To determine whether intracavernous injection of papaverine can discriminate vascular versus psychogenic impotence 40mg papaverine were injected intracorporally into 203 importens. And the diagnostic usefulness of intracavernous papaverine-induced artificial erection was compared with Snap Gauge test, penile brachial index(PBI), internal pudendal angiography and cavernosography. The results obtained were as follows ; 1. Among the 119 psychogenic impotent patients, 104(87.4%) showed full rigid erection and 1(0.8%) soft or absent erection at 5 minutes after injection, and 88(73.8%) full rigid erection and 2(1.7%) soft or absent erection at 30 minutes after injection. Among 33 patients with arteriogenic impotence none showed full rigid erection and 20(60.6%) soft or absent erection at 30 minutes. Among 12 patients with venous leak only one(8.3 %) showed full erection at 5 minutes, and none fully rigid erection and 7(58.3%) soft or absent erection at 30 minutes. 2. Of the 78 patients with an abnormal Snap Gauge test, the response papaverine injection was absent in 37(47.4%) and fully rigid erection in 11(14.1%). Of the 105 patients with a normal Snap Gauge test the response was full erection in 89(84.7%) and absent in 2(1.9%). 3. Among 17 patients of PBI < 0.75, 14(82.4%) showed soft or full erection and one(5.9%) full erection with papaverine injection. Among 186 patients of PBI >=0.75, 26(13.9%) showed soft or absent erection and 113(60.7%) full erection with papaverine injection. 4. Among 27 patients with severe arterial lesion on arteriogram, the response to papaverine injection was absent in 18(66.7%) and full erection in one(3.7%). Among 20 patients with severe venous leak on cavernosogram the response to papaverine injection was absent in 12(60.6%) and full erection in one(5.0%). Therefore, we conclude intracavernous papaverine-induced artificial erection is the best valuable test for differentialdiagnosis of psychogenic and vasculogenic impotence.
Angiography ; Erectile Dysfunction ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Papaverine

Penile duplex sonography with intracorporeal papaverine injection has been proposed as a reliable noninvasive method to evaluate the cavernosal arteries. To provide insight into the clinical value of this test. penile duplex sonography was comparatively analyzed with penile brachial index. nocturnal penile erection and selective internal pudendal pharmacoangiography in 60 patients suggestive of arteriogenic impotence. The duplex sonogram, penile brachial index and angiogram of both cavernosal arteries were evaluated separately and compared each other. Cavernosal arteries were interpreted as normal by duplex scanning if the artery demonstrated a 75% or greater increase in diameter and systolic peak flow velocity of greater than 25 cm/sec after intracorporeal injection of 60 mg or papaverine HCI. There was no significant difference between the degree of arterial dilatation and peak flow velocity on penile duplex sonogram. Arterial dilatation and peak flow velocity did not correlate with nocturnal penile erection and cavernosal arteriogram. But peak flow velocity correlate with penile brachial index. In conclusion. although penile duplex sonography is a useful method to evaluate the cavernosal arteries. it alone can make an error to misdiagnose the arteriogenic impotence. Therefore supplementary tests should be added to the duplex sonography to avoid this error.
Arteries ; Dilatation ; Female ; Humans ; Impotence, Vasculogenic* ; Male ; Papaverine ; Penile Erection

We recently experienced a case of hypervascularization of the glans after arterialization of the deep dorsal vein(Furlow`s method) in a 25-year-old man having vasculogenic impotence due to arterial insufficiency of the penis. The Hypervascularization of the glans was corrected by ligating the branches of the deep dorsal Vein at the corona of the penis.
Adult ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Penis ; Veins*

No abstract available.
Diagnosis* ; Female ; Impotence, Vasculogenic* ; Male ; Ultrasonography, Doppler, Duplex*

Penile-brachial Index(P. B. I) was measured before and after injection of papaverine in 79 psychogenic impotences, 31 arteriogenic impotences and 11 neurogenic impotences. Its diagnostic usefulness was compared with qualities of papaverine induced artificial erection and pudendal angiographic findings. The results were as follows , 1. Among 31 patients with arteriogenic impotence, 17(54.8%) patients were above 0.8 in P. B. I before injection of papaverine. Thus, the arteriogenic impotence could not be excluded in patients of P. B. I. above 0.8. 2. Among the psychogenic impotences, there was no case of P. B. I. below 0.8 after injection of papaverine. So arteriogenic impotence could be like in the case of P. B. I. below 0.8. However, the arteriogenic impotence could not be excluded in the case of P. B. I. above 0.8 because 25(86.6%) patients of arteriogenic impotence were above 0.8. 3. The specificity. sensitivity and efficiency of the P. B. I. concerning prediction of response to papaverine injection were 88.2, 41.2, 80.4% in P. B. I. of 0.8. 4. The specificity, sensitivity and efficiency of the P. B. I. concerning prediction of findings of pudendal angiogram were 71.4, 90.3, 86.8% in P. B. I. of 0.9. In conclusion, it was difficult to establish the base line of normal value of P. B. I. and there was limitation of diagnostic value of the P.B.I.
Female ; Humans ; Impotence, Vasculogenic ; Male ; Papaverine ; Reference Values ; Sensitivity and Specificity

