علاج الضعف الجنسي عند الرجال

الدراسات

Erectile Dysfunction

· Definition : inability to achieve or maintain a hard , erect penis sufficient for sexual intercourse
· How is the penile erection achieved ?
- Brain + Sensation factor psychological factor Penile nerves Direct
sensory contact .

The nerve impulses go t the corpora cavernosa. The nerve impulses cause relaxation of penile tissue and expanding of arterial blood vessels . Leading blood flow to reach the penis then swells size .

What causes erectile dysfunction ?
1. Psychological causes :

- Stress and anxiety .

2. Physical causes :

a) Blood vessel disease
b) Multiple sclerosis and alcoholism ( disease that affect the N.S )
c) Diabetes ( disease the affect vascular system and N.S )

3. Heavy smoker and heavy drinker
4. High blood pressure and high level of blood cholesterol .
5. Pelvic fractures or crush injuries .
6. Spinal cord injuries
7. Some surgeries and radiation therapy
8. Certain medication

How are causes of erectile dysfunction ?

It is begins with a patient medical and sexual history .

1st :

Medical History Sexual History : by asking the patient
1. Diabetes .
2. Heart disease and high blood pressure 
3. Any surgery, radiation exposure or accidental . 
4. injuries .
5. Smoking and alcohol and medicine .
1. if erection are painful .
2. if the penis severely bent when erect .
f yes for any question peyronies Disease .
( Caused by scar tissue in penis ) 
3. Psychological .

2nd: Physical Examination:

1. Checking for peyronie,s Disease and by consideration about gentialia and test nervous and vascular function .
Lab. Tests :
a) Blood sample and urine may be tested in a lab .e.g. Testosterone level , diabetes ,
b) Special test by :
- Ultrasound for penile arteries
- ( NPTR ) measurement .
Treatment

q if the causes are psychological :
- psychologist who specialized in sex therapy .
q if the causes are physical ( Hormone of accident )
- Vacuum constriction therapy
- Penile prostheses

1. V.C.Ds : it is a devices consist of plastic cylinder , a vacuum pump and elastic constriction band
2. Penile injection thereby : vasoative drugs injuected into erection chamber ( corpora covernosa ) leading to expanding of arteries and relaxing of penile tissue .blood flow increases into the two chambers then swelling of penis .
3. Penile prostheses : is a plastic device surgically implanted inside the penis .

Advantages and disadvantages of each treatment:

  Advantage Disadvantage
1. V.C.Ds -Reliable & safe
- No side effects
 
2. P.I.Therapy  -Easy procedure
-Painless
-Prolonged erection
-Possibility of scar tissue
-Discomfort
3. Penile prostheses -Create an erection any time
-No change in skin sensation
-No change in ability to have orgasm
-Difficult for patient
-Removal of the prostheses
-Requires another operation
-Failure of device is possible
-Possibility of complication 
  from surgery such as infection

 


     

Cost and Time :

1. V.C.D.s Far less expensive than the prosthesis and less expensive than the drugs necessary for injection therapy . Time : one training session is enough to learn to use a V.C.D.s : Far less expensive than the prosthesis and less expensive than the drugs necessary for injection therapy . Time : one training session is enough to learn to use a V.C.D.s
2. Injection Therapy: Several visits to the doctor may be necessary to learn self- injection
3. Implanting a prosthesis : one to two days in the hospital and 10-20 day before resuming usual activities after surgery

Studies

1. World Journal Of Urology .
     1992 10 : 68-70 
Title : External Vacuum Devices : 
A clinical comparison with pharmacological agents.
Result : 46 subjects were divided in 3 groups:

Group 1 :(21 men) failed pharmacologic stimulation.
Group 2 : ( 12 men) successfully used pharmacologic stimulation for at least 6 months in their homes.
Group 3 : (13 men ) who had never received intracavernosal vasoactive injections.

“This study confirms that satisfaction with vacuum constriction device is high reflecting equivalent efficiency and satisfaction among patients enrolled in home self injection program. Partner satifaction was similar to that of the patients. We conclude that vacuum constriction devices represent an effective first line therapy for organic impotence and provide an equally high secondary salvage rate for patients who either failed or expressed dissatisfaction with self injection therapy. “


2- Urology .
    Vol. XXVll, No. 2, Feb., 1986
“ The vacuum devices appear to be safe and relatively inexpensive ways for the impotent to make his penis rigid enough to engage in sexual intercourse.“


3- British Medical Journal .
     
Vol. 296, 16 Jan., 1988 
“ Erection device gave lasting erections with high mean scores for ease of use, effectiveness.  
And Satisfaction. “


4 – The Journal of Urology .
     
