Iatrogenic causes of erectile dysfunction.

Normal penile erection is a complex event dependent upon the proper sequential function of the endocrine, nervous, and vascular systems. Medical or surgical therapy can influence those systems and so cause erectile dysfunction. Physicians must understand these iatrogenic causes of erectile dysfunction in order to prevent or reverse them.

Psychosocial follow-up of penile prosthesis implant patients and partners.

One to four years after penile prosthesis surgery, detailed medical and psychosocial interviews were conducted separately with 52 patients and 22 of their partners. Patients tended to be negative or disappointed about postoperative pain, penis size, postoperative sexual frequency, and prosthesis malfunctions. Positive comments emphasized the psychological benefits of renewed masculine self-esteem, repair of humiliation, and reduction of marital guilt.

Adherence to recommendations and improvement over time in men with erectile dysfunction.

Men with erectile problems seen for a comprehensive urology-department-based medical and psychological evaluation were sent questionnaires 2 to 3 years later. A representative sample of 99 (52%) responded. The majority (51%) has taken no action and reported that their sexual function was no better.

Further studies on the effect of chronic alpha-methyldopa administration upon the central nervous system and sexual function in male rats.

Previous studies in our laboratory have demonstrated that alpha-methyldopa, a potent inhibitor of catecholamine synthesis, reduced both libido and erectile function in sexually mature male rats as it does in humans. In this report, those studies were extended to identify the drug's effect upon catecholamine content in the brain, spinal cord and penile erectile tissue in mature male rats. Because many men report that the adverse effects of alpha-methyldopa upon their sexual performance continue after withdrawal from the drug, a 2nd group of animals was retested after the drug was stopped.

Evaluation of the first 70 patients in the center for male sexual dysfunction of Beth Israel Medical Center.

We evaluated 70 patients for male sexual dysfunction in our center during its first 6 months of operation. The results of the analysis demonstrated that 55 per cent had organic impairment. Several important findings should be emphasized.

Noradrenergic innervation of the penis in control and streptozotocin-diabetic rats: evidence of autonomic neuropathy.

The noradrenergic sympathetic innervation of the penis of control and 4-month streptozotocin-diabetic rats was examined with the glyoxylic acid histofluorescence method. Noradrenergic varicosities were found in the corpora cavernosa in a dense subtunical plexus and in the perisinusoidal and trabecular regions of the erectile tissue, in the corpus spongiosum in perisinusoidal tissue, around large arteries and veins, and around small tortuous arterioles and small draining veins of the corpora cavernosa and spongiosum. Noradrenergic varicosities were diminished in number and fluorescent intensity in all regions of the penis of diabetic rats compared with controls.

The effect of chronic alpha-methyldopa upon sexual function in the adult male rat.

Erectile impotence is a commonly reported undesired side effect in patients treated for hypertension with alpha-methyldopa. However, the mechanism of that dysfunction has not been determined. In this study we report the effect of 12 days of daily intraperitoneal injections, 300 mg.

Normal sexual behavior and penile reflexes in long-term diabetic male rats.

Male rats made diabetic by streptozotocin injection were tested intermittently for copulation and penile reflexes. Eight to nine months later their bodies, penises, and seminal vesicles weighed significantly less than those of control-injected males, although serum androgen as well as penile and vas deferens norepinephrine levels were not significantly depressed. None of the measures of sexual motivation, performance, or penile responsivity was depressed in the diabetic rats, suggesting that rats are not a fruitful animal model for diabetic impotence.

The pathologic effect of ureteral ligation, with clinical implications.

Inadvertent, ureteral ligation is a frequent occurrence with pelvic surgery. We determined the effect of the ureteral ligation of varying lengths of time in an animal model in order to provide a rational basis for the clinical management of such injuries in humans. In the rat, simple deligation of a ureter that has been ligated for as long as 24 hours results in complete resolution of the injury with no gross or microscopic evidence of the trauma.

