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Impotence is not always disease related. The following are abstracts that
address the causes and some compounds that are being used/tested in the
United States and Europe. Some are in clinical trials, like papaverine HCI
topical gel which in now in Phase II trial in the U.S. The abstract of the
Open and Efficacy trial is abstract <3>.
 
Papaverine HCI topical gel is sponsored by Pentech Pharmaceutical,
Rockville, MD. If you are interested in participating in their trial,
check with your urologist to see if trials are being conducted in your
area. He can get the information from his Pentech rep, or you can call
Pentech direct.
 
Papaverine has been used in previous studies as an injectable. The problem
with the injection is that after getting a shot in a sensitive spot, you
had the "tool" but lost the urge to use it.
 
In one study, a 2 1/2 hour erection was considered a disability,(I WISH!)
so another compound was used to return everything to normal.
 
European members, look for the abstracts near your country.
 
As far as I know, none of these compounds are available for prescription..
yet. Check with your urologist.
 
<1>
Authors
  Veves A.  Webster L.  Chen TF.  Payne S.  Boulton AJ.
Institution
  University Department of Medicine, Manchester Royal Infirmary, UK.
Title
  Aetiopathogenesis and management of impotence in diabetic males: four
  years experience from a combined clinic.
Source
  Diabetic Medicine.  12(1):77-82, 1995 Jan.
Abstract
  The contribution of organic and psychogenic factors in the
  aetiopathogenesis of impotence was studied in a large number of diabetic
  males, to develop an algorithm for its management. We examined 110
  consecutive patients who were referred to the Impotence Clinic of the
  Diabetes Centre. All patients were initially evaluated by a diabetologist
  and then underwent psychosexual assessment by a specialized psychiatrist.
  Patients with primarily organic disease were referred to a urologist for
  further management while those with psychogenic impotence received
  psychosexual counselling. Peripheral neuropathy was present in 71 (65%)
  and two or more autonomic tests were abnormal in 22 (20%) patients.
  Neuropathy was the only cause detected in 29 (27%) patients, the main
  cause in 22 (20%), and contributing, but not the main factor, in 20 (18%).
  Psychogenic factors were the only cause detected in 12 (11%) patients, the
  main cause in 26 (24%) and contributed in 19 (17%). Marital disharmony,
  medical treatment, and peripheral vascular disease were the main
  aetiopathogenic factors in the remaining cases. Psychosexual counselling
  resulted in successful intercourse in 17 (60%) out of the 24 treated
  patients and papaverine injections in 31 (61%) out of 56 treated patients.
  It is concluded that although organic factors are mainly responsible for
  the development of impotence in diabetic males, psychological factors
  contribute significantly and psychosexual assessment and counselling are
  essential adjuncts to its management. Treatment with papaverine injections
  is generally inexpensive and effective to overcome the multifactorial
  causes of erectile dysfunction in this population. An algorithm which may
  facilitate the investigation and treatment of impotent diabetic males is
  proposed.
Entry Month
  9507.  Entry Week: 95073.
 
