Cd. Betts et al., ERECTILE DYSFUNCTION IN MULTIPLE-SCLEROSIS - ASSOCIATED NEUROLOGICAL AND NEUROPHYSIOLOGICAL DEFICITS, AND TREATMENT OF THE CONDITION, Brain, 117, 1994, pp. 1303-1310
Forty-eight men with multiple sclerosis and erectile dysfunction were
evaluated Emphasis was placed on the neurological features and the rel
ationship between impotence and the bladder dysfunction in multiple sc
lerosis. Erectile failure was invariably associated with pyramidal sig
ns in the lower limbs and with urinary symptoms. All of the men with i
mpotence and marked pyramidal dysfunction in their legs were found by
cystometric studies to have bladder hyperreflexia. The severity of the
urinary symptoms was related to the degree of pyramidal impairment in
the lower limbs. The posterior tibial and the pudendal cortical evoke
d potentials were abnormal in most of the men with multiple sclerosis
and erectile failure. However recording the pudendal cortical response
s in patients with multiple sclerosis and impotence provided no more i
nformation than the tibial cortical evoked potentials. The neurologica
l examination findings together with the results of the neurophysiolog
ical and cystometric tests suggest that erectile dysfunction in multip
le sclerosis is due to spinal lesions situated proximal to the sacral
cord. The feasability of papaverine intracorporeal injection therapy f
or men with multiple sclerosis and impotence was assessed. Papaverine
intracorporeal injections produced satisfactory erections in the major
ity of the impotent men. Erectile failure in patients with multiple sc
lerosis was successfully managed for up to 2 years, by intracorporeal
self-injection therapy.