadjusted odds ratio (OR) of the association between smoking and reported impotence was 1.8 (95% confidence interval (CI) 1.2-2.6). The association held even after adjustments were made for confounders, including vascular disease, psychiatric disease, hormonal factors, substance abuse, marital status, race, and age (OR = 1.5, 95% CI 1.0-2.2). Neither years smoked nor cigarettes smoked daily were significant predictors of impotence in current smokers. The authors concluded that, among the men in this study, a higher percentage of cigarette smokers reported impotence than did nonsmokers. This observation could not be totally explained by comorbidity factors related to smoking.
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PMID:Cigarette smoking: an independent risk factor for impotence? 798 47

Penile revascularization via inferior epigastric dorsal penile artery bypass is a treatment option for men with vasculogenic impotence due to proximal segmental arterial occlusion. Various diagnostic tests have been used to identify arterial vascular disease but pudendal arteriography remains the gold standard anatomical study. Unfortunately, more than 80% of impotent men have significant variations in penile arterial anatomy, and proximal arterial occlusions may prevent adequate visualization of the intrapenile arteries. We have found that intraoperative penile arteriography performed through the dorsal penile artery facilitates the planning of the arterial anastomosis to ensure adequate blood flow to the corpora cavernosum. The indications and technique of intraoperative penile arteriography are described.
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PMID:Intraoperative arteriography facilitates penile revascularization. 812 76

In the literature the importance of the neurological factor in the etiology of erectile dysfunction in patients with diabetes mellitus is subject to debate. We report on the findings of neurophysiological investigations in 27 impotent and 30 potent diabetic patients, as well as 102 impotent nondiabetic patients. Additionally, hormonal and vascular evaluations were done. The neurophysiological evaluations consisted of assessment of somatic as well as autonomic sensory nerves, by measuring the latencies of somatosensory evoked potentials of the posterior tibial and pudendal nerves, and of the bulbocavernosus and urethro-anal reflexes. The results show a higher incidence of more severe peripheral and autonomic sensory neuropathy in impotent diabetic men. Also, a preponderance of abnormal intracavernous pharmacological tests, suggesting vasculogenic impotence, was found in impotent diabetic patients. No important endocrinological differences were found among the 3 groups under investigation. Significant differences occurred for plasma glucose and glycosylated hemoglobin. We conclude that diabetic urogenital sensory neuropathy has a crucial role in the etiology of diabetic impotence. Angiopathy seems to be of secondary importance. The results show that poor diabetes regulation is associated with diabetic impotence.
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PMID:Erectile dysfunction in diabetic men: the neurological factor revisited. 812 17

Intracavernous elastic fibres may play a role in human erectile tissue compliance and elasticity. Using computerized image analysis we have measured objectively the percentage of elastic fibres in corpus cavernosum tissues in both potent and impotent men. Twenty-two penile biopsies were performed in 5 potent and 17 impotent patients due to vascular disease. The mean percentage of elastic fibres was 9% in normal patients. In 12 patients with venous leakage a significant decrease in the amount of elastic fibres of 5.1% was observed and in 5 patients with arterial disease it was 4.3%. No correlation between the reduction of the elastic fibre quantification and age was observed. Change in elastic fibre content may alter the relaxation properties of cavernosal tissue and play a role in the development of erectile dysfunction.
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PMID:Computerized measurement of penile elastic fibres in potent and impotent men. 813 55

