Gotop Logo

Organic

Impotence:

Vascular

Abnormalities

   Patient Identification: REL

 

General Medical Hx

retired widower, 6 children

 

age:             61

med.dx :      HTN, diagnosed 1975

                     spinal arthritis

surgeries:    C5, C6 disk, 1967

                     C4, C5 disk, 1970

smoker:       no

alcohol:       6 oz. wine/day x many years

meds:           Hygroton, 25my. q. d.

 

Sexual Hx

•   difficulty obtaining and maintaining erections since 1975

•   complain of penile numbness

•   gradual onset of sexual dysfunction

•   occasional A.M. erections, denies nocturnal erections

•   slight improvement of erection with masturbation and in supine position

    upon awakening

•   penile curvature: denies

•   last successful intercourse: 1979-1980

•   ejaculation intact – masturbation

•   premature ejaculation: denies

•   libido: normal

•   bladder symptoms: denies

•   bowel symptoms: denies

•   sleep disturbances: considers himself a restless sleeper ( arthritic pain

    awakens him 3-4 times/night)

 

Physical Exam

WNL except it. Kidney palpated

BP: 170/80

 

Test Results

Glucose, TST—WNL

Doppler

Rt.

Lt.

Mid

Pre-Exercise (PBI)

.80 – NI.

.79 – NI.

.73 – Borderline Abnl.

Post-Exercise (PBI)

.71 – Borderline Abnl.

.70 – Borderline Abnl.

.55 – Abnl.

Electrophysiological Tests

NCV of DNP

PER

BCR

 

42 M/sec/ - NI.

not ordered

not ordered

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

Final Dx

Organic impotence associated with vascular insufficiency

   Patient Identification: DCB

 

General Medical Hx

assistant with gas and electric company, single, 0 children

 

age:             25

med. dx:      blunt trauma to groin area (right testicle and penis by wire

                     cable on 5/85)

surgeries:    eye surgery as a child

                     repair of corpora cav. Venous shunts on 9/85

smoker:       1/2 pack per day

alcohol:       occasional drink

meds.:          none

 

Sexual Hx

  • difficulty obtaining and maintaining erections since injury 5/85 and right testicle pain
  • denies decrease of penile sensation
  • rapid onset of sexual dysfunction
  • semi A.M. erections since 5/85
  • minimal improvement of erection with other types of sexual stimuli
  • penile curvature: denies
  • last successful intercourse: 3 weeks ago, used stuffing technique
  • ejaculation intact –intercourse 3 weeks ago
  • premature ejaculation: denies
  • libido: normal
  • bladder symptoms: denies
  • bowel symptoms: denies
  • sleep disturbances: denies

 

 

Physical Exam

WNL except it. varicocele

 

Test Results

Glucose, TST, Prolactin, LH – WNL

Doppler

Rt.

Lt.

Mid

Pre-Exercise (PBI)

.98 – NI.

.91 – NI.

1.00 – NI.

Post-Exercise (PBI)

.72 – Borderline Abnl.

.75 – NI.

.75 – NI.

Electrophysiological Tests

NCV of DNP

PER

BCR

 

40 M/sec/ - NI.

not ordered

not ordered

RigiScan: Abnl. X 2 nights – abnormal tumescence and rigidity of penile shaft ( base greater than tip)

Penile Arteriogram: WNL

Corpora Cavernosagram: presence of venous shunts

Final DX

  • vasculogenic impotence secondary to venous leakage
  •  
  • 9/85 surgical repair of corpora cavernousus venous shunts.
  •  
  • RigiScan:post-op x 3 night—normal rigidity of base and tip penile shaft
  •      average base rigidity was in the 70-75% range
  •      average tip rigidity was in the 90-95% range
  •  
  • patient states he is having successful intercourse with firm erections

   Patient Identification: WOP

 