Ultrastructure of human penile erectile tissue in patients with abnormal norepinephrine content.

Past studies of the alteration of nerve morphology of penile erectile tissue in men with impotence using light and histofluorescent techniques have been inconclusive. We evaluated the ultrastructure of erectile tissue of five men; the content of the neurotransmitter norepinephrine in this tissue was also known. Our results show that in nerve fibers of men whose penile tissue samples displayed very low norepinephrine content, nerve fibers were extremely sparse.

The influence of neonatal orchiopexy upon the testis in persistent Müllerian duct syndrome.

We report on a patient with persistent müllerian duct syndrome and normal external genitalia who had embryonal cancer of the testis 16 years after neonatal bilateral orchiopexy. In previous cases the testes of these patients have not been considered predisposed to form tumors. However, the occurrence of a testis tumor has been reported in 8 patients with this syndrome.

Effect of intravenous mannitol on renal hemodynamics and renal lymph recovery during acute ureteral obstruction.

The object of this study was to determine the effect of mannitol upon lymph flow during acute unilateral renal obstruction in the dog--whether it would sustain, increase, or have an adverse effect upon renal hilar lymph flow. Two groups of dogs were used so that the efficacy of bolus injection could be compared with continuous infusion of mannitol. After ureteral obstruction renal hilar lymph flow increased significantly.

Alteration of the penile corpora in patients with erectile impotence.

We measured the content of the two principal neurotransmitters of the autonomic nervous system from the erectile tissue of four men with normal erection and 38 men impotent as a result of injury or disease. In the former the norepinephrine content was 812 +/- 82.6 (SE) pg per mg of wet weight; In the latter, statistically significant reductions of norepinephrine were found with the greatest decrease occurring with insulin-dependent diabetes mellitus.

Effect of diabetes upon penile sympathetic nerves in impotent patients.

Samples of erectile tissue taken from the corpora cavernosa of 16 male diabetic patients suffering from impotence were studied. The content of norepinephrine, which reflects sympathetic nerve activity of that tissue, was significantly lower in insulin-dependent patients 104.2 +/- 24.

The possible role of the catecholamines of the corpora in penile erection.

The etiology of impotence, which effects 50 per cent of the men with diabetes, is unknown. The neurotransmitter (norepinephrine) released from adrenergic neurons is thought to be the most direct regulator of vascular smooth muscle. We have measured the norepinephrine content of the erectile tissue of diabetic men.

Nonhomologous associations of C-heterochromatin at human male meitoic prophase.

In human male meiotic prophase, nonhomologous pairings and connections between C-heterochromatic regions were demonstrated by C-banding and G-11 staining. Approximately 40% of the pachytene stages exhibited bivalent associations at regions of C-heterochromatin. Nonhomologous associations were seen between all possible morphological types of bivalents.

Evaluation of the dermal graft inlay technique for the surgical treatment of Peyronie's disease.

The results of treatment with the dermal graft inlay technique for 7 patients with Peyronie's disease and the inability to achieve intercourse are discussed. All 7 patients were unable to attain tumescence postoperatively. We believe that patients who require surgical therapy for Peyronie's disease and who have functional impotence should be treated with silicone penile implants.

Nonassociation of hyperamylasemia and prostatic disease.

The possible correlation of hyperamylasemia and prostatic disease was investigated in patients with benign prostatic hyperplasia, adenocarcinoma of the prostate, and in patients without clinical evidence of prostatic lesion. Our results indicate that prostatic lesions whether benign or malignant are not associated with either elevation of serum amylase or abnormal isozyme zymograms.

Bilateral renal loss resulting from intravesical formalin instillation.

A patient was referred for evaluation of obstructive uropathy after treatment with 10% formalin to control recurrent hemorrhagic radiation cystitis. Progressive bilateral ureteral, pelvic, and renal parenchymal destruction occurred despite ileal ureteral replacement. This complication of therapy reinforces the concept that vesical instillation of formalin should be done only in extreme cases and then only in low concentrations.