Impotence (erectile dysfunction) due to vascular disorders. An overview

Venous incompetence: critical study of the organic basis of high maintenance flow rates during artificial erection test

We tested whether the necessity for high flow rates of saline to maintain an artificial erection actually corresponds to an organic abnormality able to induce impotence as claimed recently. A total of 56 patients with presumed vascular impotence and 13 with typical psychogenic impotence underwent dynamic cavernosography followed by the artificial erection test. The former 56 patients also underwent bilateral selective internal iliac arteriography. A severely elevated maintenance flow rate (more than 120 ml. per minute) was found in 19 of the 56 patients with vascular and none of the 13 with psychogenic impotence, while a moderately elevated maintenance flow rate (80 to 120 ml. per minute) was found in 11 and 3, respectively. In most cases a severely elevated maintenance flow rate was associated with arterial (16 patients) or neurological abnormalities able to disturb erection. However, a severely elevated maintenance flow rate seemed to correspond to an organic abnormality able to induce impotence or to worsen erectile failure induced by other organic factors. Indeed, we found no severely elevated maintenance flow rates among our 13 patients with psychogenic impotence and the nocturnal penile tumescence test was normal in only 1 of 12 tested patients, although 7 had no other organic impairment sufficient to induce impotence (only moderate arterial stenoses in 4). In addition, sexual treatment succeeded in only 1 of the 13 patients, while our success rate is 43 per cent among patients with arterial impotence exclusively and this treatment succeeded in 6 of 10 patients with a moderately elevated maintenance flow rate. On the contrary, a moderately elevated maintenance flow rate does not seem to correspond to a genuine organic abnormality able to induce impotence. Indeed, we found it in 3 of 13 patients with psychogenic impotence, and every patient with a moderately elevated maintenance flow rate and normal arteries had a normal nocturnal penile tumescence test or was cured by sexual therapy. In conclusion, a maintenance flow rate exceeding 120 ml. per minute seems to reveal a genuine venous incompetence but in most cases this abnormality is only the cofactor of an arterial obstruction.

Psychogenic erectile impotence--a useful or a misleading concept?

Psychological factors alone may not fully explain some cases of apparently purely psychogenic acute situational impotence. Chronic impotence is often due to a combination of aetiological factors. Erectile selectivity is not a reliable means of diagnosing purely psychogenic impotence. Nocturnal penile tumescence monitoring is not absolutely reliable in making a distinction between organic and psychogenic impotence. The either/or concept of impotence being organic or psychogenic should be abandoned as serious errors can be made by adhering to it.

Adjustment following surgical implantation of a penile prosthesis: a critical overview

The literature on postsurgical adjustment and/or satisfaction of patients and/or their partners following implantation of a penile prosthesis is reviewed. Only those studies that have systematically assessed psychological variables independent of surgical or functional outcome are included. It is reported that while transitory emotional problems were not uncommon, 64-100% of the implant recipients reported being at least fairly satisfied. Similar levels of satisfaction were reported for their partners when they were interviewed together or when patients responded for their partners. However, lower levels were reported when partners were interviewed separately. Satisfaction was reported to be associated with several variables, and high-risk populations were identified. It is important to interpret these conclusions with extreme caution because of the many serious methodological weaknesses contained in these studies. These methodological problems in the literature are reviewed, and recommendations for future research are presented.

Penile circumference and erection

Simultaneous registration of penile circumference and intracavernous pressure during artificial erection was performed in 6 fresh cadavers. Maximal penile circumference was obtained at an intracavernous pressure below the pressure required for full erection. This reduces the clinical value of penile tumescence measurement in evaluation of erectile function.