Nitric oxide as a mediator of cocaine-induced penile erection in the rat

Urological complications of illicit drug use

Illicit drug use is prevalent worldwide; over 24 million people are estimated to have used recreational drugs during the past month in the UK and USA alone. Illicit drug use can result in a wide spectrum of potential medical complications that include many urological manifestations. To ensure optimal care and treatment, urologists need to be cognizant of these complications in their patients, particularly among youths. Ketamine uropathy is thought to affect over one-quarter of ketamine users and can lead to severe lower urinary tract symptoms, as well as upper tract obstruction. Cannabis use has been associated with an increased risk of bladder cancer, prostate cancer and nonseminomatous germ cell tumours in case-control studies. Fournier's gangrene has been reported following injection of heroin and cocaine into the penis. Excessive use of cough medicines can lead to the development of radiolucent stones composed of ephedrine, pseudoephedrine and guaifenesin. As the current evidence is mostly limited to case reports and case series, future epidemiological studies are needed to fully address this issue.

Fournier's gangrene associated with intradermal injection of cocaine

INTRODUCTION

Cocaine abuse is associated with a number of medical complications, most notably arrhythmias, myocardial infarction, and cerebral hemorrhages. The injection of cocaine in the penis has been predominantly recorded into the corpus cavernosae and is associated with priapism.

AIM

Here we describe the injection of subcutaneous cocaine within the penile shaft skin producing ischemic necrosis and Fournier's gangrene.

MAIN OUTCOME MEASURES

We sought to highlight the effects of cocaine use within the penis and emphasize the different effects that may ensue.

METHODS

We reviewed a recent clinical case and conducted a literature review on the use of cocaine within the penis.

RESULTS

The use of cocaine has been reported previously within the literature and is mainly limited to case reports. Cocaine use within the corpora and the subcutaneous tissues produces significantly different consequences ranging from priapism to Fournier's gangrene.

CONCLUSIONS

The case illustrates the growing use of cocaine and other illicit drugs and emphasizes the importance of this issue to all clinicians.

Cocaine-related vasculitis causing scrotal gangrene

OBJECTIVE

To describe a case of possible cocaine-related vasculitis resulting in gangrene of the scrotum and review the literature on cocaine-related vascular complications.

CASE SUMMARY

A 22-year-old male presented with fever, painful swelling of the right scrotum, and a blackened ulcerated lesion on the right scrotum 3 hours after smoking crack cocaine. Blood and urine cultures and serologic tests were negative, and the D-dimer level was normal. Echocardiogram showed no evidence of vegetation and results of a chest X-ray were normal. Despite treatment for presumptive orchitis with intravenous levofloxacin 750 mg/day, the ulcerated lesion of the right scrotum progressed the next day. The patient received debridement of the necrotic tissue and pathology revealed some degenerated vessels with fibrinoid deposits and inflammatory infiltrates, suggestive of vasculitis. No further tenderness and swelling of the scrotum occurred and the patient was discharged after 10 days. When he returned for follow-up, the wound had healed completely.

DISCUSSIONS

Cocaine-related vascular complications, including ischemic stroke, myocardial infarction, and peripheral occlusive disease, all of which have various possible mechanisms, are of clinical importance. Vasculitis is one of the mechanisms of vascular complications associated with cocaine use. According to the Naranjo probability scale, cocaine was the possible causative agent of the patient's vasculitis, which led to scrotum gangrene. To our knowledge, this is the first report in the literature of scrotum gangrene developing after crack cocaine was smoked.

CONCLUSIONS

This case report describes a rare occurrence of gangrene of the scrotum associated with cocaine smoking, which is consistent with cocaine's potent vasoconstrictive activity. Cocaine abuse has the potential to cause clinically significant ischemic events anywhere in the body, independent of the method of administration.

Involvement of nitric oxide in cocaine-induced erections and ejaculations after paradoxical sleep deprivation

OBJECTIVES

As nitric oxide (NO) is involved in penile erectile (PE) function and also influences the sleep-wake cycle, we speculated that NO could play a role in PE and ejaculation of paradonical sleep deprivation (PSD) rats.

METHODS

Animals were pretreated with N(G)-nitro-L-arginine methyl ester (L-NAME, ip) and L-arginine (ip and icv) prior to saline or cocaine injection.