Vol. 141, Feb., 1989
“A total of 1,517 users: 

- 92% achieved erection or an erection like state satisfactory for intercourse. 
- 77 % had intercourse at least every two weeks. “


5- The Journal of Urology 
       Vol. 142, Sept., 1989 .
" of 402 penile prothesis implanted in the Walter- Reed Army Medical Center in Washington between 1980 and 1987
  20 % required explantation due to infection, erosion, pain or necrosis, and many of these were offered a negative pressure device with good results and satisfaction. “



6- Journal Of the American Geriatric Society .
        Vol. 38, No 3 Mar., 1990
“ 20 couples with erectile dysfunction used the vacuum device…, 19 established firm to hard erections …. And were able to have satisfactory coitus with vaginal ejaculation. "


7- The Journal Of Urology .
     
Vol. 144, Jul., 1990 
“29 men used such a device for 6 months and reported statistically significant improvements in erectile quality, frequency of intercourse attempts, frequency of orgasm and sexual satisfaction as well as decreased psychiatric symptomatology and increased self esteem, and a trend toward improved marital satisfaction. “


8- Urological Clinic of The University Hospital of Lund, Sweden .
    Dr. M.D Arne Olsson
“253 users indicated :
_ 91 % achieved a good erection.
_77 % of couples have positive attitudes toward the vacuum pump.
_ 77 % of couples reported improved self confidence.”


9- Spinal Cord Injury Journal SCI Nursing .
    Vol. 6, 2, 1989, 25-28
“20 patients with spinal cord injuries were given a vacuum device…, 13 respondents indicated an increased sexual satisfaction and increased frequency of sexual intercourse.”

Subject :

Use of vacuum constriction devise ( VCD ) in the management of erectile dysfunction ( ED ) of various etiologies on two hundred and three ( 203 ) patients .

Objective :

To evaluate the efficacy , safety , practicality and cost effectiveness of VCD as a non surgical solution for ED management .

Patients and Methods :

A total of 203 patients suffering from ED ( mean age 53 years : rang 20 - 75 ) were treated with VCD . the ED was of organic origin in 181 patients( 89 % ) while in the remaining 22 patients (11% ) it was of psychogenic origin . The follow up period was two years for each patient

All had full medical and sexual history , physical examination and laboratory tests ( urine analysis , CBC , creatnine , lipid profile, FBS , prolactin and testosterone ) optional tests like intracavernous injection of vasoactive agents . infusion cavernosometry and cavernosography , duplex ultrasonography and penile arteriography were conducted when appropriate . changes in penile firmness , orgasm , ejaculation and intercourse satisfaction was assessed . Cost of the device and any side effects from use of the device were also evaluated .

Results :

The number of practice session required before the device could be used successfully averaged 4
187 One hundred and eighty seven ( 92% ) patients achieved an eretion sufficient for intercourse . Rigid erection was achieved in 153 ( 75% ) patients , who achieved orgasm and described their sexual intercourse as highly enjoyable .
20 Twenty ( 10 % ) patients reported rigid erection for ( 5- 10 ) minutes then it started to decrease . those improved by adding another constriction band , they achieved orgasm and described their sexual intercourses as fairly enjoyable >
14 fourteen patients ( 7% ) reported tumescence but no rigidity , they were uncertain about their orgasm and they described their sexual intercourse as not very enjoyable .
16 Sixteen patients ( 8% ) used the device for few times and abandoned further use .
Several reasons for rejecting the device was noted like : pain , cumbersome to use , inhibition of sexual behavior , impair spontaneity in love making and partner dissatisfaction .
76 seventy six patients ( 37% ) developed superficial painless bruising of the penis . No serious injuries were reported . the device was found economical and affordable in nearly all our patients especially when they compared it to other modalities of ED treatment , which was for more expensive
162 One hundred and sixty two patients ( 80% ) used the device on regular basis , 24 (12% ) on occasions and 16 ( 8% ) abandoned further use .
29 Twenty nine of our 203 patients complained from premature ejaculation as well . they and their partners were satisfied with the use of the device .
18 Eighteen patients ( 9% ) reported improvement in their natural eretion after about 3 months from using the device .

conclusion :

when oral erectogenci agents ate contraindicated or not applicable , VCD can be offered as a second - line therapy for ED because it is simple , safe , noninvasive used when required , no surgery is needed , economical and affordable . Highly effective in many patients and may improve natural erection in some patients .
the use of the device for patients with premature ejaculation needs to be further evaluated .
Moreover , to date there are no studies of the effect of the device on the penile tissue.
Selecting well motivated patients and their partners is important to achieve optimum results .

Author :

DR. MOHAMMED SABAH , FRCS
CONSULTANT UROLOGIST
PRIVATE CLINIC
AMMAN - JORDAN
TEL / FAX : 00962 6 4615552
E-mail :
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for oral presentation in the second Mediterranean congress of sexual dysfunction Amman - Jordan , June 25-28,2002