<2>
Authors
  Cara AM.  Lopes-Martins RA.  Antunes E.  Nahoum CR.  De Nucci G.
Institution
  Discipline of Urology, Faculty of Medical Sciences, UNICAMP, Campinas,
  Brazil.
Title
  The role of histamine in human penile erection.
Source
  British Journal of Urology.  75(2):220-4, 1995 Feb.
Abstract
  OBJECTIVE: To investigate the relaxant action of histamine on human corpus
  cavernosum in vitro and the erectile response caused by the intracavernous
  injection of histamine in patients with psychogenic impotence. PATIENTS
  AND METHODS: Human corpus cavernosum (HCC) tissue was cut into strips of
  approximately 2 cm and suspended in a cascade bioassay. The strips were
  then superfused with oxygenated and warmed Krebs solution and
  precontracted with noradrenaline (3 microM). Glyceryl trinitrate,
  acetylcholine and histamine were injected as a single bolus in the absence
  or in the presence of mepyramine and cimetidine. For the in vivo studies,
  histamine (30-60 micrograms) was injected intracavernously as a single
  bolus into the right corpus cavernosum 1 cm from the balamo-preputial
  sulcus. Similar protocols were carried out for papaverine (50 mg). The
  erectile response was divided into four grades: no response, tumescence,
  partial and full erection. RESULTS: In vitro studies demonstrated that
  histamine (3-100 micrograms) caused dose-dependent relaxation of the HCC
  strips which was significantly inhibited by cimetidine (5-10 microM). The
  histamine H1 receptor antagonist mepyramine (1 microM) potentiated
  histamine-induced relaxation. The co-infusion of both mepyramine and
  cimetidine did not abolish histamine-induced relaxation. When injected
  intracavernously in humans, histamine (30 micrograms) caused full erection
  in 13% of the patients, whereas 87% had partial erection or tumescence. A
  higher dose of histamine (60 micrograms) caused full erection in 26% of
  the patients and 74% had partial erection or tumescence. Papaverine
  induced full erection in the majority of patients (66%). In contrast to
  papaverine, the duration of erection induced by histamine was markedly
  shorter (mean 200 and 6.5 min, respectively). The penile erections induced
  by papaverine were associated with complications such as pain, haematoma
  and priapism. Histamine did not induce any complications. Treatment of
  eight male patients with psychogenic impotence with the histamine H1
  receptor antagonist astemizol (10 mg orally once daily for 1 week) did not
  affect histamine-induced erectile responses. CONCLUSION: These results
  indicate that histamine may play a role in human penile erection. The
  erection-promoting action of histamine is probably due to H2 receptor
  activation, although another histamine receptor, possibly H3, also seems
  to be involved. This study suggests that histamine could be a valuable
  tool in the diagnosis of erectile dysfunction.
Entry Month
  9505.  Entry Week: 95053.
 
<3>
Authors
  Kim ED.  el-Rashidy R.  McVary KT.
Institution
  Department of Urology, Northwestern University Medical School, Chicago,
  Illinois 60611.
Title
  Papaverine topical gel for treatment of erectile dysfunction.
Source
  Journal of Urology.  153(2):361-5, 1995 Feb.
Abstract
  Intracavernous injection of vasoactive substances has been shown to be an
  effective means of treatment of organic erectile dysfunction. However, up
  to 50% of men eventually discontinue treatment often because of lack of
  spontaneity and needle phobia. This study was done as a phase I, placebo
  controlled, nonblinded investigation of the safety and efficacy of a
  topical papaverine gel in the treatment of erectile dysfunction. Of 20 men
  with organic impotence 17 completed the trial and 13 of these patients had
  spinal cord injuries. After application of a 15% and 20% papaverine base
  gel to the scrotum, perineum and penis, cavernous artery diameter was
  significantly increased (36%, p < 0.001) as assessed by color flow Doppler
  ultrasound. Peak systolic flow velocity increased 26%. Only 3 of 14
  patients achieved an increase in cavernous artery diameter of 75% or more
  and 2 of 14 had a peak systolic flow velocity of 25 cm. per second or more
  after application of a topical base gel. Similar findings were present
  when only the patients with spinal cord injury were analyzed. The effect
  of a papaverine base in producing flow alterations to the penis is
  dose-dependent. A diminution in blood pressure was present at 15 and 30
  minutes after application to the forearm, and the heart rate diminished
  from 68 to 62 beats per minute after application to the genitalia. No
  patient was symptomatic. Serum papaverine levels were not elevated over
  pre-application values. No hepatotoxic effects were demonstrated. Full
  clinical erections (mean duration 38.7 minutes) were present in 3 patients
  but were also present with the placebo preparation (mean duration 8.0
  minutes). In conclusion, topical papaverine gel appears to be safe and
  well tolerated after application to the genitalia, and increases blood
  flow to the penis with a 15% and 20% base preparation. Minimal systemic
  absorption occurs and, thus, effects are probably from local absorption.
  Topical therapy appears to augment reflex erections in the spinal cord
  injury patient and may be especially beneficial in this population.
  Further investigation is warranted at higher concentrations or in
  combination with different skin absorption enhancers.
Entry Month
  9504.  Entry Week: 95042.
 
