Summary
The past decade has seen a better understanding of the physiology of erection and the pathophysiology of impotence as a result of considerable innovative research. These advances also introduce a new era in the diagnosis and treatment of impotence. Many functional tests and effective medical and surgical treatments are now available. With the sudden explosion of these many tests and therapies, clinicians are often confronted by questions such as: What constitues an adequate workup? What is the treatment of choice of arteriogenic impotence? Is nocturnal penile tumescence testing necessary? Is penile arteriography necessary? Over the past several years, the author has been using a patient's goal-directed approach to the diagnosis and treatment of impotence. This approach is based on (1) the most recent advances of diagnostic technique and therapy of impotence and (2) the patient's physical and mental health, motivation, and goal. This article briefly summarizes this practical patient's goal-directed management of impotence.
Similar content being viewed by others
References
Bookstein JJ, Lurie AL (1988) Transluminal penile venoablation for impotence: a progress report. Cardiovasc Intervent Radiol 11:253–260
Bookstein JJ, Valji K, Parsons L, Kessler WO (1987) Pharmacoarteriography in the evaluation of impotence. J Urol 137:333–337
Brindley GS (1983) Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence. Br J Psychiatry 143:332–337
Buvat J, Lemaire A, Buvat-Herbaut M, Marcolin G (1989) Safety of intracavernous injection using an alpha-blocking agent. J Urol 141:1364–1367
Courtheoux P, Maiza D, Henriet J-P, Vaislic CD, Evraard C, Theron J (1986) Erectile dysfunction caused by venous leakage: treatment with detachable balloons and coils. Radiology 161:807–809
Crespo E, Soltanik E, Bove D, Farrell G (1982) Treatment of vasculogenic impotence by revascularizing cavernous and/or dorsal arteries using microvascular techniques. Urology 20:271–275
Ebbehøj J, Wagner C (1979) Insufficient penile erection due to abnormal drainage of cavernous bodies. Urology 13:507–510
Fowler JE Jr (ed) (1990) Master of surgery: urology. Little, Brown and Company, Boston
Gall H, Baehren W, Scherb W, Stief C, Thon W (1989) Diagnostic accuracy of Doppler ultrasound technique of the penile arteries in correlation to selective arteriography. Cardiovasc Intervent Radiol 11:225–231
Gilbert P, Stief CG (1986) Spongiolysis: a new surgical treatment of distal venous leakage. Abstract (13.5a) presented and published at the second world meeting on impotence, Prague, Czechoslovakia, June
Goldstein I (1986) Arterial revascularization procedures. Semin Urol 4:252–258
Goldstein I (1988) Evaluation of penile nerves. In: Tanagho EA, Lue TF, McClure RD (eds) Contemporary management of impotence and fertility. Williams and Wilkins, Baltimore, pp 70–83
Hauri D (1986) A new operative technique in vasculogenic erectile impotence. World J Urol 4:237–249
Ishii N, Watanabe H, Irisawa C, Kikuchi Y, Kawamura S, Suzuki K (1988) Studies on male sexual impotence, report 18: therapeutic trial with prostaglandin E1 for organic impotence. Jpn J Urol 77:954–962
Juenemann K-P, Alken P (1989) Pharmacotherapy of erectile dysfunction: a review. Int J Impotence Res 1:71–93
Kaneko S, Bradley WE (1986) Evaluation of erectile dysfunction with continuous monitoring of penile rigidity. J Urol 136:1026–1029
Karacan I, Howell JW (1988) Use of nocturnal penile tumescence in diagnosis of male erectile dysfunction. In: Tanagho EA, Lue TF, McClure RD (eds) Contemporary management of impotence and fertility. Williams and Wilkins, Baltimore, pp 95–103
LeVeen HH, Diaz C (1980) Treatment by corpus cavernosum revascularization. In: Zorgniotti AW; Rossi G (eds) Vasculogenic impotence. Proceedings of the first international conference on corpus cavernosum revascularization. Charles C. Thomas, Springfield, pp 217–333