RESULTS

Cocaine-induced PE in 90% of PSD rats, 60% of which ejaculated. L-NAME reduced the frequency of erection, but had no effect in the proportion of PSD-cocaine-injected rats displaying this response. L-NAME had no effect in saline groups. L-Arginine in PSD-saline rats reduced the proportion of animals displaying PE at the highest dose and reduced the frequency of PE at all doses in both saline and cocaine groups. The icv administration of L-arginine reduced PE only in PSD-cocaine rats. Results indicate that common to both drugs, whether it was NO synthase (NOS) inhibitor or NO precursor, was their capacity to strongly reduce PE frequency in cocaine-treated rats. Moreover, L-arginine (ip) played a relevant inhibitory role in the erection displayed by PSD rats.

CONCLUSIONS

Our findings suggest that the stimulating effects of PSD associated or not with cocaine on erection can be modified by alterations in the NO system.

Age-related effects on genital reflexes induced by paradoxical sleep deprivation and cocaine in rats

Although sexual function often decreases with age, a recent study demonstrated that paradoxical sleep deprivation (PSD) was effective in inducing penile erection (PE) in 60% of 22-month-old PSD rats after acute cocaine injection, whereas this behavior was absent in non-PSD control rats. The present study sought to compare alterations in genital reflexes (PE and ejaculation-EJ) induced by PSD followed by acute cocaine or saline at different points in the life span of male rats. Rats of different ages (3, 6, 10, 12, 18, 22 and 28 months), were given a single injection of either saline or cocaine (7 mg/kg, i.p.) after a 4-day period of PSD, and then evaluated for genital reflexes. Results indicated that genital reflexes in PSD rats given saline become less frequent with age and disappear after the age of 18 months. However, cocaine potentiated and prolonged these behaviors until the age of 22 months. Although a number of factors are involved in such a complex phenomenon as PE, we suggest that the previously documented dopamine receptor supersensitivity induced by PSD may be an important contributor to the potentiation by cocaine of genital reflexes after sleep deprivation.

Metachlorophenylpiperazine (m-CPP) induced intracavernous pressure responses in anaesthetized rats

Here we have recorded the effects of metachlorophenylpiperazine (m-CPP) on intracavernous pressure (ICP) in anesthetized rats pretreated with various pharmacological agents in an attempt to determine the mechanism and relevance of the m-CPP induced ICP response to other models of erection. m-CPP elicited consistent and significantly greater increases in ICP (71.5+/-6.6 mmHg) compared with the mixed 5-HT(2a/2c) agonists trifluoromethylphenylpiperazine (3.4+/-1.3 mmHg) and quipazine (10.9+/-1.8 mmHg). Blockade of 5-HT(2a) receptors with ketanserin failed to unmask any stimulatory effect of quipazine (7.2+/-1.0 mmHg). m-CPP induced ICP responses (71+/-7.0 mmHg) were unaffected in the presence of mianserin (63+/-5 mmHg) and ketanserin (51+/-12 mmHg). Spiperone significantly reduced the m-CPP induced increase in ICP (8.0+/-1.0 mmHg). Naloxone, yohimbine and 8-hydroxy-2-(di-n-propylamino)tetralin (8-OHDPAT) failed to elicit increases in ICP on their own. All three drugs significantly reduced the latency to the first m-CPP induced ICP response compared to saline. Yohimbine increased the duration of m-CPP induced ICP responses whereas 8-OHDPAT increased the mean number of m-CPP induced ICP responses compared to saline. The effects of m-CPP on ICP in anesthetized rats may not be mediated by 5-HT(2c) receptors and appears to be similar to erection in copula, but not erection elicited by other drugs or penile sheath retraction.

Hippocampal noradrenergic neurotransmission in concurrent EEG desynchronization and inhibition of penile erection induced by cocaine in the rat

We previously reported that cocaine may induce activation of cortical (cEEG) and hippocampal (hEEG) electroencephalographic signals, concurrent with inhibition of penile erection, via an action on the hippocampal formation. The present study further evaluates the role of noradrenergic neurotransmission at the hippocampal formation in this process, using adult, male Sprague-Dawley rats anaesthetized and maintained by chloral hydrate. Unilateral microinjection of cocaine (100 nmoles) into the hippocampal CA1 or CA3 subfield or dentate gyrus elicited significant activation of both cEEG and hEEG activity. At the same time, the intracavernous pressure (ICP), our experimental index for penile erection, underwent a discernible reduction. Co-administration of equimolar doses (250 pmoles) of prazosin, naftopidil, yohimbine or rauwolscine significantly reversed those effects elicited by cocaine on cEEG, hEEG and ICP. Microinjection unilaterally of equimolar doses (5 nmoles) of norepinephrine, phenylephrine or BHT 933 into the hippocampal formation, similar to cocaine, also induced appreciable cEEG and hEEG excitation, with a simultaneous decrease in ICP. We conclude that cocaine may activate cEEG and hEEG and decrease ICP via noradrenergic neurotransmission, possibly engaging at least alpha(1A/D)-, alpha(2B)- and alpha(2C)-adrenoceptors at the hippocampal formation.