<4>
Authors
  Pickard RS.  King P.  Zar MA.  Powell PH.
Institution
  Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
Title
  Corpus cavernosal relaxation in impotent men.
Source
  British Journal of Urology.  74(4):485-91, 1994 Oct.
Abstract
  OBJECTIVE: To investigate smooth muscle responsiveness in isolated
  preparations of corpus cavernosum from men with vasculogenic impotence.
  PATIENTS AND METHODS: Biopsies of corpus cavernosum were obtained from 63
  men undergoing penile surgery. These included a control group of eight men
  (mean age 59 years, range 38-82) undergoing penile amputation for
  carcinoma, 47 men with vasculogenic impotence (mean age 58, range 36-72)
  who were further sub-divided into arterial (n = 9), venous (n = 24) or
  mixed arterial/venous (n = 14) impotence according to the results of
  pre-operative haemodynamic investigation, and eight men with
  non-vasculogenic impotence (mean age 49 years, range 34-66). Smooth muscle
  contractile responses to alpha-adrenoceptor activation and relaxant
  responses to stimulation of intrinsic nerves and exposure to papaverine
  and sodium nitroprusside were recorded in tissue strips prepared from the
  biopsies. Morphology was assessed histologically using haematoxylin and
  eosin staining of tissue sections together with immunocytochemical
  labelling of intrinsic nerves. RESULTS: Nerve-evoked relaxation was
  markedly impaired in tissue from men with venous or mixed arterial/venous
  impotence. A lesser degree of impairment was found in tissue from men with
  arterial impotence alone. Tissue from men with all types of vasculogenic
  impotence also showed a decreased contractile response to
  alpha-adrenoceptor stimulation. The magnitude of relaxant responses to
  papaverine and sodium nitroprusside in the vasculogenic group was similar
  to that of the control. There were no differences in smooth muscle content
  or nerve density between the vasculogenic group and the control. In the
  non-vasculogenic group responses to relaxant nerve stimulation,
  alpha-adrenoceptor activation and relaxant drugs were similar to those of
  the control. Nerve density in this group was similar to the control but
  smooth muscle content was reduced. CONCLUSIONS: The results of this study
  demonstrate a functional impairment of smooth muscle contractility and
  neurogenic relaxation in corpus cavernosum from impotent men with abnormal
  penile haemodynamics. Altered smooth muscle responsiveness is likely to be
  a factor in the aetiology of impotence in such men and may contribute to
  the relatively poor results of vascular surgery for impotence.
Entry Month
  9504.  Entry Week: 95043.
 
<5>
Authors
  Soni BM.  Vaidyanathan S.  Krishnan KR.
Institution
  Regional Spinal Injuries Centre, District General Hospital, Southport,
  Mereyside.
Title
  Management of pharmacologically induced prolonged penile erection with
  oral terbutaline in traumatic paraplegics.
Source
  Paraplegia.  32(10):670-4, 1994 Oct.
Abstract
  Intracavernosal administration of papaverine or prostaglandin E1 for
  erectile impotence in paraplegics is being practised widely. One of the
  complications of this therapeutic regimen is prolonged erection which is
  at present being treated by aspiration of corporeal blood and
  intracavernosal administration of alpha-adrenergic agonist such as
  phenylephrine. We report successful management of
  pharmacologically-induced prolonged erection in three traumatic
  paraplegics with oral terbutaline therapy. The indications for oral
  terbutaline therapy were (1) absence of significant coronary artery
  disease and (2) full erection persisting for more than 2 1/2 h, but less
  than 4 h duration. The initial dose of terbutaline was 5 mg and the same
  dose was repeated after 15 min as full erection persisted. Within the next
  15 min, penile detumescence was achieved in two paraplegics with
  papaverine-induced prolonged erection. However, full erection still
  persisted 15 min after the second dose of terbutaline in the third patient
  who had received intracavernosal administration of 3.25 micrograms of
  prostaglandin E1. Therefore, he was given the third and final dose of 5 mg
  of terbutaline under cardiac monitoring. Penile detumescence was achieved
  within the next 15 min. It was ensured before administration of the third
  dose of terbutaline that (1) his blood pressure was within the normal
  range (for his paralysed status), (2) the heart rate was less than 100 per
  min and (3) there was no cardiac arrhythmia. Occasional premature
  ventricular contraction was observed only in the patient who received the
  third dose of terbutaline, but it was transient, self-limiting and did not
  warrant any treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Entry Month
  9504.  Entry Week: 95044.
 
