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The medical treatment of impotence: An update

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Summary

Improved understanding of penile physiology has enabled a better therapeutic approach to the treatment of impotence. The injection of vaso-active drugs into the corpora cavernosa is highly effective in a large proportion of patients, but it has major drawbacks. With the exception of hormonal abnormalities in which supplemental or suppressive medication results in a high proportion of cures, the search for effective oral or transcutaneous medication has not yet resulted in dramatic clinical success. Most research has been centered on adrenoceptor antagonists, which have exhibited only limited activity. Other compounds include vaso-dilators such as nitroglycerine, which have shown the ability to enhance tumescence, but their effectiveness remains to be proven. Dopamine receptor agonists are another group of agents of some efficacy that are now under study. The complexity of interactions among the various central and peripheral neurotransmitters suggests that effective therapy for impotence may require a combination of drugs. Renewed efforts in this direction, with proper clinical trials, are justified and hold significant promise.

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References

  1. Antonio L, Shalhoub R, Sudhkar T (1977) Reversal of uremic impotence by zinc. Lancet II:895–896

    Google Scholar 

  2. Claes H, Baert L (1989) Transcutaneous nitroglycerin therapy in the treatment of impotence. Urol Int 44:309–312

    Google Scholar 

  3. Clark JT, Smith EP, Davidson JM (1985) Evidence for the modulation of sexual behavior by alpha-adrenoceptors in male rats. Neuroendocrinology 41:36–43

    Google Scholar 

  4. Crowley WR, Zelman FP (1981) The neurochemical control of mating behavior. In: Adler NT (ed) Neuroendocrinology of reproduction, physiology and behavior. Plenum Press, New York, pp 447–458

    Google Scholar 

  5. Danjou P, Alexandre L, Warot D, Lacomblez L, Puech AJ (1988) Assessment of erectogenic properties of apomorphine and yohimbine in man. Br Clin Pharmacol 26:733–739

    Google Scholar 

  6. Grenhoff J, Svensson TH (1988) Clonidine regularizes substantia nigra dopamine cell firing. Life Sci 42:2003–2009

    Google Scholar 

  7. Grunhaus L, Tiongco D, Zelnik T (1989) Intravenous yohimbine. Selective enhancer of norepinephrine and cortisol secretion and systolic blood pressure in humans. Clin Neuropharmacol 12:106–114

    Google Scholar 

  8. Heaton JPW, Varrin S (1990) The validation of an innovative bioassay for potency in an animal model. J Urol (in press)

  9. Heaton JPW, Morales A, Owen J, Saunders FW, Fenemore J (1990) Topical glyceryltrinitrate causes measurable penile arterial dilatation in impotent men. J Urol (in press)

  10. Lal S, Ackman D, Thavundayil JX, Kiely ME, Etienne P (1984) Effect of apomorphine, a dopamine receptor agonist, on penile tumescence in normal subjects. Prog Neuropsychopharmacol Biol Psychiatry 8:695–699

    Google Scholar 

  11. Lal S, Larya E, Thavunadyil JX, Vasavan NNP, Negrete J, Ackman D, Blundell P, Gardiner RJ (1987) Apomorphine-induced penile tumescence in impotent patients-preliminary findings. Prog Neuropsychopharmacol Biol Psychiatry 11:235–242

    Google Scholar 

  12. Leonard M, Nickel JC, Morales A (1989) Hyperprolactinemia and impotence: why, when and how to investigate. J Urol 142:992–994

    Google Scholar 

  13. Levit N, Vinik A, Sive A (1981) Synthetic LHRH in impotent male diabetics: a double blind crossover trial. S Afr Med J 59:10–14

    Google Scholar 

  14. Lidberg L, Sternthal V (1977) A new approach to the hormonal treatment of impotentia erections. Pharmacopsychiatry 10:21–24

