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Organic Impotence:

Vascular & Neurologic Abnormalities

   Patient Identification: DPA

 

General Medical Hx

self-employed, single 0 children

 

age:             50

med.dx :      psoriasis

surgeries:    bilateral herniorrhaphies, 1953, 1976

smoker:       no

alcohol:       1-2 alcoholic beverages per day x many years

meds:           none

 

Sexual Hx

  • bisexual
  • difficulty obtaining and maintaining erections since 1983
  • gradual onset of sexual dysfunction
  • denies decreased penile sensation
  • semi-erections noted in A.M. and nocturnal awakenings
  • mild improvement with oral sex
  • erections are not sufficient for vaginal penetration
  • penile curvature: denies
  • last successful intercourse: June, 1984
  • ejaculation intact
  • denies premature ejaculation
  • libido: normal
  • bladder symptoms: denies
  • bowel symptoms: denies
  • sleep disturbances: none

 

Physical Exam

WNL except reduced anal tone

no BCR

BP: not available

 

Test Results

Glucose, TST, Prolactin, LH—WNL

Doppler

Rt.

Lt.

Mid

Pre-Exercise (PBI)

.96 – NI.

.1.0 – NI.

.93 – NI.

Post-Exercise (PBI)

.57 – Abnl.

.82 – NI.

.71 – Borderline Abnl.

Electrophysiological Tests

NCV of DNP

PER

BCR

 

36.10 M/sec/ - Abnl.

41.60 msec. – NI.

29.90 msec. – NI.

RigiScan: Abnl. X 3 night –NI. Tumescence with reduced rigidity at base of penis, abnormal tumescence and reduced rigidity at tip of penis

Final Dx

organic impotence with associated neuro-vascular abnormalities

   Patient Identification: CHB

 

General Medical Hx

Retired elementary teacher, married * 15 years, divorced now, 2 children

 

age:             66

med.dx :      dumping syndrome

                     alcohol abuse

surgeries:    appendectomy, 1941

                     gastrojejunostomy, 1956

                     partial thyroid, 1970

                     bowel resection, 1980

smoker:       1 pack per day * 50 + years

alcohol:       excessive alcohol consumption from 1965-1975, only occasional

                     binges since that time

meds:          Imodium, 4 tabs. D.

                     Viakase daily

                     Valium p.r.n.

 

Sexual Hx

  • difficulty obtaining and maintaining erections since the 1960’s
  • denies any degree of erections at this time
  • gradual onset of sexual dysfunction
  • complains of decreased penile sensation
  • very slight A.M. and nocturnal erections
  • other types of sexual stimuli do not improve erection
  • uses stuffing technique for vaginal penetration for short period of time
  • penile curvature: slight curvature noted
  • last successful intercourse: 10-12 years ago
  • ejaculation intact – masturbation
  • premature ejaculation noted when he was sexually active
  • libido: normal
  • bladder symptoms: denies
  • bowel symptoms: see med. dx.
  • Sleep disturbances: none

 

Physical Exam

WNL except extremely thin, cachectic male

absent dorsalis pedis pulse on the left

decreased knee and ankle reflexes

BP: 120/80

 

Test Results

Glucose, TST, Prolactin, LH—WNL

Doppler

Rt.

Lt.

Mid

Pre-Exercise (PBI)

.83 – NI.

.80 – NI.

.90 – NI.

Post-Exercise (PBI)

.69 – Borderline Abnl.

.70 – Borderline Abnl.

.78 – NI.

Electrophysiological Tests

NCV of DNP

PER

BCR

 

39.10 M/sec - Abnl.

39.10 msec. – NI.

unable to obtain  ( may be technical )

RigiScan: Abnl. X 3 nights – Abnl. Tumescence and rigidity of penile shaft base and tip.

Final Dx

Organic impotence associated with mild neurologic and vascular abnormalities

   Patient Identification: OOP

 

General Medical Hx

Retired, married x 2, 1 child

 

age:             66

med.dx :      HTN, 1982

surgeries:    L4, L5 laminectomy, 1965

smoker:       no

alcohol:       3 cocktails per day x many years

meds:          Cama, 3 tabs 1.d.

                    Prazosin, 2 tabs q.d.

                    Lasix, 20 mg. p.r.n.

 

Sexual Hx

  • difficulty obtaining and maintaining erections since 1982
  • gradual onset of sexual dysfunction
  • complains of penile numbness
  • denies A.M. and nocturnal erections
  • other types of sexual stimuli and position changes do not improve erection
  • uses stuffing technique for vaginal penetration for short period of time
  • penile curvature: denies
  • last successful intercourse: July, 1985
  • ejaculation intact – masturbation
  • premature ejaculation: denies
  • libido: normal
  • bladder symptoms: denies
  • bowel symptoms: denies
  • sleep disturbances: none
  • previously treated with methyltestosterone x 4 months just prior to this exam without success

 

Physical Exam

not available

BP: 170/80

 

Test Results

Glucose, TST, Prolactin, LH —WNL

Doppler

Rt.

Lt.

Mid

Pre-Exercise (PBI)

.53 – Abnl.

.61 – Abnl.

.56 – Abnl.

Post-Exercise (PBI)

Not performed, due

to elevated BP

Electrophysiological Tests

NCV of DNP

PER

BCR

 

38.80 M/sec - Abnl.

43.20 msec. – NI.

34.50 msec. – NI.

RigiScan: RigiScan: Abnl. x 3 nights – DISSOCIATION ( distal penile shaft softening)

Final Dx

organic impotence associated with neuro-vascular abnormalities

   Patient Identification: SB

 

General Medical Hx

retired, married * 38 years, 3 children

 

age:             65

med.dx :      HT, 1982

                     Peyronies Disease diagnosed during this examination

surgeries:    Hemorrhoidectomy, 1983

smoker:       no, quit 1 1/2 years ago

alcohol:       1 alcoholic beverage per week

meds:          HCTZ 25-50mg.q.d.

 

Sexual Hx

  • difficulty obtaining and maintaining erections since 1982, penile curvature noted 1984
  • gradual onset of sexual dysfunction
  • complains of penile numbness
  • occasional semi A.M. and nocturnal erections
  • slight improvement in erection with erotic films
  • erections sufficient for vaginal penetration, fade quickly (20 seconds)
  • no improvement in erection with position change
  • noted hard lump in penis (1984) resulting in curvature
  • last successful intercourse: 2 years ago
  • ejaculation intact – masturbation
  • libido: normal
  • bladder symtoms: denies
  • bowel symptoms: occasional constipation
  • sleep disturbances: none

 

Physical Exam

WNL except for dense plaque on left side of penile shaft which extends over 70% of the shaft

BP: 158/98

 

Test Results

Glucose, TST, Prolactin, LH – WNL

Doppler

Rt.

Lt.

Mid

Pre-Exercise (PBI)

.73 – Borderline Abnl

absent

.79 – NI.

Post-Exercise (PBI)

not performed

Electrophysiological Tests

NCV of DNP

PER

BCR

 

38.7 M/sec. -- Abnl

not ordered

not ordered

RigiScan: Abnl. X 3 night – normal tumescence of base and tip of penile shaft, unsustained rigidity – tip greater than base

Final Dx

Erectile impairment with associated neuro-vascular findings and Peyronies Disease.

 

Addendum

Potaba, 12 grams per day, administered from 1/86 – 4/86

repeat RigiScan * 2 nights remains abnl.

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