<6>
Authors
  Hattat H.  Ozkara H.  Akkus E.  Alici B.
Institution
  Sexual Dysfunctions Center, Cerraphasa School of Medicine, Istanbul,
  Turkey.
Title
  Our experience with pharmacological erection treatment of erectile
  dysfunction.
Source
  Journal of Andrology.  15 Suppl:47S-49S, 1994 Nov-Dec.
Abstract
  Administration of vasoactive drugs intracavernously is a well-known easily
  used and inexpensive alternative in treatment of a certain group of
  patients with erectile dysfunction. There are a few drugs used for this
  purpose, but we prefer papaverine as the first choice because it is easily
  available and inexpensive in our country. We used alprostadil only in
  nonresponders to papaverine or if there was any complication with
  papaverine. We present a series of 69 patients, 24 with psychogenic
  (34.8%), 27 with organic (39.1%), and 18 (26.1) with mixed etiology of
  erectile dysfunction, treated with intracavernous self-injection therapy.
  Mean follow-up of the patients was 13.6 months (7-30 months). In this
  study, 3,430 papaverine and 780 alprostadil injections were performed in
  56 and 13 patients, respectively. In 75% of the papaverine injections and
  in 83% of the alprostadil injections, erections were achieved sufficient
  for sexual intercourse. During the follow-up, there were not any abnormal
  alterations in liver function tests. The main complaint of the patients
  who used papaverine was a burning sensation (98%) during administration of
  the drug, which did not last more than 1 minute. Of 13 patients in the
  alprostadil group, 56.9% of the patients complained mainly of discomfort
  during erection. We concluded that intracavernous therapy is a good and
  inexpensive option in the management of erectile dysfunction in carefully
  selected patients.
Entry Month
  9507.  Entry Week: 95074.
 
<7>
Authors
  Kadioglu A.  Erdogru T.  Tellaloglu S.
Institution
  Department of Urology, Istanbul Faculty of Medicine, University of
  Istanbul, Turkey.
Title
  Combined intracavernous injection of papaverine and stimulation (CIS)
  test.
Source
  Journal of Andrology.  15 Suppl:50S-53S, 1994 Nov-Dec.
Abstract
  The inhibitory effect of the overactivity of the sympathetic nervous
  system that results from outpatient clinical conditions leads to poor
  erectile response to intracavernous injection of papaverine. The effects
  of self manual genital stimulation for improvement of erectile quality in
  insufficient papaverine response were investigated in 171 impotent men.
  Twenty-nine (63.04%) of 46 patients who had a normal vascular system
  showed partial response to papaverine. Following self manual genital
  stimulation, full erection was achieved in all of them. Better erections
  were achieved in 28 of 42 patients with arterial disease. In patients
  subclassified as having slight, moderate, and severe arterial disease,
  improved erections were noted in 100%, 71.42%, and 64.28%, respectively.
  In the mixed vascular (arterial+venous) disease group (n = 46), the
  combined intracavernous injection of papaverine and stimulation (CIS) test
  led to a better erection in only 41.30%, whereas in the pure venogenic
  group (n = 37), this percentage was 66.66%. The inhibitory effect of the
  overactivity of the sympathetic nervous system is significantly reduced by
  the CIS test.
Entry Month
  9507.  Entry Week: 95074.
 
