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
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
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
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
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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