Penile erection occurs in response to visual, olfactory, imaginative, and tactile stimuli initiated within the brain and/or on the periphery. Responses to these stimuli are mediated by efferent autonomic outflow originating in the sacral... more
Penile erection occurs in response to visual, olfactory, imaginative, and tactile stimuli initiated within the brain and/or on the periphery. Responses to these stimuli are mediated by efferent autonomic outflow originating in the sacral spinal cord and transmitted by the cavernosal and penile nerves. A number of neurotransmitters can play an integral role in corpus cavernosum smooth muscle relaxation, in part regulating penile erection through increased smooth muscle synthesis of the secondary messengers cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). In addition to direct-acting agents, there are indirect-acting smooth muscle-relaxing agents. Phosphodiesterase (PDE) inhibitors such as sildenafil act indirectly and require sexual stimulation and endogenous nitric oxide production to activate the cGMP pathway effectively. In contrast, agents such as prostaglandin E(1) (PGE(1)) act directly on the trabecular smooth muscle, binding to specific e-prosta...
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Erectile dysfunction is a neurovascular phenomenon that requires an intact psychological, neural, and vascular component. The advent of Food and Drug Administration approval of sildenafil citrate (Viagra) in 1998 has resulted in increased... more
Erectile dysfunction is a neurovascular phenomenon that requires an intact psychological, neural, and vascular component. The advent of Food and Drug Administration approval of sildenafil citrate (Viagra) in 1998 has resulted in increased awareness and a large population of patients seeking treatment. Unfortunately, the estimated number of patients seeking medical therapy still persists at approximately 10%. The predominant reasons suggested here are the complexity of sexuality, taboos, cultural restrictions, lack of satisfactory treatment, and acceptance of the situation as a normal sequence of aging. This perspective discusses the global prevalence and the differences in prevalence on a worldwide basis. Recent epidemiologic studies from Spain and Germany have suggested lower rates of erectile dysfunction. This, however, may actually reflect population or cultural differences in the perceptions and attitudes towards the condition. Aging, diabetes, coronary artery disease, and cigar...
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Erectile dysfunction is a neurovascular phenomenon that requires an intact psychological, neural, and vascular component. The advent of Food and Drug Administration approval of sildenafil citrate (Viagra) in 1998 has resulted in increased... more
Erectile dysfunction is a neurovascular phenomenon that requires an intact psychological, neural, and vascular component. The advent of Food and Drug Administration approval of sildenafil citrate (Viagra) in 1998 has resulted in increased awareness and a large population of patients seeking treatment. Unfortunately, the estimated number of patients seeking medical therapy still persists at approximately 10%. The predominant reasons suggested here are the complexity of sexuality, taboos, cultural restrictions, lack of satisfactory treatment, and acceptance of the situation as a normal sequence of aging. This perspective discusses the global prevalence and the differences in prevalence on a worldwide basis. Recent epidemiologic studies from Spain and Germany have suggested lower rates of erectile dysfunction. This, however, may actually reflect population or cultural differences in the perceptions and attitudes towards the condition. Aging, diabetes, coronary artery disease, and cigarette smoking as epidemiologic factors are reviewed extensively, including some of the controversies with the prevalence rates on a global scale. Chronic renal failure, pelvic surgery, and lifestyle determinants similarly suggest there may be subtle differences, requiring further education from the medical care provider in order to have patient acceptance on a relatively earlier scale. Erectile dysfunction is a worldwide health issue that affects nearly half the men over the age of 40. As the world population ages, the number of patients affected by this disorder will certainly be increased. With the identification of risk factors, it may be possible to identify patients at risk of erectile dysfunction.
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Research Interests: Ischemia Reperfusion Injury, Antioxidants, Renal transplantation, Kidney, Reactive Oxygen Species, and 20 moreAnimals, Male, Statistical Significance, Superoxide Dismutase, Clinical Sciences, Rats, Alpha-Tocopherol, Group, Wistar Rats, Rat Model, Reperfusion injury, Aortic Aneurysm, Ischemia–reperfusion, Clinical Application, Renal Dysfunction, Malondialdehyde, Xanthine Oxidase, Protein Oxidation, Electron Microscope, and Synergistic effect
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The aim of the present study was to assess the effect of lumbar disc herniation surgery for low back pain on the erectile functioning. Thirty-eight patients, with age ranging from 22 to 56 years, who had presented with pain due to... more
The aim of the present study was to assess the effect of lumbar disc herniation surgery for low back pain on the erectile functioning. Thirty-eight patients, with age ranging from 22 to 56 years, who had presented with pain due to herniated lumbar discs were included in the study. International Index of Erectile Function (IIEF) Short Form questionnaire was used to evaluate the erectile functioning. Patient visits on the 1st week,1st month and 3rd month postoperatively were analyzed. Pain scores were also noted together with side effects and the complications of the surgery. Of the 38 patients, 18 patients had reported erectile dysfunction; 10 patients mild and 8 patients moderate erectile dysfunction. Twenty patients did not report erectile problems. The herniation levels mostly were L5-S1 in 12 (31.6%). Overall, erectile dysfunction rates have improved in 31.7% of those previously with erectile dysfunction in a 3 month period after the surgery. Best results were obtained in those p...