Renal dopamine receptors in health and hypertension

During the past decade, it has become evident that dopamine plays an important role in the regulation of renal function and blood pressure. Dopamine exerts its actions via a class of cell-surface receptors coupled to G-proteins that belong to the rhodopsin family. Dopamine receptors have been classified into two families based on pharmacologic and molecular cloning studies. In mammals, two D1-like receptors that have been cloned, the D1 and D5 receptors (known as D1A and D1B, respectively, in rodents), are linked to stimulation of adenylyl cyclase. Three D2-like receptors that have been cloned (D2, D3, and D4) are linked to inhibition of adenylyl cyclase and Ca2+ channels and stimulation of K+ channels. All the mammalian dopamine receptors, initially cloned from the brain, have been found to be expressed outside the central nervous system, in such sites as the adrenal gland, blood vessels, carotid body, intestines, heart, parathyroid gland, and the kidney and urinary tract. Dopamine receptor subtypes are differentially expressed along the nephron, where they regulate renal hemodynamics and electrolyte and water transport, as well as renin secretion. The ability of renal proximal tubules to produce dopamine and the presence of receptors in these tubules suggest that dopamine can act in an autocrine or paracrine fashion; this action becomes most evident during extracellular fluid volume expansion. This renal autocrine/paracrine function is lost in essential hypertension and in some animal models of genetic hypertension; disruption of the D1 or D3 receptor produces hypertension in mice. In humans with essential hypertension, renal dopamine production in response to sodium loading is often impaired and may contribute to the hypertension. The molecular basis for the dopaminergic dysfunction in hypertension is not known, but may involve an abnormal post-translational modification of the dopamine receptor.

Differential participation of hippocampal formation in cocaine-induced cortical electroencephalographic desynchronization and penile erection in the rat

We evaluated the role of the hippocampal formation in cocaine-induced cortical electroencephalographic (EEG) desynchronization and penile erection. Adult, male Sprague-Dawley rats anesthetized and maintained by chloral hydrate were used. Intravenous (1.5 or 3.0 mg/kg) administration of cocaine dose-dependently increased intracavernous pressure (ICP), our experimental index for penile erection. This was accompanied by desynchronization of EEG activity recorded from the somatosensory cortex (cEEG), as represented by a decrease in root mean square (RMS) and an increase in mean power frequency (MPF) values. There was a simultaneous increase in the RMS values, without significant changes in the MPF values of EEG signals recorded from the hippocampal formation (hEEG). In animals that received prior application of 10% xylocaine either intrathecally (i.t.) at the L6-S1 spinal levels or directly into the bilateral hippocampal formation, the RMS values of both cEEG and hEEG signals induced by cocaine (1.5 or 3.0 mg/kg, i.v.) were appreciably reduced, along with a further increase in ICP. Unilateral microinjection of cocaine (15 or 30 microg) into the hippocampal formation elicited discernible excitation of both cEEG and hEEG signals. Intriguingly, the ICP underwent a significant and dose-dependent reduction, which was discernibly antagonized by i.t. application of xylocaine. We conclude that cocaine may effect cortical EEG desynchronization but cause a reduction in ICP via an action on the hippocampal formation.

Participation of hippocampal formation in negative feedback inhibition of penile erection in the rat

Detailed information on how the central nervous system regulates penile erection, particularly the inhibitory aspect, is sparse. We observed in Sprague-Dawley rats anesthetized and maintained with chloral hydrate that administration of papaverine (400 microg) directly into the corpora cavernosum of the penis produced an increase in intracavernous pressure (ICP). This elicited experimental index for penile erection was accompanied by a transient increase in the root mean square values, concurrent with a shift in the contribution of Theta (increase) and delta (decrease) power to the hippocampal electroencephalographic (hEEG) activity. Reversal blockade of these hEEG responses with xylocaine, given either intrathecally at the L6-S1 spinal levels or unilaterally to the hippocampal formation, significantly heightened and prolonged the ICP response. Pretreatment with xylocaine by itself, however, did not alter appreciably the baseline ICP or hEEG activity. These results suggest the presence of a novel negative feedback inhibitory mechanism in the hippocampal formation, which is triggered by ascending sensory inputs initiated by tumescence of the penis during normal erectile processes.