Clinical significance of ultrastructural findings in the corpora cavernosa of normal and impotent men.

Corpora cavernosa of 5 normal and 11 impotent living men were studied by electron microscopy. Of the smooth muscle cells 42.3% from corporeal tissues of impotent men showed a pronounced thickening of the basal lamina, a paucity of dense bodies and contractile filaments, minimal or no glycogen and fewer vesicles on the cell surface, whereas only 5.4% of the smooth muscle cells from normal men showed similar alterations. These differences were statistically significant (p less than 0.003). The percentage of altered smooth muscle cells in corporeal tissues of impotent men was proportional to the severity of symptoms and clinical findings. Morphometric analysis revealed no significant differences in the relative proportions of the major components of corporeal tissue (smooth muscle cells, extracellular matrix, vascular lumina and endothelial cells). These findings suggest the need for early detection of corporeal tissue degeneration by preoperative biopsy to assist in better selection of candidates for a penile vascular operation. They also may contribute to the development of new therapeutic modalities for erectile dysfunction.

Changes in the corpora cavernosa of impotent diabetics: comparing histological with clinical findings.

In our study, the histological findings showed significant pathological fibrosis affecting the penile arteries and erectile tissue, but no direct damage to the penile nerve fibers. Forty percent of our patients with clinical evidence of penile neuropathies showed no histological evidence to support a neurogenic mechanism of their impotence. In addition, to the consistent vascular lesion found in 90 percent of impotent diabetics in our study, a fibroproliferation of the erectile tissue was predominantly found as well. Our histopathological study seemed to correlate with our previous clinical finding. Does this confirmation of the vascular etiology as a primary cause of impotence in diabetics have practical application? The answer must be "yes". If new diagnostic developments contribute to making an earlier diagnosis of this disease, then more conservative or aggressive treatment of the impotent diabetic will become a reality.

Radioisotope penogram in diagnosis of vasculogenic impotence.

A radioisotope technique to estimate penile blood flow is described. The radioisotope penogram is noninvasive and gives a dynamic evaluation of the arterial supply, venous drainage, and blood flow in the corporeal bodies. The penogram is a valuable adjunct in evaluation of patients with vasculogenic impotence.

Vascular factor in erectile failure among diabetics.

Clinical, sexual, and laboratory evaluations were made on 47 impotent diabetics. All patients were given a Doppler PAPS examination and a neurologic assessment of the penis (BCRL and/or CMG). Nerve conductivity tests of the legs were also administered to most patients. The groups were classified as to whether they were insulin or noninsulin dependent. Abnormalities of penile arterial flow were detected in 95.7 per cent of all the patients. Penile arterial occlusions without associated penile neuropathies occurred in 61.7 per cent. Penile neuropathies were found in 34 per cent, and all were associated with varying degrees of penile arterial obstruction. Diabetics who were dependent on insulin showed a high frequency of vascular pathologies and a 12 to 15 per cent higher rate of penile neuropathies than the group not dependent on insulin. Our study suggests that obstruction of penile arteries is the primary factor in erectile dysfunction of diabetics. Those impotent diabetics without any overt penile nerve damage might be good candidates for revascularization procedures.

Penile body temperature as screening test for penile arterial obstruction in impotence.

Intraurethral penile body temperature measurement is a simple, inexpensive procedure designed for screening impotent patients which can be done in the physician's office. The results give a reliable index of penile arterial circulation and can suggest possible organic impairment, which can be verified further by other noninvasive vascular studies. In our experience, patients having more than 3 degrees F. difference between sublingual and internal penile temperature are most likely to have significant penile arterial obstruction. This method is recommended as a diagnostic procedure to help detect possible vasculogenic causes of impotence.

Importance of penile arterial pulse sound examination in impotence.

Experience with the Doppler ultrasound examination of penile arteries in 93 impotent men is presented. The technique for this examination is a simple, reliable, inexpensive office procedure for the detection of penile arterial obstruction in patients with impotence. With this test 44 per cent of impotent men were found to have obstructive blood flow in the penis as the cause of impotence. A 95 per cent accuracy rate with this technique was confirmed by penile angiography in 22 patients. Since impotence is a common problem facing the clinicians it is important to detect penile arterial disease--a main causal agent of many impotent men.