Male patients with spinal cord injury and sexual dysfunction on initial evaluation by a primary physician may seem to pose overwhelming diagnostic and management problems. This need not necessarily be the case if the primary physician has a thorough knowledge of the physiology of the erectile process and utilizes a basic treatment regimen.
The treatment regimen is guided by an uncomplicated approach that first rules out psychogenic causes. If an organic cause is then suspected, a more detailed diagnostic work-up can be performed. Various treatments are available, which include noninvasive mechanical and pharmacologic therapies as well as microsurgical procedures and prostheses.
Lemer SE, Melman A.Christ GJA review of erectile dysfunction: new insights and more questions. J Urol1993;in press.
11.
Batra, Askok K, Lue TFThe physiology of penile erection. Problems inUrology1991;5:4.
12.
Melman A., Haberman J.Current concepts on the physiology of erections: pathophysiology of erectile dysfunction. Seminars in Interventional Radiology1989;6:4.
13.
Eckhard C.Untersuchungen uber die erection des penis beim hund: beitrage zur anatomie und physiologie von C. Eckhard, III band, 1863.
14.
Willis E., Ottesen B., Wagner G., Sundler F., Fahrenkrug J.Vasoactive intestinal peptide (vip) as a putative neurotransmitter involved in penile erection. Life Science1983;33:383.
15.
Roy, AC, Ran SM, Kottegoda SR, Radnam SSAbility of human corpora cavemosa muscle to generate prostaglandins and thromboxanes in vitro. IRCS. MedicalScience1984:12:608.
16.
Rajfer J., Aronson WJ, Bush PA, Dorey FJ, Ognarro LJNitric oxide as a mediator of relaxation of the corpus cavemosum in response to nonadrenergic, noncholinergic neurotransmission. New Eng J Med1992;326:90.
17.
Comarr AENeurology of spinal cord-injured patients. Seminars in Urology1992;10(2):74-82.
18.
Stone ARThe sexual needs of the injured spinal cord patient. Problems in Urology1987.
19.
Beric A., Dimitrijevic MR, Light JKA clinical syndrome of rostran and caudal spinal injury: neurological, neurophysiological and urodynamic evidence for occult sacral lesion. J Neurol, Neurosurg, Psychiat1987:600.
20.
Beric A., Light JKFunction of the conus medullaris and cauda equina in the early period following spinal cord injury and the relationship to detrusor function. J Urol1992,1845.
21.
Whitelaw GP , Smithwick RHSome secondary effects of sympathectomy with particular reference to disturbance of sexual function. New Eng J Med1951;121.
22.
Klein EAAnatomy and physiology of normal male sexual function.-In: Montague DK (ed.). Disorders of male sexual function. Chicago: 1988.
23.
Stone B., Melman A.Management of sexual and bladder dysfunction in multiple sclerosis. J Neuro Rehab1989;167-75.
24.
Goldstein I., Siroky MB, Krane RJImpotence in diabetes mellitus. In Krane RJ , Siroky MB, Goldstein I (eds.). Male sexual dysfunction. Boston: 1983.
25.
Ellenberg J.Impotence in diabetics: the neurologic factor . Ann Int Med1971;213.
26.
Krauss DJ, Lantinga L., Kelly CMIn treating impotence urology and sex therapy are complementary. Urology1990;467-70.
27.
Tiefer L.Melman A.Interview of wives: a necessary adjunct in the evaluation of impotence. Sexuality and Disability1983:167-75.
28.
Johnson AR III, Jarow JPIs routine endocrine testing impotent men necessary? J Urol1992;15:42-43.
29.
Gillenwater J. , Grayhack J.Howard S., et al. Adult and pediatric urology. St. Louis: 1987; 1614.
30.
Seftel A., Goldstein I.Classification of male sexual dysfunction. Problems in Urology1991;496-507.
31.
Dow, JA, Gluck RW, Golimbu M., Weinberg GI, Morales P.Multiphasic diagnostic evaluation of arteriogenic, venogenic, and sinusoidogenic impotency. Value of noninvasive tests compared with penile-duplex ultrasonography . Department of Urology, Cabrini Medical Center, New York , New York. 1991;402-7.
32.
Kaneko S., Bradley WEEvaluation of erectile dysfunction with continuous monitoring of penile rigidity . J Urol1986;1026.
33.
Ek, A., Bradley W., Krane R.Noctural penile rigidity measured by the snap-gauge band. J Urol1983;964.
34.
Lue TF, Hricak H., Marich KW, Tanagho EAVasculogenic impotence evaluated by high resolution ultrasonography and pulsed doppler spectrum analysis. Radiology1985;777.
35.
Abber, JC, Lue TFEvaluation of impotence. Problems in Urology1987.
36.
Morales A., Condra M., Pwen J., Surridge D., Fenemore J., Harris C.Is yohimbine effective in the treatment of organic impotence: Results of a controlled trial. J Urol1987;1168.
37.
Susset JG, Tessier CD, Wincze J., Sudir B., Malhortra C., Schwacha MGEffect of yohimbine hydrochloride on erectile impotence. A double-blind study . J Urol1989;1360.
38.
Gregoire A.New treatments for erectile impotence. Brit J Psychiat1992;315-26.
39.
Salvatore FT , Sharman GM, Hellstrom WJVacuum constriction devices and the clinical urologist: an informed selection. Urology1991;323-27.
40.
Hashmat Al, Abrahams J, Fani K., Nostrand I.A lethal complication of papaverine-induced priapism. J Urol1991 ;145-46.
41.
Rossman B. Mieza M, Melman A.Penile vein ligation for corporal incompetence: an evaluation of short-term and long-term results. J Urol1990;679.
42.
Lewis R.Venous ligation surgery for venous leakage. International Journal of Impotence Research1990;2:1.
43.
Schramek P. Engelman U, Lauffmann F.Microsurgical arteriovenous revascularization in the treatment of vascufogenic impotence. J Urol1992;147:1028.
