ABSTRACT
Erections are inhibited by sympathetic stimulation. Anxiety or psychologic inhibition may produce abnormal response during impotence workup. The use of intracorporeal alpha blockers (phentolamine) and audiovisual sexual stimulation (AVSS) has been used to decrease sympathetic outflow and enhance erectile response. Thirty-three patients with suspected vasculogenic impotence were studied. They underwent pulsed Doppler ultrasound (PDUS) with multiple doses of tri-mix (mix of papaverine, phentolamine, and prostaglandin E1). AVSS was applied after maximal response to tri-mix. Seventeen patients (51.5%) responded to multidose with grade IV or V erection. When AVSS was started, 5 more patients responded, and 7 upgraded to grade V with overall response of 40 percent. AVSS can augment the in-office response to pharmacologic testing above that obtained by "maximal" pharmacologic dosing, thereby increasing the sensitivity and specificity of the test.
Subject(s)
Alprostadil/administration & dosage , Erectile Dysfunction/drug therapy , Papaverine/administration & dosage , Phentolamine/administration & dosage , Photic Stimulation , Alprostadil/therapeutic use , Drug Therapy, Combination , Erectile Dysfunction/etiology , Erectile Dysfunction/physiopathology , Humans , Male , Papaverine/therapeutic use , Penile Erection/drug effects , Penis/blood supply , Phentolamine/therapeutic use , Regional Blood FlowABSTRACT
We present our results with the use of transurethral injection of polytetrafluoroethylene (Teflon) in 128 female patients with moderate to severe urinary incontinence from 1964 to 1991. Of the patients 60% had undergone previous surgical treatment for the incontinence. The etiologies included stress incontinence, neurogenic bladder, congenital anomalies, trauma and others. More than 73% of the patients improved (54.3% were totally dry). The failure rate was 27%. Complications were minimal. Urinary tract infection and temporary urinary retention occurred in 7 and 6 patients, respectively. Mean followup was 31 months. This study demonstrates that transurethral polytetrafluoroethylene injection is a useful treatment of moderate to severe urinary incontinence in female patients. Polytetrafluoroethylene is particularly useful for patients with failed previous incontinence procedures and poor surgical candidates. Failures are more likely in patients with periurethral fibrosis secondary to a previous urethral operation.
