Adrian W. Zorgniotti

Auto-Injection of the Corpus Cavernosum with a Vasoactive Drug Combination for Vasculogenic Impotence

Intracavernous injection of papaverine hydrochloride with phentolamine mesylate rapidly produces transitory penile tumescence, which can be followed by erection and coitus provided there is sexual stimulation. Coital penetration was possible in 59 of 62 patients with impotence of divers etiologies (vascular, diabetic, iatrogenic and Peyronies disease) who underwent injection and were sent home to attempt coitus. One patient had a prolonged erection that was treated successfully with aspiration of a corpus. When coitus was successful the patient was offered training in self-injection. With self-injection 18 patients have had satisfactory coitus without a noteworthy complication; 5 for more than 12 months. The long-term effects of intracavernous injections remain unknown. Intracavernous injection of vasoactive substances (chemical prosthesis) may become a useful alternative treatment. Administration should be restricted to urologists able to manage the possible complication of priapism.

Diagnosis and Therapy of Vasculogenic Impotence

Penile blood pressure studies and pudendal artery angiograms indicate that vascular disease may be a frequent cause of erectile failure in men. Attempts to correct this form of impotence with revascularization of the corpus cavernosum have been satisfactory in a minority of patients.

Effect of clothing on scrotal temperature in normal men and patients with poor semen

Abstract Mean scrotal surface temperatures overlying the testis clothed and unclothed reaffirm a prior observation that patients with very low spermatozoa counts (⩽ 20 mil./ml.) have higher temperatures than subjects with high spermatozoa counts (% 100 mil./ml.). The insulating effect of clothing results in mean temperature rises of 1.2 to 1.5°C. over the unclothed state regardless of semen status. There were no differences in temperature rise between wearers of “jockey” versus “boxer” undershorts.

Thermoregulation of the Human Testis

Intrascrotal temperature was compared with oral body temperature in six subjects with fever. When the body temperature reached 37.6 to 37.9 degrees C, the testicular thermoregulatory mechanism appeared to fail and the intrascrotal temperature rose.

Chronic scrotal hypothermia: results in 90 infertile couples.

We studied the use of a testicular hypothermia device worn daily for at least 16 weeks in 64 men with subfertile semen and elevated testicular temperature, who had had an infertile marriage for 2 or more years in which the wife was judged fertile. Improvement in 1 or more semen parameters was seen in 42 patients (65.6 per cent). Semen analysis was converted into the motile oval index, a numerical value representing the count, motility and normal morphology. The motile oval index helps to predict pregnancy outcome. Of 21 patients with pre-treatment motile oval indexes greater than 4.8 million per ml. 11 (52.4 per cent) produced pregnancy. Patients with lower starting indexes did not fare as well. Of 20 patients who met the criteria, and who wore the device for less than 2 weeks or not at all and had no other treatment 1 (5.0 per cent) produced pregnancy. Mean hypothermia time to date of missed menses was 4.2 months. Six patients with nonobstructive azoospermia showed no semen change with the testicular hypothermia device.

Surgical techniques in penile revascularization

A review of the current status of penile artery revascularization and its methodology is presented. Microsurgical anastomosis of the inferior epigastric artery or central arteries produces good results in younger men. Older patients or those with diabetes, hypertension or who have had coronary bypass surgery do not appear to have good results.

Practical diagnostic screening for impotence.

The author presents the view that there is a real need to diagnose impotence in more detail as demand for physiologic solutions to erectile dysfunction make inroads into the simplistic solution offered by penile implantation. Penile blood pressure measurements are diagnostic of vascular insufficiency only when values are low, since it is possible to demonstrate obstructive disease of the internal pudendal artery and its branches with selective arteriography of the presence of normal penile blood pressure. A rational approach to the workup of impotence is called for and practitioners are asked to weigh the ultimate usefulness of each test in the context of the individual patients needs.

A Theoretical Model for Testis Thermoregulation

Studies going back as far as the early 1920s show that there is a clear relationship between testis temperature and semen quality. The most intriguing question is whether there is a mechanism of thermoregulation which, in the human, maintains testis temperature within certain limits that permit euspermia. Thermoregulation is defined as maintaining some specified (optimum?) temperature plus or minus an error over internal and ambient loss factors. A computer Model has been evolved which contains no regulation or feedback. It appears to predict human testis temperature data gathered in earlier studies. The Model accounts for countercurrent heat exchange in the pampiniform plexus and predicts, with an open loop analysis, that there is no feedback or regulation. As far as thermoregulation is concerned, there appear to be no first-order effects taking place in the human testis. This suggests that ambient temperature changes cause corresponding changes in testis temperature. Also any internal changes in thermal properties such as core temperature variations or variability of the countercurrent heat exchanger will also cause temperature change. Testis temperature as predicted by this Model is the result of the heat energy entering the testis from arterial inflow minus the venous outflow and heat loss from the scrotum. The Model predicts that the heat exchanger will function to provide precooling of arterial blood as external temperatures drop but will fail to precool effectively as temperature rises. This is predicated on the fact that the countercurrent heat exchanger becomes less effective as the temperature gradient across the exchanger becomes smaller and less heat energy is able to be transferred from arterial flow to venous flow. The Model also predicts that any diminution of the heat exchanger mechanism either from reduced venous flow or restricted scrotal heat loss will result in higher testis temperature. Lastly, the Model correctly predicted that febrile patients would experience elevated testis temperature during periods of elevated core temperature. Since more heat energy is available in the arterial blood, more heat energy is delivered to the testis under these conditions. In the human it appears that any internal or external factor causing a temperature change will not trigger or activate a feedback mechanism to control the resulting testis temperature. A major factor in subfertile semen may be the inability to check excessive temperature of the testis which impairs the ability to produce and mature fertile spermatozoa.

Selective arteriography for vascular impotence

SummarySelective pudendal arteriography plays an important role in clinical research into the vascular causes of primary and secondary impotence and forms the basis for microsurgical penile artery revascularization. Arteriography has identified a heretofore undescribed cause for impotence, arteriovenous malformation. Despite potential risks, this should be performed where revascularization is a possibility. Many patients find penile implantation undesirable and are willing to be studied in this manner.

Impotence associated with pudendal arteriovenous malformation

Three young men with impotence due to a pudendal arteriovenous malformation had a common selective pudendal arteriographic finding of early passage of contrast medium from the bulbar artery region into the venous drainage of the pelvis. Perineal exploration revealed the malformation and correction resulted in significant restoration of erectile capacity. This entity may be a frequent occurrence in young men that may become apparent only when trauma or disease affects the contralateral pudendal artery or its branches.