The quality of the anastomosed vessels before vascular grafting has been shown to influence long-term patency rates in arterial reconstructive procedures. A study was designed to assess vascular graft quality during microvascular artery bypass procedures for impotence, correlate identified vasculopathy with the clinical history and gain insight into vascular pathophysiological mechanisms. A total of 194 donor or recipient vessel segments was biopsied in 111 patients with impotence who underwent microvascular artery bypass surgery during a 10-year period. A prospective histological grading system was used in a blinded randomized fashion. A preexisting vascular pathological condition was identified in 48% of the patients. Proliferative lesions above the internal elastic lamina with luminal stenosis were identified in 38 of 69 dorsal penile artery segments (55%) and 8 of 69 inferior epigastric artery segments (12%). Venous hypertrophy or sclerosis was observed in 13 of 56 deep dorsal vein segments (23%). Systemic atherosclerosis was likely the underlying pathophysiology of vascular disease in the inferior epigastric artery. Vasculopathy in the deep dorsal vein and the dorsal penile artery segments was probably related to the consequences of blunt trauma to the pelvis, perineum or penis, which was considered to occur following direct vessel wall injury with immediate or delayed vascular disease or indirect vessel wall injury secondary to proximal arterial occlusion and delayed distal vascular disease. Future studies are needed to investigate the relationship between preexisting graft vasculopathy in microvascular artery bypass surgery for impotence and long-term clinical success rates.
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PMID:Preexisting vascular pathology in donor and recipient vessels during penile microvascular arterial bypass surgery. 815 66

Duplex ultrasound is used commonly to evaluate vascular function in impotent men. There is evidence, however, that some men with normal vascular function may have falsely abnormal duplex ultrasound results because of suppression of response to pharmacological stimulation due to anxiety. We performed a prospective blinded study of 40 impotent men comparing duplex ultrasound to a formal nocturnal penile tumescence evaluation. Duplex ultrasound was done with a standard 10 MHz. color Doppler unit after intracorporeal pharmacological stimulation. Nocturnal penile tumescence was performed at a sleep laboratory, and included measurements of penile circumference, axial rigidity, arterial pulsations, and direct patient and observer evaluation of erections. Of 40 men 20 had an abnormal duplex ultrasound result (maximum arterial velocity less than 30 cm. per second), including 9 who had normal nocturnal penile tumescence with at least 1 rigid erection (greater than 550 gm. axial rigidity) lasting at least 5 minutes. All 9 men had evidence of psychogenic dysfunction on history and personality inventory, and only 1 had evidence of vascular disease. Of the other 11 patients with abnormal duplex ultrasound and nocturnal penile tumescence findings, only 2 had evidence of psychogenic impotence and 9 had evidence of vascular disease. In these 11 men there were significant correlations between maximum arterial velocity on duplex ultrasound, and maximum rigidity and arterial pulsations on nocturnal penile tumescence. Of 40 patients 20 had a normal duplex ultrasound finding (maximum velocity greater than 30 cm. per second). Nine of these patients had a normal nocturnal penile tumescence test, of whom 5 had evidence of psychogenic impotence and only 1 had evidence of vascular disease. Eleven men with normal duplex ultrasound had an abnormal nocturnal penile tumescence test, including only 2 with any evidence of psychogenic impotence, while 9 had vascular disease and 1 had a history of neurological disease. Based on this study 9 of 14 men (64%) with a normal nocturnal penile tumescence test and other evidence of psychogenic impotence had abnormal duplex ultrasound. Therefore, an abnormal duplex ultrasound study should be interpreted cautiously if there is evidence of psychogenic impotence. In men with vasculogenic impotence there is an excellent correlation and cross-validation between maximum velocity on duplex ultrasound, and axial rigidity and arterial pulsations on nocturnal penile tumescence.
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PMID:Comparison of duplex ultrasonography and nocturnal penile tumescence in evaluation of impotence. 818 64

We provide current, normative data on the prevalence of impotence, and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study. The Massachusetts Male Aging Study was a community based, random sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject's home. A self-administered sexual activity questionnaire was used to characterize erectile potency. The combined prevalence of minimal, moderate and complete impotence was 52%. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. Subject age was the variable most strongly associated with impotence. After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension. We conclude that impotence is a major health concern in light of the high prevalence, is strongly associated with age, has multiple determinants, including some risk factors for vascular disease, and may be due partly to modifiable para-aging phenomena.
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PMID:Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. 825 33


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