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A Double Blind Controlled Crossover Study of Intracorporeal Papaverine for Erectile Impotence
Sexual Function 1094 A DOUBLE BLIND CONTROLLED CROSSOVER S'IUDY OF INTRACORPOREAL PAPAVERINE FOR ERECTILE IMPOTENCE. ''EmrIEnuel Abara, Sender Herschorn, Toronto, Ontario (Presentation to be made by Dr. Herschorn). Intracorporeal papaverine has been widely reported to be useful in the diagnosis and treatment of impotence in clinical studies. This report outlines a double-blind crossover study to test the effect of 1 cc.(32.5 mg.) of intracorporeal papaverine vs. 1 cc. of placebo (0.9% normal saline). 30 patients were included in the study. Toe patients were categorized under the following primary diagnoses on the basis of clinical and laboratory studies: vasculogenic-13, diabetic-7, psychogenic-4, horrrDnal-1, neurogenic-1, post radiation-1, and indeterminate-3. Each patient was given 1 cc, of a test drug intracorporeally and the result recorded. After a washout period of 7 days another 1 cc. of a test drug was similarly given. Each patient, therefore, was his own control. Toe results, after the code was broken, showed that there was a 100% response rate to papaverine and no response to normal saline. 'There were 2 recorded prolonged erections (4-7 hours) with the papavecine and no other side effects were seen. We conclude that there is no placebo effect in the administration of intracorporeal papaverine and the small undiluted dose is effective with few side effects.
1095 PAPAVERINE INJECTION IN NEUROGENIC IMPOTENCE.
*Lawrence Goldstone, Houston, TX (Presentation to be made by Dr. Goldstone) Intracavernous injection with papaverine has gained widespread acceptance by urologists for the diagnosis and treatment of patients with erectile dysfunction. Previously published data have revealed a 100% functional response rate for patients with a pure neurogenic cause for impotence. This study was designed to confirm these findings and correlate response to the type and level of neurologic injury. Young patients with chronic spinal cord injury without any other underlying pathology were selected for study. History and physical examination and water cystometry were performed on all patients. In addition, cortical somatosensory evoked potentials to pudenda! nerve stimulation, penile electroneurogram and measurement of the conduction velocity of the dorsal nerve of the penis were done on all subjects. When indicated, pelvic floor electromyography and measurement of the bulbocavernosus reflex threshold and latency were performed to confirm abnormalities of the sacral cord. Patients were then injected intracavernously with a papaverine hydrochloride/phentolamine mesylate combination or papaverine only. Responses were recorded by a single examination and non-responders were given repeat injections with increased doses of papaverine until a 100% response occurred or a total of 45 mg papaverine was reached, at which time they were considered failures. Preliminary data suggest an overall response rate of 85%. Non-responders tended to have severe lower motor neuron injury and absent or abnormal dorsal nerve conduction velocities. This study suggests the response may be related to intactness of the peripheral nerve supply to the penis.
1096
1097
APPLICATION OF INTRACORPORAL INJECTION OF VASOACTIVE MEDICATIONS IN THE SPINAL CORD INJURED MALE. *Donald R. Bodner, *Rosemary Lindan and *Betty Leffler, Cleveland, OH (Presentation to be made by Dr. Bodner) Obtaining and sustaining an erection that is firm and adequate for vaginal penetration and satisfactory completion of intercourse is a common problem for the spinal cord injured male. Intracavernous injection of vasoactive substances offers a new treatment option but must be approached with caution in this population. Over the past year, we have placed twenty spinal cord injured men on self injection of papaverine or papaverine with phentolamine. Patients were started with papaverine alone beginning with 7.5 mg. Sixteen paraplegics and four quadraplegics comprised this group. Nineteen of the patients were able to obtain an adequate erection for penetration, 4 on papaverine alone and 15 on papaverine with phentolamine. The one patient that did not obtain an adequate erection was proven to have anomalous penile venous drainage. Average follow-up was four months with frequency of injection averaging once per week. Six episodes of priapism occurred in three patients. These were satisfactorily treated with aspiration and injection of an epinephrine solution. One patient had a surgical shunt placed at an outlying hospital prior to entering our program and the others were treated with aspiration of the corpora and injection of epinephrine. All three have subsequently been able to obtain satisfactory erections with use of lower doses of papaverine alone. Autonomic dysreflexia was not observed. Autoinjection for restoring potency appears to offer a better treatment option for appropriately motivated spinal cord injured males than was previously available. Its application to this patient population is discussed.
OUR EXPERIENCE OF ERECTILE IMPOTENCE BY VENOUS LEAKAGE.Pierre Bondi~ Thierry Schauliege~Jean Louis Nguyen Qui;Salon de Provence,Bethune,Fran-ce.(Presentation to be made by Dr Nguyen Qui) Since 1981,60 erectile impotences by venous leakage(VL) have been operated on.Dur experience shows that there is no specific VL syndrom,the influence of the position or the associated ve-nous pathology seem not to be truly typical of VL.The diagnosis of VL is made by cavernosogra-phy with a passive erection test. Actualy,VL is evoked when the flow rate necessa -ry to maintain the erection exceeds 120 ml/mn. This criterium is however arbitrary and seems in-sufficient because potent men may show a high flow of maintenance.The criteria for VL,will also have ta be better defined,thus the intracaver-nous pression measure seems to be an improve-ment. The complexity of the venous blockade implies a physiopathological plurality with: &lack of etancheity of the cavernous bodies &decrease of compliance of the cavernous bodies by alteration of the tunica albuginea and thee-rectile tissue mechanical properties. This complexity explains the difficult problems of therapeutic indications and surgical technique, We have made a ligature-resection of the deep pe-nile veins associated or not with a pericaverno-soplasty and a cavernoplasty,without serious complications.37 patients (61%) have a good re-sult with a follow up of 20 months average.The best results have been noted when VL is isolated and fairly important.In spite of non understable failures,surgery appears to be a good treatment for VL.The success rate will probably improve with experience and better knowing of VL mechanis ms.