    Google Scholar 

  15. MacDonald E, Ruskoaho H, Scheinin M, et al. (1988) Therapeutic applications of drugs acting as alpha-adrenoceptors. Ann Clin Res 20:298–310

    Google Scholar 

  16. Margolis A, Prieto P, Stein L (1971) Statistical summary of 10000 male cases using Afrodex in the treatment of impotence. Curr Ther Res 13:616–620

    Google Scholar 

  17. Morales A (1986) Clinical use of systemic erectile agents. J Urol 135:31A

    Google Scholar 

  18. Morales A, Surridge DH, Marshall PG, Fenemore J (1982) Nonhormonal pharmacological treatment of organic impotence. J Urol 128:45–47

    Google Scholar 

  19. Morales A, Condra MS, Owen JE, Fenemore J, Surridge DH (1988) Oral and transcutaneous pharmacological agents in the treatment of impotence. Urol Clin North Am 15:87–93

    Google Scholar 

  20. Muddi JW (1977) Impotence response to glyceryl trinitrate. Am J Psychol 134:922–926

    Google Scholar 

  21. Needleman P, Corr PB, Johnson EM Jr (1985) Drugs used for the treatment of angina: organic nitrates, calcium channel blockers and B-adrenergic antagonists. In: Gilman AG, Goodman LS, Rall TW, Murad F (eds) The pharmacological basis of therapeutics. Macmillan, New York, pp 806–835

    Google Scholar 

  22. Nickerson M, Collier B (1975) Drugs inhibiting adrenergic nerves and structures innervated by them. In: Goodman L, Gilman A (eds) The pharmacological basis of therapeutics. Macmillan, New York, pp 533–564

    Google Scholar 

  23. Owen JA, Saunders F, Harris C, Fenemore J, Reid K, Surridge D, Condra M, Morales A (1989) Topical nitroglycerin: a potential treatment for impotence. J Urol 141:546–548

    Google Scholar 

  24. Palmer RMJ, Ferridge AG, Moncada S (1987) Nitric oxide accounts for the biological activity of endothelium-derived relaxing factor. Nature 327:524–525

    Google Scholar 

  25. Reid K, Surridge DH, Morales A, Condra M, Harris C, Owen J, Fenemore J (1987) Double-blind trial of yohimbine in treatment of psychogenic impotence. Lancet II:421–423

    Google Scholar 

  26. Schoeffter P, Hoyer D (1989) 5-Hydroxytryptamine 5-HT1B and 5-HT1D receptors mediating inhibition of adenylate cyclase activity. Pharmacological comparison with special reference to the effects of yohimbine, rauwolscine, and some beta-adrenoceptor antagonists. Naunyn Schmiedebergs Arch Pharmacol 340:285–292

    Google Scholar 

  27. Susset JG, Tesier CD, Wincze J, Bansal S, Malhotra C, Schwacha MG (1989) Effect of yohimbine hydrochloride on erectile impotence: a double-blind study. J Urol 141:1360–1363

    Google Scholar 

  28. Tagliamonte A, Fratta W, Del Fiacco M, Gessa DL (1974) Possible stimulatory role of brain dopamine in the copulatory behavior of male rats. Pharmacol Biochem Behav 2:257–258

    Google Scholar 

  29. Vanhoutte PM (1987) The end of the quest? Nature 327:459–460

    Google Scholar 

  30. Wolpowitz A, Barnard CN (1978) Impotence in heart transplantation. S Afr Med J 53:693

    Google Scholar 

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Authors and Affiliations

  1. Department of Urology and Human Sexuality Center, Queen's University, Kingston General Hospital, K7L 2V7, Kingston, Ontario, Canada

    Alvaro Morales & Jeremy P. W. Heaton

Authors
  1. Alvaro Morales
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  2. Jeremy P. W. Heaton
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Morales, A., Heaton, J.P.W. The medical treatment of impotence: An update. World J Urol 8, 80–83 (1990). https://doi.org/10.1007/BF01576352

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