Double-Blind Trial of Yohimbine in Treatment of Psychogenic Impotence

In contrast to the impressive advances made in somatic research on erectile dysfunction, psychogenic erectile dysfunction is usually treated as a monolithic block. In this study, we evaluated the erectogenic power of creative-dynamic image synthesis in men with psychogenic erectile dysfunction. Sixty-nine men with a mean age of 46 y, suffering from erectile dysfunction of no known organic cause, were entered in a placebo-controlled study in which the erectogenic power of imagination, yohimbine and a placebo were compared. There was a significant difference between the subjective results of creative-dynamic image synthesis (75% increase of potency) and those achieved through treatment with the drug yohimbine (55% increase in potency) and with a placebo (30% increase in potency). Creative-dynamic image synthesis is a potent initiator of erections in men with psychogenic erectile dysfunction, has no known side effects and is very costeffective.

Section: Figure 3 Integration Imagesupporting

confidence: 89%

Creative-dynamic image synthesis: a useful addition to the treatment options for impotence

Sommer¹,

Obenaus²,

Engelmann³

2001

“…8 More activity was found for the drug in the group of patients with a primarily emotional etiology: 62% for those men receiving yohimbine while only 18% for those on placebo; this difference was signi®cant (P`0.05). 9 It appears that these studies caught the interest of the medical community, perhaps with the help of the usual excitement of the lay press in these matters. 10 Over the ensuing 10 years there were numerous publications on the effect of yohimbine on erectile function.…”

Section: Resultsmentioning

confidence: 99%

Yohimbine in erectile dysfunction: the facts

Morales

2000

Yohimbine, a pharmacologically well-characterized a-2-adrenoceptor antagonist with activity in the central and peripheral nervous system, has been used for over a century in the treatment of erectile dysfunction. In-depth, systematic studies in animals have shown that the drug has a remarkable positive effect on sexual performance. Meta-analyses of the few controlled, randomized human studies have consistently shown an advantage of yohimbine over placebo. Despite such a long history and encouraging activity, the drug has not yet been subjected to scienti®cally rigorous human clinical trials. Although relevant basic pharmacological and animal research information has been available for over 15 y, recent studies were designed with a lack of insight and complete disregard of those fundamental studies. Currently, dose±response investigations are not available, alternative routes of administration (i.e. sublingual) have not been investigated, nor has continuous versus`on-demand' administration been explored. Synergistic activity with other drugs was last studied nearly four decades ago. Assessment of various populations was carried out in very limited cohorts and only in most general terms. In short, properly designed trials in humans have not been done. Why? Yohimbine is an old drug. As such it does not enjoy patent protection or commercial viability. Until molecularaformulation changes can be brought about (as recently happened with two other agents: phentolamine and apomorphine), serious investigations of yohimbine will remain in limbo. It could be that the nay sayers are right and yohimbine, indeed, lacks clinical activity as a treatment for men with erectile dysfunction. As long as it remains an orphan drug, we will never know.

“…Response was statistically signi®cant in patients with psychogenic ED, as 62% of patients treated with yohimbine responded vs 16% of those in the placebo group. 25 However, a recent trial of organic ED patients showed that yohimbine was ineffective in this patient cohort. 26 Apomorphine is a dopaminergic agonist known to induce yawning, nausea and penile erections in animals and humans when injected subcutaneously.…”

Section: Oral Therapymentioning

confidence: 86%

“…22 In a recent controlled study of patients receiving 6 mg three times a day, 21% with primary organic ED had complete recovery of erections. 25 Thirteen percent of the control group also experienced a positive response; however, no statistical signi®cance was found between yohimbine and placebo. Response was statistically signi®cant in patients with psychogenic ED, as 62% of patients treated with yohimbine responded vs 16% of those in the placebo group.…”

Section: Oral Therapymentioning

confidence: 87%

Medical and surgical advances in the radical prostatectomy patient

Nehra

2000

Maintaining the quality of life after surgery in the radical prostatectomy patient is of paramount importance. One of the major dilemmas in surgical management of radical retropubic prostatectomy (RRP) is preservation of the neurovascular bundle and, hence, erectile function and the continence mechanism. This manuscript addresses anatomical considerations for the surgeon and discusses the following issues with regard to medical and surgical therapies: (1) incidence of erectile dysfunction solely due to complications during RRP; (2) nerve damage during RRP; (3) vascular damage during RRP; (4) current medical and surgical therapies for restoring or maintaining potency; and (5) new advances on the horizon for management of the prostatectomy patient.