Diagnosis of vasculogenic erectile dysfunction (ED), which can not based on single method, is the key for the successive surgical treatment. Revascularization is a safe, effective method to treat arteriogenic ED. The key for successive treatment is to select the most suitable patients and to avoid any risk factors for the surgical candidates, especially for those revascularization as the only therapeutic method. The high failure rate in surgery of ED is due to venous leakage which has led to these techniques being abandoned by almost all urologist. Newly appeared methods with little or no damage are welcome by the patients with vasculogenic ED, and the better results can be achieved by the combination of general treatment.
Humans ; Impotence, Vasculogenic ; diagnosis ; surgery ; Male ; Practice Guidelines as Topic

We have effectively used AVS-Penogram as the primary diagnostic method for impotence. In this study, we classified the types of curve on AVS-Penogram in detail and evaluated the origin of each of the classified types for 308 patients who were finally diagnosed by comprehensive diagnostic methods. Also we divided the unstable type into the multi-peak type and the one-peak type based on the number of peaks in the curve. and the delay type into the simple-delay type and the unstable-delay type based on whether there were fluctuations or not. After evaluating and considering the clinical significance of each of the curve type. we have reached the following conclusion. I. Type I group which is similar to normal control group was proved as psychogenic impotence in 86% of the patients. 2. The impossible type II A group was proved as organic impotence in 97% of the patients and most or them had neurogenic and arteriogenic impotence. 3. The unstable type II B group was proved as psychogenic impotence in 52% of the patients ;61% in the case of the multi-peak type, and 15% in the case of the one-peak type. The difference between both types were statistically significant. We think the one-peak type is more strongly related to organic cause, and in the case of the multi-peak type. further studies are needed for differential diagnosis between psychogenic and vasculogenic impotence, which were the most frequent types. 4. The delay type II C group was proved as psychogenic impotence in 4l% of the patients; 44% in the case of the simple-delay type, and 39% in the case of the unstable-delay type. There was no significant difference between these two types. In the case of the delay type, further studies are needed for differential diagnosis between psychogenic and arteriogenic impotence, which were the most frequent types. In conclusion, AVS-Penogram is a useful method in measurement of natural erotic erection and a primary diagnostic method in impotence, and it is an important differential diagnostic parameter to divide the unstable type into the multi-peak type and the one-peak type. Also in the case of the patient classified as multi-peak type, if more studies about neurotransmitter can be done, diagnostic methods from these studies can be developed. and the objective analysis of nocturnal penile enlargement can be achieved. new organic factor will be found in the patients proved to be psychogenic impotence.
Diagnosis, Differential ; Erectile Dysfunction ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Neurotransmitter Agents

We recently experienced a case of protrusion of the penile prosthesis against thin tunicae albuginea after Hydroflex penile prosthesis in a 30-year-old man having neurogenic and vasculogenic impotence associated with urethral injury. The thin tunicae albuginea were reconstructed by application of Goretex.
Adult ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Penile Prosthesis* ; Polytetrafluoroethylene* ; Prostheses and Implants*

PURPOSE: We evaluated the contributing factors and etiology of erectile dysfunction (ED) in unmarried men. MATERIALS AND METHODS: From March 1998 to December 2001, we examined 49 unmarried men age 21 to 44 years (mean 29 years) with ED. All patients were assessed by history, physical examination, laboratory studies, combined intracavernous injection and stimulation test (CIS test), penile duplex ultrasonography, and other indicated tests to identify the etiology of erectile dysfunction. RESULTS: The majority of patients had vasculogenic impotence (arteriogenic 26.5%; venogenic 14.3%; mixed 16.3%). Less common were psychogenic (26.5%), hormonal (6.1%), neurogenic (8.1%), and other causes (2.0%). Contributing factors were present in 71.4% of patients, such as penile blunt trauma in 22 patients (44.9%), genitourinary disease in 14 (28.6%), substance abuse in 7 (14.3%), and medical illness in 5 (10.2%). CONCLUSIONS: Erectile dysfunction in unmarried men generally is vasculogenic in origin, and penile blunt trauma is the most common contributing factor.
Erectile Dysfunction* ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Physical Examination ; Single Person* ; Substance-Related Disorders ; Ultrasonography

Corporal veno-occlusive function is the essential part in the hemodynamic process of penile erection. Parameters for evaluation of the quality of the veno-occlusive mechanism are end diastolic flow velocity (EDV) and its derivative resistance index (RI) as measured by pharmacopenile duplex ultrasound which is considered as an initial screening test for the patients with vasculogenic impotence. We compared the accuracy of these parameters by investigating the correlation between the result of duplex sonographic study and some other studies, pharmacoerection test and dynamic infusion cavernosometry (DIC) in 45 patients who received all of these studies and were proved to have normal arterial inflow of the penis. EDV and RI values were well correlated with maintenance flow rate values of DIC at various levels of intracavernosal pressures (50, 100 and 150 mmHg) (R=0.418-0.701 and R=0.454-0.620 respectively). Diagnostic result of duplex scanning was identical to cavernosometric result in 80% and pharmacoerection response in 82%. We conclude that EDV and RI appeared to be used as good indices evaluating corporal veno-occlusive function.
Dacarbazine ; Female ; Hemodynamics ; Humans ; Impotence, Vasculogenic ; Male ; Mass Screening ; Penile Erection* ; Penis ; Ultrasonography*