<8>
Authors
  Chancellor MB.  Rivas DA.  Panzer DE.  Freedman MK.  Staas WE Jr.
Institution
  Department of Urology, Jefferson Medical College, Philadelphia,
  Pennsylvania.
Title
  Prospective comparison of topical minoxidil to vacuum constriction device
  and intracorporeal papaverine injection in treatment of erectile
  dysfunction due to spinal cord injury.
Source
  Urology.  43(3):365-9, 1994 Mar.
Abstract
  OBJECTIVE. To compare the effectiveness of topically applied 2% minoxidil
  to that of intracorporeal injection therapy and vacuum constriction
  devices for the treatment of erectile dysfunction in the spinal cord
  injured (SCI) male. METHODS. Eighteen SCI men, aged nineteen to sixty-five
  years (median age, 29), and level of injury C7 to L3 (15 thoracic level)
  were prospectively evaluated. All patients were able to achieve only a
  poorly sustained reflex erection that was inadequate for satisfactory
  intercourse. No patient had suffered erectile dysfunction prior to his
  SCI. In each patient, 1 mL of a 2% minoxidil solution was applied as an
  aerosol spray to the glans penis. The erectile response was compared to
  that obtained with a vacuum constriction device (VCD) and intracorporeal
  papaverine injection. In each case, the subjective assessment by both the
  patient and the physician, as well as objective results of penile base
  rigidity as measured by the RigiScan DT Monitor Device, were recorded.
  RESULTS. Papaverine increased rigidity at the base of the penis by a
  median 77 percent (range, 30-100%). The VCD increased rigidity by a median
  57 percent (range, 30-80%). Minoxidil induced no change in rigidity
  (range, 0-15%). No complications were observed for any method of inducing
  tumescence. CONCLUSIONS. Papaverine and VCD proved to be effective means
  of establishing penile erection in male SCI patients. Both subjective and
  objective erectile responses to minoxidil were poor. Nevertheless, the
  principle of topical therapy is an attractive alternative to existing
  modalities. Further investigation is warranted.
Entry Month
  9406.
 
<9>
Authors
  Betts CD.  Jones SJ.  Fowler CG.  Fowler CJ.
Institution
  Department of Uro-Neurology, National Hospital for Neurology and
  Neurosurgery, London, UK.
Title
  Erectile dysfunction in multiple sclerosis. Associated neurological and
  neurophysiological deficits, and treatment of the condition.
Source
  Brain.  117 ( Pt 6):1303-10, 1994 Dec.
Abstract
  Forty-eight men with multiple sclerosis and erectile dysfunction were
  evaluated. Emphasis was placed on the neurological features and the
  relationship between impotence and the bladder dysfunction in multiple
  sclerosis. Erectile failure was invariably associated with pyramidal signs
  in the lower limbs and with urinary symptoms. All of the men with
  impotence and marked pyramidal dysfunction in their legs were found by
  cystometric studies to have bladder hyperreflexia. The severity of the
  urinary symptoms was related to the degree of pyramidal impairment in the
  lower limbs. The posterior tibial and the pudendal cortical evoked
  potentials were abnormal in most of the men with multiple sclerosis and
  erectile failure. However, recording the pudendal cortical responses in
  patients with multiple sclerosis and impotence provided no more
  information than the tibial cortical evoked potentials. The neurological
  examination findings together with the results of the neurophysiological
  and cystometric tests suggest that erectile dysfunction in multiple
  sclerosis is due to spinal lesions situated proximal to the sacral cord.
  The feasability of papaverine intracorporeal injection therapy for men
  with multiple sclerosis and impotence was assessed. Papaverine
  intracorporeal injections produced satisfactory erections in the majority
  of the impotent men. Erectile failure in patients with multiple sclerosis
  was successfully managed for up to 2 years, by intracorporeal
  self-injection therapy.
Entry Month
  9504.  Entry Week: 95043.
 
