Impotence

Krane, Robert J.; Goldstein, Irwin; Tejada, Iñigo Sáenz de

doi:10.1056/nejm198912143212406

Cited by 587 publications

(246 citation statements)

References 115 publications

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“…Sinusoidal contraction allows the corporeal venules to drain freely to extrapenile veins. 1 With erection, arteriolar and sinusoidal smooth muscle relaxation permits an increase in arterial¯ow and sinusoidal ®lling. 1 This increase in¯ow results in high intracavernous pressures during penile erection.…”

Section: Discussionmentioning

confidence: 99%

“…Penile erection results from increased arterial ow, smooth muscle relaxation and increased venous out¯ow resistance. 1 It is estimated that well over 50% of men with impotence have an organic etiology, with the majority of vascular in origin. 2 The vascular problems results from either arterial insuf®ciency andaor incompetence of the veno-occlusive mechanism (venous leak).…”

Section: Introductionmentioning

confidence: 99%

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Vasculogenic impotence and cavernosal oxygen tension

Strohl

et al. 2000

Int J Impot Res

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Aims of this study: To determine the associations, if any, of cavernosal oxygen tension with vasculogenic impotence. Materials and Methods: We evaluated penile cavernosal blood gas levels in men with suspected vasculogenic impotence during penile duplex ultrasonography andaor dynamic infusion cavernosometry and cavernosography (DICC). Patients with suspected impotence were evaluated from 1992 ± 1996. Patient ages ranged from 24 ± 75 y (mean 48 y). Eighteen men had arteriogenic impotence diagnosed by abnormal penile duplex ultrasound after injection of a vasoactive agent, and 23 men had venous leakage diagnosed by DICC. Results: Eighteen men with arteriogenic impotence had the following mean blood gas values: pH 7.38 AE 0.01, PCO2 45.50 AE 0.94, PO2 65.17 AE 2.16. Twenty-three men with venogenic (venous leak) impotence had the following mean cavernosal blood gas values: pH 7.41 AE 0.01, PCO2 42.26 AE 0.83, PO2 74.17 AE 2.51. The differences in PO2 were signi®cant (P`0.05). A subgroup of men with severe venous leakage had PO2 values that were similar to the low arterial PO2 values. Conclusion: The low PO2 in patients with arteriogenic impotence, and the subset of men with severe venous leak impotence, support a global concept of low cavernosal PO2 as a mechanism for both arteriogenic and venogenic impotence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vasculogenic impotence and cavernosal oxygen tension

Strohl

et al. 2000

Int J Impot Res

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“…Nitric oxide is widely recognized as the most important factor involved in corpus cavernosal smooth muscle relaxation, and hence in erection [6]. Nitric oxide is synthesized and released directly from parasympathetic nonadrenergic, noncholinergic nerves [7], and from vascular endothelial cells after stimulation by acetylcholine [8].…”

Section: : 1155±1160]mentioning

confidence: 99%

Erectile and endothelial dysfunction in Type II diabetes: a possible link

et al. 2001

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Erectile dysfunction (ED) is a common complication and an important cause of decreased quality of life in men with diabetes. These patients present a risk of ED three-fold higher than the general population; the prevalence of ED increases with age, but in diabetic men it can occur 10 to 15 years earlier regardless of their insulin dependency status [1].The causes of ED in diabetic patients can be multifactorial, involving mainly vascular, neurological and Diabetologia (2001) AbstractAims/hypothesis. The aim of this study was to evaluate the relation between erectile dysfunction and endothelial functions, coagulation activation, peripheral and autonomic neuropathy in men with Type II (non-insulin-dependent) diabetes mellitus. Methods. We studied 30 Type II diabetic patients with symptomatic erectile dysfunction and 30 potent diabetic patients matched for age and disease. Endothelial functions were assessed with the l-arginine test, plasma thrombomodulin and cell adhesion molecules circulating concentrations. Haemostasis was evaluated with markers of thrombin activation and fibrinolysis. Quantitative sensory testing (vibratory, warming, and heat-pain thresholds), cardiovascular reflex tests and 24-h blood pressure monitoring were used to assess peripheral or autonomic neuropathy. Results. Mean erectile score and HbA 1 c were 10.5 5.8 and 8.3 1.6 % in patients with erectile dysfunction, and 24.0 0.7 and 6.8 1.4 % in those without erectile dysfunction, respectively (p < 0.001); there was a significant relation between HbA 1 c and erectile function score in patients with erectile dysfunction (r = ±0.45, p = 0.02). The decrease in blood pressure and platelet aggregation in response to l-arginine was lower (p < 0.05±0.02) in patients with erectile dysfunction, whereas soluble thrombomodulin, P-selectin and intercellular cell ahhesion molecule-1 concentrations were higher (p < 0.05±0.02). Indices of coagulation activation (F1 + 2 and d-dimers) and reduced fibrinolysis (PAI-1) were also found to be higher in erectile dysfunction patients. Heat-pain and warm perception thresholds, as well as cardiovascular reflex tests, were most commonly abnormal in patients with erectile dysfunction (p < 0.05). In multivariate analysis, HbA 1 c , MBP response to l-arginine, P-selectin, indices of coagulation, and quantitative sensory testing were independent predictors of erectile function score. Conclusion/interpretation. Erectile dysfunction in diabetic men correlates with endothelial dysfunction. A reduced nitric oxide activity might provide a unifying explanation. [Diabetologia (2001

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“…It is supposed to have its effect by inhibiting the release of noradrenaline from sympathetic nerve endings and by the release of Non Cholinergic Non Adrenergic (NANC) transmitters from the parasympathetic nerve endings and from the endothelial cells. 9,40 NO is one of the main NANC transmitters. 10,11 Cavernous tissue function From his experience with i.c.…”

Section: Parasympathetic Nervous Systemmentioning

confidence: 99%