BEGIN -- Cut Here -- cut here 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. END -- Cut Here -- cut here John Cottingham "KNOWLEDGE is of two kinds: we know [log in to unmask] a subject, or we know where we can OR find information upon it." [log in to unmask] Dr. Samuel Johnson