Lue TF (1989) Patient's goal-directed impotence managment. Urol Grand Rounds 29:1–5
Lue TF (1989) Penile venous surgery: technique. Urol Clin North Am 16:607–611
Lue Ft, Tanagho EA (1987) Physiology of erection and pharmacologic management of impotence. J Urol 137:829–836
Lue TF, Hricak H, Marich KW, Tanagho EA (1985) Vasculogenic impotence evaluated by high resolution ultrasonography an pulsed Doppler spectrum analysis. Radiology 155:777–781
Lue TF, Hricak H, Schmidt RA, Tanagho EA (1986) Functional evaluation of penile veins by cavernosography in papaverine induced erection. J Urol 135:479–482
Lydston CF (1908) The surgical treatment of impotence. Am J Clin Med 15:1571–1573
Michal V, Kramar R, Hejhal L (1980) Revascularization procedures of the cavernous bodies. In: Zorgniotti AW, Rossi G (eds) Vasculogenic impotence. Proceedings of the first international conference on corpus cavernosum revascularization. Charles C. Thomas, Springfield, pp 239–255
Morales A, Condra M, Owen JA, Fenemore J, Surridge DH (1988) Oral and transcutaneous pharmacologic agents for the treatment of impotence. In: Tanagho EA, Lue TF, McClure RD (eds) Contemporary management of impotence and fertility. Williams and Wilkins, Baltimore, pp 178–185
Nadig PW, Ware JC, Blumoff R (1986) Noninvasive device to produce and maintain an erection-like state. Urology 27:126–131
Padma-Nathan H (1989) Evaluation of the corporal veno-occlusive mechanism: dynamic infusion cavernosometry and cavernosography. Semin Intervent Radiol 6:205–211
Puech-Leao P, Reis MMSM, Glina S, Reichelt AC (1986) Venous leakage through the crural edge of corpus cavernosum — diagnosis and treatment. Abstract (13.10) presented and published at the second world meeting on impotence, Prague, Czechoslovakia, June
Roy JB, Petrone R, Said SI, Paul S (1988) Clinical trial of intracavernous vasoactive intestinal peptide to induce penile erection. J Urol 139:251A
Sidi AA, Chen KK (1987) Clinical experience with vasoactive intracavernous pharmacotherapy for treatment of impotence. World J Urol 5:156–159
Stackl W, Hasun R, Marberger M (1988) Intracavernous injection of prostaglandin E1 in impotent men. J Urol 140:66–68
Valji K, Bookstein JJ (1988) Transluminal angioplasty in the treatment of arteriogenic impotence. Cardiovasc Intervent Radiol 11:245–252
Virag R (1982) Intracavernous injection of papaverine for erectile failure (letter to the editor). Lancet 2:938
Virag R (1982) Revascularization of the penis. In: Williams & Wilkins, Baltimore, pp 219–233
Virag R, Spencer PP, Frydman D (1981) Artificial erection in diagnosis and treatment of impotence. Urology 24:157–161
Wagner G, Uhrenholdt A (1980) Blood flow measurement by the clearance method in the human corpus cavernosum in the flaccid and erect states. In: Zorgniotti AW, Rossie G (eds) Vasculogenic impotence. Proceedings of the first international conference on corpus cavernosum revascularization. Charles C. Thomas, Springfield, pp 41–46
Wespes E, Schulman CC (1988) Venous leakage: surgical treatment of a curable cause of impotence. J Urol 133:796–798
Wespes E, Delcour C, Struyven J, Schulman CC (1984) Cavernometry-cavernography: its role in organic impotence. Eur Urol 10:229–232
Wespes E, Delcour C, Struyven J, Schulman CC (1986) Pharmacocavernometry-cavernography in impotence. Br J Urol 58:429–433
Witherington R (1989) Vacuum constriction device for management of erectile impotence. J Urol 141:320–322
Wooten JS (1902–1903) Ligation of the dorsal vein of the penis as a cure for atonic impotence. Texas Med J 18:325–328
Zorgniotti AW, Lefleur RS (1985) Auto-injection of corpus cavernosum with a vasoactive drug combination for vasculogenic impotence. J Urol 133:39–41
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lue, T.F. Impotence: A patient's goal-directed approach to treatment. World J Urol 8, 67–74 (1990). https://doi.org/10.1007/BF01576350
Issue Date:
DOI: https://doi.org/10.1007/BF01576350