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Cauda equina syndrome is a neurological state with bilateral ischiatic pain, lower extremity weakness, and bladder and bowel dysfunction due to multiple compressive neuropathies of the lumbar and sacral nerves. Even though the... more
Cauda equina syndrome is a neurological state with bilateral ischiatic pain, lower extremity weakness, and bladder and bowel dysfunction due to multiple compressive neuropathies of the lumbar and sacral nerves. Even though the relationship between cauda equina syndrome and voiding dysfunctions is a well known fact, data on the clinical management of the condition is limited. The aim of this paper is to review the pathophysiological relationship between voiding dysfunctions and cauda equina syndrome and to refresh our knowledge about the clinical approach to this group of patients. (Archives of Neuropsychiatry 2009; 46: 187-91)
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To evaluate the efficacy of intravesical Botulinum toxin injection for overactive bladder symptoms in patients with Parkinson's disease. Parkinson's Disease... more
To evaluate the efficacy of intravesical Botulinum toxin injection for overactive bladder symptoms in patients with Parkinson's disease. Parkinson's Disease patients with overactive bladder symptoms and incontinence were included in the study. Patients were interviewed using the SEAPI questionnaire. The caregivers evaluated their decline in quality of life using the visual analog scale. Intradetrusor injection technique with 30 point template was employed. All patients received 500 i.u. of botulinum toxin-A. The follow-up was at week one and every 12 weeks thereafter for 12 months. Primary caregiver quality of life assessments were also performed using the VAS scale in every visit. Sixteen patients were followed for 12 months. The mean age of the group was 67.2 +/- 5.1. Initial mean functional bladder capacity for the group was 198.6 +/- 33.7 mL.In the third month control the mean bladder capacity increased to 319 +/- 41.1 mL. The quality of life assessment of primary caregiver as well as the patients also statistically improved after the injections (p < 0.05 for both). No neurological detoriation, confusion or disorientation were noted. At the 9th month control 6 patients experienced some urgency which they could suppress and were continent, 4 patients reported occasional incontinence (once in 2-3 days) and 6 patients reported once daily or more incontinence episodes. Medical therapy was prescribed for 12 patients and 4 asked for repeat injections. Intravesical botulinum toxin injection is an effective treatment modality with local action and no central nervous system side effects in patients with Parkinson's disease.
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Research Interests: Microsurgery, Treatment Outcome, Humans, Derivation, Hemodynamics, and 5 moreMale, Technique, Penis, Clinical Sciences, and Adult
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Research Interests: Algorithms, Urology, Adolescent, Humans, Doppler Ultrasound, and 8 moreMale, Follow-up studies, The, Penis, Clinical Sciences, Middle Aged, Adult, and Priapism
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Use of a nonmedical, catalogue type vacuum erection device resulted in a case of vacuum induced vasculogenic impotence and Peyronie's disease. A 66-year-old potent man used a nonmedical vacuum erection device (cylinder plus a hand... more
Use of a nonmedical, catalogue type vacuum erection device resulted in a case of vacuum induced vasculogenic impotence and Peyronie's disease. A 66-year-old potent man used a nonmedical vacuum erection device (cylinder plus a hand pump without a pressure-release valve and a doughnut-shaped ring at the base without tension bands) after having achieved a spontaneous rigid erection. The resultant excessive overinflation of the penis was followed by dorsal curvature, diminished rigidity and decreased erectile maintenance. Physical examination revealed a dorsal mid shaft Peyronie's plaque. Nocturnal penile tumescence testing and office injection testing were abnormal and demonstrated partial, short-lived, dorsally curved erections. Dynamic pharmaco-cavernosometry and pharmaco-cavernosography established vasculogenic impotence with site-specific crural (unrelated to the Peyronie's plaque) veno-occlusive dysfunction and dorsal penile curvature. Vacuum erection devices create pulling forces on the penis. We estimate that the pulling forces in this case were prohibitively high (approximately 29 pounds) due to absence of a pressure-release valve and to the preexistent erection at vacuum application. These intense pulling forces are hypothesized to have damaged the tunica in the mid shaft (Peyronie's disease) and the crus (veno-occlusive dysfunction), the latter being the site of attachment of the corpora to the ischiopubic ramus and a most likely location for high magnitude pulling forces to exert an abnormal injury effect. The patient underwent a Nesbit plication procedure and presently performs self-injection for satisfactory sexual activity.
Research Interests: Urology, Humans, Male, Vacuum, The, and 4 moreClinical Sciences, Aged, Middle Aged, and Penile Erection
Research Interests: Ischemia Reperfusion Injury, Antioxidants, Renal transplantation, Kidney, Reactive Oxygen Species, and 20 moreAnimals, Male, Statistical Significance, Superoxide Dismutase, Clinical Sciences, Rats, Alpha-Tocopherol, Group, Wistar Rats, Rat Model, Reperfusion injury, Aortic Aneurysm, Ischemia–reperfusion, Clinical Application, Renal Dysfunction, Malondialdehyde, Xanthine Oxidase, Protein Oxidation, Electron Microscope, and Synergistic effect
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Blunt pelvic and perineal trauma has been previously reported to result in site-specific veno-occlusive dysfunction and/or site-specific cavernosal artery insufficiency. We herein describe a case of erectile dysfunction in a young... more
Blunt pelvic and perineal trauma has been previously reported to result in site-specific veno-occlusive dysfunction and/or site-specific cavernosal artery insufficiency. We herein describe a case of erectile dysfunction in a young previously potent amputee. We postulate that the erectile dysfunction is associated with a newly described form of blunt trauma, that is, site-specific compression from a perineal weight-bearing lower extremity above-knee prosthetic device. It is hypothesized that when the force exerted by the above-knee prosthesis is directed medially towards the ischiopubic ramus, the penile crura and common penile arterial blood supply become susceptible to crush-like injury, since they are in fixed anatomic locations in the perineum sandwiched between the compressive force and the bone. Clinical evaluation of the erectile dysfunction in this patient revealed site-specific corporal veno-occlusive dysfunction and site-specific common penile arterial occlusive pathology in the precise region of the contact of the above-knee prosthesis with the perineum. Further research is needed in above-knee prosthesis design to prevent erectile dysfunction.