Increasing sexual awareness by patients and their sexual partners, the development of newer diagnostic techniques and the successful treatment of sexual dysfunction by penile prosthesis and sexual counselling have increased the number of patients presenting to the urologist for diagnosis and treatment of erectile impotence.
The requirements for normal penile erections are facilitative cerebral input to the sacral and thoracolumbar cord, parasympathetic effector fibers from the sacral cord, sympathetic effector fibers from the thoracolumbar cord, afferent input to the second through fourth sacral segments via the pudendal nerves, adequate penile arterial blood flow, normal penis anatomy, and a normal hypothalamocpituitary-gonadal hormone axis.
The neural control of penile erection does not appear to confirm to classic adrenerqic or cholinergic concepts. I briefly reviewed the anatomy of the penis and the physiologic principles of erection. I also reviewed briefly about the diagnostic procedures of evaluating impotent male and also about the various therapeutic methods.
To knoe the possible role of papaverine in the field of pharmacological penile prosthesis, I did the following clinical trials.
In 10 impotent patients by through investigations, (including NPTM c stamp or erectiometer, BCRL, PBI, CMG or pelvic angiography if needed) 30mg papaverine was injected into one of the cavernous bodies after signing an infomed consent and obtained the following results.
1. In 9 patients; penile rigidity was obtained from 3-8 minutes after the injection and lasted up to 30-90 minutes.
2. In one diabetic patient, penile rigidity was not obtained.
3. In one urethral injury patient, orgasm and ejaculation was obtained by masturbation during papaverine test.
No complications were encountered but the long-term effects of repeated injection of papaverine has yet to be evaluated.
The Jonas-silicons silver prosthesis was implanted in 7 organic impotent patients.
The etiologies were spinal cord injury 3, cystectomy 2, antihypert-ensive 1, idiopathic 1.
The sizes of the prosthesis were between 16-19cm long and 9-11mm in diameter.
There were no major complications and every patient have been doing well with the follow up period ranging from 3-13 months.
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