General Medical Hx

handyman, married x 2 (#1-12 years, divorce: #2-32years, wife deceased April,

1985 of cancer), 1 child

 

age :          64

med. dx:    none

surgeries:  Hydrocele, 1939

                   repair of corpora cav. Venous shunts on 9/85

smoker:     no

alcohol:     none

meds.:        none

 

Sexual Hx

  • difficulty obtaining and maintaining erections since June, 1985
  • complains of decreased penile sensation
  • gradual onset of sexual dysfunction
  • occasional semi A.M. and nocturnal erections
  • has not used other types of stimuli to evoke erections ( masturbation,
  • oral sex or erotic films)
  • erections are not sufficient for vaginal penetration
  • does not notice any improvement in erections with position changes
  • penile curvature: denies
  • ejaculation intact during last successful intercourse
  • complains of premature ejaculation when last attempted sex
  • libido: normal
  • has received testosterone injections and pills in the past which were unsuccessful in improving erections
  • bladder symptoms: denies, except for difficulty starting stream on occasions
  • bowel symptoms: denies
  • sleep disturbances: denies

 

 

Physical Exam

essentially WNL

BP: 130/90

 

Test Results

Glucose, TST, Prolactin, LH – WNL

Doppler

Rt.

Lt.

Mid

Pre-Exercise (PBI)

.97 – NI

1.00 – NI

absent

Post-Exercise (PBI)

.91 – NI

1.00 – NI

absent

Electrophysiological Tests

NCV of DNP

PER

BCR

 

42 M/sec/ - NI

not ordered

not ordered

RigiScan: Abnl. X 3 nights – UNCOUPLING ( nl. tumescence at base and tip of penile shaft with absent rigidity

Penile Arteriogram: NI

Corpora Cavernosagram: presence of venous shunts

Final DX

  • Vasculogenic impotence secondary to venous leakage
  • 9/85 surgical repair of corpora cavernosus venous shunts
  • RigiScan: post-op x 3 nights – normal tumescence of base and tip of
  • penile shaft with concurrent rigidity
  • (20 --50% range of base and tip of penile shaft –abnl.)
  • due to inadequate results, patient has subsequently had a penile prosthesis implanted

   Patient Identification: KJW

 

General Medical Hx

self-employed, married x 28 years, 5 children

 

age :          52

med. dx:    prostatitis in past

surgeries:  none

smoker:     no

alcohol:     1-2 beer or glasses of wine per day x many years

meds.:        Depo-Testosterone 300 mg. I.M. 7/85 – 3/86

 

Sexual Hx

  • difficulty obtaining and maintaining erections since 1980
  • denies decreased penile sensation
  • gradual onset of sexual dysfunction
  • occasional semi A.M.and nocturnal erections
  • no improvement with other forms of sexual stimuli
  • erections are never sufficient for vaginal penetration
  • no improvement in erections with position changes
  • penile curvature: denies
  • last successful intercourse: November, 1984
  • ejaculation intact – oral sex
  • complains of premature ejaculation
  • libido: normal
  • bladder symptoms: denies
  • bowel symptoms: denies
  • sleep disturbances: denies

 

 

Physical Exam

WNL

BP: not available

 

Test Results

Glucose, TST—WNL

Doppler

Rt.

Lt.

Mid

Pre-Exercise (PBI)

.72 – Borderline Abnl.

.93 – NI

.73 – Borderline Abnl.

Post-Exercise (PBI)

.72 – Borderline Abnl.

.75 – NI

.72 – Borderline Abnl.

Electrophysiological Tests

NCV of DNP

PER

BCR

 

42.8 M/sec. - NI

not ordered

not ordered

RigiScan: Abnl. X 2 night – UNCOUPLING (nl. tumescence at base and tip of penile shaft with reduced rigidity at base and tip of penile shaft) (tip greater than base)

Final DX

  • organic impotence associated with vascular impairment
  •  
  • SPECIAL NOTE: hormone injections have been ineffective in improving erections

RigiScan® is the registered trademark of GOTOP Medical, Inc.,   Copyright 2014 GOTOP Medical, Inc. All Rights Reserved.