377A
1095 PAPAVERINE INJECTION IN NEUROGENIC IMPOTENCE.
*Lawrence Goldstone, Houston, TX (Presentation to be made by Dr. Goldstone) Intracavernous injection with papaverine has gained widespread acceptance by urologists for the diagnosis and treatment of patients with erectile dysfunction. Previously published data have revealed a 100% functional response rate for patients with a pure neurogenic cause for impotence. This study was designed to confirm these findings and correlate response to the type and level of neurologic injury. Young patients with chronic spinal cord injury without any other underlying pathology were selected for study. History and physical examination and water cystometry were performed on all patients. In addition, cortical somatosensory evoked potentials to pudenda! nerve stimulation, penile electroneurogram and measurement of the conduction velocity of the dorsal nerve of the penis were done on all subjects. When indicated, pelvic floor electromyography and measurement of the bulbocavernosus reflex threshold and latency were performed to confirm abnormalities of the sacral cord. Patients were then injected intracavernously with a papaverine hydrochloride/phentolamine mesylate combination or papaverine only. Responses were recorded by a single examination and non-responders were given repeat injections with increased doses of papaverine until a 100% response occurred or a total of 45 mg papaverine was reached, at which time they were considered failures. Preliminary data suggest an overall response rate of 85%. Non-responders tended to have severe lower motor neuron injury and absent or abnormal dorsal nerve conduction velocities. This study suggests the response may be related to intactness of the peripheral nerve supply to the penis.
1096
1097
APPLICATION OF INTRACORPORAL INJECTION OF VASOACTIVE MEDICATIONS IN THE SPINAL CORD INJURED MALE. *Donald R. Bodner, *Rosemary Lindan and *Betty Leffler, Cleveland, OH (Presentation to be made by Dr. Bodner) Obtaining and sustaining an erection that is firm and adequate for vaginal penetration and satisfactory completion of intercourse is a common problem for the spinal cord injured male. Intracavernous injection of vasoactive substances offers a new treatment option but must be approached with caution in this population. Over the past year, we have placed twenty spinal cord injured men on self injection of papaverine or papaverine with phentolamine. Patients were started with papaverine alone beginning with 7.5 mg. Sixteen paraplegics and four quadraplegics comprised this group. Nineteen of the patients were able to obtain an adequate erection for penetration, 4 on papaverine alone and 15 on papaverine with phentolamine. The one patient that did not obtain an adequate erection was proven to have anomalous penile venous drainage. Average follow-up was four months with frequency of injection averaging once per week. Six episodes of priapism occurred in three patients. These were satisfactorily treated with aspiration and injection of an epinephrine solution. One patient had a surgical shunt placed at an outlying hospital prior to entering our program and the others were treated with aspiration of the corpora and injection of epinephrine. All three have subsequently been able to obtain satisfactory erections with use of lower doses of papaverine alone. Autonomic dysreflexia was not observed. Autoinjection for restoring potency appears to offer a better treatment option for appropriately motivated spinal cord injured males than was previously available. Its application to this patient population is discussed.
OUR EXPERIENCE OF ERECTILE IMPOTENCE BY VENOUS LEAKAGE.Pierre Bondi~ Thierry Schauliege~Jean Louis Nguyen Qui;Salon de Provence,Bethune,Fran-ce.(Presentation to be made by Dr Nguyen Qui) Since 1981,60 erectile impotences by venous leakage(VL) have been operated on.Dur experience shows that there is no specific VL syndrom,the influence of the position or the associated ve-nous pathology seem not to be truly typical of VL.The diagnosis of VL is made by cavernosogra-phy with a passive erection test. Actualy,VL is evoked when the flow rate necessa -ry to maintain the erection exceeds 120 ml/mn. This criterium is however arbitrary and seems in-sufficient because potent men may show a high flow of maintenance.The criteria for VL,will also have ta be better defined,thus the intracaver-nous pression measure seems to be an improve-ment. The complexity of the venous blockade implies a physiopathological plurality with: &lack of etancheity of the cavernous bodies &decrease of compliance of the cavernous bodies by alteration of the tunica albuginea and thee-rectile tissue mechanical properties. This complexity explains the difficult problems of therapeutic indications and surgical technique, We have made a ligature-resection of the deep pe-nile veins associated or not with a pericaverno-soplasty and a cavernoplasty,without serious complications.37 patients (61%) have a good re-sult with a follow up of 20 months average.The best results have been noted when VL is isolated and fairly important.In spite of non understable failures,surgery appears to be a good treatment for VL.The success rate will probably improve with experience and better knowing of VL mechanis ms.
377A