Peter G. Marshall

Nonhormonal Pharmacological Treatment of Organic Impotence

AbstractA pilot study was conducted to assess the effect of the alpha-adrenergic antagonist, yohimbine, in a group of patients with organic impotence. The results suggest that the drug may be beneficial in selected cases but the number of satisfactory results is inferior to previous reports. The need for controlled trials is emphasized.

The role of nocturnal penile tumescence in differentiating between organic and psychogenic impotence: the first stage of validation.

A study was conducted to assess the validity of nocturnal penile tumescence (NPT) as a means of distinguishing between psychogenic and organic erectile failure (impotence). On the basis of independent clinical criteria, patients were assigned to one of four diagnostic categories—organic impotence, psychogenic impotence, mixed etiology, and uncertain etiology. The NPT characteristics of the patients in the organic and psychogenic groups were compared and decision rules formulated in order to provide optimal discrimination between the two diagnostic categories. A decision rule based on the maximum erectile response observed for each patient led to the correct diagnosis in 80% of cases. Accuracy was increased to 95% when a decision rule based on the maximum frequency of nocturnal erections was employed. The clinical value and limitations of NPT as a diagnostic procedure are discussed.

The Unreliability of Nocturnal Penile Tumescence Recording as an Outcome Measurement in the Treatment of Organic Impotence

We investigated the degree of congruence between outcome measures used to evaluate pharmacological treatment of impotence. After a comprehensive multidisciplinary assessment 17 patients were treated with an adrenergic blocker during an 8-week interval. Nocturnal penile tumescence recordings were made before treatment (as part of the assessment procedure) and at its conclusion. As part of a larger study the use of nocturnal penile tumescence monitoring has been examined as a possible outcome measure. Patient and partner self-reports also were used to evaluate treatment outcome. A comparison of patient and partner self-reports with nocturnal penile tumescence records showed little agreement between the 2 measures. These findings suggest that despite its intuitive appeal as an index of erectile function nocturnal penile tumescence recording is not a reliable index of therapeutic effectiveness. Furthermore, these findings lend support to the hypothesis that nocturnal penile tumescence and sexual erections may be separate phenomena, perhaps under the control of different mechanisms.

Diagnostic significance of penile erections during sleep

The evidence for the validity of nocturnal penile tumescence as a means of differentiating between psychogenic and organic impotence is reviewed. Five necessary stages in the validation process are described, and the relevance of the research literature to each stage is examined. Problems and issues in the clinical application of NPT recording are discussed, including (1) the need to validate NPT against independent diagnostic criteria; (2) the high probability of misdiagnosis when the absolute magnitude of NPT is used to determine cause; and (3) the need for follow-up studies to establish that NPT can be of value in the diagnoses of those patients who do not clearly belong to either the psychogenic or organic categories. We conclude that further validation studies are required before the clinical utility of NPT can be determined.

Unreliability of nocturnal penile tumescence recording and mmpi profiles in assessment of impotence

The authors describe a multidisciplinary approach to the assessment of impotence that includes the recording of nocturnal penile tumescence and analysis of the patients MMPI profile. Ten patients were studied who, on the basis of physical and psychiatric assessment, were identified as being organically or psychogenically impotent. In each case, the application of decision rules based on either nocturnal penile tumescence or the MMPI would have led to misdiagnosis.

A comprehensive treatment program for a fire setting child

Abstract A treatment program was designed for an 11-yr-old child who had repeatedly set fires. The last fire gutted the group home where he had been placed by the court for firesetting. Treatment was designed to suppress fire setting, to teach appropriate, alternative behaviors and to make him aware of the consequences of firesetting. Data on collateral behavior was used in clinical decision making and to evaluate the impact of the treatment. Follow up indicates that treatment was successful in altering both the target behavior and several important collateral behaviors.

Corporeal calibration: a discriminatory test for impotence.

AbstractA common problem influencing the interpretation of the recording of nocturnal penile tumescence is the wide variation in circumferential increase found in normal individuals. A test involving the techniques of corporeal insufflation and continuous monitoring of penile circumference is described. Corporeal calibration performed in this manner allows the expression of nocturnal penile tumescence as a relative value of tumescence capacity. The application of this test permits diagnostic criteria to be established on the basis of the erectile potential, thus, avoiding the problems inherent with the use of absolute values of sleep erections.

Nocturnal Penile Tumescence Recording with Stamps: A Validity Study

AbstractA study was conducted to investigate the validity of nocturnal penile tumescence recording with stamps. To obtain precise measurement of the relationship between stamp breakage and erection normal, potent men were studied in a controlled laboratory setting. The results indicated that full erection was required before breakage occurred. Although the data obtained offer some support for the potential value of using nocturnal penile tumescence stamps in the differential diagnosis of impotence, several issues must be resolved before the clinical value of this simple technique can be established.

Evaluation of the Urological Assessment in Impotence: Findings with a New Diagnostic Rating Scale

We report the findings of a critical evaluation of urological assessment in impotence. Initially, a rating scale (Q scale) was developed, which included the individual elements of the urological assessment, such as testicular size, serum testosterone level and so forth. The items in the scale were derived from the files of patients with erectile dysfunction and were scaled according to predetermined categories. Following this, the rating scale was applied to 67 impotent patients in whom the etiology had been established clearly using criteria that were independent of the urological assessment (that is a psychiatric interview and nocturnal penile tumescence evaluation). Statistical analysis of the results indicated that the 2 diagnostic groups differed significantly on a number of the individual scale items. However, no single item by itself could be used as a reliable indicator of etiology. Further analysis indicated that when the items were considered in combination, rather than singly, etiology was identified correctly in 95 per cent of the patients in the sample. Replication of these findings in a cross-validation study will help to standardize the urological assessment and to promote the development of a common language to facilitate communication in this field.

Nocturnal Penile Tumescence with Stamps: A Comparative Study Under Sleep Laboratory Conditions

The usefulness of nocturnal penile tumescence with stamps to measure erections during sleep has been evaluated under laboratory conditions and compared to strain gauge recording. If the ring of stamps does not break a diagnosis of organic dysfunction is supported. However, if breakage occurs at the perforations no diagnostic conclusion can be made. The diagnostic importance of nocturnal penile tumescence with stamps is limited.