<10>
Authors
  Lazzeri M.  Barbanti G.  Beneforti P.  Turini D.
Institution
  Department of Urology, University of Ferrara, Italy.
Title
  Intraurethrally infused capsaicin induces penile erection in humans.
Source
  Scandinavian Journal of Urology & Nephrology.  28(4):409-12, 1994 Dec.
Abstract
  Capsaicin-sensitive primary afferents widely innervate the genitourinary
  tract and play an important role in the integration of various mechanisms
  which activate reflexes leading to penile erection. We investigated the
  effect of intraurethral capsaicin infusion in psychogenically impotent
  men. The 20 patients were prospectively randomized to four groups, each of
  five men. Group A received intraurethral infusion of saline solution,
  group B intraurethral capsaicin (10(-5) M), group C intracavernosal
  papaverine hydrochloride (8 mg) plus intraurethral saline infusion, and
  group D intracavernosal papaverine hydrochloride (8 mg) plus intraurethral
  capsaicin (10(-5) M). The penile response was recorded real-time.
  Intraurethral capsaicin induced penile erection, as did the papaverine
  injection, while saline infusion was without effect. The erectile response
  to intraurethral infusion of capsaicin is suggested to involve activation
  of a urethra-corpora cavernosa reflex arc. Further studies are necessary
  to clarify if this arc is integrated at central nervous system level or is
  locally triggered, and if it may have pathophysiologic implications.
Entry Month
  9506.  Entry Week: 95063.
 
<11>
Authors
  Desvaux P.  Mimoun S.
Institution
  Laboratoire d'explorations fonctionnelles vasculaires, Hopital Tenon,
  Paris.
Title
  [Prostaglandin E1 in the treatment of erectile insufficiency. Comparison
  of efficacy and tolerance based on different etiologies]. [French]
Original Title
  Prostaglandine E1 dans le traitement de l'insuffisance erectile.
  Efficacite et tolerance comparees selon differentes etiologies.
Source
  Journal d Urologie.  100(1):17-22, 1994.
Abstract
  Prostaglandin E1 (PGE1) is widely used for the treatment of impotence. We
  retrospectively studied 322 patients who had received injection of
  prostaglandin E1 from 1991 to 1993 and attempted to divide them into
  different subgroups as a function of the aetiology of the impotence in
  order to determine whether there is a difference in efficacy and
  tolerance. The complete work up included at least two consultations with a
  sex therapist, a pharmaco-Doppler examination, cavernometry,
  plethysmography of the nocturnal erections and blood chemistry with assay
  of the free testosterone in all patients. Erections compatible with
  penetration were observed after prostaglandin E1 injection in 85.4% of the
  patients (all aetiologies). Very favourable results were obtained in the
  group of patients with an arterial defect (n =36) since erections allowing
  intercourse were obtained in 83.3%. For the patients with occlusive venous
  dysfunction (cavernous leakage) (n = 35) the injections were less
  effective but led to satisfactory results in 74.3%. The results were
  excellent (94.7%) in the cases of psychogenic impotence (n = 113).
  Finally, in patients with diabetes related impotence (n = 21), the
  treatment was much less effective giving only 52.3% of positive results.
  In several cases (n = 151) we were able to compare the effectiveness of
  PGE1 with that of papaverine alpha blockers. For the patients with an
  arterial defect, PGE1 was slightly more effective. For patients with an
  occlusive venous dysfunction, PGE1 was always more effective than
  papaverine and finally, for patients with diabetes, the papaverine-alpha
  blocker combination was more effective than PGE1 in all cases.(ABSTRACT
  TRUNCATED AT 250 WORDS)
Entry Month
  9412.
 
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John Cottingham                     "KNOWLEDGE is of two kinds: we know
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