Spongiosolysis: A New Surgical Treatment of Impotence Caused by Distal Venous Leakage

Spongiosolysis: A New Surgical Treatment of Impotence Caused by Distal Venous Leakage

Impotence 816 REVIEW 817 OF 100 IMPOTENT PATIENTS IN A ONE-YEAR CLINICAL EX- PERIENCE. *Rick J. Postma, *Joachim Steffens, *Ludwig Steffens Eschw...

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Impotence 816 REVIEW

817 OF

100

IMPOTENT PATIENTS IN A ONE-YEAR CLINICAL EX-

PERIENCE. *Rick J. Postma, *Joachim Steffens, *Ludwig

Steffens Eschweiler, Federal Republic of Germany.

EARLY PREDICTABILITY Of FUTURE PSYCHOGENIC IMPOTENCE. Abraham M. B. Goldstein, Los Angeles, Ca. ;Jacques 1 1 Hermite~·, and Marie F. Germaine~·:, Nancy ,France. ( Presentation to be

(Presentation to be made by Dr. Postma) Each patient undergoes an extensive examination after a full anamnesis. Examination includes vascular, neurological and psychosexual status,followed by a laboratory status including serum testosterone and prolactine. Consequently each patient undergoes a penile doppler-sonography and an estimation of the penile-brachial pressure index, followed by a standardized papaverine-test. On suspection of venous insufficiency a dynamic venous cavernosography is performed. In the case of arterial insufficiency a D.S.A. of the pudendal vessels is carried out. We treated 100 patients over a one year period. In regard to etiology our patients were diversed as follows:55 % vascular, 6 % neurological, 26 % psychological and 13 % combined. In 22 % a negative papaverine-test was followed by a dynamic cavernosography while in 17 % a positiv test was

made by Dr. Goldstein)

followed by D.S.A. On regard to therapy, 45

In the group of psychogenic impotence 80 men had a first failure before the age of 35 while 15 had it after, 9 pa-

%

are in auto-

injection -therapy. We observed a high-flow priapism in 2 cases (out of over 500 injections). We did not see iatrogenic fibrosis of the corpora cavernosa. 2 Patients were treated by prothesis surgery without complications. 6 Patients were treated by venous resection. We saw a short tenn positiv result in 4 of these cases. We are exploring the possibilities of revascularization surgery.

Psychogenic impotence is the result of mental Some men develop easily inhibitions, some rarely probably never. Inhibitions in sexual relations bably in large measure on the temperamental type Since such temperamental features become obvious

inhibitionand few depend pro of the man\ early in

life and then persist throughout the rest of the life, distinguishing them in the teens may possibly help in predicting future psychogenic sexual impotence. The features we evaluated were: shyness, over sensitivity, emotionality and lack of aggressiveness. We have studied 104 patients diagnosed as suffering of psychogenic sexual impotence and 20 controls, admitted to the hospital for medical or sur-

gical problems. The age of the 104 cases when first presenting with their complaint varied between 16-83. The age of the men included in the control varied between 25-80.

tients could not remember; group admitted to at least features since their early never had a failure, 4 had

91 patients from the above one of the above temperamental life. In the control group 14 just once and 2 had occasional

failures after 47 and 65 years.

Of this group 7 denied any

temperamental features mentioned above, 10 admitted to have

been barely shy while 3 admitted to have been.

It appears

logical to expect that men with the above described temperamental features will be more prone to developing inhibitions than men without these features. If these observations are correct then it can be suspected that the presence of these temperrnental features in teenagers may indicate some predictability in their developing sexual problems at some time later in life. Treating in young men the above named features could possibly prevent many men from developing later in life psychogenic impotence.

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EXPERIENCE WITH A NEW IMPCII'ENCE THERAPY: PENILE SELF INJECTION. Arrer Z. Al-Juburi* and Pat D. O'Donnell, Little Rock, AR (Presentation to be made by Dr. Al-Juburi*) One hundred patients who were candidates for penile prosthesis surgery were treated with a reg:irren of either Papaverine Hydrocholride alone or Papaverine:Regitine mixture. Our patients included different organic impotence etiol.cgies: one or a canbination of rredical. problems like diabetes, antiliypertension medLcation, vascular insufficiency and neurological diseases. other patients p:,st major radical surgeries like abdanino perineal resection, radical cystectany, radical prostatectarl'.J or post rerroving penile prosthesis and post surgery for Pyronies disease. We also treated a patient on Diethyl Stilbestrol for cancer of the prostate and another patient post radiation treatrrent for testicular Seminana. All patients were studied for 6 to 12 rront.hs. The mixture of Papavedne:Regit.ine 30:l had sarewnat slower tine of onset of erection, sa:rewhat longer duration of erection in rrore instances tha,, Papaverine Hcl by itself, an:1 gave better patient sac:isfaction than Papaver:i.ne alone. Hcwever, Papaverine alone is considerably less expensive and should be administered first. It Papaverine alon,, is unsatisfactc,cy, the patient can be switched to the Papaverine:Hegitine mixture. Canplications fran both Papaverine alone or Papaverine:Regitine mixture seems to be the sane. The rrost ccmron ccrnplication, Priapism, oc=red in 6 percent. The canplications are not frequent, limited and rranageable. There was no drug interaction between either Papaverine alone or the Papaverine:Regitine mixture and other rredications the patients =e using. The cost is inexpensive. We recarmend that this option be available to the irrq:,otent patient who is a candidate for penile prosthesis and is worth a try.

SPONGIDSOLYSIS: A NEW SURGICAL TREATMENT OF IMPOTENCE CAUSED BY DISTAL VENOUS LEAKAGE P.Gilbert Until quite recently, ligation of the dorsal veins of the penis had been the only effective surgical treatment in cases of erectile dysfuction caused by venous insufficiency of the corpora cavernosa. Failures of this operation can be due to persistent distal venous leakage, consisting of venous shunts between the corpora cavernosa and the corpus spongiosum in their distal portion, which can be demonstrated by cavernosography. These shunts can be closed successfully by spongioscJysis, i.e. by dissecting the distal half of the corpus spongiosum and by isolating the tips of the corpora cavernosa. Out of five patients who underwent spongiosolysis, four regained the ability of erection with the help of intracavernous injection of vasoactive drugs, which was necessary because of concomitant arterial lesions. The only failure proved to be the consequence of persisting venous insufficiency of the deep dorsal vein of the penis. Since none of the patients developed any serious complication, spongiosolysis seems to be a safe procedure in the treatment of distal venous leakage.

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