[A study of middle-high aged impotent patients].

Background factors, which are causes of functional and organic impotence, of 729 impotent patients over 50 years old were evaluated. They were classified into 3 major categories, i.e., stresses at job, stresses at home, and diseases or accidents. Over 30% of the patients had 2 or more categories. A retirement from office and troubles at job were most frequent among stresses at job. As to stresses at home, marital problems such as wife's death and remarriage were most common. With respect to diseases or accidents, they were observed in 84 percent of all patients, and hypertension (HT) or diabetes mellitus (DM) were most common and the rate of medication was considerably high. The percent of clearly organic impotence was quite low (22%). Hormonal environment of 303 over 50 aged impotent patients was checked and compared with 120 impotent patients from 20 to 49 years old. Serum testosterone (T) levels in patients over 70 years of age decreased significantly. Lutenizing hormone (LH) and follicle stimulating hormone (FSH) levels in patients after age 50 progressively increased. Patients administered anti-androgenic agenst tended to show lower T and higher LH, FSH, and prolactin (PRL) levels than non-administered. Patients with psychotropic drugs showed significantly higher PRL levels. Hormonal therapy (mainly T replacement therapy) tended to be more effective in patients of low serum T levels before therapy. However, some patients with normal T improved. In 141 impotent patients, 83 cases of which were after age 50, the degrees of their penile arterial impairment were tested using penile brachial index (PBI) and pulse volume recordings (PVR). PVR waveforms were classified into 3 groups, i.e., normal, slightly abnormal, and markedly abnormal. PBI was significantly lower in abnormal groups than in normal group. Between each parameter of PVR and PBI, statistically significant correlation and relevancy were found. Crest time were significantly longer, and PBI and angle of rise significantly lower in over 50 aged patients than in 20-49 aged. We evaluated the risk factors to penile arterial impairment, such as DM, HT, smoking, and cardiovascular disorders. Each of these risk factors was minor to age factor itself. PVR proved to be useful, simple, and non-invasive method for the screening of vascular impotence. In conclusion, degenerative changes occur about hormonal environment and penile blood flow according to aging, and many kinds of background factors have direct or indirect influence to occurrence of impotence. We emphasize such matters should be considered at examination of middle-high aged impotent patients.